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Carbonell M, Alonso N, Castelblanco E, Real J, Ramírez-Morros A, Simó R, Hernández C, Jurjo C, Traveset A, Valldeperas X, Mauricio D. Assessment of Inner Retinal Layers and Choroidal Thickness in Type 1 Diabetes Mellitus: A Cross-Sectional Study. J Clin Med 2019; 8:jcm8091412. [PMID: 31500371 PMCID: PMC6780763 DOI: 10.3390/jcm8091412] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022] Open
Abstract
Recent studies have shown that retinal neurodegeneration may precede visible vascular changes in diabetic retinopathy (DR). In addition, the relationship of choroidal thickness (CT) with DR stage is not well defined. To assess the inner retinal and choroidal structural changes in type 1 diabetic subjects (T1D), a cross-sectional study was conducted in 242 T1D patients and in 69 age-matched, non-diabetic individuals. The nasal retinal nerve fibre layer (RNFL) thickness was lower in T1D patients without DR (p < 0.001), with mild DR (p < 0.001), and with advanced DR (p < 0.001) compared to control subjects. The ganglion cell layer (GCL) thickness was lower in T1D patients with advanced DR compared to those with mild DR (p = 0.003) and without DR (p < 0.001) and compared to the control subjects (p < 0.001). T1D subjects with no DR and mild DR had higher CT than the control subjects, but the CT in T1D patients with advanced DR was lower (p = 0.038) than that in T1D subjects with mild DR and was not significantly different from that of the control subjects. In conclusion, T1D subjects showed a significant thinning of the nasal RNFL in the early stages of the disease, even before any vascular changes in the retina. A decrease in the GCL thickness during advanced DR stages was observed. Choroidal thickness was higher in T1D subjects without DR and in early DR stages but decreased in advanced stages.
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Affiliation(s)
- Marc Carbonell
- Department of Ophthalmology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Department of Surgery, Barcelona Autonomous University (UAB), 08035 Barcelona, Spain.
| | - Núria Alonso
- Department of Endocrinology and Nutrition, University Hospital and Health Science Research Institute Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Medicine, Barcelona Autonomous University (UAB), 08035 Barcelona, Spain.
| | - Esmeralda Castelblanco
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08025 Barcelona, Spain.
| | - Jordi Real
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08025 Barcelona, Spain.
| | - Anna Ramírez-Morros
- Department of Endocrinology and Nutrition, University Hospital and Health Science Research Institute Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Rafael Simó
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Catalonia, Spain.
| | - Cristina Hernández
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Catalonia, Spain.
| | - Carme Jurjo
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
- Biomedical Research Institute of Lleida (IRBLleida) & University of Lleida, 25198 Lleida, Spain.
| | - Alícia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
- Biomedical Research Institute of Lleida (IRBLleida) & University of Lleida, 25198 Lleida, Spain.
| | - Xavier Valldeperas
- Department of Ophthalmology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Department of Surgery, Barcelona Autonomous University (UAB), 08035 Barcelona, Spain.
| | - Dídac Mauricio
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Medicine, Barcelona Autonomous University (UAB), 08035 Barcelona, Spain.
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08025 Barcelona, Spain.
- Biomedical Research Institute of Lleida (IRBLleida) & University of Lleida, 25198 Lleida, Spain.
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Choroidal structural changes correlate with severity of diabetic retinopathy in diabetes mellitus. BMC Ophthalmol 2019; 19:186. [PMID: 31419954 PMCID: PMC6697939 DOI: 10.1186/s12886-019-1189-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background This study aims to investigate the choroidal thickness and choroidal vascular density parameters and their correlation with severity of diabetic retinopathy (DR) in diabetes mellitus (DM) patients. Methods An observational cross-sectional study was conducted of 104 eyes, which were divided into 4 groups: Healthy controls (n = 38), DM with no DR eyes (n = 22), panretinal photocoagulation-untreated non-proliferative DR eyes (PRP-untreated NPDR eyes) (n = 24), PRP-untreated proliferative DR eyes (PRP-untreated PDR eyes) (n = 20). Optical coherence tomography (OCT) was performed. The total choroidal area (TCA), stromal area (SA), the luminal areas (LA) and the ratio of the luminal to choroidal area (L/C ratio) were compared. The choroidal parameters were also compared between PRP untreated and PRP-treated DR eyes. Results The L/C ratio values were 0.68 ± 0.06 in controls and 0.63 ± 0.04 in DM eyes (P < 0.001). But there were no statistically significant differences in retinal nerve fiber layer (RNFL) thickness, retinal thickness and subfoveal choroidal thickness (SCT) measurements between the two groups (P = 0.407, P = 0.654 and P = 0.849; respectively). The vessel density values were significantly different in DM with no DR eyes, PRP-untreated NPDR eyes and PRP-untreated PDR eyes (P < 0.001 for SCT, TCA and SA). The L/C ratio values in the three groups were significant different (P = 0.019). There was no significant difference in SCT, TCA, LA, SA and the L/C ratio between PRP-untreated and PRP-treated DR eyes. Conclusion Eyes of patients with DM showed the L/C ratio decreased compared with normal controls. The SCT increased, but L/C ratio significantly decreased with severity of DR eyes compared with DM and normal eyes. Changes in the L/C ratio may predict DR development before they are otherwise evident clinically. Choroidal blood flow deficit can be an early pathologic change in DR. Electronic supplementary material The online version of this article (10.1186/s12886-019-1189-8) contains supplementary material, which is available to authorized users.
