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Stino H, Huber KL, Kunze L, Steiner I, Bampoulidis A, Schmidt-Erfurth U, Pollreisz A. Intereye Microvascular Differences in Patients With Same-Stage Diabetic Retinopathy Revealed by OCTA. Invest Ophthalmol Vis Sci 2024; 65:11. [PMID: 38842830 PMCID: PMC11160952 DOI: 10.1167/iovs.65.6.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose To evaluate microvascular intereye differences in diabetic patients with same-stage diabetic retinopathy (DR) in both eyes as assessed using optical coherence tomography angiography (OCTA). Methods In this cross-sectional study, fovea-centered swept-source 6 × 6 mm OCTA scans were acquired using a 200 kHz OCTA device. Vessel density (VD) and fractal dimension were calculated on binarized, vessel-segmented images in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Foveal avascular zone (FAZ) area (FAZA) and perimeter (FAZP) was measured and FAZ circularity (FAZC) calculated. Absolute difference (δabs) and asymmetry index between eyes was assessed and compared across DR stages. Differences of VD, FD, and FAZ parameters between left and right eye were evaluated using linear mixed models. Results A total of 336 eyes of 168 diabetic patients without DR and with DR stages ranging from mild nonproliferative to proliferative DR were included for analysis. The intereye comparison revealed significantly lower VD in the SCP (estimate [95% CI] = -0.009 [-0.01; -0.006], P < 0.01), as well as a significantly lower FD in the SCP (-0.007 [-0.009; -0.005], P < 0.01) of the left compared to the right eye. FAZC of the left compared to the right eye was lower in eyes without DR, moderate DR, and PDR (P < 0.05). FAZ δabs and asymmetry index were higher in more advanced disease stages (P < 0.05). Conclusions OCTA metrics provide important information on the retinal microvasculature in systemic diseases such as DR. Our results reveal a significant intereye difference with lower VD and FD in the SCP as well as higher FAZ impairment of the left compared to the right eye.
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Affiliation(s)
- Heiko Stino
- Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
| | - Kim Lien Huber
- Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
| | - Laura Kunze
- Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
| | - Irene Steiner
- Medical University of Vienna, Center for Medical Data Science, Institute of Medical Statistics, Vienna, Austria
| | - Alexandros Bampoulidis
- Medical University of Vienna, Vienna Reading Center, Department of Ophthalmology, Vienna, Austria
| | | | - Andreas Pollreisz
- Medical University of Vienna, Department of Ophthalmology, Vienna, Austria
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Santamaría J, Caminal JM, Cobos E, Biarnes M, Rodriguez-Leor R, Morwani R, García-Mendieta M, Lorenzo D, García-Bru P, Arias L. Correlation between Topographic Vessel Density and Retinal Thickness Changes in Patients with Diabetic Macular Edema Treated with Anti-VEGF Therapy: Is It a Suitable OCTA Biomarker? J Pers Med 2023; 13:1718. [PMID: 38138945 PMCID: PMC10744775 DOI: 10.3390/jpm13121718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The objective of this study was to determine the correlation between topographic vessel density (VD) and retinal thickness (RT) reductions induced by vascular endothelial growth factor inhibitors (anti-VEGF) in patients with diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). This was a prospective, interventional case series. VD and RT measurements were separately taken in four parafoveal subfields at baseline and after six months of treatment. This correlation was statistically assessed using Spearman's rho correlation coefficient after adjustment for multiple comparisons. The study included a total of 48 eyes in the final analysis. Mean VD decreased from baseline to month 6 (from 45.2 (±3.5) to 44.6% (±3.2) in the superficial capillary plexus and from 50 (±3.3) to 49% (±3.9) in the deep capillary plexus). Statistically significant reductions in RT were observed in all ETDRS sectors (p < 0.0001). No significant association was found between RT and VD, even when analyzing responders and non-responders separately. After six months of anti-VEGF treatment, no significant correlation was observed between the topographic VD and RT values. These findings suggest that reductions in VD values may not solely result from a reduction in microaneurysms, also being affected by the repositioning of displaced vessels due to edema and a reduction in their caliber. Therefore, VD changes may not be a suitable indirect OCTA biomarker of microaneurysm turnover and treatment response.
