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Optical coherence tomographic angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
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  • Published on:
    Re: Optical coherence tomography angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
    • Eric D Gaier, Ophthalmologist Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
    • Other Contributors:
      • Aubrey L Gilbert, Ophthalmologist
      • Dean M Cestari, Ophthalmologist
      • John B Miller, Ophthalmologist

    Dear Editor,
    We thank Dr. Balducci and her colleagues for their interest in our paper [1]. They raise several important points regarding optic nerve angiography, and we are thankful to have the opportunity to discuss these items further.
    In preparation of our manuscript, we felt that diffuse changes in the peripapillary capillary network were best appreciated at lower magnification. Balancing this objective in presentation with a sufficient resolution to appreciate the focal deficits we highlighted, the image sizes published represent what we felt was the best compromise. For those who feel that higher magnification images are needed, we have included in this letter Figure 1, which includes the same 6x6 mm OCT-A images in the acute phase for all cases in our study. Quantitation of OCT-A signal can be a powerful way to objectively assess regional as well as between eye and patient differences. We have recently performed a quantitative assessment of angiographic signal in non-arteritic anterior ischemic optic neuropathy using a different device, the Optovue Avanti (Fremont, CA) [1]. However, in the current study, the small number of affected eyes did not allow for meaningful statistical analysis of quantitative data. In addition, quantitative analyses can be misleading when confounding artifacts or segmentation errors are present as discussed below.
    Jia and colleagues [2] showed a strong non-linear correlation between RNFL thickness and radial peripapillary...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re: Optical coherence tomography angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
    • Nicole Balducci, Ophthalmic doctor Studio Oculistico d'Azeglio, Bologna, Italy
    • Other Contributors:
      • Corrado Gizzi, Ophthalmic Doctor
      • Vincenzo Parisi, Ophthalmic Doctor
      • Piero Barboni, Ophthalmic doctor

    Dear Editor,
    We read with interest the paper by Gaier et al.1 The collection of 5 eyes affected by acute A-AION and analyzed with OCT-A is remarkable, due to the rare disease presentation. The main finding of the paper was that during the acute phase of A-AION, diffusely dilated superficial peripapillary capillaries were detectable on OCT-A. Interestingly, peripapillary capillary dilatation was also noted in the fellow eye. Unfortunately, the figures presented by the authors are too small to allow the reader to qualitatively appreciate the capillaries dilatation. More detailed images and a quantitative vessels analysis would have helped to document the microvascular changes.
    They hypothesized that the capillary dilatation may represent a form of luxury perfusion in the setting of short ciliary arterial compromise or a centrally mediated autoregolatory mechanisms in the setting of reduced perfusion of the optic nerve. These hypotheses are interesting, but it is important to differentiate the RNFL thickness increase from the capillary dilatation, as peripapillary capillary plexus density and RNFL thickness are highly correlated and fit well with a nonlinear stacked-layer model.2
    Moreover, the authors stated that OCT-A laminar analysis did not highlight the choroidal/choriocapillaris perfusion defects seen on FA. However, a recent study3 showed a tight correspondence between the choroidal perfusion defects visible on FA (and even better on indocyanine green...

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    Conflict of Interest:
    None declared.