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Maris D, Dastiridou A, Kotoula M, Karathanou A, Tsironi EE, Bargiota A, Androudi S. Macular Ischemia Changes in Patients with Diabetic Macular Edema Treated with Aflibercept and Ranibizumab. Diagnostics (Basel) 2024; 14:1306. [PMID: 38928721 PMCID: PMC11203373 DOI: 10.3390/diagnostics14121306] [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: 05/22/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Τhis study aims to assess changes in the fovea avascular zone (FAZ) in treatment naïve patients receiving aflibercept or ranibizumab injections for diabetic macular edema (DME). Best corrected visual acuity (BCVA) testing, OCT, and OCT-angiography imaging were performed at baseline and 1 month after each injection. Injections of either aflibercept or ranibizumab were administered monthly for 6 consecutive months. FAZ in the superficial (SCP) and the deep capillary plexus (DCP) using OCT angiography was recorded for each visit. Fifty eyes from fifty patients with a mean age of 67.0 ± 10.7 years were included in the study. Twenty-five patients received aflibercept and twenty-five received ranibizumab. BCVA was 40.8 ± 10.0 and increased to 52.1 ± 7.9 ETDRS letters at the last visit (p < 0.001). CRT was 295.6 ± 34.0 at baseline and 247.9 ± 29.7 at the last study visit (p < 0.001). SCP FAZ was 350.6 ± 79.5 μm2 at baseline and 339.0 ± 71.3 μm2 after sox monthly injections (p = 0.132). DCP FAZ was 558.6 ± 199.0 μm2 at baseline and 459.5 ± 156.1 μm2 after six monthly injections (p < 0.001). There was no effect of the choice of ranibizumab or aflibercept on DCP FAZ change (p = 0.277). In conclusion, treatment with 6 monthly injections of ranibizumab and aflibercept led to an increase in BCVA and a decrease in CRT and DCP FAZ area. Both drugs led to an improvement in DCP ischemia.
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Affiliation(s)
- Dimitrios Maris
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
| | - Anna Dastiridou
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
| | - Maria Kotoula
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
| | - Aikaterini Karathanou
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
| | - Evangelia E. Tsironi
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
| | | | - Sofia Androudi
- Ophthalmology Clinic, University of Thessaly, 41335 Larissa, Greece; (D.M.); (A.D.); (M.K.); (A.K.); (E.E.T.)
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Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, Kubravi H, Sivaprasad S. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel) 2024; 14:326. [PMID: 38337841 PMCID: PMC10855126 DOI: 10.3390/diagnostics14030326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.
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Affiliation(s)
- Naomi Wijesingha
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Wei-Shan Tsai
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Ayse Merve Keskin
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Christopher Holmes
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Dimitrios Kazantzis
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Swati Chandak
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Heena Kubravi
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
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Kessler LJ, Hoffmann S, Nahm W, Bagautdinov D, Auffarth GU, Łabuz G, Khoramnia R. Impact of Lens Opacity on Optical Coherence Tomography Angiography Metrics. Curr Eye Res 2023; 48:965-972. [PMID: 37409361 DOI: 10.1080/02713683.2023.2230615] [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: 03/23/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To evaluate the impact of lens opacity on the reliability of optical coherence tomography angiography metrics and to find a vessel caliber threshold that is reproducible in cataract patients. METHODS A prospective cohort study of 31 patients, examining one eye per patient, by applying 3 × 3 mm macular optical coherence tomography angiography before (18.94 ± 12.22 days) and 3 months (111 ± 23.45 days) after uncomplicated cataract surgery. We extracted superficial (SVC) and deep vascular plexuses (DVC) for further analysis and evaluated changes in image contrast, vessel metrics (perfusion density, flow deficit and vessel-diameter index) and foveal avascular area (FAZ). RESULTS After surgery, the blood flow signal in smaller capillaries was enhanced as image contrast improved. Signal strength correlated to average lens density defined by objective measurement in Scheimpflug images (Pearson's r: -.40, p: .027) and to flow deficit (r= -.70, p < .001). Perfusion density correlated to the signal strength index (r = .70, p < .001). Vessel metrics and FAZ area, except for FAZ area in DVC, were significantly different after cataract surgery, but the mean change was approximately 3-6%. A stepwise approach in extracting vessels according to their pixel caliber showed a threshold of > 6 pixels caliber (∼20-30 µm) was comparable before and after lens removal. CONCLUSION In patients with cataract, OCTA vessel metrics should be interpreted with caution. In addition to signal strength, contrast and pixel properties can serve as supplementary quality metrics to improve the interpretation of OCTA metrics. Vessels with ∼20-30 µm in caliber seem to be reproducible.
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Affiliation(s)
| | - Simon Hoffmann
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Werner Nahm
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | | - Gerd Uwe Auffarth
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Grzegorz Łabuz
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Sivaprasad S, Sen S, Cunha-Vaz J. Perspectives of diabetic retinopathy-challenges and opportunities. Eye (Lond) 2023; 37:2183-2191. [PMID: 36494431 PMCID: PMC10366207 DOI: 10.1038/s41433-022-02335-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/16/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Diabetic retinopathy (DR) may lead to vision-threatening complications in people living with diabetes mellitus. Decades of research have contributed to our understanding of the pathogenesis of diabetic retinopathy from non-proliferative to proliferative (PDR) stages, the occurrence of diabetic macular oedema (DMO) and response to various treatment options. Multimodal imaging has paved the way to predict the impact of peripheral lesions and optical coherence tomography-angiography is starting to provide new knowledge on diabetic macular ischaemia. Moreover, the availability of intravitreal anti-vascular endothelial growth factors has changed the treatment paradigm of DMO and PDR. Areas of research have explored mechanisms of breakdown of the blood-retinal barrier, damage to pericytes, the extent of capillary non-perfusion, leakage and progression to neovascularisation. However, knowledge gaps remain. From this perspective, we highlight the challenges and future directions of research in this field.
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Affiliation(s)
- Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Sagnik Sen
- Department of Retina and Vitreous, Aravind Eye Hospital and Aravind Medical Research Foundation, Madurai, India
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - José Cunha-Vaz
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
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Shah PN, Mishra DK, Falahat P, Fischer L, Guzman G, Terheyden JH, Holz FG, Krohne TU, Finger RP, Wintergerst MWM. Inter-Rater Reliability of Proliferative Diabetic Retinopathy Assessment on Wide-Field OCT-Angiography and Fluorescein Angiography. Transl Vis Sci Technol 2023; 12:13. [PMID: 37432848 DOI: 10.1167/tvst.12.7.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Purpose To assess inter-rater reliability in the detection of proliferative diabetic retinopathy (PDR) changes using wide-field optical coherence tomography angiography (WF-OCTA) versus fluorescein angiography (FA). Methods This retrospective, cross-sectional study included patients with severe nonproliferative and PDR. Images were acquired with 12 × 12 mm WF-OCTA and FA with a 55° lens. Images were cropped to represent the exact same field of view. Qualitative (detection of neovascularization at the disc [NVD] and elsewhere [NVE], enlarged foveal avascular zone [FAZ], vitreous hemorrhage [VH]) and quantitative analyses (FAZ area, horizontal, vertical, and maximum FAZ diameter) were performed by 2 masked graders using ImageJ. Inter-rater reliability was calculated using unweighted Cohen's kappa coefficient (κ) for qualitative analyses and intraclass correlation coefficients (ICC) for quantitative analyses. Results Twenty-three eyes of 17 patients were included. Inter-rater reliability was higher for FA than for WF-OCTA in qualitative analyses: κ values were 0.65 and 0.78 for detection of extended FAZ, 0.83 and 1.0 for NVD, 0.78 and 1.0 for NVE, and 0.19 and 1 for VH for WF-OCTA and FA, respectively. In contrast, inter-rater reliability was higher for WF-OCTA than for FA in the quantitative analyses: ICC values were 0.94 and 0.76 for FAZ size, 0.92 and 0.79 for horizontal FAZ diameter, 0.82 and 0.72 for vertical FAZ diameter, and 0.88 and 0.82 for maximum FAZ diameter on WF-OCTA and FA, respectively. Conclusions Inter-rater reliability of FA is superior to WF-OCTA for qualitative analyses whereas inter-rater reliability of WF-OCTA is superior to FA for quantitative analyses. Translational Relevance The study highlights the specific merits of both imaging modalities in terms of reliability. FA should be preferred for qualitative parameters, whereas WF-OCTA should be preferred for quantitative parameters.
