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Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, Kubravi H, Sivaprasad S. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel) 2024; 14:326. [PMID: 38337841 PMCID: PMC10855126 DOI: 10.3390/diagnostics14030326] [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: 01/05/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.
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Affiliation(s)
- Naomi Wijesingha
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Wei-Shan Tsai
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Ayse Merve Keskin
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Christopher Holmes
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Dimitrios Kazantzis
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Swati Chandak
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Heena Kubravi
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
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Chatziralli I, Dimitriou E, Agapitou C, Kazantzis D, Kapsis P, Morogiannis N, Kandarakis S, Theodossiadis G, Theodossiadis P. Optical Coherence Tomography Angiography Changes in Macular Area in Patients with Proliferative Diabetic Retinopathy Treated with Panretinal Photocoagulation. Biomedicines 2023; 11:3146. [PMID: 38137367 PMCID: PMC10740986 DOI: 10.3390/biomedicines11123146] [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: 09/17/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the changes in macular microvasculature using optical coherence tomography angiography (OCTA) in association with functional changes in patients with proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) with a follow up of 12 months. METHODS The participants in this study were 28 patients with PDR and no macular oedema, who were eligible for PRP. All participants underwent best-corrected visual acuity (BCVA) measurement, optical coherence tomography (OCT), and OCT angiography (OCTA) at baseline (before treatment) and at months 1, 6, and 12 after the completion of PRP treatment. The comparison of OCTA parameters and BCVA between baseline and months 1, 6, and 12 after PRP was performed. RESULTS There was a statistically significant decrease in foveal avascular zone (FAZ) area at months 6 and 12 of the follow-up period compared to baseline (p = 0.014 and p = 0.011 for month 6 and 12, respectively). Of note is that FAZ became significantly more circular 6 months after PRP (p = 0.009), and remained so at month 12 (p = 0.015). There was a significant increase in the mean foveal and parafoveal vessel density (VD) at all quadrants at the superficial capillary plexus (SCP) at month 6 and month 12 after PRP compared to baseline. No difference was noticed in VD at the deep capillary plexus (DCP) at any time-point of the follow up. BCVA remained the same throughout the follow-up period. CONCLUSIONS At months 6 and 12 after PRP, foveal and parafoveal VD at SCP significantly increased compared to baseline, while the FAZ area significantly decreased and FAZ became more circular.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Chrysa Agapitou
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Petros Kapsis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Nick Morogiannis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Stylianos Kandarakis
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Li Z, Zhou L, Huang C, Lu T, Liang J, Cong Q, Lan Y, Jin C. Long-term real-world outcomes of retinal microvasculature changes in proliferative diabetic retinopathy treated with panretinal photocoagulation vs. intravitreal conbercept. Microvasc Res 2023; 150:104586. [PMID: 37451332 DOI: 10.1016/j.mvr.2023.104586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To compare long-term real-world outcomes of retinal microvasculature changes in proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) vs. intravitreal conbercept (IVC) and to explore the potential factors affecting these changes. METHODS This study retrospectively included 96 treatment-naïve PDR eyes of 96 type 2 diabetes mellitus patients [59 PRP and 37 IVC]. Baseline characteristics and treatment details were collected. Optical coherence tomography angiography (OCTA) data of macular vessel density (VD) and optic disc capillary density (CD) at baseline and at the last follow-up were compared between groups. The differences between the baseline and the last follow-up OCTA data in each group were also tested for significance. The correlation between the change in each OCTA parameter from baseline and each baseline characteristic/treatment parameter was investigated in each group. RESULTS During a mean follow-up of two years, greater superficial (SCP) (p = 0.004) and deep capillary plexus (DCP) VD (p < 0.001) were observed in the foveal area in the PRP than in the IVC. Compared to the baseline, SCP VD in the foveal area increased in the PRP (p = 0.012), while an increased SCP VD in some sectors in the parafoveal and perifoveal areas (p < 0.05), rather than the foveal area (p = 0.908), was seen in the IVC. For both groups, eyes with a higher VD/CD at baseline tended to develop capillary dropout more intensively (all p < 0.05). In the IVC group, foveal avascular zone (FAZ) area change showed a negative correlation with baseline FAZ area (p = 0.020), and complementary PRP exerted a negative influence on FAZ area change (p = 0.002). In the PRP group, SCP VD change was positively correlated with follow-up frequency, and was negatively correlated with diastolic blood pressure (all p < 0.05); DCP VD change showed a positive correlation with PRP shot number (p = 0.019). CONCLUSION The aforementioned microvasculature changes should be considered when PRP or IVC is adopted in PDR long-term management.
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Affiliation(s)
- Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Jiandong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Qifeng Cong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Yuqing Lan
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.
