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Wei-Zhang S, He K, Zhou W, Yu J, Zhao J, He T, Chen S, Kaysar P, Sun Z, Jia D, Zhu Y, Yan H. Relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment. Eur J Ophthalmol 2024; 34:1521-1531. [PMID: 38291627 DOI: 10.1177/11206721241228010] [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] [Indexed: 02/01/2024]
Abstract
PURPOSE To assess the relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment, and to analyze the relative factors in PDR eyes. METHODS A total of 89 eyes, including 42 eyes with non-PDR (NPDR), and 47 eyes after vitrectomy with PDR were included and underwent OCTA. All images were processed by Python or FIJI. Multivariable linear regression models were used to analyze the associations between postoperative BCVA and OCTA parameters in PDR patients. RESULTS Postoperative OCTA parameters including deep capillary plexus (DCP) parafoveal and perifoveal vessel density (VD), DCP parafoveal and perifoveal vessel length density (VLD), DCP fractal dimension (FD), choriocapillaris plexus (CCP) VD, CCP VLD, were significantly lower in the PDR group than in the NPDR group. In the superficial capillary plexus (SCP), we found a negative correlation between the postoperative BCVA and VD (parafovea: β coefficient = -0.351, p = 0.023; perifovea: β coefficient = -0.338, p = 0.036). Perifoveal VLD (β coefficient = -0.343, p = 0.031) and FD (β coefficient = -0.375, p = 0.016) of the SCP were also negatively correlated with postoperative BCVA. Regarding the DCP, perifoveal VD (β coefficient = -0.396, p = 0.008), perifoveal VLD (β coefficient = -0.334, p = 0.025), vessel tortuosity (VT) (β coefficient = -0.369, p = 0.015) were negatively correlated with postoperative BCVA. In CCP, VLD (β coefficient = -0.373, p = 0.023) and number of flow voids (β coefficient = -0.334, p = 0.036) exhibited a negative association with postoperative BCVA. CONCLUSIONS Postoperative BCVA of PDR patients was related to OCTA parameters of the SCP (parafoveal and perifoveal VD, perifoveal VLD and FD), DCP (perifoveal VD, VLD, and VT) and CCP (VLD and number of flow voids).
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Affiliation(s)
- Selena Wei-Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Kai He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Wei Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jing Zhao
- Key Laboratory of Micro Opto-electro Mechanical System Technology, College of Precision Instrument & Opto- electronics Engineering, Tianjin University, Ministry of Education, Tianjin, 300072, China
| | - Tiangeng He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Song Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Parhat Kaysar
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Zhiyong Sun
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Dagong Jia
- Key Laboratory of Micro Opto-electro Mechanical System Technology, College of Precision Instrument & Opto- electronics Engineering, Tianjin University, Ministry of Education, Tianjin, 300072, China
| | - Yun Zhu
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
- School of Medicine, Nankai University, Tianjin, China
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Zhong X, Yang S, Zhu Z, Li H, Cheng W, Wang W. Trajectories of choriocapillaris perfusion in healthy individuals and patients with diabetes mellitus: a prospective cohort study. Br J Ophthalmol 2024:bjo-2024-325515. [PMID: 39197953 DOI: 10.1136/bjo-2024-325515] [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: 03/12/2024] [Accepted: 08/03/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To evaluate the longitudinal rate of choriocapillaris flow deficits (CFD) in healthy participants and patients with diabetes mellitus. METHODS This prospective cohort study included healthy individuals and diabetic patients without diabetic retinopathy (non-DR) or with mild-to-moderate non-proliferative DR (NPDR). The swept-source optical coherence tomography angiography (OCTA) was adopted for quantifying CFD annually, and linear mixed models were used to analyse the CFD change and its 95% CI overtime. RESULTS A total of 1025 individuals were included, including 465 healthy controls, 454 in the non-DR group and 106 in the NPDR group. Significant increase in CFDs was observed in NPDR group (0.423%, 95% CI 0.230% to 0.616%) and non-DR group (0.319%, 95% CI 0.225% to 0.412%), which were higher than the CFD in healthy controls (0.173%, 95% CI 0.079% to 0.266%). After adjusting for other factors, the non-DR and NPDR group had a greater annual elevation of CFD by 0.171% (95% CI 0.060% to 0.283%; p=0.003) and 0.258% (95% CI 0.068% to 0.449%; p=0.008) in comparisons with controls. Furthermore, higher serum creatinine and glycated haemoglobin levels, poorer best-corrected visual acuity, lower OCTA image quality scores and smaller CFD at baseline were independently related to accelerated CFD worsening (all p<0.05). CONCLUSIONS The CFD among healthy individuals and patients with diabetes increased consistently overtime, regardless of the presence or absence of DR, suggesting that CFD alterations could be an early indicator of microvascular complications, potentially aiding in the earlier DR detection.
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Affiliation(s)
- Xiaoying Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ziyu Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huangdong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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Nouri H, Abtahi SH, Mazloumi M, Samadikhadem S, Arevalo JF, Ahmadieh H. Optical coherence tomography angiography in diabetic retinopathy: A major review. Surv Ophthalmol 2024; 69:558-574. [PMID: 38521424 DOI: 10.1016/j.survophthal.2024.03.004] [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: 09/23/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
Diabetic retinopathy (DR) is characterized by retinal vasculopathy and is a leading cause of visual impairment. Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature. We briefly describe its functional principles and advantages over fluorescein angiography and perform a comprehensive review on its clinical applications in the screening or management of people with prediabetes, diabetes without clinical retinopathy (NDR), nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME). OCTA reveals early microvascular alterations in prediabetic and NDR eyes, which may coexist with sub-clinical neuroretinal dysfunction. Its applications in NPDR include measuring ischemia, detecting retinal neovascularization, and timing of early treatment through predicting the risk of retinopathy worsening or development of DME. In PDR, OCTA helps characterize the flow within neovascular complexes and evaluate their progression or regression in response to treatment. In eyes with DME, OCTA perfusion parameters may be of predictive value regarding the visual and anatomical gains associated with treatment. We further discussed the limitations of OCTA and the benefits of its incorporation into an updated DR severity scale.
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Affiliation(s)
- Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Mazloumi
- Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sanam Samadikhadem
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fu X, Ren X, Chen W, Chen D. Reduced macular thickness and vascular density in abnormal glucose metabolism patients: A meta-analysis of optical coherence tomography (OCT) and OCT angiography studies. Chin Med J (Engl) 2024; 137:1054-1068. [PMID: 38563217 PMCID: PMC11062653 DOI: 10.1097/cm9.0000000000003052] [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: 08/03/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Alterations in macular thickness and vascular density before clinically visible diabetic retinopathy (DR) remain inconclusive. This study aimed to determine whether retinal manifestations in abnormal glucose metabolism (AGM) patients differ from those in the healthy individuals. METHODS PubMed, Embase, and Web of Science were searched between 2000 and 2021. The eligibility criteria were AGM patients without DR. Primary and secondary outcomes measured by optical coherence tomography (OCT) and OCT angiography (OCTA) were analyzed and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). A random-effects model was used in the data synthesis. The potential publication bias for the variables was evaluated using Egger's test. RESULTS A total of 86 observational studies involving 13,773 participants and 15,416 eyes were included. OCT revealed that compared to healthy controls, the total macular thickness of AGM patients was thinner, including the thickness of fovea (-0.24, 95% CI [-0.39, -0.08]; P = 0.002, I2 = 87.7%), all regions of parafovea (-0.32, 95% CI [-0.54, -0.11]; P = 0.003; I2 = 71.7%) and the four quadrants of perifovea; the thickness of peripapillary retinal nerve fiber layer (pRNFL), macular retinal nerve fiber layer (mRNFL), and ganglion cell layer (GCL) also decreased. OCTA indicated that the superficial and deep vascular density decreased, the foveal avascular zone (FAZ) area enlarged, and the acircularity index (AI) reduced in AGM individuals. CONCLUSIONS Retinal thinning and microvascular lesions have occurred before the advent of clinically detectable DR; OCT and OCTA may have the potential to detect these preclinical changes. REGISTRATION PROSPERO; http://www.crd.york.ac.uk/prospero/ ; No. CRD42021269885.