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Affiliation(s)
- Payal N Shah
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Divyansh K Mishra
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Peyman Falahat
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Lars Fischer
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Tim U Krohne
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
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Kapsala Z, Pallikaris A, Tsilimbaris MK. Assessment of a Novel Semi-Automated Algorithm for the Quantification of the Parafoveal Capillary Network. Clin Ophthalmol 2023; 17:1661-1674. [PMID: 37313218 PMCID: PMC10259575 DOI: 10.2147/opth.s407695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction We present a novel semi-automated computerized method for the detection and quantification of parafoveal capillary network (PCN) in fluorescein angiography (FA) images. Material and Methods An algorithm detecting the superficial parafoveal capillary bed in high-resolution grayscale FA images and creating a one-pixel-wide PCN skeleton was developed using MatLab software. In addition to PCN detection, capillary density and branch point density in two circular areas centered on the center of the foveal avascular zone of 500μm and 750μm radius was calculated by the algorithm. Three consecutive FA images with distinguishable PCN from 56 eyes from 56 subjects were used for analysis. Both manual and semi-automated detection of the PCN and branch points was performed and compared. Three different intensity thresholds were used for the PCN detection to optimize the method defined as mean(I)+0.05*SD(I), mean(I) and mean(I)-0.05*SD(I), where I is the grayscale intensity of each image and SD the standard deviation. Limits of agreement (LoA), intraclass correlation coefficient (ICC) and Pearson's correlation coefficient (r) were calculated. Results Using mean(I)-0.05*SD(I) as threshold the average difference in PCN density between semi-automated and manual method was 0.197 (0.316) deg-1 at 500μm radius and 0.409 (0.562) deg-1 at 750μm radius. The LoA were -0.421 to 0.817 and -0.693 to 1.510 deg-1, respectively. The average difference of branch point density between semi-automated and manual method was zero for both areas; LoA were -0.001 to 0.002 and -0.001 to 0.001 branch points/degrees2, respectively. The other two intensity thresholds provided wider LoA for both metrics. The semi-automated algorithm showed great repeatability (ICC>0.91 in the 500μm radius and ICC>0.84 in the 750μm radius) for both metrics. Conclusion This semi-automated algorithm seems to provide readings in agreement with those of manual capillary tracing in FA. Larger prospective studies are needed to confirm the utility of the algorithm in clinical practice.
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Affiliation(s)
- Zoi Kapsala
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
| | - Aristofanis Pallikaris
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
- Vardinoyiannion Eye Institute of Crete, Medical School, University of Crete, Heraklion, Greece
| | - Miltiadis K Tsilimbaris
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
- Vardinoyiannion Eye Institute of Crete, Medical School, University of Crete, Heraklion, Greece
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7
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Morphological Changes in the Foveal Avascular Zone after Panretinal Photocoagulation for Diabetic Retinopathy Using OCTA: A Study Focusing on Macular Ischemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121797. [PMID: 36556999 PMCID: PMC9781560 DOI: 10.3390/medicina58121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Background and objectives: This study aimed to analyze the morphological changes in the foveal avascular zone (FAZ) after panretinal photocoagulation (PRP) in patients with diabetic retinopathy, with a particular focus on the presence or absence of comorbid diabetic macular ischemia (DMI), using optical coherence tomography angiography (OCTA). Materials and Methods: Treatment-naïve 25 eyes of 16 patients who received PRP were examined in this retrospective case series. FAZ area, perimeter, and circularity were calculated on a 3 × 3-mm en-face OCTA image before PRP (baseline) and 1 and 3 months after PRP. The patients were divided into two groups according to coexisting DMI, and each group was statistically analyzed. Results: In patients with DMI (9 eyes), FAZ area significantly decreased from the baseline to 3 months after PRP (0.86 ± 0.56 to 0.61 ± 0.31 mm2, p = 0.018), whereas FAZ perimeter and circularity remained unchanged following treatment (p = 0.569 and 0.971, respectively). In patients without DMI (16 eyes), FAZ parameters did not show statistically significant changes across the 3-month follow-up period. Conclusion: PRP significantly reduces FAZ area in patients with DMI.
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Zeng QZ, Li SY, Yao YO, Jin EZ, Qu JF, Zhao MW. Comparison of 24×20 mm 2 swept-source OCTA and fluorescein angiography for the evaluation of lesions in diabetic retinopathy. Int J Ophthalmol 2022; 15:1798-1805. [PMID: 36404980 PMCID: PMC9631192 DOI: 10.18240/ijo.2022.11.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 12/12/2022] Open
Abstract
AIM To compare ultra-widefield (24×20 mm2) swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA) in the evaluation of diabetic retinopathy (DR) lesions. METHODS Forty-six eyes of 23 patients with treatment-naïve DR were included at Peking University People's Hospital from September 1, 2021, until December 31, 2021, as well as 23 age and gender matched healthy controls. Quantitative assessments of DR lesions on FA and SS-OCTA (superficial capillary plexus, SCP, 24×20 mm2) were performed. RESULTS Area of fovea avascular zone (FAZ) was larger in DR cases than controls (0.34±0.069 mm2 vs 0.287±0.108 mm2, P=0.006). In DR eyes, the mean FAZ area was 0.34±0.069 and 0.334±0.087 mm2 on SS-OCTA and FA, respectively (P=0.428), while the median FAZ perimeter was 2.382 (IQR, 2.201-2.59) and 2.333 (IQR, 2.138-2.6) mm on SS-OCTA and FA images (P=0.733). There was no significant difference in the size of the non-perfusion area (NPA) between the images on SS-OCTA and FA (12.389, IQR 4.96-28.3 and 11.125, IQR 5-28.31 mm2, P=0.197). The median total microaneurysm (MA) count was 35 (IQR, 19-46) and 73 (IQR, 43-93) on SS-OCTA and FA (P<0.001), respectively. No significant difference in intra-retinal microvascular abnormality (IRMA) and neovascularization (NV) count was found between the two techniques. The intraclass coefficient (ICCs) of all the parameters above indicated stable repeatability. CONCLUSION Ultra-widefield SS-OCTA represents a reliable, noninvasive, and quantitative imaging technique in the assessment of microvasculature in DR, which offers a potential substitute for FA in DR evaluation.
