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Nesper PL, Fawzi AA. Perfusion Deficits in Diabetes Without Retinopathy Localize to the Perivenular Deep Capillaries Near the Fovea on OCT Angiography. OPHTHALMOLOGY SCIENCE 2024; 4:100482. [PMID: 38751454 PMCID: PMC11090878 DOI: 10.1016/j.xops.2024.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 05/18/2024]
Abstract
Purpose To localize early capillary perfusion deficits in patients with diabetes mellitus (DM) without clinical diabetic retinopathy (DR) using averaged OCT angiography (OCTA). Design Retrospective cross-sectional study. Participants Patients with DM without DR and healthy controls. Methods We measured perfusion deficits in the full retina, superficial capillary plexus (SCP), and deep capillary plexus (DCP) on averaged 3 × 3-mm OCTA images. Perfusion deficits were defined as the percentage of retinal tissue located >30 μm from blood vessels, excluding the foveal avascular zone (FAZ). One eye from each patient was selected based on image quality. We measured deficits in the parafoveal region, the 300 μm surrounding the FAZ, and 300 to 1000 μm surrounding the FAZ. If a capillary layer within one of these regions was significantly different in DM without DR compared with controls, we further characterized the location of perfusion deficit as periarteriolar, perivenular, or the capillaries between these 2 zones. Main Outcome Measures Location of increased perfusion deficits in patients with DM without DR compared with controls. Results Sixteen eyes from 16 healthy controls were compared with 16 eyes from 16 patients with DM without DR (age 45.1 ± 10.7 and 47.4 ± 15.2 years respectively, P = 0.64). Foveal avascular zone area and perfusion deficits in the entire parafovea and the 300 to 1000-μm ring around the FAZ were not significantly different between groups (P > 0.05 for all). Perfusion deficits in 300 μm around the FAZ were significantly increased in patients with DM without DR in full retinal thickness, SCP, and DCP (P < 0.05 for all). When analyzing the perivenular, periarteriolar, and capillary zones, only the perivenular DCP perfusion deficits were significantly increased (5.03 ± 2.92% in DM without DR and 2.73 ± 1.97% in controls, P = 0.014). Conclusions Macular perfusion deficits in patients with DM without DR were significantly increased in the region nearest the FAZ, mainly at the perivenular deep capillaries. Further research on these early changes may improve our understanding of the capillaries most susceptible to vascular injury and disruption during diabetes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Peter L. Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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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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Yılmaz Tuğan B, Sönmez HE, Şahin N, Bayrak YE, Yüksel N, Karabaş L. Retinal vessel density and choroidal flow changes in oligoarticular juvenile idiopathic arthritis with and without uveitis. Jpn J Ophthalmol 2024:10.1007/s10384-024-01074-2. [PMID: 38874664 DOI: 10.1007/s10384-024-01074-2] [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: 10/31/2023] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE This cross-sectional optical coherence tomography angiography (OCTA) study aimed to assess the macular and optic nerve head (ONH) vascular density, foveal avascular zone, and outer retina and choriocapillaris flow in oligoarticular juvenile idiopathic arthritis (oJIA). STUDY DESIGN Prospective. METHODS Twenty-two eyes of 22 oJIA patients with uveitis (oJIA-U), 20 eyes of 20 oJIA patients without uveitis (isolated oJIA), and 26 healthy volunteers of similar ages and sexes were investigated. The superficial capillary plexus (SCP) and deep capillary plexus (DCP), ONH, foveal avascular zone (FAZ) parameters, the flow area of the outer retina, and choriocapillaris were evaluated. RESULTS Compared with the control group, both the oJIA-U group and isolated oJIA group showed significantly decreased vessel density of parafovea (p = 0.031 and p = 0.047, respectively) in DCP. Choriocapillaris flow area at 1 mm radius was significantly lower in the oJIA-U group compared to the control group (p = 0.001). Choriocapillaris flow area at 2- and 3-mm radius were significantly lower in the oJIA-U group compared to the control group (p < 0.001, for both) and isolated oJIA-U group compared to the control group (p = 0.008 and p = 0.001, respectively). The VD and thickness parameters of SCP and ONH, FAZ, and outer retina flow area were similar between the groups. CONCLUSIONS oJIA patients with and without uveitis revealed a decreased vessel density in the deep parafoveal region and choriocapillaris flow. Our findings suggest that retinal choroidal microvascular changes could be evident in oJIA-U patients without posterior segment involvement as well as oJIA patients without uveitis.
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Affiliation(s)
| | | | - Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Yunus Emre Bayrak
- Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
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Johnson DA, Doble N, Choi SS. Quantitative Analysis of the Vasculature and Cone Photoreceptors in Subjects With Diabetes Without Diabetic Retinopathy. Curr Eye Res 2024; 49:650-662. [PMID: 38407181 DOI: 10.1080/02713683.2024.2320787] [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: 10/27/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To characterize any differences in the vasculature and cone photoreceptor packing geometry (CPG) between subjects with diabetes without/no diabetic retinopathy (NDR) and healthy controls. METHODS Eight NDR and five controls were enrolled. Optical coherence tomography angiography (OCTA) taken at the macula was used to measure vessel density, vessel length density, and vessel density index (VDI) in three vascular plexuses, namely, the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP). The choriocapillaris (CC) flow deficit (FD) was also measured. OCTA images were binarized and processed to extrapolate the parafovea and parafoveal quadrants and the OCTA indices mentioned above. The CC was processed with six different radii to quantify FD. Adaptive optics - scanning laser ophthalmoscopy images were acquired and processed to extract CPG indices, i.e., cone density (CD), cone-to-cone spacing (CS), linear dispersion index, heterogeneity packing index and percent of cells with six neighbors at 3.6° in the temporal retina. RESULTS In all eyes, statistically significant differences were found (i) in parafoveal FD across the six radii (p < 0.001) and (ii) in the correlation between the parafoveal temporal quadrant (PTQ) DCP VDI and CS (r = 0.606, p = 0.048). No other significant correlations were found. For OCTA or CPG indices, no significant differences were found between the cohorts in the parafovea or parafoveal quadrants. CONCLUSIONS CS is the most sensitive CPG index for detecting alterations in the cone mosaic. The DCP and the cone photoreceptors are significantly correlated, indicating that alterations in the DCP can affect the cones. Future work elucidating the vascular alterations and neurodegeneration present in diabetic eyes should focus on the DCP and multiple CPG indices, not solely CD. Moreover, such alterations are highly localized, hence using larger regions e.g. parafovea versus smaller areas, such as the PTQ, will potentially mask significant correlations.
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Affiliation(s)
- Danae A Johnson
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Nathan Doble
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
| | - Stacey S Choi
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
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Fekrazad S, Hassanzadeh G, Salehi MA, Mozafar M, Shahrabi Farahani M, Arevalo JF. Optical coherence tomography angiography measurements in systemic lupus erythematosus: A systematic review and meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00047-X. [PMID: 38744406 DOI: 10.1016/j.survophthal.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting various organs. Ocular involvement, particularly retinopathy, is common, emphasizing the significance of early detection. Optical coherence tomography angiography (OCTA), a non-invasive imaging technique, reveals microvascular changes, aiding SLE diagnosis and monitoring. This study evaluates OCTA's effectiveness in detecting SLE-related retinal alterations. A systemic search was undertaken across PubMed, Embase, and Scopus databases to identify studies presenting OCTA measurements in SLE patients compared to healthy controls. The meta-analysis, employing either fixed-effects or random-effects models based on heterogeneity levels, was conducted. Additionally, subgroup and sensitivity analyses, meta-regression, and quality assessments were carried out. Thirteen studies of 565 eyes in the SLE group and 560 eyes in the control group were included. The meta-analyses revealed that SLE patients had a significantly lower retinal vessel density in the superficial and deep capillary plexus layers, choriocapillaris flow area, and foveal avascular zone (FAZ) circularity index compared to healthy controls, but that there were no significant differences in the FAZ area and perimeter. These findings highlight how OCTA can provide a noninvasive assessment of SLE effects on the retinal microvasculature, potentially presenting a reliable biomarker for more precise detection of SLE and disease activity monitoring.
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Affiliation(s)
- Sepehr Fekrazad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; International Network for Photomedicine and Photodynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | | | - Mehrdad Mozafar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hein M, Qambari H, An D, Balaratnasingam C. Current understanding of subclinical diabetic retinopathy informed by histology and high-resolution in vivo imaging. Clin Exp Ophthalmol 2024; 52:464-484. [PMID: 38363022 DOI: 10.1111/ceo.14363] [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: 10/30/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
The escalating incidence of diabetes mellitus has amplified the global impact of diabetic retinopathy. There are known structural and functional changes in the diabetic retina that precede the fundus photography abnormalities which currently are used to diagnose clinical diabetic retinopathy. Understanding these subclinical alterations is important for effective disease management. Histology and high-resolution clinical imaging reveal that the entire neurovascular unit, comprised of retinal vasculature, neurons and glial cells, is affected in subclinical disease. Early functional manifestations are seen in the form of blood flow and electroretinography disturbances. Structurally, there are alterations in the cellular components of vasculature, glia and the neuronal network. On clinical imaging, changes to vessel density and thickness of neuronal layers are observed. How these subclinical disturbances interact and ultimately manifest as clinical disease remains elusive. However, this knowledge reveals potential early therapeutic targets and the need for imaging modalities that can detect subclinical changes in a clinical setting.
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Affiliation(s)
- Martin Hein
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Hassanain Qambari
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Dong An
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Chandrakumar Balaratnasingam
- Physiology and Pharmacology Group, Lions Eye Institute, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Huang Y, Wang S, Cai C, Huang X, Chen Y, Wu X, Zhang Y, Zhang Y, Lin X. Retinal vascular density as a potential biomarker of diabetic cerebral small vessel disease. Diabetes Obes Metab 2024; 26:1789-1798. [PMID: 38433711 DOI: 10.1111/dom.15492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 03/05/2024]
Abstract
AIM The retina and brain share similar anatomical and physiological features. Thus, retinal imaging by optical coherence tomography angiography (OCTA) might be a potential tool for the early diagnosis of diabetic cerebral small vessel disease (CSVD). In this study, we aimed to evaluate retinal vascular density (VD) in diabetic CSVD by OCTA imaging and explore the associations between retinal VD and cerebral magnetic resonance imaging (MRI) markers and cognitive function. METHODS In total, 131 patients were enrolled, including CSVD (n = 43) and non-CSVD groups (n = 88). The VD and foveal avascular zone of the retinal capillary plexus were measured with OCTA. A brain MRI was performed. RESULTS MRI imaging showed that in the diabetic CSVD group, white matter hyperintensities (WMHs), particularly deep WMHs (58.82%), are the most common MRI marker, followed by cerebral microbleeds in the subtentorial and cortical areas (34.78%). The CSVD group showed increases in the prevalence of cognitive dysfunction (p = .034) and depression (p = .033) and decreases in visuospatial/executive ability and delayed recall ability. In the CSVD group, VDs of the macular superficial vascular plexus (32.93 ± 7.15% vs. 36.97 ± 6.59%, p = .002), intermediate capillary plexus (20.87 ± 4.30% vs. 23.08 ± 4.30%, p = .005) and deep capillary plexus (23.54 ± 5.00% vs. 26.05 ± 4.20%, p = .003) were lower than those of the non-CSVD group. Multiple linear regression analysis showed that VD of the macular superficial vascular plexus was independently associated with cerebral microbleeds. Meanwhile, VD of the macular intermediate capillary plexus was associated with white matter lacunar infarcts after adjustment. CONCLUSIONS Diabetic CSVDs are characterized by MRI markers, including deep WMHs and cerebral microbleeds, and showed impaired cognition with decreased visuospatial/executive ability and delayed recall ability. OCTA imaging revealed a significant decrease in retinal microvascular perfusion in diabetic CSVD, which was related to MRI markers and cognitive function. OCTA might be a valuable potential measurement for the early diagnosis of CSVD.