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Affiliation(s)
- Xiangyu Fu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiang Ren
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenyue Chen
- Department of Ophthalmology, The People’s Hospital of Guizhou Province, Guiyang, Guizhou 550002, China
| | - Danian Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Courtie E, Kirkpatrick JRM, Taylor M, Faes L, Liu X, Logan A, Veenith T, Denniston AK, Blanch RJ. Optical coherence tomography angiography analysis methods: a systematic review and meta-analysis. Sci Rep 2024; 14:9643. [PMID: 38670997 PMCID: PMC11053039 DOI: 10.1038/s41598-024-54306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/11/2024] [Indexed: 04/28/2024] Open
Abstract
Optical coherence tomography angiography (OCTA) is widely used for non-invasive retinal vascular imaging, but the OCTA methods used to assess retinal perfusion vary. We evaluated the different methods used to assess retinal perfusion between OCTA studies. MEDLINE and Embase were searched from 2014 to August 2021. We included prospective studies including ≥ 50 participants using OCTA to assess retinal perfusion in either global retinal or systemic disorders. Risk of bias was assessed using the National Institute of Health quality assessment tool for observational cohort and cross-sectional studies. Heterogeneity of data was assessed by Q statistics, Chi-square test, and I2 index. Of the 5974 studies identified, 191 studies were included in this evaluation. The selected studies employed seven OCTA devices, six macula volume dimensions, four macula subregions, nine perfusion analyses, and five vessel layer definitions, totalling 197 distinct methods of assessing macula perfusion and over 7000 possible combinations. Meta-analysis was performed on 88 studies reporting vessel density and foveal avascular zone area, showing lower retinal perfusion in patients with diabetes mellitus than in healthy controls, but with high heterogeneity. Heterogeneity was lowest and reported vascular effects strongest in superficial capillary plexus assessments. Systematic review of OCTA studies revealed massive heterogeneity in the methods employed to assess retinal perfusion, supporting calls for standardisation of methodology.
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Affiliation(s)
- Ella Courtie
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Matthew Taylor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Livia Faes
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Ann Logan
- Axolotl Consulting Ltd., Droitwich, Worcestershire, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tonny Veenith
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Critical Care Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Trauma Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Richard J Blanch
- Neuroscience and Ophthalmology Research Group, University of Birmingham, Birmingham, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
- Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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Cui Y, Feng D, Wu C, Wang P, Cui R, Wang X, Chang W, Shang W, Zhao B, Liu J, Qin X. Quantitative assessment of OCT and OCTA parameters in diabetic retinopathy with and without macular edema: single-center cross-sectional analysis. Front Endocrinol (Lausanne) 2024; 14:1275200. [PMID: 38523868 PMCID: PMC10960358 DOI: 10.3389/fendo.2023.1275200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 03/26/2024] Open
Abstract
Aim The retinal and choroidal parameters were analyzed to understand the impairment of microcirculation of both retina and choroid in patients with diabetic retinopathy (DR). Methods Fifty-five treatment-naive non-proliferative diabetic retinopathy (NPDR) patients (75 eyes) with type 2 diabetes mellitus (T2DM), including 28 patients (36 eyes) with diabetic macular edema (DME) and 27 patients (39 eyes) without DME, and 25 healthy subjects (47 eyes) were enrolled in this study. The following parameters of DR patients with and without DME were evaluated: the foveal avascular zone area (FAZ-a), FAZ perimeter (FAZ-p), FAZ circularity index (FAZ-CI), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow area percentage, superficial capillary plexus (SCP), and deep capillary plexus (DCP). Results SCP, DCP, and the percentage of choriocapillaris flow area were significantly different between DR patients with and without DME. The DR patients presented lower LA, CVI, and FAZ-CI compared to those of healthy controls (all p < 0.05). The percentage of choriocapillaris flow area in DR patients with and without DME was significantly lower than that in healthy controls (p < 0.05). SCP and DCP were significantly correlated with FAZ-a and FAZ-p but presented insignificant associations with FAZ-CI. Conclusions Optical coherence tomography (OCT) and OCT angiography (OCTA) parameters, such as LA, CVI, FAZ-CI, and the percentage of choriocapillaris flow area, were reduced compared to those in controls, indicating that the microcirculations of the retina and choroid in the macular area were impaired in DR patients with DME and without DME.
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Affiliation(s)
- Yanyan Cui
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
| | | | | | - Ping Wang
- Ophthalmological Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ruoxi Cui
- Nanchang University Queen Mary School, Nanchang, China
| | - Xiaokun Wang
- Civil Aviation Medical Center of CAAC Northeast Regional Administration, Shenyang, China
| | - Weiwei Chang
- Department of Ophthalmology, Affiliated Hospital of Jining Medical University, Jining, China
| | | | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuejiao Qin
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
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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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8
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Viggiano P, Miere A, Borrelli E, Boscia G, Grassi MO, Souied EH, Alessio G, Boscia F. The Impact of Diabetic Retinopathy on the Choriocapillaris in Neovascular AMD. Invest Ophthalmol Vis Sci 2023; 64:32. [PMID: 37988106 PMCID: PMC10668630 DOI: 10.1167/iovs.64.14.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
Purpose To investigate the impact of diabetic retinopathy (DR) on morphological choriocapillaris (CC) modifications in eyes with type 1 macular neovascularization (MNV) secondary to AMD using optical coherence tomography angiography (OCTA). Methods Eyes with AMD-related type 1 MNV with and without DR were prospectively included. We performed 3 × 3 mm OCTA scans at two visits: before the loading phase of intravitreal injections of aflibercept (T1) and 1 month after the last injection (T2). OCTA En face flow images of the CC were analyzed for flow deficit percentage (FD%), FD average area and FD number in a 500-µm-wide ring surrounding the dark halo (DH) around type 1 MNV. Results A total of 65 eyes, out of which 30 eyes had mild DR, were included. In the group without diabetes, there was a gradual reduction in FD% in the CC ring around the DH after antiangiogenic therapy, indicating reperfusion of the CC (P = 0.003). However, in the DR group, there were no significant changes in CC parameters between the two study visits. Specifically, the FD% in the CC ring around the DH did not show a significant reduction at T2 compared with T1 values (P > 0.05). Furthermore, the comparison of the variation in FD% between the two groups was statistically significant. The nondiabetic group exhibited a gradual CC reperfusion after the loading phase of aflibercept, whereas the diabetic eyes did not show significant changes (P = 0.029). Conclusions The CC surrounding the DH associated to type 1 MNV exhibited greater hypoperfusion in diabetic eyes compared with eyes without diabetes, both before starting therapy and after the loading phase. Hence, DR may be a potential risk factor in the development and progression of late-stage AMD and may also influence the response to antiangiogenic therapy.