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Affiliation(s)
- Qiao-Zhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Si-Ying Li
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Yu-Ou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - En-Zhong Jin
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Jin-Feng Qu
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
| | - Ming-Wei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing 100044, China,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
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9
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Gutierrez-Benitez L, Palomino Y, Casas N, Asaad M. Automated measurement of the foveal avascular zone in healthy eyes on Heidelberg spectralis optical coherence tomography angiography. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:432-442. [PMID: 35680537 DOI: 10.1016/j.oftale.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/30/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To develop and evaluate an automated method to measure the foveal avascular zone (FAZ) area in healthy eyes on Heidelberg Spectralis Optical Coherence Tomography Angiography (HS-OCTA). This method is referred to as the modified Kanno-Saitama macro (mKSM) which is an evolution of the Kanno-Saitama macro (KSM) approach. METHODS This cross-sectional study included 29 eyes of 25 healthy volunteers who underwent HS-OCTA at the macular area twice at the same time. Regardless of the quality of the images, all of them were included. Macular data on the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus were processed by mKSM. The FAZ area was measured twice automatically using the mKSM and KSM and twice manually by two independent examiners. RESULTS From 174 images, KSM could not measure correctly 31% while mKSM could successfully measure all of them. Intrascan intraclass coefficient ranged from 0,948 to 0,993 for manual measurements and was 1 for mKSM method. Despite that the difference between human examiners is smaller than between human examiners and mKSM according to Bland-Altman plots, the scatterplots show a strong correlation between human and automatic measurements. The best results are obtained in ICP. CONCLUSIONS With mKSM, the automated determination of the FAZ area in HS-OCTA is feasible and less human-dependent. It solves the inability of KSM to measure the FAZ area in suboptimal quality images which are frequent in daily clinical practice. Therefore, the mKSM processing could contribute to our understanding of the three vascular plexuses.
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Affiliation(s)
- L Gutierrez-Benitez
- Departamento de Oftalmología, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain.
| | - Y Palomino
- Departamento de Oftalmología, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - N Casas
- Universidad Politécnica de Catalunya, Barcelona, Spain
| | - M Asaad
- Departamento de Oftalmología, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
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Elnahry AG, Abdel-Kader AA, Habib AE, Elnahry GA, Raafat KA, Elrakhawy K. Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema. Rev Recent Clin Trials 2021; 15:188-198. [PMID: 32427087 PMCID: PMC7536789 DOI: 10.2174/1574887115666200519073704] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
Background Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern. Objective To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME. Methods Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness. Results Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic patients with DME. Some of these studies, however, depended on post-hoc analysis. Several more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence tomography angiography (OCTA) in this evaluation and found more conflicting results. Conclusion The large clinical trials recently performed depended mainly on FA in the analysis of MP changes following injections and generally found no worsening of MP. More recently, smaller case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized controlled trials using OCTA are thus needed.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed E Habib
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim A Raafat
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled Elrakhawy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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11
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Elnahry AG, Elnahry GA. Optical Coherence Tomography Angiography of Macular Perfusion Changes after Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review. J Diabetes Res 2021; 2021:6634637. [PMID: 34124270 PMCID: PMC8169275 DOI: 10.1155/2021/6634637] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/14/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. METHODS Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outcome measures assessed, and the effect of injections on different MP parameters. RESULTS A total of 16 studies were included. The studies assessed various OCTA parameters that define MP including the foveal avascular zone area and superficial and deep vascular density and yielded conflicting results. Seven studies showed stable or improved MP following treatment, while 7 studies showed worsening MP following treatment, and 2 studies showed inconclusive results. This could have been due to differences in study design, inclusion criteria, type of anti-VEGF agents used, treatment duration, and methods of image analysis and vascular density quantification. All identified studies were noncomparative case series, and 14 of them (87.5%) used the RTVue XR Avanti OCTA machine. Only one study compared OCTA to fluorescein angiography findings. CONCLUSION Analysis of MP changes following VEGF inhibition for DME could benefit from a unified scanning protocol and analysis approach that uses similar study designs to eliminate potential sources of bias. This may provide more definitive conclusions regarding the effect of treatment on MP.
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Affiliation(s)
- Ayman G. Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Elnahry Eye Clinics, Giza, Egypt
| | - Gehad A. Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Elnahry Eye Clinics, Giza, Egypt
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12
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Correlation between the Nonperfusion Area on Ultra-Widefield Fluorescein Angiography and Nonflow Area on Optical Coherence Tomographic Angiography in Retinal Vein Occlusion. J Ophthalmol 2021; 2021:5581319. [PMID: 34007482 PMCID: PMC8110371 DOI: 10.1155/2021/5581319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 04/24/2021] [Indexed: 01/10/2023] Open
Abstract
Aims To compare the relationship between the nonperfusion area (NPA) on ultra-widefield fluorescein angiography (UWFFA) and the nonflow area (NFA) on optical coherence tomographic angiography (OCTA) in retinal vein occlusion (RVO). Methods Cross-sectional study. 46 eyes of 46 RVO patients who underwent UWFFA and OCTA. NPA and ischemic index (ISI) were quantified on UWWFA. NFA, vessel density (VD) of the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the size foveal avascular zone (FAZ) on 3 ∗ 3 mm OCTA were measured. The association of the NPA and ISI on UWWFA and the parameters on OCTA were analyzed. Spearman correlation was used for statistical testing. Results The NPA and ISI on UWFFA were significantly correlated with the NFA on OCTA in RVO, and r values were 0.688 (p < 0.01) and 0.680 (p < 0.01), respectively. VD in the SCP of the temporal quadrant was negatively correlated with NPA and ISI, and r values were -0.346 (p < 0.05) and -0.337 (p < 0.05), respectively. VD in the DCP of the temporal quadrant was negatively correlated with the NPA, and the r value was -0.246 (p < 0.05). No significant correlation was found between the NPA and ISI on UWFFA and VD of other quadrants in the SCP or DCP and the FAZ area on OCTA. Conclusion NPA in the peripheral retina was correlated with NFA in macula. NFA detected by OCTA could be an indicator of the ischemic status in RVO.
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13
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Elnahry AG, Ramsey DJ. Automated Image Alignment for Comparing Microvascular Changes Detected by Fluorescein Angiography and Optical Coherence Tomography Angiography in Diabetic Retinopathy. Semin Ophthalmol 2021; 36:757-764. [PMID: 33784213 DOI: 10.1080/08820538.2021.1901122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To quantitatively compare microvascular features in the macula of patients with diabetic retinopathy (DR) using fluorescein angiography (FA) and optical coherence tomography angiography (OCTA). METHODS Patients with DR were recruited from the Cairo University Hospital. FA was performed using a Topcon TRC-50DX or Heidelberg Spectralis HRA+OCT. OCTA was performed using an Optovue RTVue-XR Avanti. FA images were cropped and aligned to the corresponding OCTA images using i2k Align Retina software. The foveal avascular zone (FAZ), area of ischemia, and microaneurysms (MAs) were manually quantified using ImageJ. The fractal dimension (FD) was calculated from each skeletonized image using the FracLac plugin of ImageJ after retinal vascular segmentation. RESULTS Twenty-four eyes of 17 patients were evaluated, but only 18 eyes were successfully aligned. There was no difference in FAZ area measured for FA and OCTA images. Compared with OCTA images, FD was significantly less for FA images (1.66 ± 0.048 versus 1.72 ± 0.023, p < .001). Significantly more MAs were identified on FA images (102 ± 27.5) compared with OCTA (47.5 ± 11.7, p < .0001). The number of MAs on FA correlated with decreasing best corrected visual acuity (r2 = 0.315, p = .015) and increasing central macular thickness (r2 = 0.492, p = .001). No such associations were found with MAs detected on OCTA. Nevertheless, the area of ischemia in the FA images (8.5 ± 4.1%) was significantly smaller compared with the area measured in both the superficial (30.7 ± 9.5%) and deep capillary plexus (21.6 ± 10.9%) of the OCTA (p < .001). Interestingly, number of MAs in the FA images correlated with increasing area of ischemia in the FA (r2 = 0.568, p < .001) but only the superficial segment of the depth-resolved OCTA scans (r2 = 0.539, p < .001). CONCLUSIONS OCTA is a non-invasive tool capable of resolving the retinal vasculature in greater detail when compared with FA but detects significantly fewer MAs. Automatic alignment facilitates quantitative comparison of the microvascular features in DR.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - David J Ramsey
