9 Postoperative follow-up by SD-OCT reduces the need for more invasive techniques as FA and ICGA. 9 This observation of the three revascularization stages with SD-OCT was confirmed previously by fluorescein angiography (FA) and indocyanine green angiography (ICGA). This is accompanied by a change in gray shading of the vessel lumina, suggesting blood flow. The third step is the efferent vessel stage: the thickness of the graft and the diameter of the vessels may slightly decrease while the number of vessels may slightly increase. 10 The second step is the afferent vessel stage: the number and the mean diameter of the vessels increase and the graft becomes thicker. Serum imbibition is a name used for this process in free dermal skin grafts to describe this passive filling of vessel lumina. In this early phase after transplantation, plasma exudes from the recipient site's damaged arteries and veins, fills the lumina of the graft vessels, and supposedly supports graft-tissue metabolism. 9 The first step is the serum imbibition stage: small vessel lumina are visible inside the graft, and the graft appears to be very thin. As described previously, spectral domain optical coherence tomography (SD-OCT) allows the visualization of structural tissue changes during three well-established revascularization stages in an RPE-choroid graft shortly after surgery. We hypothesize that best functional outcome for this treatment relates to a preserved neuroretina in the macula and revascularization of the graft. There is potential future use of PRD-OCT for the visualization of vascularization patterns in other pathologies. The use of both techniques to monitor the revascularization process in a free graft in patients are an interesting example of replacing more invasive by noninvasive techniques. The PRD-OCT findings directly confirmed the revascularization that was otherwise based on the more circumstantial evidence provided by SD-OCT images and angiography. The PRD-OCT study was able to detect the presence of blood flow in a free RPE-choroid graft. The PRD-OCT confirmed flow in three patients when SD-OCT indicated the afferent vessel ingrowth stage, and in all seven patients when the SD-OCT indicated the efferent vessel ingrowth stage. With PRD-OCT the presence of flow was imaged postoperatively. Spectral domain optical coherence tomography (SD-OCT) was used to measure the revascularization stage. Seven patients with age-related macular degeneration underwent an RPE-choroid graft translocation in a prospective institutional cohort study. We directly demonstrated the revascularization in a free retinal pigment epithelium (RPE)-choroid graft with direct blood flow detection by experimental phase-resolved Doppler optical coherence tomography (PRD-OCT).
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December 2022
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