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Affiliation(s)
- Yinqiong Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Siyun Wang
- Department of Endocrinology, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, China
| | - Chi Cai
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xinwei Huang
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yan Chen
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xiaohong Wu
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yiping Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yan Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiahong Lin
- Department of CT/MRI, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Department of Geriatric, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 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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Lajmi H, Choura R, Zahaf A, Ben Othmen A, Hmaied W. OCT-Angiography of deep and superficial retinal vascular density changes in diabetes without diabetic retinopathy. J Fr Ophtalmol 2024; 47:103966. [PMID: 37806935 DOI: 10.1016/j.jfo.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/24/2023] [Accepted: 07/18/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To analyze the vascular density values (VD) in the superficial and the deep retinal network and in all perimacular sectors of diabetic eyes without clinical retinopathy, comparing them to that of healthy, nondiabetic control eyes. We investigated the factors that may influence these values. METHODS This was a cross-sectional study including diabetics without diabetic retinopathy and healthy control subjects. All subjects underwent OCTA examination (RTVue-XR Avanti; Optovue, Fremont, CA, USA). The scanned area was 3×3mm and centered on the fovea. In the superficial and deep capillary plexus, we evaluated the total VD, parafoveal, temporal, nasal, superior and inferior sectors, as well as the superior and inferior hemi-sector VD. The sectors with the greatest area under the curve (AUC) were determined. We evaluated the correlation between certain risk factors and VD values. RESULTS VD values in all sectors of the superficial capillary plexus layer and deep capillary plexus layer in the diabetic group were significantly lower than in the control group. Among all the parameters, the superficial total VD and superficial parafoveal VD had the greatest AUC (0.992 and 0.991 respectively). The sector with the greatest AUC was the temporal sector in both the SCP (0.990) and DCP (0.976). Age, creatinine clearance and hyperlipemia correlated with vascular density. CONCLUSIONS Superficial and deep retinal VD are both decreased in diabetic patients without diabetic retinopathy. Our results suggest that OCTA might be a promising tool for diabetic retinopathy screening. Quantitative microvascular changes might precede clinical damage.
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Affiliation(s)
- H Lajmi
- Ophthalmology Department, FSI Hospital, University of Tunis El Manar, La Marsa, Tunisia.
| | - R Choura
- Ophthalmology Department, FSI Hospital, University of Tunis El Manar, La Marsa, Tunisia
| | - A Zahaf
- Ophthalmology Department, FSI Hospital, University of Tunis El Manar, La Marsa, Tunisia
| | - A Ben Othmen
- Ophthalmology Department, FSI Hospital, University of Tunis El Manar, La Marsa, Tunisia
| | - W Hmaied
- Ophthalmology Department, FSI Hospital, University of Tunis El Manar, La Marsa, Tunisia
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10
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Yang X, Yi G, Chen Y, Ma K, Chen B, Liang S, Zheng C, Ai S, Cao M, Fu M. Optical coherence tomography angiography metrics in diabetes: Focusing on diabetic retinopathy and carotid atherosclerosis. Photodiagnosis Photodyn Ther 2023; 44:103799. [PMID: 37696316 DOI: 10.1016/j.pdpdt.2023.103799] [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: 06/27/2023] [Revised: 08/10/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND To explore the value of Optical Coherence Tomography Angiography (OCTA) metrics in the early diagnosis of vascular complications in diabetes. METHODS All participants underwent OCTA with a swept-source OCT device. Automated measurements of the foveal avascular zone (FAZ) area, vessel density (VD), and blood flow density (BFD) of both 3 × 3 and 6 × 6 windows were then obtained after a quality check. RESULTS Diagnostic models based on multiple risk factors were developed separately for diabetic retinopathy and carotid atherosclerosis using random forest and multivariate logistic regression methods. The addition of specific OCTA metrics improved the diagnostic prediction of DR compared with the models of risk factors alone (Inner Retinal Blood Flow Density in 3 × 3 window, IRBFD; Brier score 0.124 vs. 0.149; AUC, 0.887 vs. 0.836) (Central Retinal Blood Flow Density in 3 × 3 window, CRBFD; Brier score 0.142 vs. 0.149; AUC, 0.851 vs. 0.836). Adding diabetic peripheral vascular disease (DPVD) indicator improved the prediction of carotid atherosclerosis (Brier score, 0.180 vs. 0.192; AUC, 0.802 vs. 0.781. The FAZ in the 3 × 3 window also achieved this effect when targeting only T2DM patients (AUC, 0.797 vs. 0.766; Brier score, 0.183 vs. 0.195). CONCLUSIONS Focusing on IRBFD and CRBFD in the 3 × 3 window of OCTA allows for a more sensitive prediction of the occurrence of DR in diabetic patients. Meanwhile, the quantitative microvascular information provided by OCTA and the occurrence of DPVD may be crucial for diagnosing carotid atherosclerosis. For T2DM patients, we also propose the possibility of FAZ in the 3 × 3 window as a potential diagnostic indicator.
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Affiliation(s)
- Xiongyi Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, PR China; The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Guoguo Yi
- Department of Ophthalmology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No. 26, Erheng Road, Yuancun, Tianhe, Guangzhou, Guangdong, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, PR China
| | - Yanxia Chen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Kedi Ma
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Bingxu Chen
- Zhujiang Hospital, Southern Medical University, Guangzhou, PR China; The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shilong Liang
- Zhujiang Hospital, Southern Medical University, Guangzhou, PR China; The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Cong Zheng
- Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, PR China
| | - Shibei Ai
- Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, PR China
| | - Mingzhe Cao
- Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, PR China.
| | - Min Fu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China.
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11
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Pang Y, Cao T, Zhang Q, Hu H, Wang Z, Nie J, Jin M, Chen G, Zhang X. Retinal microvasculature features in patients with migraine: a systematic review and meta-analysis. Front Neurol 2023; 14:1187559. [PMID: 37780703 PMCID: PMC10540451 DOI: 10.3389/fneur.2023.1187559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Migraine is a central nervous system disorder involving neuronal and vascular factors. The brain has a close anatomical relationship with retinal vessels and similar regulatory processes, and the retinal vascular system is the only in vivo vessel that can be directly visualized, while optical coherence tomography angiography (OCTA) is an advanced retinal vascular imaging technique. In this study, OCTA was used to study the retinal vascular density (VD) and foveal avascular zone (FAZ) in migraine patients, which provided a theoretical basis for its use as a candidate for rapid and non-invasive diagnosis of migraine. Methods Published studies comparing retinal microvascular profiles between migraine patients and healthy controls were obtained by a comprehensive search of electronic databases. Nine studies were finally included, including 775 eyes (migraine group: 444 eyes, control group: 331 eyes). Pooled effect sizes were presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager software (version 5.30). Results The combined results revealed that the superficial and deep macular whole enface VD (MWEVD) (superficial VD: SMD = -0.30, P = 0.0001; deep VD: SMD = -0.61, P = 0.02), superficial foveal VD (FVD) (SMD = -0.42, P = 0.03), deep parafoveal VD (PFVD) (SMD = -0.31, P = 0.002), and peripapillary VD (PVD) (SMD = -0.49, P = 0.002) were significantly reduced in migraine patients compared with healthy people. However, there was a significant increase in the area of the FAZ in migraine patients (SMD = 0.56, P < 0.0001). Conclusion Migraine patients are prone to retinal microcirculation disorders, such as decreased blood vessel density and increased avascular area in the fovea. This provides a theoretical basis for OCTA as a candidate for rapid, non-invasive diagnosis of migraine.
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Affiliation(s)
- Yulian Pang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Ting Cao
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
- Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qinglin Zhang
- Department of Ophthalmology, Huangshi Central Hospital, Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
| | - Haijian Hu
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Zhiruo Wang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Jiahe Nie
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Ming Jin
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Guiping Chen
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Xu Zhang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
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Ji L, Waduge P, Wu Y, Huang C, Kaur A, Oliveira P, Tian H, Zhang J, Stout JT, Weng CY, Webster KA, Li W. Secretogranin III Selectively Promotes Vascular Leakage in the Deep Vascular Plexus of Diabetic Retinopathy. Int J Mol Sci 2023; 24:10531. [PMID: 37445707 PMCID: PMC10341987 DOI: 10.3390/ijms241310531] [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: 04/12/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Diabetic retinopathy (DR), a leading cause of vision loss in working-age adults, induces mosaic patterns of vasculopathy that may be associated with spatial heterogeneity of intraretinal endothelial cells. We recently reported that secretogranin III (Scg3), a neuron-derived angiogenic and vascular leakage factor, selectively binds retinal vessels of diabetic but not healthy mice. Here, we investigated endothelial heterogeneity of three retinal vascular plexuses in DR pathogenesis and the therapeutic implications. Our unique in vivo ligand binding assay detected a 22.7-fold increase in Scg3 binding to retinal vessels of diabetic mice relative to healthy mice. Functional immunohistochemistry revealed that Scg3 predominantly binds to the DR-stressed CD31- deep retinal vascular plexus but not to the relatively healthy CD31+ superficial and intermediate plexuses within the same diabetic retina. In contrast, VEGF bound to healthy and diabetic retinal vessels indiscriminately with low activity. FITC-dextran assays indicated that selectively increased retinal vascular leakage coincides with Scg3 binding in diabetic mice that was independent of VEGF, whereas VEGF-induced leakage did not distinguish between diabetic and healthy mice. Dose-response curves showed that the anti-Scg3 humanized antibody (hAb) and anti-VEGF aflibercept alleviated DR leakage with equivalent efficacies, and that the combination acted synergistically. These findings suggest: (i) the deep plexus is highly sensitive to DR; (ii) Scg3 binding to the DR deep plexus coincides with the loss of CD31 and compromised endothelial junctions; (iii) anti-Scg3 hAb alleviates vascular leakage by selectively targeting the DR-stressed deep plexus within the same diabetic retina; (iv) combined anti-Scg3 and anti-VEGF treatments synergistically ameliorate DR through distinct mechanisms.
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Affiliation(s)
- Liyang Ji
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA;
| | - Prabuddha Waduge
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yan Wu
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA;
| | - Chengchi Huang
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Avinash Kaur
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Paola Oliveira
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hong Tian
- Everglades Biopharma, LLC, Houston, TX 77098, USA
| | - Jinsong Zhang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110005, China;
| | - J. Timothy Stout
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christina Y. Weng
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Keith A. Webster
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
- Everglades Biopharma, LLC, Houston, TX 77098, USA
| | - Wei Li
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
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Lazăr AS, Stanca HT, Tăbăcaru B, Danielescu C, Munteanu M, Stanca S. Quantitative Parameters Relevant for Diabetic Macular Edema Evaluation by Optical Coherence Tomography Angiography. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1120. [PMID: 37374324 DOI: 10.3390/medicina59061120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Diabetic macular edema (DME) is one of the main ocular complications of diabetes mellitus (DM) that can lead to important vision loss in diabetic patients. In clinical practice, there are cases of DME with unsatisfying treatment responses, despite adequate therapeutic management. Diabetic macular ischemia (DMI) is one of the causes suggested to be associated with the persistence of fluid accumulation. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality, able to give in-depth information about retinal vascularization in a 3-dimensional manner. The OCTA devices currently available can provide various OCTA metrics that quantitatively assess the retinal microvasculature. In this paper, we reviewed the results of multiple studies that investigated the changes in OCTA metrics in the setting of DME and their possible contribution to the diagnosis, therapeutic management, follow-up and prognosis of patients with DME. We analyzed and compared relevant studies that investigated OCTA parameters related to changes in macular perfusion in the setting of DME and we evaluated the correlations between DME and several quantitative parameters, such as vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ)-related parameters, as well as complexity indices of retinal vasculature. The results of our research showed that OCTA metrics, evaluated especially at the level of the deep vascular plexus (DVP), are useful instruments that can contribute to the assessment of patients with DME.