- Department of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Peabody, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
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14
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Cheung CMG, Pearce E, Fenner B, Sen P, Chong V, Sivaprasad S. Looking Ahead: Visual and Anatomical Endpoints in Future Trials of Diabetic Macular Ischemia. Ophthalmologica 2021; 244:451-464. [PMID: 33626529 DOI: 10.1159/000515406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
Diabetic macular ischemia (DMI) is a common complication of diabetic retinopathy that can lead to progressive and irreversible visual loss. Despite substantial clinical burden, there are no treatments for DMI, no validated clinical trial endpoints, and few clinical trials focusing on DMI. Therefore, generating consensus on validated endpoints that can be used in DMI for the development of effective interventions is vital. In this review, we discuss potential endpoints appropriate for use in clinical trials of DMI, and consider the data required to establish acceptable and meaningful endpoints. A combination of anatomical, functional, and patient-reported outcome measures will provide the most complete picture of changes that occur during the progression of DMI. Potential endpoint measures include change in size of the foveal avascular zone measured by optical coherence tomography angiography and change over time in best-corrected visual acuity. However, these endpoints must be supported by further research. We also recommend studies to investigate the natural history and progression of DMI. In addition to improving understanding of how patient demographics and comorbidities such as diabetic macular edema affect clinical trial endpoints, these studies would help to build the consensus definition of DMI that is currently missing from clinical practice and research.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Elizabeth Pearce
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Beau Fenner
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Piyali Sen
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
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15
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Tsai ASH, Jordan-Yu JM, Gan ATL, Teo KYC, Tan GSW, Lee SY, Chong V, Cheung CMG. Diabetic Macular Ischemia: Influence of Optical Coherence Tomography Angiography Parameters on Changes in Functional Outcomes Over One Year. Invest Ophthalmol Vis Sci 2021; 62:9. [PMID: 33404598 PMCID: PMC7794267 DOI: 10.1167/iovs.62.1.9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose To prospectively evaluate whether diabetic macular ischemia detected with coherence tomography angiography (OCTA) is associated with change in functional outcomes over a period of one year. Methods This is a one-year prospective, observational study that included 56 eyes with varying levels of diabetic retinopathy. All participants underwent best corrected visual acuity evaluation, swept-source OCTA and microperimetry at baseline and repeated at one year. Parafoveal vessel densities (VD) and foveal avascular zone (FAZ) areas were generated from OCTA in the superficial and deep vascular plexuses. The influence of baseline and change in OCTA parameters on change in visual acuity and retinal sensitivity over one year was evaluated. Results Over the one-year follow-up period, 16% (9) of eyes had at least one line worsening in BCVA and 7% (4) of eyes had at least 5% decrease in retinal sensitivity compared to baseline. Diabetic retinopathy progressed in 12.5%. Mean superficial vascular plexus (SVP) FAZ area increased (0.32 ± 0.15 to 0.39 ± 0.18 mm2, P = 0.003) and parafoveal VD in deep vascular plexus (DVP) decreased (49.8 ± 3.7% to 48.8 ± 2.9%, P = 0.040) at one year compared to baseline. In the multivariate regression analysis, larger baseline DVP FAZ area was associated with worsening of BCVA over one year (β = 0.16 logMAR per mm2, 95% CI 0.02 to 0.31, P = 0.032). In addition, larger decreases in SVP VD (β = -4.18 db per 10% decrease, 95% CI -6.55 to -1.80, P = 0.002) was associated with worsening of retinal sensitivity over one year. Conclusions Progression of parafoveal microvasculature changes over one year can be detected using OCTA. Larger baseline DVP FAZ area on OCTA is predictive of worsening in visual outcomes, and larger decreases in SVP VD were associated with worsening of retinal sensitivity over a course of one year in diabetic individuals.
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Affiliation(s)
- Andrew S H Tsai
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Alfred T L Gan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
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16
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Sidorczuk P, Pieklarz B, Konopinska J, Saeed E, Mariak Z, Dmuchowska D. Foveal Avascular Zone Does Not Correspond to Choroidal Characteristics in Patients with Diabetic Retinopathy: A Single-Center Cross-Sectional Analysis. Diabetes Metab Syndr Obes 2021; 14:2893-2903. [PMID: 34234487 PMCID: PMC8254029 DOI: 10.2147/dmso.s318860] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of the study was to compare two non-overlapping blood supply systems of the retina to obtain a better insight into the relation between diabetic macular retinopathy and choroidopathy. Specifically, the study focused on the relationships between (1) retinal vascular changes around the fovea in fluorescein angiography (FA) and (2) choroidal thickness, volume and other parameters assessed by optical coherence tomography (OCT). PATIENTS AND METHODS The retrospective cross-sectional single-center study included 210 eyes from 152 patients with diabetic retinopathy (mean age 60.7±12.4 years, 49.3% of women; foveal avascular zone [FAZ] outline: 44.3% grade ≤2, 55.7% grade ≥3). The outline of FAZ, a measure of capillary loss due to ischemic processes, was analyzed on FA according to the Early Treatment Diabetic Retinopathy Study Research Group (ETDRS) standards. The eyes were stratified according to the FAZ outline and size and the presence of clinically significant diabetic macular edema (CSME). Then, resultant groups were compared in terms of the spectral domain OCT parameters: choroidal thickness and volume (within ETDRS subfields), luminal, stromal and total choroidal areas and choroidal vascularity index (based on the foveal scan). Statistical analysis was based on univariate models with the choroidal parameters as independent variables, and age, sex, panretinal photocoagulation, the severity of diabetic retinopathy and CSME as covariates. RESULTS No significant relationships were found between the FAZ outline and area and choroidal characteristics of patients with diabetic retinopathy. In patients without CSME, no correlation was observed between the FAZ area and choroidal characteristics. In patients with CSME, no correlation was found between the FAZ area and choroidal characteristics other than the choroidal vascularity index. CONCLUSION In patients with diabetic retinopathy, damage to the macular retinal vasculature (FAZ) does not seem to be associated with changes in the choroidal vasculature, and these two processes appear to occur independently.
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Affiliation(s)
- Patryk Sidorczuk
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Barbara Pieklarz
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Emil Saeed
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Diana Dmuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
- Correspondence: Diana Dmuchowska Department of Ophthalmology, Medical University of Białystok, 24a M. Sklodowskiej-Curie, Bialystok, 15-276, PolandTel +48857468372Fax +48857468604 Email
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17
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Zhu Z, Liang Y, Yan B, Meng Z, Long K, Zhang Y, Luo J. Clinical effect of conbercept on improving diabetic macular ischemia by OCT angiography. BMC Ophthalmol 2020; 20:382. [PMID: 32977791 PMCID: PMC7519504 DOI: 10.1186/s12886-020-01648-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Varying degrees of macular ischemia generally occur in diabetic retinopathy (DR). This study aims to evaluate the effect of conbercept with 3+ pro re nata (PRN) on macular perfusion status in patients with diabetic macular edema (DME) and quantitatively assess changes in foveal avascular zone (FAZ) areas and capillary density in macular regions by applying optical coherence tomography angiography (OCTA). METHODS Fifty patients were divided into ischemic (n = 31) and non-ischemic (n = 19) groups according to the presence of ischemia on OCTA at baseline. All patients received intravitreal injections of 0.5 mg of conbercept with 3+ PRN principle. The FAZ areas and macular vessel density measured using OCTA were evaluated at baseline, 3 months, and 6 months after treatment in both groups. RESULTS At months 3 and 6, the FAZ area in the ischemic group changed from 0.510 ± 0.171 mm2 to 0.441 ± 0.158 mm2 then to 0.427 ± 0.153 mm2 (p = 0.003, p = 0.296); in the non-ischemic group, it remained stable (p = 0.269, p = 0.926). The superficial vessel density changed from 41.1 ± 4.1 to 42.5% ± 4.7% then to 42.6% ± 4.6% (p = 0.043, p = 0.812), and the deep vessel density changed from 40.7 ± 4.4 to 42.3% ± 3.6% then to 42.3% ± 4.7% (p = 0.072, p = 0.961) in the ischemic group. In the non-ischemic group, the superficial vessel density changed from 44.8 ± 3.2 to 46.0% ± 3.5% then to 45.7% ± 3.3% (p = 0.108, p = 0.666), whereas the deep vessel density changed from 43.6 ± 3.6 to 43.8% ± 3.2% then to 43.5% ± 4.5% (p = 0.882, p = 0.736). Reperfusion in macular nonperfusion areas was observed. CONCLUSION Anti-vascular endothelial growth factor treatment may have a positive effect on macular perfusion status. Furthermore, OCTA had advantages in quantifying and calculating blood flow index in the study of macular perfusion status.