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Affiliation(s)
- Juan Santamaría
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | - José María Caminal
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | - Estefanía Cobos
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | - Marc Biarnes
- OMIQ Research, c/Tamarit 39, 08205 Sabadell, Spain;
| | | | - Rahul Morwani
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | | | - Daniel Lorenzo
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | - Pere García-Bru
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
| | - Luis Arias
- Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.S.); (E.C.); (R.M.); (D.L.); (P.G.-B.); (L.A.)
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3
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Yang DW, Tang ZQ, Tang FY, Szeto SK, Chan J, Yip F, Wong CY, Ran AR, Lai TY, Cheung CY. Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study. Br J Ophthalmol 2023; 107:1311-1318. [PMID: 35450939 DOI: 10.1136/bjophthalmol-2021-320779] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
AIMS We investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion at the level of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in a cohort of patients with diabetes mellitus (DM). MATERIALS AND METHODS 617 patients with DM were recruited from July 2015 to December 2020 at the Chinese University of Hong Kong Eye Centre. Image quality assessment (gradable or ungradable for assessing DMI) and DMI evaluation (presence or absence of DMI) were assessed at the level of the SCP and DCP by OCTA. RESULTS 1107 eyes from 593 subjects were included in the final analysis. 560 (50.59%) eyes had DMI at the level of SCP, and 647 (58.45%) eyes had DMI at the level of DCP. Among eyes without diabetic retinopathy (DR), DMI was observed in 19.40% and 24.13% of eyes at SCP and DCP, respectively. In the multivariable logistic regression models, older age, poorer visual acuity, thinner ganglion cell-inner plexiform layer thickness, worsened DR severity, higher haemoglobin A1c level, lower estimated glomerular filtration rate and higher low-density lipoprotein cholesterol level were associated with SCP-DMI. In addition to the aforementioned factors, presence of diabetic macular oedema and shorter axial length were associated with DCP-DMI. CONCLUSION We reported a series of associated factors of SCP-DMI and DCP-DMI. The binary outcome of DMI might promote a simplified OCTA-based DMI evaluation before subsequent quantitative analysis for assessing DMI extent and fulfil the urge for an updating diabetic retinal disease staging to be implemented with OCTA.
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Affiliation(s)
- Da Wei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zi Qi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Fanny Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Cherie Yk Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Zhao T, Laotaweerungsawat S, Chen Y, Liu X, Liu D, Stewart JM. Right versus left eye asymmetry of microvasculature in diabetes revealed by optical coherence tomography angiography. Sci Rep 2023; 13:9332. [PMID: 37291258 PMCID: PMC10250307 DOI: 10.1038/s41598-023-36058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/28/2023] [Indexed: 06/10/2023] Open
Abstract
In this study, we explored inter-ocular asymmetry (between the two eyes of the same patient) using optical coherence tomography angiography (OCTA) in patients with diabetes mellitus (DM) at different retinopathy stages. A total of 258 patients were divided into four groups: no DM, DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), and proliferative DR (PDR). Superficial and deep vessel density (SVD, DVD), superficial and deep perfusion density (SPD, DPD), foveal avascular zone (FAZ) area, perimeter and circularity were calculated, and asymmetry index (AI) was used to evaluate the asymmetry of two eyes of the same subject. AIs of SPD, SVD, FAZ area and FAZ perimeter in the PDR group were larger than all other 3 groups (all p < 0.05). The AIs of DPD, DVD, FAZ area and FAZ perimeter in males were larger than in females (p = 0.015, p = 0.023, p = 0.006 and p = 0.017). Hemoglobin A1c (HbA1c) was positively correlated with AI of FAZ perimeter (p = 0.02) and circularity (p = 0.022). In conclusion, PDR patients' eyes were significantly asymmetric in both vascular density and FAZ metrics. Male sex and HbA1c are risk factors that influenced symmetry. This study highlights that right-left asymmetry should be taken into account in DR-related studies, particularly those analyzing microvascular changes with OCTA.