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Affiliation(s)
- Alina-Simona Lazăr
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, Strada Dionisie Lupu No. 37, 020021 Bucharest, Romania
- Clinical Department of Ophthalmology, "Prof. Dr. Agrippa Ionescu" Emergency Hospital, Strada Ion Mincu No. 7, 011356 Bucharest, Romania
| | - Horia T Stanca
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, Strada Dionisie Lupu No. 37, 020021 Bucharest, Romania
- Clinical Department of Ophthalmology, "Prof. Dr. Agrippa Ionescu" Emergency Hospital, Strada Ion Mincu No. 7, 011356 Bucharest, Romania
| | - Bogdana Tăbăcaru
- Clinical Department of Ophthalmology, "Prof. Dr. Agrippa Ionescu" Emergency Hospital, Strada Ion Mincu No. 7, 011356 Bucharest, Romania
| | - Ciprian Danielescu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Strada Universitatii No. 16, 700115 Iasi, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Simona Stanca
- Clinical Department of Pediatrics, University of Medicine and Pharmacy "Carol Davila", Strada Dionisie Lupu No. 37, 020021 Bucharest, Romania
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Ong CJT, Wong MYZ, Cheong KX, Zhao J, Teo KYC, Tan TE. Optical Coherence Tomography Angiography in Retinal Vascular Disorders. Diagnostics (Basel) 2023; 13:diagnostics13091620. [PMID: 37175011 PMCID: PMC10178415 DOI: 10.3390/diagnostics13091620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Traditionally, abnormalities of the retinal vasculature and perfusion in retinal vascular disorders, such as diabetic retinopathy and retinal vascular occlusions, have been visualized with dye-based fluorescein angiography (FA). Optical coherence tomography angiography (OCTA) is a newer, alternative modality for imaging the retinal vasculature, which has some advantages over FA, such as its dye-free, non-invasive nature, and depth resolution. The depth resolution of OCTA allows for characterization of the retinal microvasculature in distinct anatomic layers, and commercial OCTA platforms also provide automated quantitative vascular and perfusion metrics. Quantitative and qualitative OCTA analysis in various retinal vascular disorders has facilitated the detection of pre-clinical vascular changes, greater understanding of known clinical signs, and the development of imaging biomarkers to prognosticate and guide treatment. With further technological improvements, such as a greater field of view and better image quality processing algorithms, it is likely that OCTA will play an integral role in the study and management of retinal vascular disorders. Artificial intelligence methods-in particular, deep learning-show promise in refining the insights to be gained from the use of OCTA in retinal vascular disorders. This review aims to summarize the current literature on this imaging modality in relation to common retinal vascular disorders.
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Affiliation(s)
- Charles Jit Teng Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Mark Yu Zheng Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Jinzhi Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore 169857, Singapore
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15
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Eid P, Creuzot-Garcher C, Aho LS, Gabrielle PH, Charpin E, Haddad D, Steinberg LA, Bron A, Verges B, Arnould L. Early Retinal Microvascular Changes Assessed with Swept-Source OCT Angiography in Type 1 Diabetes Patients without Retinopathy. J Clin Med 2023; 12:jcm12072687. [PMID: 37048770 PMCID: PMC10094932 DOI: 10.3390/jcm12072687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Type 1 diabetes is a chronic disease that can lead to vision loss when diabetic retinopathy develops. Retinal microvascular alterations occur before the appearance of clinical signs on a fundus examination. This study aimed to analyze retinal vascular parameters on optical coherence tomography angiography (OCT-A) in patients with type 1 diabetes without diabetic retinopathy in comparison with non-diabetic volunteers. This cross-sectional study was conducted at Dijon University Hospital from 2018 to 2020. Vascular densities were measured using macular OCT-A. In total, 98 diabetes patients and 71 non-diabetic volunteers were enrolled. A statistically significant lower vascular density of the inner circle was found in the superficial capillary plexus (SCP) in the diabetes group (p < 0.01). There was a statistically significant correlation between central vascular density in the deep capillary plexus (DCP) and total daily insulin intake (p = 0.042); furthermore, use of the FreeStyle Libre (FSL) device was associated with higher vascular densities in both the SCP (p = 0.034 for outer circle density) and DCP (p < 0.01 for inner circle density and p = 0.023 for outer circle density). Retinal microvascularization was early-altered in type 1 diabetes, and using the FSL device seemed to preserve retinal microvascularization.
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Affiliation(s)
- Pétra Eid
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Ludwig Serge Aho
- Epidemiology Department, University Hospital, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Estelle Charpin
- Endocrinology-Diabetology Department, University Hospital, 21000 Dijon, France
| | - Déa Haddad
- Ophthalmology Department, University Hospital, 21000 Dijon, France
| | | | - Alain Bron
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Bruno Verges
- Endocrinology-Diabetology Department, University Hospital, 21000 Dijon, France
- INSERM, LNC-UMR1231, 21000 Dijon, France
| | - Louis Arnould
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 21000 Dijon, France
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16
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Ashimatey BS, Zhou X, Chu Z, Alluwimi M, Wang RK, Kashani AH. Variability of Vascular Reactivity in the Retina and Choriocapillaris to Oxygen and Carbon Dioxide Using Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2023; 64:9. [PMID: 36745450 PMCID: PMC9910388 DOI: 10.1167/iovs.64.2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the regional and layer-specific vascular reactivity of the healthy human retina and choriocapillaris to changes in systemic carbon dioxide or oxygen. Methods High-resolution 3 × 3-mm2 optical coherence tomography angiography (OCTA) images were acquired from the central macula, temporal macula, and peripapillary retina while participants were exposed to three gas breathing conditions-room air, 5%CO2, and 100% O2. OCTA from all three regions were extracted and the apparent skeletonized vessel density (VSD) was assessed. The mean flow deficit sizes (MFDSs) of the choriocapillaris were also assessed. Repeated-measures analysis of variance was used to compare the ratio of intrasubject VSD change induced by the gas conditions from baseline in the superficial retinal layer (SRL) and deep retinal layer (DRL) for each retinal region independently, as well as the MFDS of the choriocapillaris. We also compared the vessel reactivity between the retinal capillaries and the choriocapillaris. Results The cumulative intrasubject response to the gas conditions differed significantly among regions of the SRL (F(2, 7) = 28.22, P < 0.001), with the temporal macula showing the largest response (15%) compared to the macula (8%) and radial peripapillary capillaries (7%). A similar trend was found in the DRL. The choriocapillaris reactivity was similar between the macula (5.8%) and temporal macula (5.6%). There was also a significant heterogeneity in the layer-specific gas responses, with the DRL showing the largest response (28.2%) and the choriocapillaris showing the smallest response (2.8%). Conclusions Capillary reactivity to changes in inhaled O2 and CO2 is spatially heterogeneous across the retina but not choriocapillaris.
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Affiliation(s)
- Bright S. Ashimatey
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Xiao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Muhammed Alluwimi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States,Department of Ophthalmology, University of Washington Seattle, Washington, United States
| | - Amir H. Kashani
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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Prediction of OCT images of short-term response to anti-VEGF treatment for diabetic macular edema using different generative adversarial networks. Photodiagnosis Photodyn Ther 2023; 41:103272. [PMID: 36632873 DOI: 10.1016/j.pdpdt.2023.103272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE This study sought to assess the predictive performance of optical coherence tomography (OCT) images for the response of diabetic macular edema (DME) patients to anti-vascular endothelial growth factor (VEGF) therapy generated from baseline images using generative adversarial networks (GANs). METHODS Patient information, including clinical and imaging data, was obtained from inpatients at the Ophthalmology Department of Qilu Hospital. 715 and 103 pairs of pre-and post-treatment OCT images of DME patients were included in the training and validation sets, respectively. The post-treatment OCT images were used to assess the validity of the generated images. Six different GAN models (CycleGAN, PairGAN, Pix2pixHD, RegGAN, SPADE, UNIT) were applied to predict the efficacy of anti-VEGF treatment by generating OCT images. Independent screening and evaluation experiments were conducted to validate the quality and comparability of images generated by different GAN models. RESULTS OCT images generated f GAN models exhibited high comparability to the real images, especially for edema absorption. RegGAN exhibited the highest prediction accuracy over the CycleGAN, PairGAN, Pix2pixHD, SPADE, and UNIT models. Further analyses were conducted based on the RegGAN. Most post-therapeutic OCT images (95/103) were difficult to differentiate from the real OCT images by retinal specialists. A mean absolute error of 26.74 ± 21.28 μm was observed for central macular thickness (CMT) between the synthetic and real OCT images. CONCLUSION Different generative adversarial networks have different prognostic efficacy for DME, and RegGAN yielded the best performance in our study. Different GAN models yielded good accuracy in predicting the OCT-based response to anti-VEGF treatment at one month. Overall, the application of GAN models can assist clinicians in prognosis prediction of patients with DME to design better treatment strategies and follow-up schedules.
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Diplotti L, Pignatto S, Franco F, Zanatta M, Veritti D, Cogo P, Lanzetta P. Ocular complications of diabetes mellitus in a pediatric population and proposals for screening and follow-up programs. Ther Adv Ophthalmol 2023; 15:25158414231174141. [PMID: 37333996 PMCID: PMC10272666 DOI: 10.1177/25158414231174141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/08/2023] [Indexed: 06/20/2023] Open
Abstract
Background Diabetes mellitus (DM) is one of the world's greatest health emergencies of the 21st century. Ocular complications of DM are commonly chronic and progressive, but vision loss can be effectively prevented or delayed with early detection and timely treatment. Therefore, regular comprehensive ophthalmologic examinations are mandatory. Ophthalmic screening and dedicated follow-up for adults with DM are well established, whereas, there is no consensus on optimal recommendations for the pediatric population, reflecting the lack of clarity about the current burden of disease in this age group. Objectives To determine the epidemiology of ocular complications of diabetes and to assess optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) macular features in a pediatric population with DM. To review ophthalmological screening and follow-up plans for the diabetic pediatric population. Design Observational study. Methods Retrospective consecutive cohort study of all 165 diabetic patients (330 eyes) aged 0-18 years, examined between January 2006 and September 2018 at the Pediatric Department of 'S. Maria della Misericordia' Udine Hospital who underwent at least one complete ophthalmologic examination at the Ophthalmology University Clinic at the Udine Hospital. OCT and OCTA data were available for 37 patients (72 eyes, 2 excluded). The associations between ocular complications and selected potential risk factors were evaluated by univariate analyses. Results No patient had signs of ocular diabetic complications or any macular morphological or micro-vascular impairment, regardless of any potential risk factor. The prevalence of strabismus and refractive errors in the study group, was found to be similar to non-diabetic pediatric populations. Conclusion Screening and follow-up of ocular diabetic complications in children and adolescents could be performed less frequently than in adults with diabetes. There is no need to screen potentially treatable visual disorders in diabetic children earlier or more frequently than in the healthy children thus reducing time spent in hospital and permitting a better tolerance to medical examinations in diabetic pediatric patients. We described the OCT and OCTA patterns in a pediatric population with DM.