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Affiliation(s)
- Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
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Lee H, Han KD, Shin J. Association between glycemic status and age-related macular degeneration: A nationwide population-based cohort study. DIABETES & METABOLISM 2023; 49:101442. [PMID: 36931431 DOI: 10.1016/j.diabet.2023.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
AIM The risk of dry and wet age-related macular degeneration (AMD) based on fasting glucose levels and disease duration of type 2 diabetes was investigated. METHODS Using a health insurance claims database and the results of health examinations in South Korea, we conducted a retrospective, population-based cohort study of 2,103,604 adults ≥ 45 years of age who were AMD-free based on health checkups in 2009 and observed from January 1, 2011, to December 31, 2018. Glycemic status was classified into five groups: normal, impaired fasting glucose, new-onset diabetes (fasting glucose level ≥ 126 mg/dl but no diabetes diagnosis or diabetes medication), diabetes diagnosis < 5 years, and diabetes ≥ 5 years. According to the presence and absence of choroidal neovascularization, AMD was classified as wet AMD and dry AMD, respectively. Adjusted hazard ratios (HRs) of AMD occurrence were estimated in each category. RESULTS For dry AMD (n = 36,271, 1.72%), the HR was 1.192 (1.141-1.245) among subjects with diabetes < 5 years and 1.294 (1.242-1.349) among subjects with diabetes ≥ 5 years compared with subjects with normal glycemic status after adjusting for age, sex, body mass index, lifestyle, and medical history. For wet AMD (n = 12,912, 0.61%), the HR was 1.103 (1.011-1.203) among subjects with new-onset diabetes, 1.252 (1.167-1.344) among subjects with diabetes < 5 years, and 1.506 (1.413-1.605) among subjects with diabetes ≥ 5 years. The HR of AMD was significantly increased among participants ≤ 65 years old and those who did not have hypertension. CONCLUSIONS The incidence of dry and wet AMD increased among diabetes patients compared to the normal glycemic status group. These risks increased when the duration of diabetes was 5 years or more. The risk of wet AMD was increased among new-onset diabetes patients. These results suggest that high blood glucose levels without treatment might induce the vision-threatening condition of wet AMD, emphasizing the importance of early blood glucose management.
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Affiliation(s)
- Hyungwoo Lee
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University of Korea, Seoul 06978, Republic of Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea.
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Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia. Eur J Ophthalmol 2022:11206721221146680. [PMID: 36562094 DOI: 10.1177/11206721221146680] [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: 12/24/2022]
Abstract
INTRODUCTION The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). METHODS We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. RESULTS No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group (p > 0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes (p < 0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube (p < 0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance (p > 0,05). CONCLUSION We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.
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Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Swept-source optical coherence tomography angiography automatic analysis of microvascular changes secondary to systemic hypertension. Eur J Ophthalmol 2022; 33:1452-1458. [PMID: 36529872 DOI: 10.1177/11206721221146674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction The aim of our study is to report swept-source optical coherence tomography angiography (SS-OCTA) quantitative parameters of retinal and choroidal microvasculature in patients with systemic hypertension (HTN) using a built-in software of SS-OCTA. Methods We performed a retrospective study. This study enrolled 93 eyes of 51 subjects with HTN and 71 eyes of 38 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP), total capillary plexus (TCP) and choriocapillaris (CC)) of the OCTA cube of 4,5 mm × 4,5 mm were recorded. Results A decrease of parafoveal VD in CC, DCP and TCP were demonstrated between HTN group and control group ( p < 0,05). Conversely, no differences were demonstrated in parafoveal VD of SCP and MCP ( p > 0,05). Subgroup analysis revealed a diminution of central VD at SCP, DCP and TCP in patients taking one antihypertensive drug compared to patients treated with two medications ( p < 0,05). Correlation analysis showed a significant, albeit weak, negative correlation between HTN duration, and parafoveal VD in the SCP and FAZ area at SCP, DCP and TCP ( p < 0,05 and r < 0,300). Conclusion When normative data are available, OCTA might be used as a potential tool in the prevention and follow-up of end-organ damage secondary to HTN. Nonetheless, further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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Quantitative analysis of choriocapillaris alterations in Swept-Source OCT-Angiography during radiation retinopathy. Retina 2022; 42:1995-2003. [DOI: 10.1097/iae.0000000000003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Quantitative analysis of early retinal vascular changes in type 2 diabetic patients without clinical retinopathy by optical coherence tomography angiography. Int Ophthalmol 2022; 42:367-375. [DOI: 10.1007/s10792-022-02230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/02/2020] [Indexed: 10/19/2022]
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Marques JH, Marta A, Castro C, Baptista PM, José D, Almeida D, Ribeiro A, Barbosa I. Choroidal changes and associations with visual acuity in diabetic patients. Int J Retina Vitreous 2022; 8:6. [PMID: 34998439 PMCID: PMC8742927 DOI: 10.1186/s40942-021-00355-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background The variable visual function observed in diabetic retinopathy (DR) patients is not fully explained by the classic staging system. Our purpose was to evaluate choroidal changes, in standardized sectors, in DR patients and to find associations between choroidal measurements and visual function. Methods Cross-sectional study that included the right eye of diabetic patients (n = 265) without active edema, ischemia or neovascularization and age-matched controls (n = 73). Optical coherence tomography (OCT) imaging was performed with enhanced depth imaging protocol. Choroidal vascularity index (CVI) was calculated in a 5 mm scan centered in the fovea. Results CVI decreased with age (p < 0.001) but was not influenced by axial length. A multivariate analysis adjusting for age confirmed a significant difference in CVI between DR eyes that had previous treatments (intravitreal injections and/or photocoagulation) compared to control eyes (p = 0.013) and to DR eyes that never required treatment (p = 0.002). There was no significant difference between non-DR diabetic patients and normal controls. Considering the group of DR patients that had previous treatments, in eyes without optic media opacification, BCVA correlated with CVI (r = − 0.362, p < 0.001), whereas full retina thickness and individual retinal layer thickness did not (p > 0.066). Conclusions A reduction in CVI was observed in patients with a more advanced stage of DR. In treated DR patients with stable disease, choroidal biomarkers correlated with best-corrected visual acuity whereas retinal biomarkers did not. Trial registration: N/A Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00355-z.
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Affiliation(s)
- João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Ana Marta
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Catarina Castro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Diana José
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Daniel Almeida
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - António Ribeiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Irene Barbosa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Hunt M, Teper S, Wylęgała A, Wylęgała E. Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography. J Diabetes Res 2022; 2022:3547461. [PMID: 35237693 PMCID: PMC8885291 DOI: 10.1155/2022/3547461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). METHODS This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 μm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. RESULTS Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 μm (±77.15) to 350.25 μm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 (p < 0.001) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 (p < 0.001), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 (p < 0.001) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 (p = 0.001). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. CONCLUSION The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.