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Le Boité H, Gaudric A, Erginay A, Tadayoni R, Couturier A. Is There a Nonperfusion Threshold on OCT Angiography Associated With New Vessels Detected on Ultra-Wide-Field Imaging in Diabetic Retinopathy? Transl Vis Sci Technol 2023; 12:15. [PMID: 37738057 PMCID: PMC10519435 DOI: 10.1167/tvst.12.9.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose To determine whether the nonperfusion index (NPI) measured on widefield (WF) optical coherence tomography angiography (OCTA) could be used as an alternative method for the diagnosis of proliferative diabetic retinopathy (PDR) and to study the relationship between the NPI and the location of new vessels (NV) in eyes with PDR. Methods Fifty-one treatment-naïve eyes with either severe nonproliferative DR (NPDR) or PDR were imaged using ultra-wide-field imaging and wide-field OCTA. Results The NPI was significantly higher in eyes with PDR (18.94% vs. 7.51%; P < 0.01). Using the NPI on the whole image to assess PDR status, the area under the curve was 0.770, but the area under the curve increased when the NPI of the most peripheral circle was used (area under the curve of 0.792). Four eyes with PDR (17%) had NV outside the OCTA image field, and their mean NPI (6.15 %) did not differ from that measured in severe NPDR eyes (7.51%; P = 0.67) and was lower than in other eyes with PDR (21.49%; P = 0.023). The presence of NV in a sector was associated with a higher NPI in the same sector (29.2% vs. 6.0%; P < 10-15). Conclusions Although the NPI was significantly higher in eyes with PDR compared with severe NPDR eyes, its measurement on the whole wide-field OCTA image was not sensitive enough to replace the detection of NV for the diagnosis of PDR. Translational Relevance Because the presence of new vessels was related to the local nonperfusion index in the same sector, the assessment of nonperfusion outside the optical coherence tomography angiography field is important in diabetic retinopathy.
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Affiliation(s)
- Hugo Le Boité
- Universite Paris Cité, Paris, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alain Gaudric
- Universite Paris Cité, Paris, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Ali Erginay
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Universite Paris Cité, Paris, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
- Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Aude Couturier
- Universite Paris Cité, Paris, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
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Zhang J, Huo Q, Xia D, Wang M, Li X. Advances in application of swept-source optical coherence tomography angiography in diagnosis and treatment of diabetic retinopathy. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1116391. [PMID: 38983076 PMCID: PMC11182126 DOI: 10.3389/fopht.2023.1116391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/11/2023] [Indexed: 07/11/2024]
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the leading causes of global blinding. More attention should be paid to the diagnosis, treatment and prognosis of DR. Swept-source optical coherence tomography angiography (SS-OCTA) is a novel imaging technique presented in recent years. It can accurately present the various levels of the retina, choriocapillaris, macula, and the optic papillary microcirculation, which is new to the diagnosis and prognosis of DR. However, SS-OCTA is limited by poor fixation or severe media clouding and is susceptible to motion artefacts and segmentation errors. Future limitations need to be addressed and large prospective trials conducted to refine the relevance of SS-OCTA to DR. The present study reviews the advances in clinical application of SS-OCTA in diagnosis, treatment and prognosis of DR.
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Affiliation(s)
- Jinyan Zhang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Qianqian Huo
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Deyu Xia
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Mingfang Wang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xiuyun Li
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
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Zhou X, Yu G, Yao L. Efficacy of laser photocoagulation plus ranibizumab in patients with diabetic retinopathy and their effect on VEGF. Am J Transl Res 2023; 15:193-201. [PMID: 36777841 PMCID: PMC9908459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/12/2022] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To investigate the efficacy of laser photocoagulation combined with ranibizumab in patients with diabetic retinopathy and their effect on VEGF. METHODS The medical records of 98 patients with diabetic retinopathy treated in the First People's Hospital of Linping District from February 2020 to January 2022 were collected for a retrospective analysis. Among them, 48 patients treated with laser photocoagulation were a control group (CG), and another 50 treated with laser photocoagulation combined with ranibizumab were an observation group (OG). The treatment efficacy, best corrected visual acuity (BCVA), central macular concave thickness (CMT), and change in neovascularization area were compared between the two groups. Also, the changes in serum vascular endothelial growth factor (VEGF), homocysteine (HCY), vitamin B12 and folic acid were compared. The adverse effects that occurred with treatment were assessed. The relationship of pre-treatment BCVA, CMT, neovascularization area and VEGF levels with clinical outcomes were observed, and their predictive values were analyzed by receiver operating characteristic (ROC) curve. RESULTS The total response rate of patients in the CG was lower than that in the OG (P<0.05). The BCVA, CMT, and neovascularization area were dramatically lower, while vitamin B12 and folic acid were markedly higher in the OG than in the CG after treatment (P<0.05). There was no statistical difference in adverse reactions between the two groups (P>0.05). In patients with effective response, the BCVA, CMT, VEGF and Hcy before treatment were dramatically lower than in those with ineffective response (P<0.05), while the neovascularization area, vitamin B12, and folic acid did not differ between them before treatment (P>0.05). ROC curve analysis revealed that the areas under the curve of BCVA, CMT, VEGF and Hcy were all greater than 0.7 for predicting patient outcomes, and the area under the curve of the combination of the above indexes was 0.945, with a specificity of 92.30% and sensitivity of 88.23%. CONCLUSION Laser photocoagulation combined with ranibizumab may provide good therapeutic efficacy in diabetic retinopathy, by effectively improving neovascularization and reducing VEGF levels to control further progression of the lesions.