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Affiliation(s)
- Laura Diplotti
- Department of Ophthalmology, Institute for Maternal and Child Health–IRCCS ‘Burlo Garofolo’, Trieste, Italy
| | - Silvia Pignatto
- Department of Medicine–Ophthalmology, University of Udine, Udine, Italy
| | - Francesca Franco
- Department of Paediatrics, Presidio Ospedaliero Universitario ‘Santa Maria della Misericordia’, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Manuela Zanatta
- Department of Rare Diseases, Presidio Ospedaliero Universitario ‘Santa Maria della Misericordia’, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Daniele Veritti
- Department of Medicine–Ophthalmology, University of Udine, Udine, Italy
| | - Paola Cogo
- Department of Paediatrics, Presidio Ospedaliero Universitario ‘Santa Maria della Misericordia’, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Cutruzzolà A, Carnevali A, Gatti V, Latella G, Lamonica L, Oliverio F, Borelli M, Parise M, Di Molfetta S, Scorcia V, Irace C, Gnasso A. Continuous Glucose Monitoring-Derived Metrics and Capillary Vessel Density in Subjects with Type 1 Diabetes without Diabetic Retinopathy. J Diabetes Res 2023; 2023:9516059. [PMID: 37096234 PMCID: PMC10122598 DOI: 10.1155/2023/9516059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Optical coherence tomography angiography (OCTA) is an innovative and reliable technique detecting the early preclinical retinal vascular change in patients with diabetes. We have designed our study to evaluate whether an independent relationship exists between continuous glucose monitoring (CGM)-derived glucose metrics and OCTA parameters in young adult patients with type 1 diabetes without diabetic retinopathy (DR). Inclusion criteria were age ≥ 18 years, diagnosis of type 1 diabetes from ≥ 1 year, stable insulin treatment in the last three months, use of real-time CGM, and CGM wear time ≥ 70%. Each patient underwent dilated slit lamp fundus biomicroscopy to exclude the presence of DR. A skilled operator performed OCTA scans in the morning to avoid possible diurnal variation. CGM-derived glucose metrics from the last 2 weeks were collected through the dedicated software during OCTA. Forty-nine patients with type 1 diabetes (age 29 [18; 39] years, HbA1c 7.7 ± 1.0%) and 34 control subjects participated in the study. Vessel density (VD) of the whole image and parafoveal retina in the superficial (SCP) and deep capillary plexus (DCP) was significantly lower in patients with type 1 diabetes compared to controls. The coefficient of variation of average daily glucose, evaluated by CGM, significantly correlated with foveal and parafoveal VD in SCP and with foveal VD in DCP. High glucose variability might be responsible for the early increase of VD in these areas. Prospective studies may help understand if this pattern precedes DR. The difference we detected between patients with and without diabetes confirms that OCTA is a reliable tool for detecting early retinal abnormalities.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Adriano Carnevali
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Valentina Gatti
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Giovanni Latella
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Luca Lamonica
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Flavia Oliverio
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Massimo Borelli
- UMG School of Ph.D. Programmes Life Sciences and Technologies, University “Magna Græcia”, Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Sergio Di Molfetta
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Scorcia
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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20
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Chai Q, Yao Y, Guo C, Lu H, Ma J. Structural and functional retinal changes in patients with type 2 diabetes without diabetic retinopathy. Ann Med 2022; 54:1816-1825. [PMID: 35786137 PMCID: PMC9258434 DOI: 10.1080/07853890.2022.2095010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The characteristics of the early changes in preclinical diabetic retinopathy (DR) are poorly known. This study aimed to analyse the changes in the structure and function of the fundus in diabetic patients without diabetic retinopathy (NDR). METHODS This prospective study enrolled patients with type 2 diabetes and healthy controls from April to December 2020. Retinal sensitivity was measured by microperimetry. The peripapillary retinal nerve fibre layer (p-RNFL) thickness, macular retinal thickness, and retinal volume were measured by optical coherence tomography (OCT). The vessel density (VD) and perfusion density (PD) of the peripapillary area, as well as the foveal avascular zone (FAZ) area, FAZ perimeter, and FAZ circularity, were measured by optical coherence tomographic angiography (OCTA). RESULTS A total of 71 cases (100 eyes) were enrolled in the study, including 34 cases (51 eyes) in the NDR group and 37 cases (49 eyes) in the control group. The mean retinal sensitivity was lower in the NDR group than in the control group for all sectors (all p < .001). Compared with controls, the NDR group showed thinner p-RNFL in the T sector (76.24 ± 14.29 vs. 85.47 ± 19.66 µm, p = .035). The NDR group had a thinner retina in the N2 sector (304.55 ± 16.07 vs. 312.02 ± 12.30 µm, p = .010). The PD of DCP was lower in the N2 sector in the NDR group (44.92 ± 11.77 vs. 50.27 ± 6.37%, p = .044). The VD was higher in the NDR group in RPCP-S/N/I, and the PD was higher in the RPCP-S/N (all p < .05). The frequencies of perifoveal capillary drop-out, notched or punched out borders of the superficial FAZ, and loss of smooth contour were all higher in the NDR group (all p < .05). CONCLUSION The structure (p-RNFL thickness, VD, and PD) and function (retinal sensitivity) display some changes in diabetic patients even if they had not been found to have DR.Key messagesDecreased retinal sensitivity was observed in diabetic patients before the onset of diabetic retinopathy.Compared with the control group, we found the changes in vessel density or perfusion density in a certain area, whether in SCP, DCP, or RPCP in the NDR group.Before the onset of diabetic retinopathy, the structure and function of the retina in diabetic patients had changed.
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Affiliation(s)
- Qiannan Chai
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yimin Yao
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Congrong Guo
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingxue Ma
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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21
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Quantitative assessment of textural features in the early detection of diabetic retinopathy with optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2022; 41:103214. [PMID: 36460230 DOI: 10.1016/j.pdpdt.2022.103214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
The diagnostic power of the textural features and fractal dimension (FD) for early detection of diabetic retinopathy (DR) were quantitatively evaluated with optical coherence tomography angiography (OCTA). 41 normal healthy OD eyes (age: 46.41 ± 13.69), and 10 diabetic OD eyes (age: 60.90 ± 13.46) in the early stages of DR (mild or moderate non-proliferative diabetic retinopathy (NPDR)) were employed. Four retinal vascular plexuses including nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were generated by using OCTA. The FD and the five textural features including contrast, correlation, entropy, energy, and homogeneity in four parafoveal sectors were extracted from OCTA images. The factor of aging on textural features and FD was evaluated based on the comparisons among five normal healthy subgroups. Our results showed that FD in superior sector of NFLVP and in nasal sector of ICP had the significant decreases when comparing the older healthy subgroup (age range: 60-69) with the younger healthy subgroup (age range: 20-29). Our results also indicated that the correlation did not show the significant differences in all sectors of the four retinal sublayers among the normal healthy subgroups except in the temporal sector in NFLVP. Furthermore, our results indicated that the correlation in nasal and inferior sectors in SVP can effectively differentiate diabetic patients in early stages of DR from normal healthy subjects with the highest AUROC values. In our study, the specific textural feature - correlation can effectively stage the early DR, which may contribute to the diagnosis of DR in clinic practice.
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22
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Panda NR, Sahoo AK. A Detailed Systematic Review on Retinal Image Segmentation Methods. J Digit Imaging 2022; 35:1250-1270. [PMID: 35508746 PMCID: PMC9582172 DOI: 10.1007/s10278-022-00640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022] Open
Abstract
The separation of blood vessels in the retina is a major aspect in detecting ailment and is carried out by segregating the retinal blood vessels from the fundus images. Moreover, it helps to provide earlier therapy for deadly diseases and prevent further impacts due to diabetes and hypertension. Many reviews already exist for this problem, but those reviews have presented the analysis of a single framework. Hence, this article on retinal segmentation review has revealed distinct methodologies with diverse frameworks that are utilized for blood vessel separation. The novelty of this review research lies in finding the best neural network model by comparing its efficiency. For that, machine learning (ML) and deep learning (DL) were compared and have been reported as the best model. Moreover, different datasets were used to segment the retinal blood vessels. The execution of each approach is compared based on the performance metrics such as sensitivity, specificity, and accuracy using publically accessible datasets like STARE, DRIVE, ROSE, REFUGE, and CHASE. This article discloses the implementation capacity of distinct techniques implemented for each segmentation method. Finally, the finest accuracy of 98% and sensitivity of 96% were achieved for the technique of Convolution Neural Network with Ranking Support Vector Machine (CNN-rSVM). Moreover, this technique has utilized public datasets to verify efficiency. Hence, the overall review of this article has revealed a method for earlier diagnosis of diseases to deliver earlier therapy.
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Affiliation(s)
- Nihar Ranjan Panda
- Department of Electronics and Communication Engineering, Silicon Institute of Technology, Bhubaneswar, Orissa, 751024, India.
| | - Ajit Kumar Sahoo
- Department of Electronics and Communication Engineering, National Institute of Technology, Rourkela, Odisha, 769008, India
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23
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Yılmaz Tuğan B, Sönmez HE, Yüksel N, Karabaş L. Subclinical Retinal Capillary Abnormalities in Juvenile Systemic Lupus Erythematosus without Ocular Involvement. Ocul Immunol Inflamm 2022; 31:576-584. [PMID: 36067490 DOI: 10.1080/09273948.2022.2116584] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aimed to evaluate subclinical retinal microvascular changes with OCTA in juvenile systemic lupus erythematosus (JSLE) patients without ocular involvement. METHODS Ten eyes of 10 JSLE and 13 eyes of 13 age and sex-matched healthy controls (HCs) were enrolled. The superficial (SCP) and deep capillary plexus (DCP), FAZ parameters, the flow area of the outer retina, and choriocapillaris were evaluated using OCTA. RESULTS All vessel density (VD) parameters in DCP were significantly lower in JSLE group compared to HCs. There was no significant difference between the groups in VD parameters of both SCP and ONH, FAZ, outer retina and choriocapillaris flow area. All DCP VD parameters showed a good ability to differentiate JSLE from HCs. CONCLUSION OCTA could detect retinal vascular impairment in the deep macular region in JSLE patients with normal ocular examination. Furthermore, all DCP VD parameters have a good ability to discriminate JSLE from HCs.
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Affiliation(s)
| | - Hafize Emine Sönmez
- Division of Pediatrics, Department of Pediatric Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
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24
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Parravano M, Fragiotta S, Querques G. Prognostic relevance of optical coherence tomography angiography biomarkers in diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Serena Fragiotta
- Ophthalmology Unit, NESMOS Department, “Sapienza” University of Rome, St. Andrea Hospital, Rome, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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25
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Jung JJ, Lim SY, Chan X, Sadda SR, Hoang QV. Correlation of Diabetic Disease Severity to Degree of Quadrant Asymmetry in En Face OCTA Metrics. Invest Ophthalmol Vis Sci 2022; 63:12. [PMID: 35943732 PMCID: PMC9379327 DOI: 10.1167/iovs.63.9.12] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine if diabetic retinopathy (DR) severity affects quadrant asymmetry (QA) of optical coherence tomography angiography (OCTA) metrics differentially. Methods Ninety eyes (60 patients) with no diabetes mellitus (DM) (n = 39) or varying levels of DR (n = 51) had OCTA images (3 × 3 mm, Cirrus5000) acquired five times and averaged. The vessel length density (VLD) and perfusion density (PD) of the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured. QA was defined as the maximum minus minimum value among four parafoveal Early Treatment Diabetic Retinopathy quadrants, and compared with DR severity by linear regression including fixed effects for each individual and eye. Results The mean patient age was 55.5 years (range, 24–88 years) and 60% were male. Comparing severe nonproliferative DR or proliferative DR versus no DM/DR eyes, QA was significantly higher for SRL VLD, and PD (+0.67 ± 0.16 and +0.014 ± 0.003; P < 0.001) and DRL VLD, and PD (+1.25 ± 0.16 and +0.032 ± 0.003; P < 0.001). When comparing mild or moderate nonproliferative DR versus no DM/DR, the DRL VLD, and PD were significantly higher (+0.51 ± 0.13 and +0.015 ± 0.003; P < 0.001). For every step increase in DR severity, there was a +0.20 QA for SRL VLD, +0.004 SRL PD, +0.33 DRL VLD and +0.009 DRL PD (P < 0.001). Regression analysis comparing intraquadrant effect on DR severity demonstrated that the superior quadrant was most affected for all OCTA metrics. Conclusions DR severity affects VLD and PD more asymmetrically across Early Treatment Diabetic Retinopathy quadrants with a linear increase in QA for each worsening level of DR. Individual intraeye metrics such as QA can accurately quantify DR severity without concerns for intereye variabilities that could affect the reproducibility and reliability of OCTA quantification.