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Affiliation(s)
- Magdalena Hunt
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
| | - Sławomir Teper
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Edward Wylęgała
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
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Alé-Chilet A, Bernal-Morales C, Barraso M, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Esquinas C, Gimenez M, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus-Report 2: Diabetic Kidney Disease. J Clin Med 2021; 11:197. [PMID: 35011940 PMCID: PMC8745787 DOI: 10.3390/jcm11010197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to investigate potential associations between optical coherence tomography angiography (OCTA) parameters and diabetic kidney disease (DKD) categories in type 1 diabetes mellitus (T1DM) patients and controls. A complete ocular and systemic examination, including OCTA imaging tests and bloods, was performed. OCTA parameters included vessel density (VD), perfusion density (PD), foveal avascular zone area (FAZa), perimeter (FAZp) and circularity (FAZc) in the superficial vascular plexus, and DKD categories were defined according to glomerular filtration rate (GFR), albumin-creatinine ratio (ACR) and KDIGO prognosis risk classifications. A total of 425 individuals (1 eye/1 patient) were included. Reduced VD and FAZc were associated with greater categories of GFR (p = 0.002, p = 0.04), ACR (p = 0.003, p = 0.005) and KDIGO risk prognosis classifications (p = 0.002, p = 0.005). FAZc was significantly reduced in greater KDIGO prognosis risk categories (low risk vs. moderate risk, 0.65 ± 0.09 vs. 0.60 ± 0.07, p < 0.05). VD and FAZc presented the best diagnostic performance in ROCs. In conclusion, OCTA parameters, such as VD and FAZc, are able to detect different GFR, ACR, and KDIGO categories in T1DM patients and controls in a non-invasive, objective quantitative way. FAZc is able to discriminate within T1DM patients those with greater DKD categories and greater risk of DKD progression.
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Affiliation(s)
- Aníbal Alé-Chilet
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Marina Barraso
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Teresa Hernández
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Cristian Oliva
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08036 Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
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Time-related OCT-A changes in preclinical retinopathy and their association with systemic factors. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Optical coherence tomography angiography (OCT-A) is a promising tool for the detection of microvascular impairment at the preclinical stage of diabetic retinopathy (DR). Evaluation of dynamic OCT-A changes and their association with systemic factors can help to reveal early biomarkers of DR progression.Aim: to evaluate time-related OCT-A changes and their association with systemic factors in type 1 diabetes mellitus (DM1) patients with no apparent DRMaterials and methods. 38 DM1 patients with no apparent DR and 39 healthy volunteers were included in the study. All participants underwent 7-fi eld fundus photography, OCT and OCT-A. We analyzed OCT-A parameters (foveal avascular zone (FAZ) area (mm2), acircularity index (AI), vessel density (VD), skeletonized density (SD)) as well as the results of blood and urea tests.Results. After one year of observation, AI was significantly higher (р = 0.005) and VD0–300 was signifi cantly lower in superfi cial vascular plexus (SVP, p < 0.0001) and deep capillary plexus (DCP, р = 0.032) in DM1 patients. We have also registered a positive correlation between AI and triglycerides (TG) level (r = 0.627, p = 0.007) as well as a negative correlation between ketones and VD (SVP VD0–300: r = –0.695, p = 0.030; intermediate capillary plexus (ICP, VD0–300: r = –0.551, p = 0.041; DCP, VD0–300: r = –0.704, p = 0.003; SVP, VD300–600: r = –0.853, p = 0.001).Conclusions. After one year of observation, we have registered an increase in AI level and a decline in VD in SVP and DCP which can be the earliest signs of DR progression. A signifi cant correlation between these parameters and systemic factors indicates their role as potential DR biomarkers.
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Abstract
PURPOSE OF REVIEW Diabetic retinopathy (DR), the leading cause of blindness in working-aged adults, remains clinically defined and staged by its vascular manifestations. However, early retinal neurodegeneration may precede vascular pathology, suggesting that this neuronal damage may contribute to disease pathogenesis and represent an independent target for intervention. This review will discuss the evidence and implications for diabetic retinal neurodegeneration. RECENT FINDINGS A growing body of literature has identified progressive retinal thinning and visual dysfunction in patients with diabetes even prior to the onset of DR, though advances in retinal vascular imaging suggest that vascular remodeling and choroidal changes occur during these early stages as well. Animal models of diabetes and in vitro studies have also suggested that diabetes may directly affect the retinal neural and glial tissue, providing support to the concept that diabetic retinal neurodegeneration occurs early in the disease and suggesting potentially relevant molecular pathways. Diabetic retinal neurodegeneration may represent a "preclinical" manifestation of diabetic retinal disease and remains an active area of investigation. As the natural history and molecular mechanisms become increasingly understood, it may lead to upcoming developments in not only the treatment options but also the clinical definition of DR.
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Affiliation(s)
- Mira M Sachdeva
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 748, Baltimore, MD, 21287 MD, USA.
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20
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Loria O, Kodjikian L, Denis P, Vartin C, Dimassi S, Gervolino L, Maignan A, Kermarrec R, Chambard C, Pradat P, Mathis T. QUANTITATIVE ANALYSIS OF CHORIOCAPILLARIS ALTERATIONS IN SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DIABETIC PATIENTS. Retina 2021; 41:1809-1818. [PMID: 33411469 DOI: 10.1097/iae.0000000000003102] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate quantitative alterations of the choriocapillaris in swept-source optical coherence tomography angiography in diabetic patients. METHODS We included normal patients and diabetic patients with and without diabetic retinopathy (DR), excluding patients with macular edema. Angiograms in 3 × 3 mm were acquired with Plexelite 9000 swept-source optical coherence tomography angiography. Choroidal flow voids were analyzed after removal of projection artifacts. The main evaluation was the correlation between choroidal flow voids area (FVA-CC) and DR stage. RESULTS A total of 120 eyes of 72 patients were analyzed. There were 17 eyes from healthy subjects, 30 eyes without DR, 22 eyes with minimal nonproliferative DR, 30 eyes with moderate nonproliferative DR, 16 eyes with severe nonproliferative DR, and 5 eyes with proliferative DR (PDR). The percentage of FVA-CC for each group was, respectively, 10.9 ± 3.4%, 14.6 ± 4.8%, 17.6 ± 3.5%, 20.7 ± 5.9%, 19.9 ± 2.9%, and 26.6 ± 4.4%. FVA-CC and DR stage significantly correlated (P < 0.0001). FVA-CC was significantly increased in diabetic patients without DR compared with healthy subjects (P = 0.008). CONCLUSION Diabetes is associated with quantifiable choriocapillaris alterations in swept-source optical coherence tomography angiography. These alterations precede clinical signs of DR and are correlated with DR stage.
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Affiliation(s)
- Olivier Loria
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Philippe Denis
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Christine Vartin
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Sarra Dimassi
- Service d'Ophtalmologie, Groupe Hospitalier Public Sud de l'Oise, Creil, France
| | - Lucas Gervolino
- Institut des Sciences et Techniques de la Réadaptation-Orthoptie, Lyon, France; and
| | - Antoine Maignan
- Institut des Sciences et Techniques de la Réadaptation-Orthoptie, Lyon, France; and
| | - Ronan Kermarrec
- Institut des Sciences et Techniques de la Réadaptation-Orthoptie, Lyon, France; and
| | - Claudine Chambard
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
- Institut des Sciences et Techniques de la Réadaptation-Orthoptie, Lyon, France; and
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Thibaud Mathis
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, Villeurbane, France
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21
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Stulova AN, Semenova NS, Zheleznyakova AV, Akopyan VS, Lipatov DV. OCTA and Functional Signs of Preclinical Retinopathy in Type 1 Diabetes Mellitus. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S30-S34. [PMID: 34310241 DOI: 10.3928/23258160-20210518-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE There is an emerging role for optical coherence tomography angiography (OCTA) in detecting microvasculature changes in diabetic retinopathy (DR). This study aimed to investigate visual functions and OCTA parameters of retinal and choriocapillaris (CC) flow in patients with type 1 diabetes mellitus (T1DM) without apparent DR. PATIENTS AND METHODS Patients and age-matched healthy volunteers were enrolled. All participants underwent low-luminance visual acuity assessment, OCT, and OCTA. Assessed OCTA parameters included foveal avascular zone area, acircularity index, vessel density (VD), skeletonized density, and CC flow deficits. RESULTS Low-luminance deficit (LLD) was significantly higher in patients with diabetes mellitus and correlated with skeletonized density and VD in the superficial vascular plexus (SVP). In the T1DM group, vessel density and skeletonized density were reduced in the SVP and deep capillary plexus. Flow deficits density and the mean size of the flow deficits were increased in patients with T1DM. CONCLUSION Functional and microvasculature changes were observed at the preclinical stage of DR. Correlation of LLD and OCTA parameters can be a sign of early neurovascular impairment. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S30-S34.].