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Morphological Changes in the Foveal Avascular Zone after Panretinal Photocoagulation for Diabetic Retinopathy Using OCTA: A Study Focusing on Macular Ischemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121797. [PMID: 36556999 PMCID: PMC9781560 DOI: 10.3390/medicina58121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Background and objectives: This study aimed to analyze the morphological changes in the foveal avascular zone (FAZ) after panretinal photocoagulation (PRP) in patients with diabetic retinopathy, with a particular focus on the presence or absence of comorbid diabetic macular ischemia (DMI), using optical coherence tomography angiography (OCTA). Materials and Methods: Treatment-naïve 25 eyes of 16 patients who received PRP were examined in this retrospective case series. FAZ area, perimeter, and circularity were calculated on a 3 × 3-mm en-face OCTA image before PRP (baseline) and 1 and 3 months after PRP. The patients were divided into two groups according to coexisting DMI, and each group was statistically analyzed. Results: In patients with DMI (9 eyes), FAZ area significantly decreased from the baseline to 3 months after PRP (0.86 ± 0.56 to 0.61 ± 0.31 mm2, p = 0.018), whereas FAZ perimeter and circularity remained unchanged following treatment (p = 0.569 and 0.971, respectively). In patients without DMI (16 eyes), FAZ parameters did not show statistically significant changes across the 3-month follow-up period. Conclusion: PRP significantly reduces FAZ area in patients with DMI.
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Acar OPA, Onur IU. Effect of panretinal photocoagulation on retina and choroid in diabetic retinopathy: An optical coherence tomography angiography study. Photodiagnosis Photodyn Ther 2022; 40:103166. [PMID: 36261094 DOI: 10.1016/j.pdpdt.2022.103166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To analyze the quantitative changes in both macular, and choroidal thickness, and microvascularization after panretinal photocoagulation (PRP) in eyes with proliferative diabetic retinopathy (PDR) or severe non-proliferative diabetic retinopathy (NPDR) by using optical coherence tomography angiography (OCT-A). METHODS The patients diagnosed with severe NPDR or PDR according to the Early Treatment Diabetic Retinopathy Study (ETDRS) and decided to be treated with PRP were included in this prospective and observational study. Ten eyes of 10 patients with PDR and twelve eyes of 12 patients with severe NPDR were examined. Macular scans (6 × 6 mm) were obtained from OCT-A at baseline and at month 6 after PRP. Subfoveal choroidal thickness (SFCT) measurements that were obtained through the foveolar center on a high-definition line scan were recorded. RESULTS Best-corrected visual acuity (BCVA) significantly decreased (p = 0.018), central foveal thickness and mean parafoveal thickness significantly increased (p < 0001 and p < 0.001, respectively) six months after PRP. The thickness of all parafoveal retinal quadrants (temporal, superior, nasal, inferior) increased (p = 0.001, p = 0.003, p < 0.001, p < 0.001, respectively) and mean parafoveal, parafoveal temporal, and parafoveal nasal vessel density of the deep capillary plexus (DCP) significantly decreased six months after PRP compared with the baseline values (p = 0.023, p = 0.041, p = 0.018, respectively). CONCLUSIONS The parafoveal vessel density of DCP decreased significantly 6 months after PRP in eyes with PDR or severe NPDR. While the difference in SFCT and choroidal flow density was not significant from the baseline; central and parafoveal retinal thickness increased and BCVA decreased significantly 6 months after PRP treatment.