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Affiliation(s)
- Jesse J Jung
- East Bay Retina Consultants Inc., Oakland, California, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Shen Yi Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Xavier Chan
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, California, United States.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, United States
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26
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Xu F, Li Z, Gao Y, Yang X, Huang Z, Li Z, Zhang R, Wang S, Guo X, Hou X, Ning X, Li J. Retinal Microvascular Signs in Pre- and Early-Stage Diabetic Retinopathy Detected Using Wide-Field Swept-Source Optical Coherence Tomographic Angiography. J Clin Med 2022; 11:jcm11154332. [PMID: 35893423 PMCID: PMC9329884 DOI: 10.3390/jcm11154332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Using a wide-field, high-resolution swept-source optical coherence tomographic angiography (OCTA), this study investigated microvascular abnormalities in patients with pre- and early-stage diabetic retinopathy. Methods 38 eyes of 20 people with diabetes mellitus (DM) type 2 without diabetic retinopathy (DR) and 39 eyes of 21 people with DR were enrolled in this observational and cross-sectional cohort study, and a refractive error-matched group consisting of 42 eyes of 21 non-diabetic subjects of similar age were set as the control. Each participant underwent a wide-field swept-source OCTA. On OCTA scans (1.2 cm × 1.2 cm), the mean central macular thickness (CMT), the vessel density of the inner retina, superficial capillary plexus (SCP), and deep capillary plexus (DCP) were independently measured in the whole area (1.2 cm diameter) via concentric rings with varying radii (0–0.3, 0.3–0.6, 0.6–0.9, and 0.9–1.2 cm). Results Patients whose eyes had pre-and early-stage DR showed significantly decreased vessel density in the inner retina, SCP, DCP and CMT (early-stage DR) compared with the control. In addition, compared with the average values upon wide-field OCTA, the decreases were even more pronounced for concentric rings with a radius of 0.9–1.2 cm in terms of the inner retina, SCP, DCP and CMT. Conclusions Widefield OCTA allows for a more thorough assessment of retinal changes in patients with pre- and early-stage DR.; retinal microvascular abnormalities were observed in both groups. In addition, the decreases in retinal vessel density were more significant in the peripheral concentric ring with a radius of 0.9–1.2 cm. The application of novel and wide-field OCTA could potentially help to detect earlier diabetic microvascular abnormalities.
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Affiliation(s)
- Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan 250012, China; (F.X.); (Z.L.); (X.Y.); (R.Z.)
- Shandong Key Laboratory: Magnetic Field-Free Medicine & Functional Imaging, Jinan 250000, China; (Y.G.); (Z.H.); (X.N.)
- Magnetic Field-Free Medicine & Functional Imaging, Research Institute of Shandong University, Jinan 250000, China
| | - Zhiwen Li
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan 250012, China; (F.X.); (Z.L.); (X.Y.); (R.Z.)
| | - Yang Gao
- Shandong Key Laboratory: Magnetic Field-Free Medicine & Functional Imaging, Jinan 250000, China; (Y.G.); (Z.H.); (X.N.)
- Magnetic Field-Free Medicine & Functional Imaging, Research Institute of Shandong University, Jinan 250000, China
- School of Physics, Beihang University, Beijing 100191, China
| | - Xueying Yang
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan 250012, China; (F.X.); (Z.L.); (X.Y.); (R.Z.)
| | - Ziyuan Huang
- Shandong Key Laboratory: Magnetic Field-Free Medicine & Functional Imaging, Jinan 250000, China; (Y.G.); (Z.H.); (X.N.)
- Magnetic Field-Free Medicine & Functional Imaging, Research Institute of Shandong University, Jinan 250000, China
- School of Physics, Beihang University, Beijing 100191, China
| | - Zhiwei Li
- Department of Ophthalmology, Jinan Aier Eye Hospital, Jinan 250000, China;
| | - Rui Zhang
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan 250012, China; (F.X.); (Z.L.); (X.Y.); (R.Z.)
| | - Shaopeng Wang
- Department of Ophthalmology, Zibo Central Hospital, Binzhou Medical University, Zibo 250012, China;
| | - Xinghong Guo
- Department of Endocrinology, Qilu Hospital, Shandong University, Jinan 255000, China; (X.G.); (X.H.)
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital, Shandong University, Jinan 255000, China; (X.G.); (X.H.)
| | - Xiaolin Ning
- Shandong Key Laboratory: Magnetic Field-Free Medicine & Functional Imaging, Jinan 250000, China; (Y.G.); (Z.H.); (X.N.)
- Magnetic Field-Free Medicine & Functional Imaging, Research Institute of Shandong University, Jinan 250000, China
- School of Physics, Beihang University, Beijing 100191, China
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan 250012, China; (F.X.); (Z.L.); (X.Y.); (R.Z.)
- Shandong Key Laboratory: Magnetic Field-Free Medicine & Functional Imaging, Jinan 250000, China; (Y.G.); (Z.H.); (X.N.)
- Magnetic Field-Free Medicine & Functional Imaging, Research Institute of Shandong University, Jinan 250000, China
- Correspondence: ; Tel.: +86-185-6008-7118
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Retinal Microvascular and Neuronal Changes Are Also Present, Even If Differently, in Adolescents with Type 1 Diabetes without Clinical Diabetic Retinopathy. J Clin Med 2022; 11:jcm11143982. [PMID: 35887746 PMCID: PMC9323684 DOI: 10.3390/jcm11143982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
The purpose of this study was to evaluate retinal changes in adolescents with childhood-onset, long-lasting type 1 diabetes mellitus (T1D). Patients and healthy controls (HC) underwent optical coherence tomography (OCT) and OCT-angiography (OCTA). Individual macular layers, peripapillary retinal nerve fiber layer (pRNFL), and vascular parameters (vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI)) of macular superficial vascular (SVP), intermediate (ICP), deep (DCP) and radial peripapillary capillary plexuses (RPCP) were quantified. Thirty-nine patients (5 with (DR group) and 34 without (noDR group) diabetic retinopathy) and 20 HC were enrolled. The pRNFL and ganglion cell layer (GCL) were thicker in noDR compared to HC and DR, reaching statistically significant values versus HC for some sectors. At the macular level, VAD and VLF were reduced in DR versus HC in all plexuses, and versus noDR in SVP (p < 0.005 for all). At the RPCP level, VAD and VDI were increased in noDR versus HC, significantly for VDI (p = 0.0067). Glycemic indices correlated to retinal parameters. In conclusion, in T1D adolescents, retinal capillary and neuronal changes are present after long-lasting disease, even in the absence of clinical DR. These changes modify when clinical retinopathy develops. The precocious identification of specific OCT and OCTA changes may be a hallmark of subsequent overt retinopathy.
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Tombolini B, Borrelli E, Sacconi R, Bandello F, Querques G. Diabetic macular ischemia. Acta Diabetol 2022; 59:751-759. [PMID: 35133500 DOI: 10.1007/s00592-021-01844-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
AIM Since its relevance on diagnosis and prognosis of diabetic retinopathy (DR), this review will examine a multimodal imaging approach to detect diabetic macular ischemia (DMI). METHODS A PubMed engine search was carried out using the term "macular ischemia" paired with "diabetes," and "diabetic macular ischemia" paired to "fluorescein angiography," "ultra-wide field fluorescein angiography," "optical coherence tomography angiography," "octa," "2D octa," "ultra-wide field octa," "3D octa," "visual acuity." All studies published in English up to October 2021 irrespective of their publication status were reviewed, and relevant publications were included in this review. RESULTS Recently, new technologies have been proposed as an alternative to fluorescein angiography (FA), which is an actual diagnostic gold standard technique. Nowadays, optical coherence tomography angiography (OCTA) has emerged as the most promising and reliable procedure able to provide a qualitative and quantitative description of DMI. Newer three-dimensional (3D) OCTA approach will be discussed too. Moreover, we will discuss how OCTA might identify preclinical alterations before the onset of DR and allow prediction about the progression of disease. CONCLUSION OCTA has significantly expanded our knowledge on diabetic macular ischemia.
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Affiliation(s)
- Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Temel E, Özcan G, Yanık Ö, Demirel S, Batıoğlu F, Kar İ, Özmert E. Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. Int Ophthalmol 2022; 42:3661-3672. [PMID: 35604622 DOI: 10.1007/s10792-022-02363-w] [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: 04/09/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (˂ 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 μm nasal, and 1500 μm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.
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Affiliation(s)
- Emine Temel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Gökçen Özcan
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
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30
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Yang N, Li MX, Peng XY. Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study. BMC Ophthalmol 2022; 22:187. [PMID: 35459162 PMCID: PMC9034536 DOI: 10.1186/s12886-022-02397-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background We examined the retinal microvascular changes and associated factors in type 2 diabetes mellitus (T2DM) before and after intensive insulin therapy. Methods This prospective observational study recruited patients with T2DM and divided them into intensive insulin therapy and oral hypoglycemic agent groups. All patients enrolled in this study had diabetes without retinopathy or non-proliferative diabetic retinopathy. Optical coherence tomography angiography (OCTA) was used in all patients before treatment and at 1, 3, and 6 months after treatment. Vessel density (VD) and thickness changes in the macular and optic disc areas were assessed. Results The study included 36 eyes in the intensive insulin therapy group and 36 in the oral hypoglycemic agent group. One month after treatment, VD in the deep capillary plexus (DCP) and peripapillary capillary VD (ppVD) were significantly decreased by intensification (P = 0.009, 0.000). At three months after treatment, decreases in VD induced by intensification were found in the superficial capillary plexus (SCP), DCP, foveal density in a 300-μm-wide region around the foveal avascular area (FD-300), and ppVD (P = 0.032, 0.000, 0.039, 0.000). Six months after treatment, decreases in VD by intensification were observed in the DCP and ppVD groups (P = 0.000, 0.000). Vessel density showed no significant change in the oral hypoglycemic agent group after treatment. The amount of DCP-VD reduction was correlated with macular thickening (r = 0.348, P = 0.038; r = 0.693, P = 0.000 and r = 0.417, P = 0.011, respectively) after intensive insulin therapy. Conclusions Insulin-intensive treatment caused a transient reduction in vessel density in the macular and optic disc areas. DCP-VD and ppVD were more susceptible at an earlier stage. Retinal microvasculature monitoring using OCTA is vital for patients with type 2 diabetes receiving intensive insulin therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02397-9.
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Affiliation(s)
- Ning Yang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, No.17 Hougou Lane, Chongnei Street, Beijing, 100005, China.,Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, 99 West Huaihai RdJiangsu, Xuzhou, 221002, China
| | - Ming-Xin Li
- Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, 99 West Huaihai RdJiangsu, Xuzhou, 221002, China
| | - Xiao-Yan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, No.17 Hougou Lane, Chongnei Street, Beijing, 100005, China.
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Han Y, Wang X, Sun G, Luo J, Cao X, Yin P, Yu R, He S, Yang F, Myers FL, Zhou L. Quantitative Evaluation of Retinal Microvascular Abnormalities in Patients With Type 2 Diabetes Mellitus Without Clinical Sign of Diabetic Retinopathy. Transl Vis Sci Technol 2022; 11:20. [PMID: 35446407 PMCID: PMC9034707 DOI: 10.1167/tvst.11.4.20] [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] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate microvascular abnormalities in the macula and peripapillary area in diabetic patients without clinical signs of diabetic retinopathy (DR) and compare them with healthy control eyes, using optical coherence tomography angiography (OCTA). Methods A prospective study was performed of 49 eyes from 49 diabetic patients without clinical signs of DR and a control group of 52 eyes from 52 healthy normal individuals. The 3 × 3 mm macular scans and 4.5 × 4.5 mm optic disc scans were obtained with the OCTA RTVue-XR Avanti system. Angiograms from the superficial capillary plexus, the deep capillary plexus of the macula scans, and radial peripapillary capillary plexus of the optic disc scans were analyzed with MATLAB. Multivariate binary logistic regression and the least absolute shrinkage and selection operator (LASSO) regression were used to select ideal parameters that distinguish diabetic eyes without DR from normal eyes. A receiver operating characteristic (ROC) curve was generated, and sensitivity and specificity were calculated. Results Our final model identified FD-300 (foveal vessel density in a 300-µm-wide region around foveal avascular zone) as the only parameter selected by both the LASSO regression and the final multivariate logistic regression model that significantly differentiates diabetic eyes without clinical signs of DR from healthy normal eyes. The area under the ROC curve of FD-300 was 0.685, and sensitivity and specificity were 65.3% and 71.2%, respectively. Conclusions Quantitative evaluation of retinal microvascular abnormalities using OCTA identified FD-300 as a useful biomarker versus the other macular and peripapillary OCTA metrics in the early detection of preclinical diabetic retinal abnormalities. Translational Relevance OCTA may be useful in detecting early retinal microvascular abnormalities in diabetic patients before the clinical findings of DR become visible.