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22
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Parravano M, Ziccardi L, Borrelli E, Costanzo E, Frontoni S, Picconi F, Parisi V, Sacconi R, Di Renzo A, Varano M, Querques G. Outer retina dysfunction and choriocapillaris impairment in type 1 diabetes. Sci Rep 2021; 11:15183. [PMID: 34312425 PMCID: PMC8313686 DOI: 10.1038/s41598-021-94580-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022] Open
Abstract
To study the outer retina morpho-functional characteristics and the choriocapillaris (CC) features in type 1 diabetic (T1D) patients, with and without signs of diabetic retinopathy (NPDR and NoDR). Twenty-five NPDR and 18 NoDR eyes were imaged by Optical Coherence Tomography Angiography. Ellipsoid zone (EZ) “normalized” reflectivity and CC perfusion density parameters, as flow deficits number (FDn), flow deficit average area (FDa) and flow deficit percentage (FD%), were analysed. Multifocal electroretinogram (mfERG) response amplitude densities (RADs) were measured. Mean EZ “normalized” reflectivity, CC FDn and FD% values, were similar (p > 0.05) in both groups, FDa was significant greater (p > 0.05) in NPDR compared with NoDR eyes. MfERG-RADs were similar in both groups. NPDR eyes showed a significant (p < 0.05) linear correlation between RADs and both, CC FDa and FD%. The EZ “normalized” reflectivity was negatively correlated with CC FD% in NoDR eyes. In NPDR T1D eyes a significant relationship between abnormal outer retina functional responses and CC impairment was observed, while in NoDR eyes the photoreceptor reflectivity was correlated to CC abnormalities. The outer retina dysfunction in NPDR correlated to CC drop-out let hypothesize that the outer retinal elements are functionally impaired in proportion to the CC vascular supply deficit.
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Affiliation(s)
| | | | - E Borrelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, Milan, Italy
| | | | - S Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - F Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - V Parisi
- IRCCS - Fondazione Bietti, Rome, Italy
| | - R Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, Milan, Italy
| | | | - M Varano
- IRCCS - Fondazione Bietti, Rome, Italy
| | - G Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, Milan, Italy.
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23
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Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Soler Sanchis MI, Cervera Taulet E. Quantitative analysis of retinal and choroidal vasculature in patients with chorioretinal folds secondary to hyperopia. Eur J Ophthalmol 2021; 32:1694-1701. [PMID: 34308685 DOI: 10.1177/11206721211035618] [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: 11/15/2022]
Abstract
INTRODUCTION There is a lack of information on quantitative parameters of optical coherence tomography angiography (OCTA) in cases of chorioretinal folds (CRF). The aim of this study was to compare OCTA retinal and choriocapillary vessel density (VD) between normal subjects and patients with CRF. METHODS We conducted an observational retrospective study. A total of 16 eyes of eight patients were recruited (eight eyes with CRF and eight control eyes). Data on best-corrected visual acuity (BCVA), refractive error, central macular thickness (CMT), central subfoveal thickness (CST), and OCTA findings (VD and foveal avascular zone (FAZ) area in superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), and VD in choriocapillaris (CC)) were recorded in each eye. RESULTS Compared with control group, CRF group showed decreased VD in the foveal region of SCP and MCP (p value 0.003 and 0.001), and increased VD in nasal region of SCP and MCP (p value 0.02 and 0.001), and in parafoveal area of MCP (p value 0.005). No differences were found in DCP and CC layers. Furthermore, we observed an enlargement of FAZ in CRF group at SCP and MCP slabs (p value <0.001 and 0.015). Respect to optical coherence tomography parameters, we demonstrated a thicker choroid in the CRF group (p value 0.002). CONCLUSION To the best of our knowledge, this is the first study reported in the literature quantifying VD of retinal capillary plexus and CC in a group of patients with a diagnosis of CRF secondary to hyperopia.
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Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | | | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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24
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Ghassemi F, Fadakar K, Berijani S, Babeli A, Gholizadeh A, Sabour S. Quantitative assessment of vascular density in diabetic retinopathy subtypes with optical coherence tomography angiography. BMC Ophthalmol 2021; 21:82. [PMID: 33579225 PMCID: PMC7881539 DOI: 10.1186/s12886-021-01831-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Quantitative assessment of vascular density (VD) of retinal and choriocapillaris (CC) in various stages of diabetic retinopathy (DR) using spectral domain optical coherence tomography angiography (SD OCTA). Methods 188 eyes of 97 participants were recruited in this cross-sectional study. The macular OCTA (3x3mm) scan was performed and the computer algorithm assessed VD at the level of superficial capillary plexus (SCP), deep capillary plexus (DCP) and CC. Results All measured parameters were decreased in retinal VD at the more extreme stages of DR, with the exception of SCP foveal VD. There was a constant pattern of decrease in VD of CC from normal cases to cases of NDR and NPDR and then a slight increase occurred in the PDR stage but never touching the normal quantities. Age, fasting blood sugar, and years of diabetes mellitus were correlated with reduced VD in different segments. Multivariate linear regression analysis showed that best-corrected visual acuity (BCVA) was positively correlated with parafoveal VD at SCP and VD of foveal area at CC. VD of all subfields of macular area except foveal DCP VD showed reduced levels in diabetic macular edema (DME) patients compared to those without DME. Conclusions The findings of the study endorse retina VD changes as a potential biomarker for DR development before retinopathy becomes clinically evident. It seems that parafoveal VD of SCP and foveal VD of CC are good biomarkers to predict VA in the diabetic patients.
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Affiliation(s)
- Fariba Ghassemi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran. .,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kaveh Fadakar
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Berijani
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Ameneh Babeli
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Alireza Gholizadeh
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran
| | - Siamak Sabour
- Department of clinical epidemiology, School of Health and Safety, Safety promotion and Injury prevention research centre, Tehran, Iran.,Department of clinical epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Zhang B, Chou Y, Zhao X, Yang J, Chen Y. Early Detection of Microvascular Impairments With Optical Coherence Tomography Angiography in Diabetic Patients Without Clinical Retinopathy: A Meta-analysis. Am J Ophthalmol 2021; 222:226-237. [PMID: 32976846 DOI: 10.1016/j.ajo.2020.09.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/23/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate microvascular impairments with optical coherence tomography angiography (OCTA) in the eyes of diabetic patients with no diabetic retinopathy (NDR). DESIGN Systematic review and meta-analysis. METHODS The PubMed and Embase databases were comprehensively searched to identify studies comparing the microvascular changes between diabetic eyes without clinical retinopathy and healthy controls using OCTA. Data of interest were extracted and analyzed by Review Manager V.5.3 and Stata V.14.0. The weighted mean differences and their 95% confidence intervals were used to assess the strength of the association. RESULTS Forty-five cross-sectional studies involving 2241 diabetic and 1861 healthy eyes were ultimately included. OCTA unambiguously revealed that compared with the healthy control group, the NDR group manifested enlarged areas and increased perimeters of the foveal avascular zone, with decreased perfusion density (PD) in both superficial and deep capillary plexus of the macula (except parafoveal PD of the inner retina and foveal PD) and reduced radial peripapillary capillary PD. In addition, subgroup analyses according to the type of diabetes mellitus indicated that most of those differences became nonsignificant (except parafoveal PD in the deep capillary plexus) in type 1 diabetes mellitus, while in type 2 diabetes mellitus they remained statistically significant. CONCLUSION Our results suggested that retinal microvascular impairments might have occurred antecedent to clinically visible diabetic retinopathy and could be detected early by OCTA. However, those manifestations could be inconsistent according to the types of diabetes mellitus.