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Affiliation(s)
- Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Yi Chen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- School of Optometry, Shenzhen University, Shenzhen, China
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Dongwei Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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Prangel D, Prasuhn M, Rommel F, Grisanti S, Ranjbar M. Comparison of Automated Thresholding Algorithms in Optical Coherence Tomography Angiography Image Analysis. J Clin Med 2023; 12:jcm12051973. [PMID: 36902761 PMCID: PMC10004628 DOI: 10.3390/jcm12051973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
(1) Background: Calculation of vessel density in optical coherence tomography angiography (OCTA) images with thresholding algorithms varies in clinical routine. The ability to discriminate healthy from diseased eyes based on perfusion of the posterior pole is critical and may depend on the algorithm applied. This study assessed comparability, reliability, and ability in the discrimination of commonly used automated thresholding algorithms. (2) Methods: Vessel density in full retina and choriocapillaris slabs were calculated with five previously published automated thresholding algorithms (Default, Huang, ISODATA, Mean, and Otsu) for healthy and diseased eyes. The algorithms were investigated with LD-F2-analysis for intra-algorithm reliability, agreement, and the ability to discriminate between physiological and pathological conditions. (3) Results: LD-F2-analyses revealed significant differences in estimated vessel densities for the algorithms (p < 0.001). For full retina and choriocapillaris slabs, intra-algorithm values range from excellent to poor, depending on the applied algorithm; the inter-algorithm agreement was low. Discrimination was good for the full retina slabs, but poor when applied to the choriocapillaris slabs. The Mean algorithm demonstrated an overall good performance. (4) Conclusions: Automated threshold algorithms are not interchangeable. The ability for discrimination depends on the analyzed layer. Concerning the full retina slab, all of the five evaluated automated algorithms had an overall good ability for discrimination. When analyzing the choriocapillaris, it might be useful to consider another algorithm.
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Affiliation(s)
- David Prangel
- Laboratory for Angiogenesis & Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Michelle Prasuhn
- Laboratory for Angiogenesis & Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
- Correspondence:
| | - Felix Rommel
- Laboratory for Angiogenesis & Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Mahdy Ranjbar
- Laboratory for Angiogenesis & Ocular Cell Transplantation, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Department of Ophthalmology, University Hospital Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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6
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Huang Y, Kong X, Zhou L, Shen P, Su P, Su H. Values of optical coherence tomography angiography for diagnosing diabetic retinopathy and evaluating treatment outcomes. J Fr Ophtalmol 2023; 46:25-32. [PMID: 36470750 DOI: 10.1016/j.jfo.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To compare the consistency between fundus fluorescein angiography (FFA) and optical coherence tomography angiography (OCTA) for the diagnosis of diabetic retinopathy (DR). MATERIALS AND METHODS Ninety-six diabetic patients (185 eyes) treated from January 2019 to December 2019 underwent OCTA and FFA. The image characteristics of fundus lesions were recorded. Sixty-nine patients (137 eyes) who were diagnosed with DR by both examinations and needed to receive panretinal photocoagulation (PRP) were selected. The retinal nerve fiber layer (RNFL) thickness, macular superficial vascular complex (SVC) and deep vascular complex (DVC) blood flow density, 300μm area surrounding foveal avascular zone (FAZ) (FD300) blood flow density and FAZ parameters were compared. RESULTS The Kappa coefficient of FFA and OCTA for diagnosing DR was 0.537 (P=0.000). FFA and OCTA had substantial consistency for detecting retinal microaneurysms and macular edema (Kappa coefficient=0.643/0.616, P=0.000), perfect consistency for detecting retinal neovascularization and retinal non-perfusion area (Kappa coefficient=0.809/0.832, P=0.000), and moderate consistency for detecting structural changes in the macular ring (Kappa coefficient=0.423, P=0.000). The RNFL thickness in the peripapillary and the superior temporal, temporal inferior, inferior nasal and superior nasal regions rose 1 week after PRP but declined 1 year after treatment (P<0.05). The macular SVC, DVC and FD300 blood flow density declined 1 week after PRP but rose 1 year after treatment (P<0.05). CONCLUSIONS OCTA shows consistency with FFA for diagnosing DR, which remedies the deficiency of FFA. The reduction in fundus lesions after PRP can be quantified by OCTA.