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Affiliation(s)
- Ziyi Zhu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Youling Liang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Bin Yan
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Zhishang Meng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Kejun Long
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Yiwei Zhang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011 People’s Republic of China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan 410011 People’s Republic of China
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18
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Frizziero L, Parrozzani R, Londei D, Pilotto E, Midena E. Quantification of vascular and neuronal changes in the peripapillary retinal area secondary to diabetic retinopathy. Br J Ophthalmol 2020; 105:1577-1583. [PMID: 32933938 DOI: 10.1136/bjophthalmol-2020-316468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate and quantify peripapillary vascular and neuronal changes secondary to diabetic retinopathy, using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA). DESIGN This was a cross-sectional study. METHODS 51 eyes of 51 patients affected by non-proliferative diabetic retinopathy (NPDR) and 19 age-matched healthy control eyes underwent full ophthalmic examination, including OCT and OCTA in the peripapillary area. Vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI) were quantified in a ring-shaped region of interest of each OCTA image. Capillaries and larger vessels were separately analysed. The thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell complex (GCC) was also analysed. RESULTS VAD and VLF of peripapillary capillaries were significantly reduced in NPDR eyes, along with the progression of NPDR (p<0.05). VDI was significantly reduced in mild (p=0.0093) and moderate (p=0.0190) NPDR eyes, but not in severe NPDR (p=0.0841). Larger peripapillary vessels showed a significant increase of both VAD and VDI in NPDR eyes. pRNFL and GCC thickness decreased in NPDR eyes, reaching statistical significance only for GCC. No statistically significant correlation was found between perfusion parameters and pRNFL and GCC thickness. CONCLUSIONS Retinal capillary remodelling in NPDR involves the peripapillary vascularisation too, as confirmed by OCTA quantitative parameters. The peripapillary macrovasculature and microvasculature need to be separately evaluated. The lack of direct correlation between peripapillary capillaries changes and the loss of retinal nerve fibres suggests that neuronal damage cannot be simply considered secondary to the microvascular one.
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Affiliation(s)
| | | | - Davide Londei
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Edoardo Midena
- IRCCS - Fondazione Bietti, Rome, Italy .,Department of Ophthalmology, University of Padova, Padova, Italy
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19
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Bawany MH, Ding L, Ramchandran RS, Sharma G, Wykoff CC, Kuriyan AE. Automated vessel density detection in fluorescein angiography images correlates with vision in proliferative diabetic retinopathy. PLoS One 2020; 15:e0238958. [PMID: 32915904 PMCID: PMC7485882 DOI: 10.1371/journal.pone.0238958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the correlation between quantifiable vessel density, computed in an automated fashion, from ultra-widefield fluorescein angiography (UWFFA) images from patients with proliferative diabetic retinopathy (PDR) with visual acuity and macular thickness. Methods We performed a secondary analysis of a prospective randomized controlled trial. We designed and trained an algorithm to automate retinal vessel detection from input UWFFA images. We then used our algorithm to study the correlation between baseline vessel density and best corrected visual acuity (BCVA) and CRT for patients in the RECOVERY study. Reliability of the algorithm was tested using the intraclass correlation (ICC). 42 patients from the Intravitreal Aflibercept for Retinal Non-Perfusion in Proliferative Diabetic Retinopathy (RECOVERY) trial who had both baseline UWFFA images and optical coherence tomography (OCT) data were included in our study. These patients had PDR without significant center-involving diabetic macular edema (central retinal thickness [CRT] ≤320μm). Results Our algorithm analyzed UWFFA images with a reliability measure (ICC) of 0.98. A positive correlation (r = 0.4071, p = 0.0075) was found between vessel density and BCVA. No correlation was found between vessel density and CRT. Conclusions Our algorithm is capable of reliably quantifying vessel density in an automated fashion from baseline UWFFA images. We found a positive correlation between computed vessel density and BCVA in PDR patients without center-involving macular edema, but not CRT. Translational relevance Our work is the first to offer an algorithm capable of quantifying vessel density in an automated fashion from UWFFA images, allowing us to work toward studying the relationship between retinal vascular changes and important clinical endpoints, including visual acuity, in ischemic eye diseases.
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Affiliation(s)
- Mohammad H. Bawany
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Li Ding
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, United States of America
| | - Rajeev S. Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, United States of America
| | - Charles C. Wykoff
- Retina Consultants of Houston, Houston, Texas, United States of America
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, Texas, United States of America
| | - Ajay E. Kuriyan
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, United States of America
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States of America
- Center for Visual Science, University of Rochester, Rochester, New York, United States of America
- * E-mail:
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20
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Quantification of Microvascular Density of the Optic Nerve Head in Diabetic Retinopathy Using Optical Coherence Tomographic Angiography. J Ophthalmol 2020; 2020:5014035. [PMID: 32411429 PMCID: PMC7206883 DOI: 10.1155/2020/5014035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 01/10/2023] Open
Abstract
Aims To quantify the capillary density of the optic nerve head in healthy control eyes and different stages of diabetic retinopathy (DR) eyes and identify the parameters to detect eyes with or without DR using optical coherence tomographic angiography (OCTA). Methods In this cross-sectional study, 211 eyes of 121 participants with type 2 diabetes with different stages of DR or without DR and 73 eyes of 38 healthy age-matched controls were imaged by OCTA. Radial peripapillary capillary (RPC) plexus density and retinal nerve fiber layer (RNFL) thickness were examined. The mixed model binary logistic regression model was used to identify the parameters to detect eyes with or without DR. The area under the receiver operating characteristic (ROC) curve was calculated. Results RPC density decreased significantly in diabetic patients without DR compared with the healthy controls, and it was negatively correlated with the severity of DR (P < 0.01). RPC density was a significant parameter to distinguish diabetic eyes with or without DR (P < 0.01). The area under the ROC curve was 0.743. Conclusions Quantification of RPC density by OCTA provides evidence of microvascular changes in the optic nerve in diabetic patients. RPC density can serve as a possible biomarker in detecting eyes with DR. Larger cohort studies need to support this statement.
