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Optical Coherence Tomography Angiography of the Retinal
Microvasculature using the ZEISS AngioPlex
Expert review by: Giovanni Staurenghi 1
Symposium Speakers: Giovanni Staurenghi, 1 Jose Cunha-Vaz 2 and Jean-Francois Korobelnik 3
1. Department of Biomedical and Clinical Science ‘Luigi Sacco’, Sacco Hospital, University of Milan, Milan, Italy; 2. Department of Ophthalmology, University of
Coimbra, and Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; 3. University Hospital Pellegrin, Bordeaux, France
Abstract AngioPlex TM optical coherence tomography (OCT) is a new approach to diagnostic imaging in retinal disease. This technology uses amplitude and
phase aspects of the OCT signal and novel algorithms to enable highly detailed visualisation of the retinal microvasculature. This system detects
capillary flow rather than the presence of an injected dye. Unlike fluorescein angiography (FA), AngioPlex OCT imaging can discriminate capillaries
at the superficial and deep retina and can also generate a colour map of the retinal vessels providing unparalleled views of diseased capillaries
and net structures. Retinal and choroidal pathologies that are amenable to AngioPlex OCT examination include diabetic retinopathy (DR), vein
occlusions, age-related macular degeneration and pathological myopia. In addition, AngioPlex OCT can be used to explore the vasculature of
the optic nerve. These applications have considerable potential for improved retinal and choroidal disease diagnosis, but further experience and
debate are needed to fully interpret the images. AngioPlex OCT is rapid, non-invasive and improves the patient experience and has been granted
US Food and Drug Administration (FDA) 510(k) clearance for clinical use. The convenience and the range of retinal disease applications may
encourage widespread adoption of the technology. AngioPlex OCT may therefore become a standard initial examination step for patients with
retinal disease prior to and during treatment and may also indicate where further investigations including FA or indocyanine green are necessary.
Keywords Optical coherence tomography, angiography, non-invasive ophthalmic vascular imaging
Disclosure: Giovanni Staurenghi has been a consultant to Heidelberg Engineering and ZEISS and has received congress presentation fees from Heidelberg Engineering,
ZEISS, Optovue and Centervue. Giovanni Staurenghi’s institution has received research grants from ZEISS, Heidelberg Engineering, Canon, Nidek, Optovue and Centervue. Jose
Cunha-Vas has received consulting fees/honoraria from Alimera Sciences, Allergan, Bayer, Fovea Pharmaceuticals, GeneSignal, Novartis, OM Pharma, Pfizer, Roche and ZEISS.
Jean-Francois Korobelnik has been a consultant to Alcon, Alimera Sciences, Allergan, Bayer, Horus, Novartis, Roche, Thea and ZEISS. He has been an investigator for Allergan,
Beyer, Novartis, Roche, Second Sight and Thea.
Acknowledgements : Editorial assistance was provided by James Gilbart at Touch Medical Media, funded by ZEISS.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation
and reproduction provided the original author(s) and source are given appropriate credit.
Received: 27 October 2015 Published Online: 23 December 2015 Citation: European Ophthalmic Review, 2015;9(2):147–56
Correspondence: Giovanni Staurenghi, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Sacco Hospital, University of Milan, via GB Grassi, 74, 20157 Milan, Italy.
Support: This article was supported ZEISS. The views and opinions expressed are those of the speakers and not necessarily those of ZEISS. This article reports the
proceedings of a sponsored satellite symposium held at the EURETINA 2015 Congress and, as such, has not been subject to this journal’s usual peer-review process. This
report was reviewed for scientific accuracy by Giovanni Staurengh before publication.
Optical coherence tomography (OCT) has proved to be a valuable
approach to imaging ocular vasculature and is becoming a critical method
in precisely diagnosing the type and identifying the location of retinal
disease. 1–7 Fluorescein angiography (FA), used to examine the retinal
microvasculature, to date has produced valuable diagnostic information
and insights into the pathophysiology of retinal disease. FA continues to be
an important diagnostic method in retinal disease but its use necessitates
an intravenous injection of dye for each analysis. The advantage of OCT
angiography is that it is a rapid, higher-contrast and less-invasive technique,
which helps to diagnose and monitor retinal disease and treatment. There
are now more than three approaches to OCT angiography: this article
reports the application of the new AngioPlex OCT angiography technology
on CIRRUS HD-OCT in specific pathologies. Specific cases of its application
were discussed at a symposium convened by ZEISS in Nice, France during
the September 2015 EURETINA Congress.
TOU CH MED ICA L MEDIA
AngioPlex Optical Coherence Tomography
Angiography – An Overview
AngioPlex TM OCT angiography is a new technology that runs on the ZEISS
CIRRUS HD-OCT instruments, and can be enabled on existing instruments
with new software and minor hardware upgrades. This approach uses the
entire OCT signal, and utilises FastTrac TM and Optical Micro Angiography
Complex [OMAG C ] algorithms to visualise microvasculature. AngioPlex
uses both amplitude and phase aspects of the OCT signal, which is
different from other systems that only use one. A scanning laser diode
scans each retinal position up to four times and eye motion during
the scans is corrected with live-tracking using FastTrac technology
(see Figure 1). Although the OCT angiography field of view is limited to
3 mm by 3 mm or 6 mm by 6 mm, the scan can be positioned over an
area of neovascularisation. FastTrac allows this area to be scanned on
subsequent visits to monitor changes with progression of disease, or