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Affiliation(s)
- Y Huang
- Ophthalmology Center, The Second People's Hospital of Foshan, 528000 Foshan, Guangdong Province, China
| | - X Kong
- Foshan Hospital Affiliated to Southern Medical University, 528000 Foshan, Guangdong Province, China
| | - L Zhou
- Ophthalmology Center, The Second People's Hospital of Foshan, 528000 Foshan, Guangdong Province, China
| | - P Shen
- Ophthalmology Center, The Second People's Hospital of Foshan, 528000 Foshan, Guangdong Province, China
| | - P Su
- Ophthalmology Center, The Second People's Hospital of Foshan, 528000 Foshan, Guangdong Province, China
| | - H Su
- Department of Ultrasonography, Nanhai Hospital, Guangdong Provincial People's Hospital, 528000 Foshan, Guangdong Province, China.
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Wang XN, Cai X, Li SW, Li T, Long D, Wu Q. Wide-field swept-source OCTA in the assessment of retinal microvasculature in early-stage diabetic retinopathy. BMC Ophthalmol 2022; 22:473. [PMID: 36474199 PMCID: PMC9727974 DOI: 10.1186/s12886-022-02724-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To perform a quantitative analysis of retinal microvasculature in patients with early-stage diabetic retinopathy (DR) using wide-field swept-source optical coherence tomography angiography (SS-OCTA). METHODS: One hundred nineteen eyes of 119 patents (67 eyes with no DR and 52 eyes with mild-moderate nonproliferative diabetic retinopathy (NPDR)) were enrolled in this observational and cross-sectional cohort study, and an age-matched group consisting of 39 eyes of 39 non-diabetic subjects were set as the control. Each participant underwent a full ophthalmic examination, including wide-field SS-OCTA imaging. On OCTA scans (12 mm * 12 mm), the mean perfusion area (PA) and vessel density (VD) were independently measured in all 16 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors. Linear regression analyses were conducted to evaluate the influences of PA. RESULTS In the central ring, there were no significant differences in the average PA and VD among the groups. In the 3 mm radius, the PA and VD of the no DR and mild-moderate NPDR were significantly decreased compared with the control group in superior and inferior quadrants. In the wide-field scans (9 and 12 mm radius), there was no significant difference in average PA and VD between the groups in each sectors (p > 0.05). Regression analysis found that the effect of VD on PA was statistically different (b = 1.311, p < 0.001). CONCLUSION Wide-field OCTA imaging is useful for evaluating peripheral capillary perfusion in eyes with early-stage DR. Decrease in PA and VD was greater in the S3 and I3 sectors, and reductions in PA and VD were uneven in wide-filed sectors (9 and 12 mm radius).
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Affiliation(s)
- Xiang-ning Wang
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China
| | - Xuan Cai
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China
| | - Shi-wei Li
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China
| | - Tingting Li
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China
| | - Da Long
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China
| | - Qiang Wu
- grid.412528.80000 0004 1798 5117Department of Ophthalmology, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 Xuhui District China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233 China
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8
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Liu T, Lin W, Shi G, Wang W, Feng M, Xie X, Liu T, Zhou Q. Retinal and Choroidal Vascular Perfusion and Thickness Measurement in Diabetic Retinopathy Patients by the Swept-Source Optical Coherence Tomography Angiography. Front Med (Lausanne) 2022; 9:786708. [PMID: 35372401 PMCID: PMC8971655 DOI: 10.3389/fmed.2022.786708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To observe the changes in retinal and choroidal microstructures in patients with different stages of diabetic retinopathy (DR) and to evaluate the vascular perfusion of retina and choroid retinal thickness, retinal and choroidal vessel density by the swept-source optical coherence tomography angiography (SS-OCTA). Methods Subjects were divided into three groups: healthy control group (30 cases, 51 eyes), non-proliferative diabetic retinopathy (NPDR, 42 cases, 71 eyes) and proliferative diabetic retinopathy (PDR, 31 cases, 53 eyes). The area of the foveal avascular zone (FAZ), retinal and choroidal vascular perfusion, and the deep vascular complexes, including the intermediate capillary plexus (ICP) and deep capillary plexus (DCP) within the radius of 3, 6, 9, and 12 mm around the fovea were measured by SS-OCTA. Results Compared with the healthy control group, DR patients presented significantly increased fovea avascular area, while vessel density (VD) in the ICP and DCP, vascular perfusion rate, and the retinal thickness were considerably decreased. There were significant differences in the retinal thickness, ICP, and DCP vessel densities between the control and NPDR groups, or control and PDR groups, or PDR and NPDR groups. The deep vascular perfusion rate also significantly differed between the control and PDR groups, but there was no significant difference between the PDR and NPDR groups. The choroidal perfusion exhibited significant differences across different areas and amongst the three groups. Furthermore, the choroidal thickness showed a significant difference between the PDR and NPDR groups. Conclusion Our results showed significant differences in the area of the avascular fovea and the VD of deep vascular complexes between DR patients and healthy control subjects. Moreover, there were significant differences in retinal VD, especially in the deep-retinalregions, choroidal perfusion, and the volume of large vessel choroid in DR patients with different degrees of disease severity. Notably, SS-OCTA provided in-depth information for detecting the potential VD damage in DR patients caused by a multitudeof factors.