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26
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Ashraf M, Sampani K, Clermont A, Abu-Qamar O, Rhee J, Silva PS, Aiello LP, Sun JK. Vascular Density of Deep, Intermediate and Superficial Vascular Plexuses Are Differentially Affected by Diabetic Retinopathy Severity. Invest Ophthalmol Vis Sci 2021; 61:53. [PMID: 32866267 PMCID: PMC7463180 DOI: 10.1167/iovs.61.10.53] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate differences in optical coherence tomography angiography (OCTA) metrics in the superficial (SCP), intermediate (ICP), and deep (DCP) vascular plexuses across diabetic retinopathy (DR) severity levels. Methods This was a cross sectional observational retrospective chart review study. Eligible patients with diabetes who underwent same day RTVue XR Avanti OCTA, spectral-domain optical coherence tomography (SD-OCT), and 200-degree Optos ultrawide field color imaging. SCP, ICP, and DCP vessel density (VD) and vessel length density (VLD) were assessed using 3-D projection artifact removal software (PAROCTA) software. Results Of 396 eyes (237 patients), 16.1% had no DR, 26.9% mild nonproliferative DR (NPDR), 21.1% moderate NPDR, 12.1% severe NPDR, 10.1% proliferative DR (PDR) without panretinal photocoagulation (PRP), and 13.4% PDR with PRP. When comparing mild NPDR to no DR eyes, ICP and DCP VD and VLD were significantly lower, but there was no difference for SCP metrics. In eyes with more severe DR, there were significant differences in SCP VD and VLD between DR severity levels (mild versus moderate NPDR: VD 35.45 ± 3.31 vs. 34.14 ± 3.38, P = 0.008 and VLD 17.59 ± 1.83 vs. 16.80 ± 1.83, P = 0.003; moderate versus severe NPDR: VLD 16.80 ± 1.83 vs. 15.79 ± 1.84, P = 0.019), but no significant differences in ICP or DCP. Conclusions Although VD of each of the three individual layers decreases with increasing DR severity, DR severity has a substantially different effect on OCTA parameters within each layer. Vascular changes in eyes with no to early DR were present primarily in the deeper vascular layers, whereas in eyes with advanced DR the opposite was observed. This study highlights the effects of ICP and the importance of assessing SCP and DCP changes independently across each DR severity level.
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Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Allen Clermont
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
| | - Omar Abu-Qamar
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
| | - Jae Rhee
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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27
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Santos T, Warren LH, Santos AR, Marques IP, Kubach S, Mendes LG, Sisternes LD, Madeira MH, Durbin M, Cunha-Vaz JG. Swept-source OCTA quantification of capillary closure predicts ETDRS severity staging of NPDR. Br J Ophthalmol 2020; 106:712-718. [PMID: 33355147 PMCID: PMC9046755 DOI: 10.1136/bjophthalmol-2020-317890] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 12/05/2020] [Indexed: 11/12/2022]
Abstract
Purpose To test whether a single or composite set of parameters evaluated with optical coherence tomography angiography (OCTA), representing retinal capillary closure, can predict non-proliferative diabetic retinopathy (NPDR) staging according to the gold standard ETDRS grading scheme. Methods 105 patients with diabetes, either without retinopathy or with different degrees of retinopathy (NPDR up to ETDRS grade 53), were prospectively evaluated using swept-source OCTA (SS-OCTA, PlexElite, Carl Zeiss Meditec) with 15×9 mm and 3×3 mm angiography protocols. Seven-field photographs of the fundus were obtained for ETDRS staging. Eyes from age-matched healthy subjects were also imaged as control. Results In eyes of patients with type 2 diabetes without retinopathy or ETDRS levels 20 and 35, retinal capillary closure was in the macular area, with predominant alterations in the parafoveal retinal circulation (inner ring). Retinal capillary closure in ETDRS stages 43–53 becomes predominant in the retinal midperiphery with vessel density average values of 25.2±7.9 (p=0.001) in ETDRS 43 and 23.5±3.4 (p=0.001) in ETDRS 47–53, when evaluating extended areas of 15×9 protocol. Combination of acquisition protocols 3×3 mm and 15×9 mm, using SS-OCTA, allows discrimination between eyes with mild NPDR (ETDRS 10, 20, 35) and eyes with moderate-to-severe NPDR (ETDRS grades 43–53). Conclusions Retinal capillary closure, quantified by SS-OCTA, can identify NPDR severity progression. It is located mainly in the perifoveal retinal capillary circulation in the initial stages of NPDR, whereas the retinal midperiphery is predominantly affected in moderate-to-severe NPDR.
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Affiliation(s)
- Torcato Santos
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | | | - Ana Rita Santos
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Department of Orthoptics, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Inês Pereira Marques
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Luís G Mendes
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | | | - Maria H Madeira
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mary Durbin
- R&D, Carl Zeiss Meditec, Dublin, California, USA
| | - Jose G Cunha-Vaz
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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28
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Dai Y, Zhou H, Zhang Q, Chu Z, Olmos de Koo LC, Chao JR, Rezaei KA, Saraf SS, Wang RK. Quantitative assessment of choriocapillaris flow deficits in diabetic retinopathy: A swept-source optical coherence tomography angiography study. PLoS One 2020; 15:e0243830. [PMID: 33306736 PMCID: PMC7732066 DOI: 10.1371/journal.pone.0243830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To quantitatively assess choriocapillaris (CC) flow deficits in eyes with diabetic retinopathy (DR) using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic subjects with different stages of DR and age-matched healthy subjects were recruited and imaged with SS-OCTA. The en face CC blood flow images were generated using previously published and validated algorithms. The percentage of CC flow deficits (FD%) and the mean CC flow deficit size were calculated in a 5-mm-diameter circle centered on the fovea from the 6×6-mm scans. Results Forty-five diabetic subjects and 27 control subjects were included in the study. The CC FD% in diabetic eyes was on average 1.4-fold greater than in control eyes (12.34±4.14% vs 8.82±2.61%, P < 0.001). The mean CC FD size in diabetic eyes was on average 1.4-fold larger than in control eyes (2151.3± 650.8μm2 vs 1574.4±255.0 μm2, P < 0.001). No significant difference in CC FD% or mean CC FD size was observed between eyes with nonproliferative DR and eyes with proliferative DR (P = 1.000 and P = 1.000, respectively). Conclusions CC perfusion in DR can be objectively and quantitatively assessed with FD% and FD size. In the macular region, both CC FD% and CC FD size are increased in eyes with DR. SS-OCTA provides new insights for the investigations of CC perfusion status in diabetes in vivo.