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103
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Choroidal binarization analysis: clinical application. Int Ophthalmol 2019; 39:2947-2973. [PMID: 31140022 DOI: 10.1007/s10792-019-01122-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Image processing of optical coherence tomography scans through binarization techniques represent a non-invasive way to separately asses and measure choroidal components, in vivo. In this review, we systematically search the scientific literature regarding binarization studies published so far. METHODS A systematic research was conducted at PubMed database, including English literature articles for all of the following terms in various combinations: binarization, choroid/al, enhanced depth spectral domain/swept source optic coherence tomography, and latest publications up to November 2018 were reviewed. RESULTS Thirty-seven articles were included and analyzed regarding studied disease, binarization method, studied variables, and outcomes. Most of the studies have focused on the more common retinal pathologies, such as age-related macular degeneration, central serous chorioretinopathy and diabetic retinopathy but binarization techniques have also been applied to the study of choroidal characteristics in ocular inflammatory diseases, corneal dystrophies and in postsurgical follow-up. Advantages and disadvantages of binarization techniques are also discussed. CONCLUSION Binarization of choroidal images seems to represent a promising approach to study choroid subcomponents in an increasingly detailed manner.
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Relationship between choroidal structure and duration of diabetes. Graefes Arch Clin Exp Ophthalmol 2019; 257:1133-1140. [DOI: 10.1007/s00417-019-04295-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 12/11/2022] Open
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Rasheed MA, Sahoo NK, Goud A, Vupparaboina KK, Chhablani J. Qualitative comparison of choroidal vascularity measurement algorithms. Indian J Ophthalmol 2019; 66:1785-1789. [PMID: 30451178 PMCID: PMC6256898 DOI: 10.4103/ijo.ijo_663_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To compare the accuracy of manual and automated binarization technique for the analysis of choroidal vasculature. Methods: This retrospective study was performed on a total of 98 eyes of 60 healthy subjects. Fovea-centered swept source optical coherence tomography (SS-OCT) scans were obtained and choroidal area was binarized using manual and automated image binarization technique separately. Choroidal vessel visualization in the binarized scans were subjectively graded (grades 0–100) by comparing them with the original OCT scan images by two masked graders. The subjective variability and repeatability was compared between two binarization method groups. Intergrader and intragrader variability was estimated using paired t-test. The degree of agreement between the grades for each observer and between the observers was evaluated using Bland–Altman plot. Results: The mean accuracy grades of the automatically binarized images were significantly (P < 0.001) higher (93.38% ± 1.70%) than that of manually binarized images (78.06% ± 2.92%). There was a statistically significant variability and poor agreement between the mean interobserver grades in the manual binarization arm. Conclusion: Automated image binarization technique is faster and appears to be more accurate in comparison to the manual method.
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Affiliation(s)
- Mohammed A Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Niroj K Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran K Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Correlation of systemic arterial stiffness with changes in retinal and choroidal microvasculature in type 2 diabetes. Sci Rep 2019; 9:1401. [PMID: 30718731 PMCID: PMC6361886 DOI: 10.1038/s41598-018-37969-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022] Open
Abstract
This study was conducted to assess whether systemic arterial stiffness, indicated by cardio-ankle vascular index (CAVI), is related to changes in the microvasculature of the retina and choroid in diabetes mellitus (DM). This study included 113 patients with a confirmed diagnosis of type-2 DM. Among them, 18 patients did not have diabetic retinopathy (DR), 71 had non-proliferative DR (NPDR), and 24 had proliferative DR (PDR). The mean CAVI was 7.58 ± 1.41 in no DR, 8.72 ± 1.47 in NPDR, and 8.43 ± 1.25 in PDR group. Of the 113 eyes, 42 (37.2%) were classified as abnormal CAVI group (CAVI ≥ 9). This group had significantly higher cardiac autonomic neuropathy risk index score, decreased central choroidal thickness, and decreased choroidal vascularity index (CVI). Deep foveal avascular zone area was higher in the abnormal CAVI group. After adjustment for possible confounding factors, CAVI showed negative correlation with the CVI (r = -0.247, P = 0.013). In conclusion, there was a significant correlation between arteriosclerosis and choroidal vascular changes in DR. We suggest prompt ophthalmic evaluation in patients with systemic arteriosclerosis. If the ophthalmologist notes advanced DR, the patient should be referred to a cardiovascular clinic for detailed evaluation of systemic arteriosclerosis.
