[Optical Coherence Tomography Angiography in Intensive Care Medicine : A new Field of Application?]

Overview

Journal Ophthalmologe

Specialty Ophthalmology

Date 2019 May 30

PMID 31139886

Citations 2

Authors

Michael Hessler

Florian Lehmann

Philip-Helge Arnemann

Nicole Eter

Christian Ertmer

Maged Alnawaiseh

Affiliations

Soon will be listed here.

Abstract

Background: Many critically ill patients show a disturbance of the microcirculation, which is not yet regularly examined in the clinical routine; however, for treatment decisions and estimation of the prognosis it would be important to obtain detailed information about the microcirculation in critically ill patients. Optical coherence tomography angiography (OCTA) is a non-invasive, contact-free technique, which enables visualization of the blood flow in the retinal microcirculation within a few seconds. Therefore, it may have the potential to diagnose microcirculation disorders in critically ill patients.

Objective: The aims of the study were to assess the importance of the microcirculation in intensive care medicine, a comparison of the methods of video microscopy and OCTA and analysis of preclinical and clinical data on the use of OCTA in intensive care medicine.

Material And Methods: A selective literature review and data analysis were carried out.

Results: A direct visualization of the microcirculation has been possible for many years with the technique of video microscopy but this has not become established in the clinical routine due to the susceptibility to interferences and a time-consuming manual analysis. The OCTA is a non-invasive and contact-free method for the visualization of retinal blood flow. First preclinical data in septic and hemorrhagic shock show good results of OCTA for analysis of the microcirculation.

Conclusion: The non-invasive technique of OCTA is a promising measurement method to enable bedside analysis of the microcirculation in critically ill paients in the future; however, some technical limitations must still be overcome.

Citing Articles

Ocular perfusion in patients with reduced left ventricular ejection fraction measured by optical coherence tomography angiography.

Alnawaiseh M, Eckardt F, Mihailovic N, Frommeyer G, Diener R, Rosenberger F Graefes Arch Clin Exp Ophthalmol. 2021; 259(12):3605-3611.

PMID: 34236473 DOI: 10.1007/s00417-021-05253-6.

[Optical coherence tomography angiography and cardiovascular diseases. An overview of the current knowledge].

Leclaire M, Eter N, Alnawaiseh M Ophthalmologe. 2021; 118(11):1119-1127.

PMID: 33616736 PMC: 8568759. DOI: 10.1007/s00347-021-01336-1.

References

De Backer D, Creteur J, Preiser J, Dubois M, Vincent J . Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002; 166(1):98-104. DOI: 10.1164/rccm.200109-016oc. View

Spronk P, Zandstra D, Ince C . Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care. 2004; 8(6):462-8. PMC: 1065042. DOI: 10.1186/cc2894. View

Ince C . The microcirculation is the motor of sepsis. Crit Care. 2005; 9 Suppl 4:S13-9. PMC: 3226164. DOI: 10.1186/cc3753. View

Cooper L, Wong T, Klein R, Sharrett A, Bryan R, Hubbard L . Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the Atherosclerosis Risk in Communities Study. Stroke. 2005; 37(1):82-6. DOI: 10.1161/01.STR.0000195134.04355.e5. View

Makita S, Hong Y, Yamanari M, Yatagai T, Yasuno Y . Optical coherence angiography. Opt Express. 2009; 14(17):7821-40. DOI: 10.1364/oe.14.007821. View

Goedhart P, Khalilzada M, Bezemer R, Merza J, Ince C . Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2009; 15(23):15101-14. DOI: 10.1364/oe.15.015101. View

Tachon G, Harrois A, Tanaka S, Kato H, Huet O, Pottecher J . Microcirculatory alterations in traumatic hemorrhagic shock. Crit Care Med. 2014; 42(6):1433-41. DOI: 10.1097/CCM.0000000000000223. View

Jia Y, Wei E, Wang X, Zhang X, Morrison J, Parikh M . Optical coherence tomography angiography of optic disc perfusion in glaucoma. Ophthalmology. 2014; 121(7):1322-32. PMC: 4082728. DOI: 10.1016/j.ophtha.2014.01.021. View

Ince C . The rationale for microcirculatory guided fluid therapy. Curr Opin Crit Care. 2014; 20(3):301-8. DOI: 10.1097/MCC.0000000000000091. View

10.

Eriksson S, Nilsson J, Sturesson C . Non-invasive imaging of microcirculation: a technology review. Med Devices (Auckl). 2014; 7:445-52. PMC: 4267586. DOI: 10.2147/MDER.S51426. View

11.

van Elteren H, Ince C, Tibboel D, Reiss I, de Jonge R . Cutaneous microcirculation in preterm neonates: comparison between sidestream dark field (SDF) and incident dark field (IDF) imaging. J Clin Monit Comput. 2015; 29(5):543-8. PMC: 4565887. DOI: 10.1007/s10877-015-9708-5. View

12.

Spaide R, Fujimoto J, Waheed N . IMAGE ARTIFACTS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2015; 35(11):2163-80. PMC: 4712934. DOI: 10.1097/IAE.0000000000000765. View

13.

Ince C . Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2016; 19 Suppl 3:S8. PMC: 4699073. DOI: 10.1186/cc14726. View

14.

Al-Sheikh M, Tepelus T, Nazikyan T, Sadda S . Repeatability of automated vessel density measurements using optical coherence tomography angiography. Br J Ophthalmol. 2016; 101(4):449-452. DOI: 10.1136/bjophthalmol-2016-308764. View

15.

Carsetti A, Aya H, Pierantozzi S, Bazurro S, Donati A, Rhodes A . Ability and efficiency of an automatic analysis software to measure microvascular parameters. J Clin Monit Comput. 2016; 31(4):669-676. DOI: 10.1007/s10877-016-9928-3. View

16.

Arnemann P, Hessler M, Kampmeier T, Morelli A, Van Aken H, Westphal M . Comparison of an automatic analysis and a manual analysis of conjunctival microcirculation in a sheep model of haemorrhagic shock. Intensive Care Med Exp. 2016; 4(1):37. PMC: 5116019. DOI: 10.1186/s40635-016-0110-5. View

17.

Ocak I, Kara A, Ince C . Monitoring microcirculation. Best Pract Res Clin Anaesthesiol. 2016; 30(4):407-418. DOI: 10.1016/j.bpa.2016.10.008. View

18.

Ploner S, Moult E, Choi W, Waheed N, Lee B, Novais E . TOWARD QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: Visualizing Blood Flow Speeds in Ocular Pathology Using Variable Interscan Time Analysis. Retina. 2016; 36 Suppl 1:S118-S126. PMC: 5193243. DOI: 10.1097/IAE.0000000000001328. View

19.

Wang R, Zhang Q, Li Y, Song S . Optical coherence tomography angiography-based capillary velocimetry. J Biomed Opt. 2017; 22(6):66008. PMC: 5472241. DOI: 10.1117/1.JBO.22.6.066008. View

20.

Yang J, Liu L, Campbell J, Huang D, Liu G . Handheld optical coherence tomography angiography. Biomed Opt Express. 2017; 8(4):2287-2300. PMC: 5516829. DOI: 10.1364/BOE.8.002287. View