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Affiliation(s)
- Yining Dai
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Lisa C. Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Jennifer R. Chao
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Kasra A. Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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29
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Foveal avascular zone analysis by optical coherence tomography angiography in patients with type 1 and 2 diabetes and without clinical signs of diabetic retinopathy. Int Ophthalmol 2020; 41:649-658. [PMID: 33156947 DOI: 10.1007/s10792-020-01621-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the early macular microvascular alterations in patients with type 1 and 2 diabetes mellitus (DM) without diabetic retinopathy (DR), using optical coherence tomography angiography (OCT-A), and compare these with nondiabetic patients. METHODS This prospective study involved 93 patients with type 1 diabetes (DM1), 104 patients with type 2 diabetes (DM2) without signs of DR, and 71 healthy subjects for the control group. The foveal avascular zone (FAZ) area and the vessel density (VD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS The SCP and DCP FAZ areas were significantly larger in the DM1 group in comparison with the controls (p = .001), while no significant differences were observed between the DM2 group and the healthy control group (p = .12). Additionally, no significant differences in FAZ area were found between the DM1 and DM2 groups (p = .26). The VD was significantly reduced in DM1 and DM2 groups compared to controls. A direct correlation was found between the duration of diabetes and SCP FAZ area (r = 0.44; R2 = 0.19; p = .0001). Statistically significant differences in the FAZ area at SCP and DCP were observed when comparing patients with a diabetes duration > 10 years and < 10 years in the DM2 group (p = .0001, respectively) and only in the FAZ area at the DCP in the DM1 group (p = .0001). CONCLUSION Diabetic patients without DR demonstrate early microvascular alteration in the macular area on OCT-A, which is more pronounced in type I DM, and correlates with the duration of the disease.
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Jung JJ, Soh YQ, Sha P, Yu S, Durbin MK, Hoang QV. Effects of Induced Astigmatism on Spectral Domain-OCT Angiography Quantitative Metrics. Am J Ophthalmol 2020; 219:49-58. [PMID: 32681911 DOI: 10.1016/j.ajo.2020.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To analyze the effect of induced astigmatism on en-face spectral-domain optical coherence tomography angiography quantitative metrics. DESIGN Prospective crossover study. METHODS Normal eyes without astigmatism and with 0.75, 1.75, and 2.75 diopters (D) of with-the-rule (WTR) astigmatism were imaged using a 3 × 3-mm scan pattern SD-OCTA CIRRUS 5000 HD-OCT with AngioPlex (Carl Zeiss Meditec, Dublin, CA, USA). Quantitative parameters, including foveal avascular zone metrics, parafoveal vessel length density (VD), and perfusion density (PD) were corrected for magnification secondary to axial length and analyzed. Univariate linear regressions were performed within each eye to correlate quantitative metrics to the level of an induced astigmatic cylinder. RESULTS Fifteen eyes from 15 patients were imaged. Every 1-D increase in induced WTR astigmatism was associated with a statistically significant decrease in VD and PD within all Early Treatment Diabetic Retinopathy Study inner ring quadrants; however, especially more so nasally (VD: 0.63; P < .001; PD: 0.0089; P = .001). For every 1-D increase in induced astigmatism, the resulting decrease in the inner ring superior quadrant was 12% greater for VD and 16% greater for PD versus that in the inferior quadrant. The resulting decrease in the inner ring nasal quadrant was 40% greater for VD and 48% greater for PD versus that in the temporal quadrant. CONCLUSIONS Increasing levels of induced WTR astigmatism correlated with globally diminishing VD and PD, was more symmetrical for vertical than horizontal quadrants, and was most pronounced nasally. This may be due to a high prevalence of horizontally oriented vessels nasally and the horizontal optical defocus induced by WTR astigmatism.
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Shen C, Li Y, Wang Q, Chen YN, Li W, Wei WB. Choroidal vascular changes in retinitis pigmentosa patients detected by optical coherence tomography angiography. BMC Ophthalmol 2020; 20:384. [PMID: 32993583 PMCID: PMC7523071 DOI: 10.1186/s12886-020-01640-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate choroidal vascular changes, including choriocapillaris (CC) and middle/large choroidal vessels, in retinitis pigmentosa (RP) patients using wide-angle optical coherence tomography angiography (OCTA) and to determine whether changes in the choroidal vascularity have a relationship with visual function and retinal structural changes. METHODS 34 patients with a confirmed diagnosis of RP and 48 controls were recruited. All patients underwent detailed ophthalmologic and imaging examinations, including two types of OCTA (Optovue, 3 × 3 mm, 6 × 6 mm; VG-200, 12 × 12 mm). CC defects were defined according to the choroidal vascular structure in five degrees. To evaluate middle and large choroidal vascular changes, the choroidal vascularity index (CVI), which was the luminance volume to the total choroidal volume, was used. RESULTS Defects of choroidal vascularity of RP eyes were detected in comparison to control eyes. The defects were observed in the CC layer with a concentric or lobular pattern at different degrees. CVI, which was used to reflect middle/large choroidal vascularity, decreased in the perifoveal, pararetinal and periretinal regions in the RP eyes. CC defects degree were correlated with the BCVA (p = 0.001, r = - 0.556), the Humphrey indexes (mean deviation, MD, p < 0.001, r = - 0.673; PVF, p = 0.003, r = - 0.639; 10° mean sensitivity, 10° MS, p = 0.002, r = - 0.651) and microperimetry index (mean sensitivity, MS, p < 0.001, r = - 0.807). The preserved CC area (mean value: 28.65 ± 12.50 mm2) was negatively correlated with MS measured by microperimetry (p = 0.005, r = - 0.449). Ordinary regression analysis revealed that the CC defect degree was associated with the CVI of perifovea (p = 0.002, 95% CI: - 102.14 to - 24.01), the EZ length (p = 0.006, 95% CI: - 0.006 to - 0.001) and the VAD (vascular area density) of the DCP (deep capillary plexus) in the fovea (p = 0.022, 95% CI: 0.038-0.478). No correlations were detected between BCVA and CVI in any retinal regions. No correlations were found between the CVI and the VAD in any retinal regions. CONCLUSION The choroidal vascularity was widely defected in RP. Choriocapillaris and middle/large choroidal vascularity defects were correlated with each other. Visual function and retinal structural changes were found to be associated with choriocapillaris defects but not with middle/large choroidal vascular defects.
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Affiliation(s)
- Chang Shen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Yu-Ning Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Wei Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China.
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An D, Chandrasekera E, Yu DY, Balaratnasingam C. Non-Proliferative Diabetic Retinopathy Is Characterized by Nonuniform Alterations of Peripapillary Capillary Networks. Invest Ophthalmol Vis Sci 2020; 61:39. [PMID: 32340031 PMCID: PMC7401967 DOI: 10.1167/iovs.61.4.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose The purpose of this study was to use three-dimensional confocal microscopy to quantify the spatial patterns of capillary network alterations in nonproliferative diabetic retinopathy (NPDR). Methods The retinal microvasculature was perfusion-labelled in seven normal human donor eyes and six age-matched donor eyes with NPDR. The peripapillary microcirculation was studied using confocal scanning laser microscopy. Capillary density and diameters of the radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were quantified and compared. Three-dimensional visualization strategies were also used to compare the communications between capillary beds and precapillary arterioles and postcapillary venules. Results Mean capillary diameter was significantly increased in the NPDR group (P < 0.001). Intercapillary distance was significantly increased in the DCP (P = 0.004) and RPCP (P = 0.022) of the NPDR group (P = 0.010) but not the SCP (P = 0.155) or ICP (P = 0.103). The NPDR group was associated with an increased frequency of inflow communication between the SCP and ICP/DCP and a decreased frequency of communication between the SCP and RPCP (P = 0.023). There was no difference in the patterns of outflow communications between the two groups (P = 0.771). Conclusions This study demonstrates that capillary plexuses are nonuniformly perturbed in NPDR. These structural changes may be indicative of perturbations to blood flow patterns between different retinal layers. Our findings may aid the interpretation of previous clinical observations made using optical coherence tomography angiography as well as improve our understanding of the pathogenesis of NPDR.