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107
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Gupta C, Tan R, Mishra C, Khandelwal N, Raman R, Kim R, Agrawal R, Sen P. Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema-A novel OCT based imaging biomarker. PLoS One 2018; 13:e0207435. [PMID: 30533048 PMCID: PMC6289408 DOI: 10.1371/journal.pone.0207435] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/31/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate structural changes in the choroid among patients with diabetic macular edema (DME), with varying grades of diabetic retinopathy (DR), using enhance depth imaging spectral domain optical coherence tomography (EDI SD-OCT) scans. METHODS A cross-sectional study was conducted on 82 eyes with DR and DME and 86 healthy control eyes. Eyes with DME were classified according to the severity of DR as per the international DR severity scale. Sub foveal choroidal thickness (SFCT)was obtained using EDI SD-OCT scans. These scans were binarized into luminal and stromal areas, to derive the choroidal vascularity index (CVI). CVI and SFCT were analyzed between the study and control group using paired-T test. Tukey's test was used to correlate the differences in CVI and SFCT between different grades of DR. Further analysis was done to look for the effect of DR severity and type of DME on CVI as well as SFCT using correlation coefficient and linear regression analysis. RESULTS SFCT was significantly increased in eyes with DME as compared to the controls (334.47±51.81μm vs 284.53±56.45μm, p<0.001), and showed an ascending trend with worsening of DR, though this difference was not statistically significant [mild non-proliferative diabetic retinopathy (NPDR) = 304.33±40.39μm, moderate NPDR = 327.81±47.39μm, severe NPDR = 357.72±62.65μm, proliferative DR (PDR) = 334.59±47.4μm, p-0.09]. CVI was significantly decreased in DME with DR eyes as compared to controls (63.89±1.89 vs 67.51±2.86, p<0.001). CVI was also significantly decreased with worsening DR (mild NPDR = 66.38±0.3, moderate NPDR = 65.28±0.37, severe NPDR = 63.50±0.47, PDR = 61.27±0.9, p<0.001). CONCLUSION SFCT and CVI are dynamic parameters that are affected by DME. Unlike CVI, SFCT is also affected by ocular and systemic factors like edema and hypertension. CVI may be a more accurate surrogate marker for DME and DR and can potentially be used to monitor the progression of DR.
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Affiliation(s)
- Chanda Gupta
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Roy Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Neha Khandelwal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Rajiv Raman
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ramasamy Kim
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Parveen Sen
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Quantitative analysis of retinal and choroidal microvascular changes in patients with diabetes. Sci Rep 2018; 8:12146. [PMID: 30108264 PMCID: PMC6092390 DOI: 10.1038/s41598-018-30699-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/02/2018] [Indexed: 12/27/2022] Open
Abstract
The relationship between choroidal and retinal microvascular changes has not yet been well described, and there were limited data on diagnostic ability of optical coherence tomography (OCT)-derived vascular parameters for determining diabetic retinopathy (DR) progression. We quantitatively analyzed OCT-derived vascular parameters at superficial (SCP) and deep retinal capillary plexus (DCP), and choroid. We assessed foveal avascular zone (FAZ), vessel density, vessel length density, and choroidal vascularity index in conjunction with DR stage. In this study, patients with diabetes and healthy controls were retrospectively analyzed. One-hundred seventy-four eyes were divided into six groups as follows: Healthy controls, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR. There were significant quantitative changes in retinal and choroidal vascular parameters with DR progression. The FAZ area and perimeter correlated positively with worsening DR severity; the FAZ circularity index, retinal vessel density, retinal vessel length density, and choroidal vascularity index correlated negatively with worsening severity. Among these, FAZ circulatory index demonstrated good diagnostic performance for DR. Our results cautiously suggest that functional circulatory disturbances in retinal and choroidal vasculatures occur before DR presents. As DR progresses, DCP retinal microvasculature changes precede SCP changes.
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