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Affiliation(s)
- Yongqing Han
- Department of Ophthalmology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia, P.R. China
| | - Xiaogang Wang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, P.R. China
| | - Gang Sun
- Department of Intelligence and Collaboration, Yangzhou Collaborative Innovation Research Institute of Shenyang Aircraft Design and Research Institute, Yangzhou, Jiangsu, P.R. China
| | - Jing Luo
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Xing Cao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Pengyi Yin
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Renhe Yu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Fang Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Frank L Myers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Liang Zhou
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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A multi-branch convolutional neural network for screening and staging of diabetic retinopathy based on wide-field optical coherence tomography angiography. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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ERMURAT S, Koyuncu K. Evaluation of subclinical retinal microvascular changes in systemic lupus erythematosus patients using optical coherence tomography angiography and its relationship with disease activity. Lupus 2022; 31:541-554. [DOI: 10.1177/09612033221084222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective This study aimed to investigate subclinical retinal microvascular changes with optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) and healthy controls (HCs), and to evaluate the relationship between OCTA findings and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Materials and Methods In this study, 47 eyes of SLE and 41 eyes of healthy control (HC) were evaluated. The SLE patients were divided into two subgroups: low disease activity (LDA) (SLEDAI≤5) and high disease activity (HDA) (SLEDAI>6). The results of OCTA were compared between SLE patients and HCs as well as the SLE subgroups. The relationship between OCTA results and SLEDAI-2K was evaluated. Results There were no differences in foveal avascular zone (FAZ) areas between the SLE patients and HCs. Central foveal thickness (CFT) was lower in SLE patients ( p = .046). Superficial capillary plexus (SCP) vessel density (VD) in SLE patients was significantly lower only in the foveal area compared to that in HCs ( p = .006). Deep capillary plexus (DCP) VD in SLE patients was significantly lower in all areas except the temporal parafoveal area compared to that in the HCs. There was no statistically significant difference between SLE groups with LDA and HDA in FAZ or any of the other areas, including SCP and DCP. When the correlation between OCTA findings and SLEDAI-2K was examined, both SCP and DCP VD were found to be negatively correlated. conclusions It was observed that DCP VDs were affected in SLE patients with LDA, and SCP VDs were also affected in addition to DCP with HDA. This suggests that DCP may be the first capillary plexus to be comprised in SLE. VDs were negatively correlated with disease activity. It was concluded that OCTA can be a useful tool in assessing subclinical retinal microvascular pathology and disease activity in patients with SLE.
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Affiliation(s)
- Selime ERMURAT
- Department of Rheumatology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Kevser Koyuncu
- Department of Ophthalmology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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A Classification Tree Model with Optical Coherence Tomography Angiography Variables to Screen Early-Stage Diabetic Retinopathy in Diabetic Patients. J Ophthalmol 2022; 2022:9681034. [PMID: 35211344 PMCID: PMC8863461 DOI: 10.1155/2022/9681034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Aim To establish a classification tree model in DR screening and to compare the DR screening accuracy between the classification tree model and the logistic regression model in type 2 diabetes mellitus (T2DM) patients based on OCTA variables. Methods Two hundred forty-one eyes of 241 T2DM patients were included and divided into two groups: the development cohort and the validation cohort. Optical coherence tomography angiography (OCTA) images were acquired in these patients. The data of foveal avascular zone area, superficial capillary plexus (SCP) density, and deep capillary plexus (DCP) density were exported after automatically analyzing the macular 6 × 6 mm OCTA images, while the data of radial peripapillary capillary plexus (RPCP) density was exported after automatically analyzing the optic nerve head 4.5 × 4.5 mm OCTA images. These OCTA variables were adopted to establish and validate the logistic regression model and the classification tree model. The area under the curve (AUC), sensitivity, specificity, and statistical power for receiver operating characteristic curves of two models were calculated. Results In the logistic regression model, best-corrected visual acuity (BCVA) (LogMAR) and SCP density were entered (BVCA : OR= 60.30, 95% CI= [2.40, 1513.82], p = 0.013; SCP density: OR= 0.86, 95% CI= [0.78, 0.96], p = 0.006). The AUC, sensitivity, and specificity for detecting early-stage DR (mild to moderate NPDR) in the development cohort were 0.75 (95% CI: [0.66, 0.85]), 63%, and 83%, respectively. The AUC, sensitivity, and specificity in the validation cohort were 0.75 (95% CI: [0.66, 0.84]), 79%, and 72%, respectively. In the classification tree model, BVCA (LogMAR), DM duration, SCP density, and DCP density were entered. The AUC, sensitivity, and specificity for detecting early-stage DR were 0.72 (95% CI: [0.60, 0.84]), 66%, and 76%, respectively. The AUC, sensitivity, and specificity in the validation cohort were 0.74 (95% CI: [0.65, 0.83]), 74%, and 72%, respectively. The statistical power of the development and validation cohorts in two models was all more than 99%. Conclusions Compared to the logistic regression model, the classification tree model has similar accuracy in predicting early-stage DR. The classification tree model with OCTA variables may be a simple tool for clinical practitioners to identify early-stage DR in T2DM patients. Moreover, SCP density is significantly reduced in mild-to-moderate NPDR eyes and might be a biomarker in early-stage DR detection. Further improvement and validation of the DR diagnostic model are awaiting to be performed.
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Tan B, Lim NA, Tan R, Gan ATL, Chua J, Nusinovici S, Cheung CMG, Chakravarthy U, Wong TY, Schmetterer L, Tan G. Combining retinal and choroidal microvascular metrics improves discriminative power for diabetic retinopathy. Br J Ophthalmol 2022:bjophthalmol-2021-319739. [PMID: 35140059 PMCID: PMC10359699 DOI: 10.1136/bjophthalmol-2021-319739] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To use optical coherence tomography angiography (OCTA) parameters from both the retinal and choroidal microvasculature to detect the presence and severity of diabetic retinopathy (DR). METHOD This is a cross-sectional case-control study. OCTA parameters from retinal vasculature, fovea avascular zone (FAZ) and choriocapillaris were evaluated from 3×3 mm2 fovea-centred scans. Areas under the receiver operating characteristic (ROC) curve were used to compare the discriminative power on the presence of diabetes mellitus (DM), the presence of DR and need for referral: group 1 (no DM vs DM no DR), group 2 (no DR vs any DR) and group 3 (non-proliferative DR (NPDR) vs proliferative DR (PDR)). RESULTS 35 eyes from 27 participants with no DM and 132 eyes from 75 with DM were included. DR severity was classified into three groups: no DR group (62 eyes), NPDR (51 eyes), PDR (19 eyes). All retinal vascular parameters, FAZ parameters and choriocapillaris parameters were strongly altered with DR stages (p<0.01), except for the deep plexus FAZ area (p=0.619). Choriocapillaris parameters allowed to better discriminate between no DM versus DM no DR group compared with retinal parameters (areas under the ROC curve=0.954 vs 0.821, p=0.006). A classification model including retinal and choroidal microvasculature significantly improved the discrimination between DR and no DR compared with each parameter separately (p=0.029). CONCLUSIONS Evaluating OCTA parameters from both the retinal and choroidal microvasculature in 3×3 mm scans improves the discrimination of DM and early DR.
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
| | - Nicole-Ann Lim
- Singapore Eye Research Institute, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, Singapore
| | - Rose Tan
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore
| | | | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore.,Singapore National Eye Centre, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Usha Chakravarthy
- School of Medicine, Dentistry and Biomedical Sciencens, Queen's University Belfast, Belfast, UK
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore .,Singapore National Eye Centre, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore
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Evliyaoglu F, Kurt M, Yilmaz M, Akpolat C. Evaluation of microvascular density and retinal vessel diameter in gestational and type 2 diabetes using swept-source OCT-A technology. J Fr Ophtalmol 2022; 45:430-437. [DOI: 10.1016/j.jfo.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 10/19/2022]
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Xu F, Li Z, Yang X, Gao Y, Li Z, Li G, Wang S, Ning X, Li J. Assessment of choroidal structural changes in patients with pre- and early-stage clinical diabetic retinopathy using wide-field SS-OCTA. Front Endocrinol (Lausanne) 2022; 13:1036625. [PMID: 36743939 PMCID: PMC9892628 DOI: 10.3389/fendo.2022.1036625] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To investigate the micro-vascular changes in choroidal structures in patients with pre- and early-stage clinical diabetic retinopathy (DR) using wide-field Swept-Source Optical Coherence Tomography Angiography (SS-OCTA). METHOD This observational cross-sectional study included 131 eyes of 68 subjects that were divided into healthy controls (group 1, n = 46), pre-DR (group 2, n = 43), early-stage DR (group 3, n = 42) cohorts. All participants that underwent SS-OCTA examination were inpatients in the department of Ophthalmology and the department of Endocrinology, Qilu Hospital, Shandong University, and Department of Ophthalmology, Aier Eye Hospital, Jinan, from July 11, 2021 to March 17, 2022. The choroidal vascularity index (CVI), choroidal thickness (ChT) and central macular thickness (CMT) in the whole area (diameter of 12 mm) and concentric rings with different ranges (0-3, 3-6, 6-9, and 9-12 mm) were recorded and analyzed from the OCTA image. RESULT Compared with healthy eyes, decreases in CVI and ChT were found in the eyes of patients with pre-or early-stage DR. The changes were more significant in the peripheral choroid, with the most prominent abnormalities in the 9-12mm area (P < 0.001). However, there was no obvious difference in the average CMT value. Furthermore, CVI and ChT were significantly correlated with the duration of diabetes in the range of 6-9 and 9-12 mm (Ps < 0.05; Correlation coefficient = -0.549, -0.395, respectively), with the strongest correlation (Ps < 0.01; Correlation coefficient = -0.597, -0.413, respectively) observed at 9-12 mm. CONCLUSION The CVI and ChT values of diabetic patients are significantly lower than in healthy controls, especially in patients with early-stage DR. In addition, the peripheral choroidal capillaries are more susceptible to early DM-induced injury than in the central area.
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Affiliation(s)
- Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- Research Institute of Shandong University: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
| | - Zhiwen Li
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan, China
| | - Xueying Yang
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan, China
| | - Yang Gao
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- Research Institute of Shandong University: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- School of Physics, Beihang University, Beijing, China
| | - Zhiwei Li
- Jinan Aier Eye Hospital, Jinan, China
| | - Guihua Li
- Zibo Central Hospital, Binzhou Medical University, Zibo, Shandong, China
| | - Shaopeng Wang
- Zibo Central Hospital, Binzhou Medical University, Zibo, Shandong, China
| | - Xiaolin Ning
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- Research Institute of Shandong University: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- School of Physics, Beihang University, Beijing, China
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- Research Institute of Shandong University: Magnetic Field-free Medicine & Functional Imaging, Jinan, China
- *Correspondence: Jianqiao Li,
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Xu Q, Gong C, Qiao L, Feng R, Liu H, Liu Y, Ji S, Zhang Y, Wu S, Li S. Aqueous Level of ANGPTL4 Correlates with the OCTA Metrics of Diabetic Macular Edema in NPDR. J Diabetes Res 2022; 2022:8435603. [PMID: 35097131 PMCID: PMC8791715 DOI: 10.1155/2022/8435603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/09/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the aqueous levels of angiogenic factors in nonproliferative diabetic retinopathy (NPDR) patients with diabetic macular edema (DME) and to ascertain their association with optical coherence tomography angiography (OCTA) metrics. METHODS This study enrolled 21 NPDR eyes with DME (NPDR/DME+), 17 NPDR eyes without DME (NPDR/DME-), and 16 diabetic eyes without retinopathy (DWR). Luminex bead-based multiplex array was used to measure the levels of 25 cytokines. OCTA system with a scan area of 3 × 3 mm was used to measure retinal thickness (RT), retinal volume (RV), superficial vessel density (SVD), deep vessel density (DVD), foveal avascular zone (FAZ) area, perimeter and acircularity index. RESULTS The levels of ANGPTL4 were significantly different among the three groups (P < 0.05), in which NPDR/DME+ group had the highest level and NPDR/DME- group had a higher level than the DWR group (all, P < 0.0167). OCTA examination showed that, compared with DWR and NPDR/DME- group, RT and RV increased and the whole/parafoveal DVD decreased in NPDR/DME+ group (all, P < 0.05). Meanwhile, NPDR/DME- group had lower parafoveal DVD than the DWR group (P < 0.05). Correlation analysis showed that the levels of ANGPTL4 were positively correlated with foveal/parafoveal RT and RV and negatively correlated with whole/parafoveal DVD in NPDR patients (all, P < 0.05). As the influencing factor of RT, RV, and DVD, every additional 103 pg/ml of ANGPTL4 was associated with an increase in foveal and parafoveal RT of 4.299 μm and 3.598 μm, respectively. Every additional 106 pg/ml of ANGPTL4 was associated with an increase in foveal and parafoveal RV of 3.371 mm3 and 17.705 mm3, respectively. Every additional 104 pg/ml of ANGPTL4 was associated with a decrease in whole and parafoveal DVD of 1.705% and 1.799%, respectively. CONCLUSIONS The level of ANGPTL4 in aqueous humor of NPDR patients with DME was significantly increased and ANGPTL4 might predict RT, RV, and parafoveal DVD of DME in NPDR patients.