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21
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Khatri A, Pradhan E, Kc BK, Kharel M, Rijal RK, Timalsena S, Gurung J, Gautam S, Kc A. Detection, localization, and characterization of vision-threatening features of microaneurysms using optical coherence tomography angiography in diabetic maculopathy. Eur J Ophthalmol 2020; 31:1208-1215. [PMID: 32380861 DOI: 10.1177/1120672120924609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetic maculopathy is a leading retinal cause of blindness. This study was conducted using optical coherence tomography angiography and noninvasive imaging modalities. Microaneurysms were evaluated for location, flow, and adjacent retinal tissue changes to establish knowledge of possible vision-threatening features.Methodology: This is a hospital-based, cross-sectional observational study. Eighteen patients with diabetic maculopathy were included in the study. Fundus photo, red-free filter image, infrared images with shadowgrams, optical coherence tomography cross sections, and optical coherence tomography angiography were analyzed. Mean, standard deviation, odds ratio, and 95% confidence interval were used for statistical analysis, and p-value of <0.05 was considered statistically significant where applicable. RESULTS A total of 64 microaneurysms were evaluated. Forty-six (71.8%) microaneurysms were identifiable in all imaging modalities. In total, 53 (82.8%) were high-flow microaneurysms and 11 (17.2%) were low-flow microaneurysms. Thirty-eight of the high-flow microaneurysms (71.6% of the high-flow microaneurysms) were found in the deep capillary plexus, while only 15 (28.4% of the high-flow microaneurysms) were found in the superficial capillary plexus. Twenty-seven (71%) of the high-flow microaneurysms in deep capillary plexus were present in the areas of retinal thickening (odds ratio: 4.5, 95% confidence interval: 1.26-16.0, p = 0.02). A total of 11 microaneurysms were classified as low-flow microaneurysms and identified using fundus photo, red-free filter image, infrared images with shadowgrams, and optical coherence tomography-cross sections. They had a tendency to be present in the areas of decreased capillary plexus density (odds ratio: 25.6, 95% confidence interval: 5.09-128.7, p = 0.001). CONCLUSION Noninvasive imaging modalities combined with optical coherence tomography angiography can provide valuable information regarding microaneurysms. Certain features such as location and flow may help in predicting impending macular edema or ischemia.
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Affiliation(s)
| | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | - Muna Kharel
- Department of Ophthalmology, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Ashma Kc
- Birat Eye Hospital, Biratnagar, Nepal
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VASCULAR ABNORMALITIES IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WIDEFIELD IMAGING. Retina 2020; 39:79-87. [PMID: 29135803 DOI: 10.1097/iae.0000000000001938] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To detect vascular abnormalities in diabetic retinopathy using swept-source optical coherence tomography angiography (SS-OCTA) widefield images, and to compare the findings with color fundus photographs (CFPs) using Early Treatment Diabetic Retinopathy Study severity grading. METHODS 3 mm × 3 mm and 12 mm × 12 mm scans were acquired to cover 70° to 80° of the posterior pole using a 100-kHz SS-OCTA instrument. Two masked graders assessed the presence of vascular abnormalities on SS-OCTA and the Early Treatment Diabetic Retinopathy Study level on CFP. The grading results were then compared. RESULTS A total of 120 diabetic eyes (60 patients) were imaged with the SS-OCTA instrument. Cohort 1 (91 eyes; SS-OCTA grading only) showed microaneurysms in 91% (n = 83), intraretinal microvascular abnormalities in 79% (n = 72), and neovascularization in 21% (n = 19) of cases. Cohort 2 (52 eyes; CFP grading compared with SS-OCTA) showed microaneurysms on CFP in 90% (n = 47) and on SS-OCTA in 96% (n = 50) of cases. Agreement in intraretinal microvascular abnormality detection was fair (k = 0.2). Swept-source optical coherence tomography angiography detected 50% of intraretinal microvascular abnormality cases (n = 26), which were missed on CFP. Agreement in detecting neovascularization was moderate (k = 0.5). CONCLUSION Agreement in detection of diabetic retinopathy features on CFP and SS-OCTA varies depending on the vascular changes examined. Swept-source optical coherence tomography angiography shows a higher detection rate of intraretinal microvascular abnormalities (P = 0.039), compared with Early Treatment Diabetic Retinopathy Study grading.
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Macular Optical Coherence Tomography Angiography in Nephropathic Patients with Diabetic Retinopathy in Iran: A Prospective Case–Control Study. Ophthalmol Ther 2020; 9:139-148. [PMID: 32077043 PMCID: PMC7054472 DOI: 10.1007/s40123-020-00236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Indexed: 11/09/2022] Open
Abstract
Background Diabetic macular ischemia (DMI) is an important category of diabetic retinopathy (DR) which leads to severe visual loss. Clinically, it is defined by an enlargement of the foveal avascular zone (FAZ) that can be detected by optical coherence tomography angiography (OCTA). Studies have described a relationship between renal disease and these changes in FAZ area. The aim of this study was to compare disturbances in FAZ area in diabetic patients with or without overt nephropathy. Methods Following approval of the ethics committee, we examined diabetic patients with retinopathy. Patients were divided into two groups of DR, namely, with overt nephropathy and without overt nephropathy. The FAZ area was measured using OCTA. A P value of < 0.05 was considered to be statistically significant. Result A total of 46 patients (78 eyes) were enrolled in this study. All eyes with DR showed significant changes in FAZ area, but the sizes of the FAZ area were larger in both the superficial and deep layers in patients with clinical albuminuria than in those with no microalbuminuria (P = 0.007 and P = 0.002, respectively). Conclusion These results demonstrate that OCTA provides highly detailed information on retinal microvasculature and that it is a reliable modality to assess DR progression in patients with nephropathy. They also show that renal impairment as a systemic risk factor was associated with enlarged FAZ area in DM.
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Gurung RL, FitzGerald LM, McComish BJ, Verma N, Burdon KP. Identifying Genetic Risk Factors for Diabetic Macular Edema and the Response to Treatment. J Diabetes Res 2020; 2020:5016916. [PMID: 33274237 PMCID: PMC7683113 DOI: 10.1155/2020/5016916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). DR is complex and the term encompasses several clinical subtypes of diabetic eye disease, including diabetic macular edema (DME), the most frequent cause of central vision loss in DR patients. Both genetic and environmental factors contribute to the pathophysiology of DR and its subtypes. While numerous studies have identified several susceptibility genes for DR, few have investigated the impact of genetics on DME susceptibility. This review will focus on the current literature surrounding genetic risk factors associated with DME. We will also highlight the small number of studies investigating the genetics of response to antivascular endothelial growth factor (anti-VEGF) injection, which is used to treat DME.
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Affiliation(s)
- Rajya L. Gurung
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Liesel M. FitzGerald
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bennet J. McComish
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Nitin Verma
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Kathryn P. Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Um T, Seo EJ, Kim YJ, Yoon YH. Optical coherence tomography angiography findings of type 1 diabetic patients with diabetic retinopathy, in comparison with type 2 patients. Graefes Arch Clin Exp Ophthalmol 2019; 258:281-288. [PMID: 31832768 DOI: 10.1007/s00417-019-04517-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare optical coherence tomography angiography (OCT-A) parameters between type 1 and type 2 diabetic patients with diabetic retinopathy (DR). METHODS A total of 70 patients with type 1 diabetes and 70 with type 2 diabetes were retrospectively analyzed. DR was graded as no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). Using OCT-A, the foveal avascular zone (FAZ) area (mm2) and vascular density (VD) (%) were calculated in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS In both type 1 and 2 diabetes patients, the FAZ area (mm2) in both capillary plexuses (CP) increased with DR progression, whereas the VD (%) progressively decreased. The changes in the FAZ area and the VD were significantly greater in the DCP than in the SCP in both types of diabetes patients(p < 0.001). In the analysis of decreasing slope of the VD in the DCP, attenuation was not significant until severe NPDR stage but then abruptly decreased when it progressed to PDR stage in type 1 diabetes. In type 2 diabetes, the DCP VD decreased gradually as DR stage progressed. CONCLUSIONS As DR progression, the increasing in FAZ area and the decreasing in VD are more severe in the DCP than in the SCP in both types of diabetes. In type 1 diabetes eyes, they were remained in relatively healthy until it gets to the advanced stage of DR, while the gradual deterioration of FAZ area and VD was found from the early stage to the advanced stage of DR in type 2 diabetes.