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Affiliation(s)
- Tingting Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- *Correspondence: Tingting Liu
| | - Wei Lin
- School of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Genggeng Shi
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Wenqi Wang
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng Feng
- School of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Xiao Xie
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tong Liu
- Department of Medicine, Xizang Minzu University, Xianyang, China
| | - Qingjun Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Qingjun Zhou
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A Classification Tree Model with Optical Coherence Tomography Angiography Variables to Screen Early-Stage Diabetic Retinopathy in Diabetic Patients. J Ophthalmol 2022; 2022:9681034. [PMID: 35211344 PMCID: PMC8863461 DOI: 10.1155/2022/9681034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Aim To establish a classification tree model in DR screening and to compare the DR screening accuracy between the classification tree model and the logistic regression model in type 2 diabetes mellitus (T2DM) patients based on OCTA variables. Methods Two hundred forty-one eyes of 241 T2DM patients were included and divided into two groups: the development cohort and the validation cohort. Optical coherence tomography angiography (OCTA) images were acquired in these patients. The data of foveal avascular zone area, superficial capillary plexus (SCP) density, and deep capillary plexus (DCP) density were exported after automatically analyzing the macular 6 × 6 mm OCTA images, while the data of radial peripapillary capillary plexus (RPCP) density was exported after automatically analyzing the optic nerve head 4.5 × 4.5 mm OCTA images. These OCTA variables were adopted to establish and validate the logistic regression model and the classification tree model. The area under the curve (AUC), sensitivity, specificity, and statistical power for receiver operating characteristic curves of two models were calculated. Results In the logistic regression model, best-corrected visual acuity (BCVA) (LogMAR) and SCP density were entered (BVCA : OR= 60.30, 95% CI= [2.40, 1513.82], p = 0.013; SCP density: OR= 0.86, 95% CI= [0.78, 0.96], p = 0.006). The AUC, sensitivity, and specificity for detecting early-stage DR (mild to moderate NPDR) in the development cohort were 0.75 (95% CI: [0.66, 0.85]), 63%, and 83%, respectively. The AUC, sensitivity, and specificity in the validation cohort were 0.75 (95% CI: [0.66, 0.84]), 79%, and 72%, respectively. In the classification tree model, BVCA (LogMAR), DM duration, SCP density, and DCP density were entered. The AUC, sensitivity, and specificity for detecting early-stage DR were 0.72 (95% CI: [0.60, 0.84]), 66%, and 76%, respectively. The AUC, sensitivity, and specificity in the validation cohort were 0.74 (95% CI: [0.65, 0.83]), 74%, and 72%, respectively. The statistical power of the development and validation cohorts in two models was all more than 99%. Conclusions Compared to the logistic regression model, the classification tree model has similar accuracy in predicting early-stage DR. The classification tree model with OCTA variables may be a simple tool for clinical practitioners to identify early-stage DR in T2DM patients. Moreover, SCP density is significantly reduced in mild-to-moderate NPDR eyes and might be a biomarker in early-stage DR detection. Further improvement and validation of the DR diagnostic model are awaiting to be performed.