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Affiliation(s)
- Qing Xu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Chaoju Gong
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Lei Qiao
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Ruifang Feng
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Haiyang Liu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Yalu Liu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Sujuan Ji
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Yipeng Zhang
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Shuang Wu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
| | - Suyan Li
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, 221116 Jiangsu Province, China
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Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review. Biomedicines 2021; 10:biomedicines10010088. [PMID: 35052768 PMCID: PMC8773551 DOI: 10.3390/biomedicines10010088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.
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Fractalkine-induced microglial vasoregulation occurs within the retina and is altered early in diabetic retinopathy. Proc Natl Acad Sci U S A 2021; 118:2112561118. [PMID: 34903661 PMCID: PMC8713803 DOI: 10.1073/pnas.2112561118] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
This work identifies a role for microglia, the innate immune cells of the CNS, in the local control of the retinal vasculature and identifies deficits early in diabetes. Microglia contact neurons and vasculature and express several vasoactive agents. Activation of microglial fractalkine-Cx3cr1 signaling leads to capillary constriction and blocking the renin-angiotensin system (RAS) with candesartan abolishes microglial-mediated vasoconstriction in the retina. In early diabetes, reduced retinal blood flow is coincident with capillary constriction, increased microglial–vessel association, loss of microglial–capillary regulation, and altered microglial expression of the RAS pathway. While candesartan restores retinal capillary diameter early in diabetes, targeting of microglial–vascular regulation is required to prevent coincident dilation of large retinal vessels and reduced retinal blood flow. Local blood flow control within the central nervous system (CNS) is critical to proper function and is dependent on coordination between neurons, glia, and blood vessels. Macroglia, such as astrocytes and Müller cells, contribute to this neurovascular unit within the brain and retina, respectively. This study explored the role of microglia, the innate immune cell of the CNS, in retinal vasoregulation, and highlights changes during early diabetes. Structurally, microglia were found to contact retinal capillaries and neuronal synapses. In the brain and retinal explants, the addition of fractalkine, the sole ligand for monocyte receptor Cx3cr1, resulted in capillary constriction at regions of microglial contact. This vascular regulation was dependent on microglial Cx3cr1 involvement, since genetic and pharmacological inhibition of Cx3cr1 abolished fractalkine-induced constriction. Analysis of the microglial transcriptome identified several vasoactive genes, including angiotensinogen, a constituent of the renin-angiotensin system (RAS). Subsequent functional analysis showed that RAS blockade via candesartan abolished microglial-induced capillary constriction. Microglial regulation was explored in a rat streptozotocin (STZ) model of diabetic retinopathy. Retinal blood flow was reduced after 4 wk due to reduced capillary diameter and this was coincident with increased microglial association. Functional assessment showed loss of microglial–capillary response in STZ-treated animals and transcriptome analysis showed evidence of RAS pathway dysregulation in microglia. While candesartan treatment reversed capillary constriction in STZ-treated animals, blood flow remained decreased likely due to dilation of larger vessels. This work shows microglia actively participate in the neurovascular unit, with aberrant microglial–vascular function possibly contributing to the early vascular compromise during diabetic retinopathy.
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The Determination of Type 2 Diabetes Mellitus's Impact on the Density of Retinal Blood Vessels and the Choriocapillaris: Optical Coherence Tomography Angiography Study. J Ophthalmol 2021; 2021:7043251. [PMID: 34853704 PMCID: PMC8629665 DOI: 10.1155/2021/7043251] [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: 08/26/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) was used to analyze the alterations in the density of retinal blood vessels and the choriocapillaris (VD) in patients suffering from type 2 diabetes mellitus (T2DM). One hundred sixty-six eyes of 83 patients (43 of whom were men and 40 women, with a mean age of 58.59 ± 14.04) with T2DM and without diabetic retinopathy were examined for the purpose of conducting the observational prospective study. The control group (CG) consisted of 66 eyes in 33 healthy subjects (15 male and 18 female, with a mean age of 55.12 ± 12.70). The measurement regions of vessel density (VD) included the deep capillary plexus (DCP), the superficial capillary plexus (SCP), and the choriocapillaris. The results indicate considerable differences in the VD of the DCP and SCP when comparing the control group with the study groups (p < 0.001). In comparison with the control group (p < 0.001), there was a statistically significant reduction in the VD of the choriocapillaris in the study group. Furthermore, patients with T2DM showed a significantly decreased VD concerning the control in different macular regions. Thickness in several macular regions in the study group significantly decreased compared to the ones in the control group. OCTA was used to gather relevant information about the vascular changes which occurred in T2DM patients, assessed through the quantitative analysis of the blood flow in the retina and choriocapillaris.
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Ulutas HG, Guclu M, Aslanci ME, Karatas G. The relationship between carotid intima-media thickness and microvascular changes in retinal zones and optic disc in patients with type 1 diabetes mellitus. Eur J Ophthalmol 2021; 32:2328-2337. [PMID: 34851200 DOI: 10.1177/11206721211064024] [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: 11/17/2022]
Abstract
PURPOSE The aim of this study was to detect early retinal vascular changes with optical coherence tomography angiography (OCTA) in type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy and to evaluate the correlation of the results with carotid intima-media thickness (IMT). DESIGN This is a case-control and cross-sectional study. METHODS This study included 38 adult patients with T1DM, and 38 age and gender-matched healthy controls. Retinal and optic disc (OD) measurements were taken using OCTA. The carotid artery IMT of each patient was measured using Doppler ultrasonography. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density, foveal avascular zone (FAZ), non-flow area (NFA) and foveal density (FD) were analysed in the fovea centred 6 × 6 mm macular area. The superficial capillary plexus and DCP were also scanned centred on the peripapillary region. The correlations between OCTA measurements and carotid IMT, duration of DM and haemoglobin A1c levels in patients with T1DM were evaluated. RESULTS The mean values for carotid IMT were significantly higher in diabetic patients than in controls (p < 0.001). The mean values for vessel density SCP, DCP and OD were significantly lower in the diabetic group (p < 0.05). There were correlations between the carotid IMT and duration of T1DM and the evaluated parameters of OCTA. CONCLUSION Microvascular changes in the SCP and DCP in patients with T1DM without DR offer important data. OCTA can be used to detect early microvascular changes in patients with T1DM without DR. In addition, a relationship was found between SCP vascular dropout and carotid IMT.
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Affiliation(s)
- Hafize Gokben Ulutas
- Department of Ophthalmology, University of Health Sciences, 147003Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Metin Guclu
- Department of Endocrinology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Emin Aslanci
- Department of Ophthalmology, University of Health Sciences, 147003Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Gokhan Karatas
- Department of Radiology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Palma F, Camacho P. The role of Optical Coherence Tomography Angiography to detect early microvascular changes in Diabetic Retinopathy: a systematic review. J Diabetes Metab Disord 2021; 20:1957-1974. [PMID: 34900835 PMCID: PMC8630307 DOI: 10.1007/s40200-021-00886-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/22/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate quantitative parafoveal microvascular changes using Optical Coherence Tomography Angiography (OCTA) by comparing the area of foveal avascular zone (FAZ) and vessel density (VD) between nondiabetic controls and patients with different levels of Diabetic Retinopathy (DR). METHODS A systematic review was performed according to the recommendations of the "Cochrane Handbook for Systematic Reviews of Interventions" and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three electronic databases including PubMed, Web of Science and Cochrane Library were systematically retrieved by using key terms with Boolean operators. The data extracted from each study included: first author, year of publication, study design, sample size and participant characteristics (mean age, type of diabetes mellitus and mean duration of diabetic disease). Outcome variables included: VD and area of FAZ, in superficial and deep capillary plexuses of parafovea. RESULTS 355 articles were identified from our search of databases and 10 studies were included in this systematic review. Patients with diabetes with or without clinical signs of DR have a significantly enlarged area of FAZ and decreased parafoveal VD compared to healthy controls, as well as an association between these microvascular changes and worsening DR. CONCLUSION OCTA can provide valuable information about early and subtle microvascular changes of parafoveal capillary plexuses in patients with diabetes and can identify preclinical DR before the manifestation of clinically apparent retinopathy. The non-invasive nature of OCTA allows routine imaging of the retinal vasculature, so this approach may be a promising tool for screening programmes of DR.
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Affiliation(s)
- Filipa Palma
- ESTeSL- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Pedro Camacho
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
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Arias JD, Arango FJ, Parra MM, Sánchez-Ávila RM, Parra-Serrano GA, Hoyos AT, Granados SJ, Viteri EJ, Gaibor-Santos I, Perez Y. Early microvascular changes in patients with prediabetes evaluated by optical coherence tomography angiography. Ther Adv Ophthalmol 2021; 13:25158414211047020. [PMID: 34708184 PMCID: PMC8543708 DOI: 10.1177/25158414211047020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Timely detection of early microvascular changes in patients with prediabetes
could help reduce the likelihood of progression of diabetes-related retinal
complications. Aim: To determine early microvascular changes in patients with prediabetes using
optical coherence tomography angiography (OCT-A). Methods: In this single-center retrospective case-control study, macular OCT-A images
of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were
analyzed in non-diabetic controls, and prediabetic and diabetic subjects. A
quantitative analysis was performed using ImageJ software of the foveal
avascular zone (FAZ) area, acircularity index (AI), perfusion density (PD),
and vascular length density (VLD). Results: A total of 94 eyes of 53 patients were included in this study. The global
mean age was 57.7 years, 39.6% men and 60.4% women. In SCP, the mean PD was
0.283 ± 0.15, 0.186 ± 0.720, and 0.186 ± 0.07 in non-diabetic controls, and
prediabetic and diabetic groups, respectively. The mean VLD was
8.728 ± 3.425 in non-diabetic controls, 6.147 ± 1.399 in prediabetic group,
and 6.292 ± 1.997 in patients with diabetes. The comparison of prediabetic
patients and controls shows statistical differences between PD and VLD in
both plexus SCP (p = 0.002 and p = 0.001,
respectively) and DCP (p = 0.005 and
p = 0.002, respectively). The mean area of FAZ in patients
with diabetes and normal individuals was 0.281 and 0.196 mm2,
respectively (p < 0.001). AI was higher in the control
group (0.87 ± 0.14) and prediabetic group (0.80 ± 0.17) compared to diabetic
patients (0.64 ± 0.19). There were no differences in FAZ area and AI between
prediabetic and non-diabetic controls. Conclusion: PD and VLD demonstrated to be early microvascular changes in prediabetic
patients evaluated by OCT-A. No alterations of FAZ were evidenced in this
group.