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Affiliation(s)
- Taewoong Um
- Department of Ophthalmology, Pureun Eye Center, Jeonju, South Korea
| | - Eoi Jong Seo
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
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Tey KY, Teo K, Tan ACS, Devarajan K, Tan B, Tan J, Schmetterer L, Ang M. Optical coherence tomography angiography in diabetic retinopathy: a review of current applications. EYE AND VISION 2019; 6:37. [PMID: 31832448 PMCID: PMC6859616 DOI: 10.1186/s40662-019-0160-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/14/2019] [Indexed: 01/09/2023]
Abstract
Background Diabetic retinopathy (DR) is a leading cause of vision loss in adults. Currently, the standard imaging technique to monitor and prognosticate DR and diabetic maculopathy is dye-based angiography. With the introduction of optical coherence tomography angiography (OCTA), it may serve as a potential rapid, non-invasive imaging modality as an adjunct. Main text Recent studies on the role of OCTA in DR include the use of vascular parameters e.g., vessel density, intercapillary spacing, vessel diameter index, length of vessels based on skeletonised OCTA, the total length of vessels, vascular architecture and area of the foveal avascular zone. These quantitative measures may be able to detect changes with the severity and progress of DR for clinical research. OCTA may also serve as a non-invasive imaging method to detect diabetic macula ischemia, which may help predict visual prognosis. However, there are many limitations of OCTA in DR, such as difficulty in segmentation between superficial and deep capillary plexus; and its use in diabetic macula edema where the presence of cystic spaces may affect image results. Future applications of OCTA in the anterior segment include detection of anterior segment ischemia and iris neovascularisation associated with proliferative DR and risk of neovascular glaucoma. Conclusion OCTA may potentially serve as a useful non-invasive imaging tool in the diagnosis and monitoring of diabetic retinopathy and maculopathy in the future. Future studies may demonstrate how quantitative OCTA measures may have a role in detecting early retinal changes in patients with diabetes.
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Affiliation(s)
- Kai Yuan Tey
- Hobart Clinical School, Level 3, 43 Collins Street, Hobart, TAS 7000 Australia
| | - Kelvin Teo
- 2Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751 Singapore
| | - Anna C S Tan
- 2Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751 Singapore
| | - Kavya Devarajan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Bingyao Tan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Jacqueline Tan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Leopold Schmetterer
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Marcus Ang
- 4Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751; Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
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Pereira F, Godoy BR, Maia M, Regatieri CV. Microperimetry and OCT angiography evaluation of patients with ischemic diabetic macular edema treated with monthly intravitreal bevacizumab: a pilot study. Int J Retina Vitreous 2019; 5:24. [PMID: 31508244 PMCID: PMC6721188 DOI: 10.1186/s40942-019-0176-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Functional and anatomical evaluation of patients with ischemic diabetic macular edema after monthly injections of Bevacizumab. Methods Five eyes from five patients with diabetic macular edema associated with macular ischemia in fluorescein angiography (FA), received 6 monthly intravitreal injections of Bevacizumab. All subjects underwent SD-OCT, FA, OCT angiography (OCTA) and microperimetry at baseline and after 6 months follow-up. Primary outcome measures were improvement of best corrected visual acuity (BCVA), microperimetry and assessment of macular perfusion (foveal avascular zone size and capillary loss). Results Five patients completed the follow-up. BCVA improved from 20/180 to 20/74 (p = 0.01) and macular sensitivity improved from 11.66 to 16.26 dB (p < 0.007). We also observed that areas of ischemia on OCTA represented areas of lower macular sensitivity on microperimetry. No changes in macular perfusion status were noted. Conclusions Monthly intravitreal Bevacizumab in patients with ischemic diabetic macular edema improved BCVA and macular sensitivity without compromise of perfusion in the macula. Capillary dropout areas in OCTA correlated with lower retinal sensitivity on microperimetry.
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Affiliation(s)
- Felipe Pereira
- 1Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 821, São Paulo, SP 04023-062 Brazil
| | - Bruno Rebello Godoy
- 1Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 821, São Paulo, SP 04023-062 Brazil
| | - Mauricio Maia
- 1Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 821, São Paulo, SP 04023-062 Brazil
| | - Caio Vinicius Regatieri
- 1Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 821, São Paulo, SP 04023-062 Brazil.,2New England Eye Center, Tufts Medical School, Boston, USA
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Cicinelli MV, Cavalleri M, Brambati M, Lattanzio R, Bandello F. New imaging systems in diabetic retinopathy. Acta Diabetol 2019; 56:981-994. [PMID: 31203437 DOI: 10.1007/s00592-019-01373-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023]
Abstract
Various imaging modalities are of significant utility in the screening, grading, treatment, and follow-up of the different stages of diabetic retinopathy (DR) and diabetic macular edema. Color stereographic photography, fluorescein angiography, and optical coherence tomography (OCT) have been the gold standard for DR imaging for years. Besides these tools, newer technologies are gaining validation and popularity, such as fundus autofluorescence and OCT angiography. Furthermore, widefield retinography and ultra-widefield retinography have been introduced for a more comprehensive evaluation of the medium-far and very-far retinal peripheries, which is crucial for the assessment of the diverse manifestations of the disease. The aim of this review is to illustrate the recent advancements of the imaging systems for diagnosing DR, with a focus on the newest and noninvasive diagnostic tools.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, via Olgettina 60, 20132, Milan, Italy
| | - Michele Cavalleri
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, via Olgettina 60, 20132, Milan, Italy
| | - Maria Brambati
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, via Olgettina 60, 20132, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, via Olgettina 60, 20132, Milan, Italy.
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Park SW, Ghim W, Oh S, Kim Y, Park UC, Kang J, Yu HG. Association of vitreous vitamin C depletion with diabetic macular ischemia in proliferative diabetic retinopathy. PLoS One 2019; 14:e0218433. [PMID: 31216331 PMCID: PMC6583975 DOI: 10.1371/journal.pone.0218433] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 06/02/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose Vitreous vitamin C, as an anti-oxidant, is responsible for regulating oxygen tension and oxidative stress in the eye. Oxidative stress and retinal ischemia are implicated in the development of proliferative diabetic retinopathy (PDR). In this study, we aimed to determine whether vitreous level of vitamin C is compromised in patients with PDR and to investigate the association of diabetic macular ischemia and vitamin C. Methods This prospective study enrolled forty patients who underwent pars plana vitrectomy for the treatment of PDR (PDR group, n = 20) and idiopathic epiretinal membrane (control group, n = 20). Serum, aqueous humor, and the vitreous were collected for the analysis of vitamin C level by HPLC. Diabetic macular ischemia (DMI) in PDR group was evaluated with fluorescein angiography (FA). Results PDR patients (60.4 ± 2.1 y) were younger than non-diabetic control patients (67.4 ± 1.2 y). Serum, aqueous, and vitreous levels of vitamin C in PDR were 38.7%, 22.5%, and 11.1% of non-diabetic control group, respectively. All PDR patients had DMI (grade 1: 25%, grade 2: 30%, grade 3: 30%, grade 4: 15%). DMI grade was inversely correlated with the level of vitreous vitamin C (r = -0.546, P = 0.019), not with HbA1C, serum, or aqueous vitamin C level. In addition, the level of vitreous vitamin C (4.5 ± 2.6 μg/ml) in high DMI group (Gr 3 &4) was lower than that (31.0 ± 9.1 μg/ml) in low DMI group (Gr 1&2) (P = 0.015). Conclusions Vitreous level of vitamin C in PDR patients showed a tenfold decrease, which was associated with the degree of macular ischemia. This suggests that vitreous vitamin C depletion may cause macula ischemia in PDR patients.