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Xie N, Tan Y, Liu S, Xie Y, Shuai S, Wang W, Huang W. Macular vessel density in diabetes and diabetic retinopathy with swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258:2671-2679. [PMID: 32661699 DOI: 10.1007/s00417-020-04832-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Previous studies on the association between macular vessel density (VD) and diabetic retinopathy had conflicting conclusions. This study assessed the alterations of macular VD, as well as other factors, in diabetic patients using swept-source optical coherence tomography angiography (SS-OCTA) in a large-scale sample from Chinese communities. METHODS Patients with type 2 diabetes without history of ocular treatment were recruited from 2017 to 2018. The average and quadrant parafoveal vessel density (PVD) were obtained with a commercial SS-OCTA device (Triton, Topcon, Japan). The univariate and multivariate linear regression was used to analyse the correlation of PVD with diabetic retinopathy (DR), diabetic macular edema (DME), HbA1c, and other factors. RESULTS A total of 919 patients were included in the final statistical analysis. After adjusting for other confounding factors, the DR patients had significantly lower average PVD (β = - 1.062, 95% CI = - 1.424 to - 0.699, P < 0.001) in comparison with those without DR. In addition, the patients with mild DR or vision-threatening diabetic retinopathy (VTDR) also had significantly lower PVD (P < 0.001 for mild DR, and P = 0.008 for VTDR) compared with those without DR. Age and HbA1c were also significantly related to PVD measurements, as shown by multivariable linear regression. Participants with DME had a significantly lower average PVD and temporal PVD than those without DME (P < 0.05). CONCLUSIONS Reduced PVD was independently associated with more severe DR, older age, higher HbA1c level, and the presence of DME. These findings suggested that macular vessel alterations in DR warrant further evaluation in the longitudinal studies.
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Affiliation(s)
- Naiqiang Xie
- The First People's Hospital of Zhaoqing, Zhaoqing City, People's Republic of China
| | - Yan Tan
- School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Sen Liu
- School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yining Xie
- The First People's Hospital of Zhaoqing, Zhaoqing City, People's Republic of China
| | - Shaoshuai Shuai
- The First People's Hospital of Zhaoqing, Zhaoqing City, People's Republic of China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
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Gendelman I, Alibhai AY, Moult EM, Levine ES, Braun PX, Mehta N, Zhao Y, Ishibazawa A, Sorour OA, Baumal CR, Witkin AJ, Reichel E, Fujimoto JG, Duker JS, Waheed NK. Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept-source optical coherence tomography angiography. Int J Retina Vitreous 2020; 6:6. [PMID: 32206342 PMCID: PMC7081691 DOI: 10.1186/s40942-020-00209-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to investigate the association between diabetic retinopathy (DR) severity and macular choriocapillaris (CC) flow deficit percentage (FD %) in different macular regions using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic patients with SS-OCTA images were graded by severity and retrospectively assessed. CC FD % was calculated in four different regions of the OCTA image: inner, middle, outer, and full-field region. The generalized estimating equations (GEE) approach for clustered eye data was used to determine effect size and significance of age and disease severity on FD % for each region. Results 160 eyes from 90 total diabetic patients met inclusion criteria. Out of 90 patients, 33 had no DR, 17 had mild nonproliferative DR (NPDR), 8 had moderate NPDR, 10 had severe NPDR and 22 had proliferative DR. Age and DR severity had a significant positive association with FD % for each region studied with a greater effect in the two centermost regions. The increase in flow deficit percentage per year of age by region was: inner 0.12 (p < 0.001), middle 0.09 (p < 0.001), outer 0.05 (p < 0.001, full-field 0.06 (p < 0.001). The increase in flow deficit percentage per increase in diabetic retinopathy severity stage by region was: inner 0.65 (p < 0.0087), middle 0.56 (p < 0.0012), outer 0.33 (p < 0.045), full-field 0.36 (p < 0.018). Conclusions Topographic analysis of the CC FD % in diabetic eyes suggests that CC flow impairment corresponds to DR severity, with all studied regions of the CC significantly affected. There was greater regional impairment due to age and disease severity in the inner and middle regions.
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Affiliation(s)
- Isaac Gendelman
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,2Tufts University School of Medicine, Boston, MA USA
| | - A Yasin Alibhai
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Eric M Moult
- 5Department Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Emily S Levine
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,2Tufts University School of Medicine, Boston, MA USA
| | - Phillip X Braun
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,3Yale University School of Medicine, New Haven, CT USA
| | - Nihaal Mehta
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,4Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Yi Zhao
- 6Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Akihiro Ishibazawa
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,7Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Osama A Sorour
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,8Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Caroline R Baumal
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Andre J Witkin
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Elias Reichel
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - James G Fujimoto
- 5Department Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Nadia K Waheed
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
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Park YG, Kim M, Roh YJ. Evaluation of Foveal and Parafoveal Microvascular Changes Using Optical Coherence Tomography Angiography in Type 2 Diabetes Patients without Clinical Diabetic Retinopathy in South Korea. J Diabetes Res 2020; 2020:6210865. [PMID: 32832562 PMCID: PMC7428972 DOI: 10.1155/2020/6210865] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate foveal and parafoveal microvascular changes in retinal vascular plexuses in patients with type 2 diabetes mellitus (DM) without clinical diabetic retinopathy (NDR) using optical coherence tomography angiography (OCTA) in South Korea. We included 64 patients in the NDR group and included 48 healthy control subjects for comparison. All subjects underwent ocular examination with visual acuity and wide-field fundus photos. Foveal and parafoveal vessel density and foveal avascular zone (FAZ) area (mm2) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed. Foveal vessel densities in both the SCP and DCP were decreased in the NDR group compared to the controls (p = 0.034 and 0.001, respectively). Vessel densities in the superior and inferior parafoveae in the DCP were decreased in the NDR group compared to the controls (p = 0.006 and 0.034, respectively). The FAZs of the SCP and DCP were significantly different between the NDR group and the controls (p = 0.003 and 0.001, respectively). The average vessel densities of the SCP and DCP were not correlated with HbA1c, serum creatinine, or the duration of DM in the NDR group. We demonstrated that OCTA can identify early-stage DR before the manifestation of clinically apparent retinopathy in diabetic eyes. Diabetic patients without clinical DR have microvascular alterations (foveal vessel density, parts of the parafovea, and enlarged FAZ) in the SCP and DCP. Our results suggest that OCTA might be a promising tool for early detection of eyes with DR.
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Affiliation(s)
- Young Gun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seochu-gu, Seoul 06591, Republic of Korea
| | - Minhee Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 63-ro 10, Yeoungdeongpo-gu, Seoul 07345, Republic of Korea
| | - Young Jung Roh
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 63-ro 10, Yeoungdeongpo-gu, Seoul 07345, Republic of Korea
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Choriocapillaris flow impairment predicts the development and enlargement of drusen. Graefes Arch Clin Exp Ophthalmol 2019; 257:2079-2085. [DOI: 10.1007/s00417-019-04403-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022] Open
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