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Affiliation(s)
- Ozge Pinar Akarsu Acar
- Department of Ophthalmology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Ismail Umut Onur
- Department of Ophthalmology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Lee MW, Baek SK, Lee KH, Lee SC, Kim JY, Lee YH. Comparison of retinal layer thickness and microvasculature changes in patients with diabetic retinopathy treated with intravitreous bevacizumab vs panretinal photocoagulation. Sci Rep 2022; 12:1570. [PMID: 35091585 PMCID: PMC8799708 DOI: 10.1038/s41598-022-05513-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
To compare changes in retinal layers and microvasculature in diabetic retinopathy (DR) patients after bevacizumab therapy and panretinal photocoagulation (PRP). This prospective study divided patients into two groups: patients treated with bevacizumab and those treated with PRP. Patients visited our retinal clinic at 1, 3, and 6 months after treatment. Retinal layer thickness and vessel density (VD) using optical coherence tomography angiography were analyzed. 37 eyes in the bevacizumab group and 36 eyes in the PRP group were enrolled. In the bevacizumab group, the parafoveal RNFL, GCL, and IPL thicknesses significantly decreased (P < 0.001, P = 0.013, and P = 0.017, respectively), whereas the thicknesses in the PRP group showed an increasing tendency over time (P = 0.087, P = 0.005, and P = 0.003, respectively). The VD of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the bevacizumab group did not show significant changes, whereas the VD in the PRP group significantly increased over time (both P < 0.001). Additionally, RNFL (P = 0.001) and GCL thicknesses (P = 0.035) were significant factors affecting changes in BCVA, whereas the VDs of SCP and DCP did not. Patients who received bevacizumab therapy did not show a significant change in macular VD, whereas the VD of patients after PRP significantly increased after treatment. The increased macular VD in patients after PRP would be associated with the increased inner retinal layer thickness after treatment, which was significantly related to the impairment in visual acuity.
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Affiliation(s)
- Min-Woo Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, #158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | | | - Kook-Hyung Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, #158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Sung-Chul Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, #158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chugnam National University Hospital, Daejeon, Republic of Korea
| | - Young-Hoon Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, #158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
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Update on Optical Coherence Tomography and Optical Coherence Tomography Angiography Imaging in Proliferative Diabetic Retinopathy. Diagnostics (Basel) 2021; 11:diagnostics11101869. [PMID: 34679567 PMCID: PMC8535055 DOI: 10.3390/diagnostics11101869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
Proliferative diabetic retinopathy (PDR) is a major cause of blindness in diabetic individuals. Optical coherence tomography (OCT) and OCT-angiography (OCTA) are noninvasive imaging techniques useful for the diagnosis and assessment of PDR. We aim to review several recent developments using OCT and discuss their present and potential future applications in the clinical setting. An electronic database search was performed so as to include all studies assessing OCT and/or OCTA findings in PDR patients published from 1 January 2020 to 31 May 2021. Thirty studies were included, and the most recently published data essentially focused on the higher detection rate of neovascularization obtained with widefield-OCT and/or OCTA (WF-OCT/OCTA) and on the increasing quality of retinal imaging with quality levels non-inferior to widefield-fluorescein angiography (WF-FA). There were also significant developments in the study of retinal nonperfusion areas (NPAs) using these techniques and research on the impact of PDR treatment on NPAs and on vascular density. It is becoming increasingly clear that it is critical to use adequate imaging protocols focused on optimized segmentation and maximized imaged retinal area, with ongoing technological development through artificial intelligence and deep learning. These latest findings emphasize the growing applicability and role of noninvasive imaging in managing PDR with the added benefit of avoiding the repetition of invasive conventional FA.
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Russell JF, Han IC. Toward a New Staging System for Diabetic Retinopathy Using Wide Field Swept-Source Optical Coherence Tomography Angiography. Curr Diab Rep 2021; 21:28. [PMID: 34448072 DOI: 10.1007/s11892-021-01401-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW For over 50 years, diabetic retinopathy (DR) has been classified by pathologic features seen on clinical examination and conventional retinal photographs. However, newer technology such as optical coherence tomography angiography (OCTA) now enables rapid acquisition of retinal structural and vascular information in a reliable, non-invasive, high-resolution fashion. Here, we highlight recent studies that have explored wide field swept-source OCTA (WF SS-OCTA) for the diagnosis and management of DR. RECENT FINDINGS Multiple studies have demonstrated the utility of WF SS-OCTA for detection of all clinically relevant features of DR. An updated DR staging system is proposed that leverages the advantages of WF SS-OCTA, including the ability to correlate detailed vascular and structural pathology over time with longitudinal imaging. WF SS-OCTA has tremendous potential for evaluating patients with DR. A new WF SS-OCTA-based staging system may be useful in routine clinical practice and for clinical trials.
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Affiliation(s)
- Jonathan F Russell
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, PFP 11196K, Iowa City, IA, 52242, USA
| | - Ian C Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, PFP 11196K, Iowa City, IA, 52242, USA.
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