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Affiliation(s)
- Sung Wook Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woonhyung Ghim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sanghyeon Oh
- Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Interdisciplinary Program in Stem Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yejin Kim
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeseung Kang
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Retinal Degeneration Laboratory, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
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Law TSM, Cheung WC, Wu F, Zhang R, Chung JPW, Wang CC, Chen X, Li TC. Endometrial Vascularization Characterized by Optical Coherence Tomography and Immunohistochemistry in Women Undergoing In Vitro Fertilization-Embryo Transfer Treatment. ACTA ACUST UNITED AC 2019; 55:medicina55040081. [PMID: 30934763 PMCID: PMC6524031 DOI: 10.3390/medicina55040081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Background and objective: Endometrial angiogenesis is a prerequisite for successful pregnancy. Optical coherence tomography (OCT) is a non-invasive physically optical imaging technique widely used in ophthalmology and cardiology. However, there is no study using OCT to evaluate endometrium. The aim of this study was to use OCT and traditionally histological methods to investigate endometrial vascularization in women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment and to determine the association with the pregnancy outcome. Methods: A total of 47 women were included in this study. OCT was used to assess endometrial vascularization by determining the high signal areas precisely on the seventh day after luteinizing hormone surge in non-conception natural cycles. Endometrial biopsies were obtained following OCT and immunohistochemistry was used to determine micro vessel and expression of vascular endothelial growth factor-A (VEGF-A) in the luminal epithelium, glandular epithelium and stroma, separately. Micro vessel counting was performed and the result was expressed as micro vessel density (MVD). A semi-quantitative H-score was used to determine the staining intensity of VEGF-A. Results: In women who successfully conceived after embryo transfer, the proportion of extensive high signal area in the uterine body detected by OCT (80%, 8/10), MVD (median number of micro vessels/mm2 of 10, range 4–17) and stromal expression of VEGF-A (median H-score of 189, range 72–395) were found to be significantly higher than those of women who did not conceive after embryo transfer in the subsequent IVF-ET treatment (OCT: 30%, 3/10; MVD: median number of micro vessels/mm2 of 7, range 4–10; VEGF-A: median H-score of 125, range 86–299, respectively). In addition, a significantly higher stromal expression of VEGF-A (median H-score of 196, range 84–395) and MVD (median number of micro vessels/mm2 of 9, range 5–16) was found in women with extensive high signal area in uterine body, compared to those with focal or no high signal area (stromal VEGF-A: median H-score of 135, range 92–302; MVD: number of micro vessels/mm2 of 6, range 4-11). Conclusions: Both immunohistochemistry and OCT demonstrated significant difference in vascularization of the peri-implantation endometrium between subjects who did and did not conceive after IVF-ET treatment. Our findings also suggest OCT appears to be a promising non-invasive or minimally invasive alternative to study endometrial vascularity in women with reproductive failure.
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Affiliation(s)
- Tracy Sze Man Law
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Wing Ching Cheung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Fangrong Wu
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Ruizhe Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Jacqueline Pui Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Chi Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong.
- School of Biomedical Science, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Mochi T, Anegondi N, Girish M, Jayadev C, Sinha Roy A. Quantitative Comparison Between Optical Coherence Tomography Angiography and Fundus Fluorescein Angiography Images: Effect of Vessel Enhancement. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e175-e181. [PMID: 30457653 DOI: 10.3928/23258160-20181101-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the vascular parameters derived from optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) images. PATIENTS AND METHODS Twenty-two eyes of 22 patients were imaged with OCTA and FFA. FFA images were cropped to the same dimension as OCTA images after registration. Vessel enhancement using a Frangi filter and local fractal analysis was applied to the superficial layer of the OCTA and cropped FFA images. Foveal avascular zone (FAZ) area, vessel density, spacing between large vessels, and spacing between small vessels were quantified. RESULTS FAZ area was similar between original OCTA, Frangi-filtered OCTA, and FFA images (P = .32). Actual OCTA images had significantly higher vessel density (35.2% ± 1.45%, P < .001) than Frangi-filtered OCTA images (29.8% ± 0.78%) and Frangi-filtered FFA images (25.5% ± 2.41%). Spacing between large vessels was significantly lower in original OCTA images (31.9% ± 1.47%, P < .001) than Frangi-filtered OCTA images (36.8% ± 1.24%) and Frangi-filtered FFA images (60.1% ± 2.68%). Further, FFA images had significantly lower spacing between small vessels (14.4% ± 0.43%, P < .001) than original OCTA images (32.7% ± 1.03%) and Frangi-filtered OCTA images (33.4% ± 0.81%). CONCLUSION FAZ area was similar between OCTA and FFA, independent of vessel enhancement. However, vessel enhancement improved the agreement of vascular parameters between OCTA and FFA images of the same eye. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e175-e181.].
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Retinal vascular density evaluated by optical coherence tomography angiography in macular telangiectasia type 2. Int Ophthalmol 2019; 39:2245-2256. [PMID: 30607862 DOI: 10.1007/s10792-018-01060-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the retinal and choroidal vascular changes through optical coherence tomography angiography (OCTA) in patients with macular telangiectasia type 2 (MacTel 2). METHODS Our study included 20 patients (40 eyes) with MacTel 2, and age-matched and sex-matched 18 subjects (36 eyes) in the control group. Fundus color photographs, fundus autofluorescence, fundus fluorescein angiography, spectral-domain optical coherence tomography and OCTA were performed. Foveal vascular density and parafoveal vascular density (PFVD), and foveal retinal thickness and parafoveal retinal thickness, choroidal thickness (CT) and retinal ganglion cell-inner plexiform layer (GCIPL) were compared between MacTel 2 patients and normal age-matched controls. RESULTS The retinal whole vascular density and PFVD of the deep plexus were significantly lower in patients with MacTel 2 than that of the control group (56.93% vs. 58.54%, p = 0.003; and 60.38% vs. 61.66%, p = 0.045). The foveal avascular zone (FAZ) of the deep plexus was significantly enlarged in patients with MacTel 2 than that of the control group (0.44 vs. 0.36, p = 0.009). There was a positive and statistically significant correlation between the FAZ of the superficial and deep plexus and CT in patients with MacTel 2. There was a positive and statistically significant correlation between retinal whole, parafoveal temporal quadrant vascular density of the superficial and deep plexus and GCIPL thickness in patients with MacTel 2. CONCLUSIONS Our study demonstrated that important retinal vascular density and FAZ changes in MacTel 2 occur in the deep capillary plexus of the retina.
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Cohen SY, Miere A, Nghiem-Buffet S, Fajnkuchen F, Souied EH, Mrejen S. Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years. Eur J Ophthalmol 2018; 28:491-502. [PMID: 29554812 DOI: 10.1177/1120672117753704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.
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Affiliation(s)
- Salomon Y Cohen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France.,2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Alexandra Miere
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | | | | | - Eric H Souied
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Sarah Mrejen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France
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Khadamy J, Abri Aghdam K, Falavarjani KG. An Update on Optical Coherence Tomography Angiography in Diabetic Retinopathy. J Ophthalmic Vis Res 2018; 13:487-497. [PMID: 30479720 PMCID: PMC6210870 DOI: 10.4103/jovr.jovr_57_18] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a novel non-invasive imaging modality for 3-dimensional visualization of retinal and optic nerve capillary networks. In this article, a comprehensive review of relevant original articles in the PubMed database was performed using the search terms "diabetic retinopathy," "diabetic macular edema," "diabetes mellitus," and "optical coherence tomography angiography." OCTA was found to detect microvascular changes early in diabetes mellitus, even before they become clinically evident. Morphological and qualitative assessment of vascular changes can help to determine the pathophysiological processes, activity, treatment, and follow-up of diabetic retinopathy (DR). Vessel density and foveal avascular zone are the most investigated quantified indices shown to be early predictors of DR, correlated to DR severity and visual function, and useful in predicting response to treatment. OCTA has shown to be a promising alternative to fluorescein angiography in the management of DR. Further studies are warranted to determine the role of OCTA in the routine clinical management of DR.
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Affiliation(s)
- Joobin Khadamy
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Abri Aghdam
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Yoon YS, Woo JE, Woo JM. Optical Coherence Tomography Angiography According to Severity of Diabetic Retinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.6.653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Yo Sep Yoon
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Eun Woo
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Je Moon Woo
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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