OSLI Retina

October 2016

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October 2016 · Vol. 47, No. 10 971 lack of decorrelation suggestive of CNV. Such lesions have been described in cases of Type 2 CNV. 7 These vessels were also visible in scans segmented below the Bruch's membrane. However, the image of the vessels seen below the Bruch's membrane is exactly the same as that above the RPE-Bruch's membrane complex. This is likely due to a projection artifact. Presence of such a projection artifact in cases of Type 2 CNV has been suggested previously by El Ameen et al. 7 The ex- act cause and nature of the area of lack of decorrelation adjacent to a CNV on OCTA scans is not known. It is presumed to be due to either a decrease in flow den- sity or due to turbulent flow. 7 Correlating the SS-OCT scans and the OCTA images of our patient, we feel that the CNV associated with FCE seen in our patient was Type 2 CNV. We avoided doing a fluorescein and in- docyanine angiography in our patient to confirm the diagnosis of a secondary CNV formation in a case of FCE and found OCTA to be a useful, least–time-con- suming, and noninvasive investigation for detection of the secondary CNV. This enabled further management of the patient with intravitreal ranibizumab. REFERENCES 1. Lim FMP, Loh BK, Cheung CM, Lim LS, Chan CM, Wong DW. Evalu- ation of focal choroidal excavation in the macula using swept-source opti- cal coherence tomography. Eye (Lond). 2014;28(9):1088-1094. 2. Katome T, Mitamura Y, Hotta F, Niki M, Naito T. Two cases of focal choroidal excavation detected by spectral-domain optical coherence to- mography. Case Rep Ophthalmol. 2012;3(1):96-103. 3. de Carlo TE, Romano A, Waheed NK, Duker JS. A review of optical coherence tomography angiography (OCTA). International Journal of Retina and Vitreous. 2015;1(5). doi: 10.1186/s40942-015-0005-8. 4. Liu GH, Lin B, Sun XQ, et al. Focal choroidal excavation: a pre- liminary interpretation based on clinic and review. Int J Ophthalmol. 2015;8(3):513-521. 5. Lee CS, Woo SJ, Kim YK, et al. Clinical and spectral-domain optical co- herence tomography findings in patients with focal choroidal excavation. Ophthalmology. 2014;121(5):1029-1035. 6. Lee JH, Won KL. Choroidal neovascularization associated with focal cho- roidal excavation. Am J Ophthalmol. 2014;157(3):710-718. 7. El Ameen A, Cohen SY, Semoun O, et al. Type 2 neovascularization sec- ondary to age-related macular degeneration imaged by optical coherence tomography angiography. Retina. 2015;35(11):2212-2218. Figure 2. (A) Optical coherence tomography angiography (OCTA) en face scans segmented just above the retinal pigment epithelium (RPE)-Bruch's membrane complex revealed a glomerulus-like network of vessels (within the yellow line) with an adjacent dark area, sug- gestive of choroidal neovascularization. (B) OCTA en face scans segmented below the RPE-Bruch's membrane complex also reveal the same glomerulus-like network of vessels (yellow arrow) and the focal adjacent area of lack of decorrelation (red arrow). (C) Shows the level of segmentation on the OCT scan for acquiring the OCTA en face image above the RPE-Bruch's membrane complex. (D) Shows the level of segmentation on the OCT scan for acquiring the OCTA en face image below the RPE-Bruch's membrane complex.

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