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Abdel-Kader AA, Ramsey DJ, Yussuf WA, Mohalhal AA, Eldaly MA, Elnahry AG. Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography. Indian J Ophthalmol 2023; 71:3085-3090. [PMID: 37530285 PMCID: PMC10538827 DOI: 10.4103/ijo.ijo_3155_22] [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: 12/02/2022] [Revised: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual-Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results Twenty-eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low-flow regions, likely because capillary loss is associated with their regression.
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Affiliation(s)
- Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Wael A Yussuf
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Mohalhal
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Eldaly
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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Wang M, Wang Y, Xie T, Zhan P, Zou J, Nie X, Shao J, Zhuang M, Tan C, Tan J, Dai Y, Sun J, Li J, Li Y, Shi Q, Leng J, Wang X, Yao Y. Prostaglandin E 2/EP 2 receptor signalling pathway promotes diabetic retinopathy in a rat model of diabetes. Diabetologia 2019; 62:335-348. [PMID: 30411254 DOI: 10.1007/s00125-018-4755-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Diabetic retinopathy is a common microvascular complication of diabetes mellitus and is initiated by inflammation and apoptosis-associated retinal endothelial cell damage. Prostaglandin E2 (PGE2) has emerged as a critical regulator of these biological processes. We hypothesised that modulating PGE2 and its E-prostanoid receptor (EP2R) would prevent diabetes mellitus-induced inflammation and microvascular dysfunction. METHODS In a streptozotocin (STZ)-induced rat model of diabetes, rats received intravitreal injection of PGE2, butaprost (a PGE2/EP2R agonist) or AH6809 (an EP2R antagonist). Retinal histology, optical coherence tomography, ultrastructure of the retinal vascular and biochemical markers were assessed. RESULTS Intravitreal injection of PGE2 and butaprost significantly accelerated retinal vascular leakage, leucostasis and endothelial cell apoptosis in STZ-induced diabetic rats. This response was ameliorated in diabetic rats pre-treated with AH6809. In addition, pre-treatment of human retinal microvascular endothelial cells with AH6809 attenuated PGE2- and butaprost-induced activation of caspase 1, activation of the complex containing nucleotide-binding domain and leucine rich repeat containing family, pyrin domain containing 3 (NLRP3) and apoptosis-associated speck-like protein containing a C-terminal caspase-activation and recruitment domain (ASC), and activation of the EP2R-coupled cAMP/protein kinase A/cAMP response element-binding protein signalling pathway. CONCLUSIONS/INTERPRETATION The PGE2/EP2R signalling pathway is involved in STZ-induced diabetic retinopathy and could be considered as a potential target for diabetic retinopathy prevention and treatment.
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Affiliation(s)
- Man Wang
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Yangningzhi Wang
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Tianhua Xie
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Pengfei Zhan
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Jian Zou
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Xiaowei Nie
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
- Wuxi Institute of Translational Medicine, Wuxi, Jiangsu, People's Republic of China
| | - Jun Shao
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Miao Zhuang
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Chengye Tan
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Jianxin Tan
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Youai Dai
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Jie Sun
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China
| | - Jiantao Li
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yuehua Li
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Department of Pathophysiology, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Qian Shi
- Yixing Eye Hospital, Wuxi, Jiangsu, People's Republic of China
| | - Jing Leng
- Cancer Center, Department of Pathology, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiaolu Wang
- Center of Clinical Research, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China.
- Wuxi Institute of Translational Medicine, Wuxi, Jiangsu, People's Republic of China.
| | - Yong Yao
- Department of Ophthalmology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi, Jiangsu, People's Republic of China.
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Lee CS, Lee AY, Sim DA, Keane PA, Mehta H, Zarranz-Ventura J, Fruttiger M, Egan CA, Tufail A. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography. Am J Ophthalmol 2015; 159:101-10.e1. [PMID: 25284762 DOI: 10.1016/j.ajo.2014.09.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the agreement between clinical examination, spectral-domain ocular coherence tomography (SD OCT), and fluorescein angiography (FA) in diagnosing intraretinal microvascular abnormality (IRMA) and neovascularization elsewhere (NVE) and define the SD OCT features that differentiate NVEs from IRMAs. DESIGN Retrospective study. METHODS Data were collected from 23 lesions from 8 diabetic patients, seen from July 2012 through October 2013 at Moorfields Eye Hospital, United Kingdom. Main outcomes were SD OCT features and FA leakage of IRMA and neovascular complex. The agreement between 3 evaluations was analyzed by Fleiss' kappa. RESULTS The following 5 SD OCT features significantly differentiated IRMAs from NVEs: (1) hyperreflective dots in superficial inner retina (P = .002); (2) the outpouching of internal limiting membrane (ILM) (P = .004); (3) the breach of ILM (P = .004); (4) the breach of posterior hyaloid (P = .0005); (5) hyperreflective dots in vitreous (P = .008). The agreement was moderate between 3 evaluations (κ = 0.48, P = 7.11 × 10(-5)) but substantial between clinical and SD OCT evaluation (κ = 0.72, P = .00055). There was no significant agreement between OCT evaluation and FA leakage (κ = 0.249, P = .232). CONCLUSIONS SD OCT will be a valuable adjunct in evaluating IRMA and NVE, since it can verify the histopathologic correlate. SD OCT provides subtle anatomic insights and may be more accurate than clinical examination or leakage on FA, our current method of diagnosing this important endpoint, which has implications in future trial design for proliferative diabetic retinopathy prevention.
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Affiliation(s)
- Cecilia S Lee
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Aaron Y Lee
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Pearse A Keane
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom
| | - Hemal Mehta
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Javier Zarranz-Ventura
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Marcus Fruttiger
- University College London, Institute of Ophthalmology, London, United Kingdom
| | - Catherine A Egan
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Adnan Tufail
- Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
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