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Affiliation(s)
- Juan D Arias
- Foscal Internacional clinic, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
| | | | - Maria Margarita Parra
- Fellow of Retina and Vitreous, Foscal Internacional clinic, Universidad Autónoma de Bucaramanga (UNAB), Cr 29 n° 16-23, Molinos Bajos, Floridablanca 681004, Colombia
| | - Ronald M Sánchez-Ávila
- Ophthalmological Research Foundation, Fernández-vega University Institute, University of Oviedo, Oviedo, Spain
| | | | | | | | - Eduardo J Viteri
- Foscal Internacional clinic, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
| | - Ivetteh Gaibor-Santos
- Foscal Internacional clinic, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
| | - Yanny Perez
- Pontificia Universidad Javeriana de Cali, Cali, Colombia
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Mahjoub A, Cherni I, Khayrallah O, Ben Abdesslam N, Mahjoub A, Anas R, Ghorbel M, Mahjoub H, Knani L, Krifa F. Contribution of optical coherence tomography angiography OCT-A in diabetic maculopathy. Ann Med Surg (Lond) 2021; 70:102904. [PMID: 34703579 PMCID: PMC8519827 DOI: 10.1016/j.amsu.2021.102904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Diabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization. Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. Patients and methods This is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. Results Microanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p < 0,05). Capillary nonperfusion areas were identified in 82,5% of cases in SCP and in 60% of cases in DCP. The main peri-foveal vascular density was 18,95 ± 5,37%. The main surface of foveal avascular zone (FAZ) in the SCP was 462,52 μm2 and was 555,04 ± 329,11 μm2 in the DCP where it was larger. Conclusion OCT-A is a modern imaging tool that could be used for the diagnosis and monitoring of DR as well as the understanding of its pathophysiology. Retinal microvascular abnormalities on OCT-A are observed in diabetic retinopathy and are proportional to its severity. Deep capillary plexus was more severely affected than superficial capillary plexus. The assessment of macular ischemia could be based on the identification of areas of vascular rarefaction. Quantitative assessment of vascular density and the study of the foveal avascular zone can assess the macular ischemia
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Affiliation(s)
| | | | - Oumayma Khayrallah
- Corresponding author. Ophtalmology department, Farhat Hached Hospital of Sousse, Faculty of medicine of Sousse, Tunisia.
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Retinal Vascular Response to Hyperoxia in Patients with Diabetes Mellitus without Diabetic Retinopathy. J Ophthalmol 2021; 2021:9877205. [PMID: 34691774 PMCID: PMC8536458 DOI: 10.1155/2021/9877205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the retinal vascular response to hyperoxia in patients with diabetes at the preclinical stage of diabetic retinopathy (DR) and to quantify the changes in comparison with normal subjects using optical coherence tomography angiography (OCTA). Methods In this prospective study, 40 eyes of 20 participants comprising 10 diabetic patients with no diabetic retinopathy (NDR) and 10 normal subjects were recruited. OCTA images were acquired in the resting position and were repeated after a hyperoxic challenge using a nasal mask connected to a reservoir bag supplying 100% oxygen at the rate of 15 L per minute for 5 minutes. The changes of mean parafoveal vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the foveal avascular zone (FAZ) size, and the outer retina flow index were compared between two conditions in each group and between the two study groups. The statistical significance of differences in the means was evaluated using Student's t-test for unpaired samples with consideration of the generalized estimating equations (GEE) for intereye correlation. Results At baseline, the mean parafoveal VD of SCP and DCP were significantly lower in the NDR participants compared to the healthy subjects (P < 0.001 and P = 0.006, respectively). After induction of the hyperoxic challenge in healthy participants, mean parafoveal VD reduced at both the SCP and DCP, but reached a statistical significance only in DCP (P = 0.006). However, following induction of hyperoxic challenge in patients with NDR, no significant decline was noticed in mean parafoveal VD of SCP and DCP. The degree of change in mean parafoveal VD of DCP was statistically significantly more pronounced in healthy subjects compared to the NDR group (P = 0.034). The change in FAZ size and the outer retina flow index were comparable between the two study groups. Conclusion Retinal capillary layers responded differently to hyperoxia-induced challenge, and in normal subjects, the autoregulatory mechanism was mostly effective in the parafoveal DCP. Retinal vascular reactivity was impaired in SCP and DCP at the preclinical stage of DR. OCTA as a noninvasive modality was able to quantify the retinal vascular response to the hyperoxic challenge.
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Le P, Zehden J, Zhang AY. Role of Optical Coherence Tomography Angiography Imaging in Patients with Diabetes. Curr Diab Rep 2021; 21:42. [PMID: 34665347 DOI: 10.1007/s11892-021-01405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Ocular manifestations in patients with diabetes mellitus (DM) can present as microvascular changes. These microvascular changes can be challenging to identify on exams, and imaging technologies have commonly aided in the diagnosis and management of patients with DM. Optical coherence tomography angiography (OCTA) provides noninvasive image segmentation of various layers of the retina and choroid. Also, post-processing of images and associated quantitative measurements offer potential clinical enhancements. Our aim is to review the current evidence on the utility of OCTA for patients with DM. RECENT FINDINGS Research suggests OCTA to potentially provide potential clinical enhancements and alternative methods in detecting subclinical manifestation of diabetic retinopathy, staging diabetic retinopathy, management of diabetic macular edema, and monitoring of systemic markers in patients with diabetes mellitus. OCTA is a promising but relatively new modality, and differences in terminology, research designs, and image processing techniques provide a difficult landscape to navigate. Standardization within further validation is needed to determine the extent of OCTA's clinical utility, but the current literature suggests the potential for earlier detection of ocular manifestations in patients with DM, additional objective measurements for grading and management, and opportunity for additional biomarkers for treatment outcomes.
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Affiliation(s)
- Patrick Le
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Jason Zehden
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
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Koca SB, Akdogan M, Koca S. Evaluation of early retinal vascular changes by optical coherence tomography angiography in children with type 1 diabetes mellitus without diabetic retinopathy. Int Ophthalmol 2021; 42:423-433. [PMID: 34625889 DOI: 10.1007/s10792-021-02059-7] [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: 04/24/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate macular and peripapillary vascular changes by optical coherence tomography angiography (OCTA) in children with type 1 diabetes mellitus (T1DM) without diabetic retinopathy (DR). METHODS This study included 46 patients with T1DM and 46 age-sex matched healthy subjects. All participants were evaluated in terms of macular and optic disk parameters by using AngioVue. Foveal avascular zone (FAZ) area, macular and optic disk vessel density (VD) were analyzed. The correlation of these parameters with metabolic factors such as disease duration, mean hemoglobin A1c (HbA1c), insulin-like growth factor 1 (IGF-1) standard deviation score (SDS), homocysteine (Hcy) level, body mass index (BMI) SDS and daily insulin dose was also investigated in T1DM group. RESULTS No significant difference was found in FAZ area and optic disk radial peripapillary capillary (RPC) VD comparing diabetic and control groups. In all macular regions, VD was significantly lower in T1DM versus control group both in superficial capillary plexus (SCP) and deep capillary plexus (DCP). None of the metabolic parameters was correlated with FAZ area and optic disk RPC-VD. Vascular density in SCP was negatively correlated with mean HbA1c and positively correlated with IGF-1 SDS. Homocysteine level was negatively correlated with DCP-VD in all areas. CONCLUSION In children with T1DM without clinically apparent DR, VD in SCP and DCP was decreased and OCTA is a valuable imaging technique for detecting early vascular changes. The metabolic parameters such as mean HbA1c, IGF-1 SDS and Hcy affect the macular VD in diabetic children. TRIAL REGISTRATION NUMBER 2011-KAEK-2, 2021/4, Trial registration date: 02.04.2021.
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Affiliation(s)
- Serkan Bilge Koca
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Muberra Akdogan
- Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Semra Koca
- Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey. .,, 1444. Sokak Kandilli Konakları D Blok 2/8, Afyonkarahisar, Türkiye.
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Borrelli E, Grosso D, Parravano M, Costanzo E, Brambati M, Viganò C, Sacconi R, Querques L, Pina A, De Geronimo D, Bandello F, Querques G. Volume rendered 3D OCTA assessment of macular ischemia in patients with type 1 diabetes and without diabetic retinopathy. Sci Rep 2021; 11:19793. [PMID: 34611239 PMCID: PMC8492730 DOI: 10.1038/s41598-021-99297-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to measure macular perfusion in patients with type 1 diabetes and no signs of diabetic retinopathy (DR) using volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). We collected data from 35 patients with diabetes and no DR who had OCTA obtained. An additional control group of 35 eyes from 35 healthy subjects was included for comparison. OCTA volume data were processed with a previously presented algorithm in order to obtain the 3D vascular volume and 3D perfusion density. In order to weigh the contribution of different plexuses' impairment to volume rendered vascular perfusion, OCTA en face images were binarized in order to obtain two-dimensional (2D) perfusion density metrics. Mean ± SD age was 27.2 ± 10.2 years [range 19-64 years] in the diabetic group and 31.0 ± 11.4 years [range 19-61 years] in the control group (p = 0.145). The 3D vascular volume was 0.27 ± 0.05 mm3 in the diabetic group and 0.29 ± 0.04 mm3 in the control group (p = 0.020). The 3D perfusion density was 9.3 ± 1.6% and 10.3 ± 1.6% in diabetic patients and controls, respectively (p = 0.005). Using a 2D visualization, the perfusion density was lower in diabetic patients, but only at the deep vascular complex (DVC) level (38.9 ± 3.7% in diabetes and 41.0 ± 3.1% in controls, p = 0.001), while no differences were detected at the superficial capillary plexus (SCP) level (34.4 ± 3.1% and 34.3 ± 3.8% in the diabetic and healthy subjects, respectively, p = 0.899). In conclusion, eyes without signs of DR of patients with diabetes have a reduced volume rendered macular perfusion compared to control healthy eyes.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Domenico Grosso
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | | | | | - Maria Brambati
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Chiara Viganò
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Adelaide Pina
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | | | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, Milan, Italy.
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Krásný J, Magera L, Pluhovský P, Čeledová J, Holubová L. PRE-RETINOPATHY OF TYPE 1 DIABETES IN THE CONTEXT OF FUNCTIONAL, STRUCTURAL AND MICROCIRCULATORY CHANGES IN THE MACULAR AREA. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2021; 77:170-182. [PMID: 34507493 DOI: 10.31348/2021/20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The authors assessed the development of intraocular changes in type 1 diabetes (T1DM) from the onset of the disease leading to diabetic retinopathy (DR). The quote: “There must be an intermediate stage between the physiological intraocular finding and the diabetic retinopathy itself “, (prof. Jan Vavřinec). METHODS A two-year study (2018 and 2019) was conducted at the Department of Ophthalmology of the Teaching Hospital Kralovske Vinohrady in Prague (Czech Republic). There were 54 patients aged 17-42 years, the detection of T1DM ranged between the 1st and 14th year of life, with a duration of 12-35 years. Individual patients were always examined simultaneously by three methods: CS (contrast sensitivity), SD-OCT (spectral domain optical coherence tomography) and OCT-A (optical coherence tomography-angiography). We examined 106 eyes once and in a comprehensive manner. RESULTS We have shown that there is an intermediate stage between the physiological finding on the retina and DR, so-called diabetic pre-retinopathy (DpR). Subsequent redistribution of the observed into two DpR subgroups was derived from the size of the FAZ, either with its smaller area or with a larger area determining the microvascularity of the central area of the retina. The results of both other methods were assigned to these values. For SD-OCT, the depth of the fovea (the difference between the central retinal thickness and the total average retinal thickness) was determined, which was affected by the increased the macular cubature. In all patients it was on average 10.3 μm3. The retina in the central area was significantly strengthened compared to the healthy population at the level of significance p 0,001. We divided the actual DpR into an image: DpR1 in 26.5 % of eyes - condition with an average shallower fovea only by 21.5 μm below the level of the surrounding retina and an average narrower FAZ: 0.165 mm2 and with a more significant decrease in CS; DpR2 in 40.5 % of eyes - condition with average deeper fovea by 42 μm, i.e., more significantly and average larger FAZ: 0.325 mm2 with lower decrease of CS. At the same time, other changes in microvascularity were noted, such as disorders in the sense of non-perfusion in the central part of the retina of various degrees. This finding differed significantly from changes in already established (non-proliferative) NPDR in 36 % of eyes, when a significant decrease in CS with normal visual acuity was found 4/4 ETDRS. Statistical differences in CS between DpR1 and DpR2 and NPDR were determined - always p 0.001. The average depth of the fovea was NPDR: 29.5 μm. NPDR had the largest average FAZ: 0.56 mm2. Also significant were the most significant changes in non-perfusion and especially the presence of microaneurysms. CONCLUSIONS These three non - invasive methods helped to monitor the dynamics of the development of ocular changes in T1DM of better quality than the determination of visual acuity and ophthalmoscopic examination. Increased retinal volume induced hypoxia of visual cells with subsequent dual autoregulatory mechanism conditioning two types of diabetic pre-retinopathy before the onset of DR.
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