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Retinal Vascularization Abnormalities Studied by Optical Coherence Tomography Angiography (OCTA) in Type 2 Diabetic Patients with Moderate Diabetic Retinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020379. [PMID: 35204470 PMCID: PMC8871460 DOI: 10.3390/diagnostics12020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p < 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p < 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group.
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Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review. Biomedicines 2021; 10:biomedicines10010088. [PMID: 35052768 PMCID: PMC8773551 DOI: 10.3390/biomedicines10010088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.
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Ozcalıskan S, Pehlıvanoglu S, Huseyınhan Z, Alagoz C, Erdogan G, Artunay O. Macular and peripapillary microvasculature after dexamethasone injection in diabetic macular edema. Eur J Ophthalmol 2021; 32:2752-2759. [PMID: 34766511 DOI: 10.1177/11206721211057695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the microvascular changes in the macular and peripapillary area after intravitreal dexamethasone implant in diabetic macular edema (DME). MATERIAL AND METHODS We included 31 eyes of 31 patients treated with a single dose dexamethasone implant for DME. All subjects underwent swept-source optical coherence tomography (OCT) and OCT angiography imaging before (T0), and one month (T1), two months (T2), and four months (T4) after dexamethasone injection. The foveal avascular zone (FAZ) area of superficial and deep capillary plexus (SCP and DCP) was calculated by delineating the FAZ border using the measurement tool of the device. The vessel density (VD) of SCP and DCP and choriocapillaris (CC) in the macular and peripapillary area were automatically calculated. RESULTS There was an insignificant reduction in FAZ area measurements of SCP after dexamethasone injection in DME patients (p = 0.846). The FAZ area of DCP were significantly smaller compared to T0 measurements at T1, T2, and T4 (p = 0.013, p = 0.031, and p = 0.029, respectively). The mean average parafoveal VD measurements were significantly decreased after dexamethasone injection in SCP and DCP (p = 0.004, p = 0.005). The peripapillary VD in retinal capillary plexuses and choriocapillaris showed no significant difference after dexamethasone injection. CONCLUSION Intravitreal dexamethasone leads to a significant FAZ area decrease in DCP with a reduction in parafoveal VD measurements. In addition, no significant VD changes were observed in the peripapillary area after dexamethasone. These findings indicate that dexamethasone may improve macular ischemia with no significant effects on peripapillary microvasculature in DME patients.
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Affiliation(s)
- Sehnaz Ozcalıskan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Seren Pehlıvanoglu
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Zahid Huseyınhan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Alagoz
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Erdogan
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Artunay
- University of Health Sciences, 147017Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Discordance in Retinal and Choroidal Vascular Densities in Patients with Type 2 Diabetes Mellitus on Optical Coherence Tomography Angiography. J Ophthalmol 2021; 2021:8871602. [PMID: 33747557 PMCID: PMC7945675 DOI: 10.1155/2021/8871602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/03/2020] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose In the present study, the retinal and choroidal vascular densities (VDs) in type 2 diabetes mellitus (DM) patients were analyzed using optical coherence tomography angiography (OCTA). Methods The study included 282 eyes of 152 patients with type 2 DM (114 without retinopathy, 79 nonproliferative diabetic retinopathy (NPDR), 48 severe NPDR, and 41 proliferative diabetic retinopathy (PDR) eyes). The superficial and deep retinal vessel, choriocapillaris, and choroidal VDs were measured using a binarization method on OCTA images. VDs were compared based on retinopathy severity. Correlations among densities were analyzed. Results Retinal and choriocapillaris VDs were lower in PDR than in NPDR (all P < 0.05). Correlation analysis showed significant positive correlations among densities of superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Choroidal VD showed a negative correlation with superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Retinal and choriocapillaris VDs showed a negative correlation with diabetic retinopathy (DR) grade (all P < 0.001); however, the choroidal VD showed a weak positive correlation (P=0.030). Conclusion Choroidal VD increased as retinal and choriocapillaris VDs decreased, indicating that the outer layer of the choroid is less affected by DR severity and VD of larger choroidal vessels may even be increased as a compensatory mechanism for decreased retinal and choriocapillaris VDs in type 2 DM patients.
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