Optical coherence tomography angiography: microvascular alterations in diabetic eyes without diabetic retinopathy

Agra, Cristiana Lumack do Monte; Lira, Rodrigo Pessoa Cavalcanti; Pinheiro, Fernanda Galvão; Sá, Larissa Halley Soares e; Bravo-Filho, Vasco

doi:10.5935/0004-2749.20210023

Cited by 11 publications

(5 citation statements)

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“…In contrast, some studies deny OCTA as the most appropriate tool for detecting preclinical changes in patients with diabetes, suggesting that clinical examinations and glycaemic control should be kept on as the primary clinical parameter during DR screening [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

et al. 2021

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Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.

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Section: Resultsmentioning

confidence: 99%

Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

et al. 2021

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“…The structural and ow calculation abilities of the retinal vasculature in the OCTA software might directed researchers to apply OCTA in the diagnose of preclinical DRP, and along with primary care partners to achieve a better clinical and ophthalmological outcome by controlling glycemia, blood pressure and other biochemical components. Across these studies, there is no widely accepted consensus on the vascular densities or perfusion changes of retinal plexus and choriocapillaris according to the recent OCTA studies comparing the non-DRP patients and healthy controls [20,[23][24][25][26]. However, patients with nonproliferative DRP or proliferative DRP mostly represented with decreased vessel and perfusion densities and increased FAZ dimensions [23,25,27].…”

Section: Discussionmentioning

confidence: 99%

“…Agra CLDM et al compared the OCTA results between type 2 diabetes and controls with a close objective and methodology to our study, and they reported no difference on the super cial and deep VDs and FAZ area, and resulted slight but signi cant excess of CC ow area (mm 2 ) resembling our results. They discussed OCTA may not be in the expected position for ensuring an early diagnosis of DRP, and nowadays it cannot replace the clinical funduscopic examinations due to their statistically signi cant, but clinically insigni cant changes [20]. CC, which is a dense vascular network is essential for nutrition and oxygen supply of the outer retinal cells such as photoreceptors and retinal pigment epithelium to maintain normal vision [32].…”

Section: Discussionmentioning

confidence: 99%

“…Screenings with a signal strength index below 40 and a central macular thickness over 300µm (due to any type of macular oedema and/or diffuse thickening of intraretinal layers and/or any type of intra retinal uid), and unreliable scans (due to disruption of the microvascular structure) were excluded to standardise the results between groups [17]. The automated angio-analytic software of version 2018.1.0.43 was used for the analysis of super cial macular (VD-SP, the segmentation was adjusted between 3 µm below the internal limiting membrane and 15 µm below the inner line of internal plexiform layer), deep macular (VD-DP, from 15 µm below the inner line of the internal plexiform layer to 70 µm below the inner border of the inner plexiform retinal layer) and choriocapillaris (VD-CC, 30 µm below the junction of the retinal pigment epithelium and Bruch's membrane) structures (%) [18][19][20]. Also, foveal avascular zone (FAZ) area (mm 2 ), FAZ perimetry (mm), total retinal VD 300µm around the FAZ perimetry (FD, %), acirculatory index (AI) which shows the ratio between perimeter of the FAZ to perimeter of a circle with equal area [21,22].…”

Section: Ophthalmological Evaluation and Exclusion Criteriamentioning

confidence: 99%

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Comparison of the macular vascular densities between molecularly confirmed MODY patients with GCK variants and age-matched healthy controls

Çavdarlı

Büyükyılmaz²,

Çavdarlı³

et al. 2023

Preprint

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Background: Several structural, vascular density and perfusion studies were conducted in type 1 and 2 diabetes, even in the absence of retinopathy. The current study is the first to compare macular vessel densities (VD) by optical coherence tomography angiography (OCTA) between maturity onset diabetes of the young (MODY) patients and healthy controls. Methods: The macular VD of superficial, deep retina, and choriocapillaris, and central macular thickness (CMT), foveal avascular zone area (FAZ), FAZ perimetry, VD of total retina at 300µm around the FAZ (FD), acirculatory index (AI) measurements were captured by the OCTA, which operates with built into software (RTVue-XR100-2 Avanti, Angiovue), and were compared between molecularly confirmed (GCK mutations) MODY patients and controls. Results: Twenty-five MODY patients and 30 controls were included. Mean plasma HbA1c level of the MODY group was 6.39±0.38 (min:5,4 max:6,9, %). Average age was 13.8±2.1 in the MODY group, and was 12.6±2.5 years among controls. There was no significant difference in terms of age, superficial and deep retinal VD, FAZ, FAZ perimetry, CMT, FD, and AI between groups. Significant increase of VD only at the parafoveal and perifoveal regions of choriocapillaris in the MODY group was observed (P=0.034 and P=0.009). Conclusion: No significant difference of macular VD was observed between non-retinopathic MODY patients and controls, except VD of choriocapillaris at the parafovea and perifovea. Previous thickness and VD results were distributed in a wider range suggesting not yet defined factors may be affecting the choroidal vasculature independent of glycemia or as a contributing factor.

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“…Most of the previous studies on the retinal changes of diabetic patients without diabetic retinopathy by OCTA showed a significant reduction in retinal vessel density ( Cao et al, 2019 ; Zeng et al, 2019 ; Zhang et al, 2021 ). But Agra et al found that there were no significant differences in retinal microvascular parameters between diabetic patients without diabetic retinopathy and controls ( Agra et al, 2021 ). In our study, no significant differences were found in OCTA parameters between IS patients with or without diabetes, suggesting that diabetes might not affect the OCTA parameters in IS patients.…”

Section: Discussionmentioning

confidence: 99%

Retinal Neurovascular Changes in Patients With Ischemic Stroke Investigated by Optical Coherence Tomography Angiography

Liang

Xiao²,

Zeng³

et al. 2022

Front. Aging Neurosci.

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BackgroundTo investigate retinal neurovascular structural changes in patients with ischemic stroke (IS) using optical coherence tomography angiography (OCTA).Materials and MethodsThe cross-sectional study was conducted in Guangdong Provincial People’s Hospital, China, consisting of 159 eyes from IS patients and 109 eyes from age-matched control subjects. Retinal microvascular parameters including the vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and neural parameters such as ganglion cell complex thickness (GCCt) and retinal nerve fibre layer thickness (RNFLt) were measured by OCTA.ResultsThe VD of SCP and DCP in the macular area were significantly reduced in IS patients compared to the control group (all p < 0.001). The VD of RPC at the optic disc was also significantly reduced in IS patients (all p < 0.05). IS patients showed reduced GCCt and RNFLt and increased GCC focal loss volume and global loss volume compared with the controls (all p < 0.05). Among patients with IS, the parafovea SCP VD was positively correlated with GCCt (r = 0.346–0.408, all p < 0.001) but not with DCP VD (all p > 0.1). In the optic disc region, the whole image RPC VD was positively correlated with mean RNFLt (r = 0.467–0.548, all p < 0.001).ConclusionReduction of retinal VD, GCCt and RNFLt was observed in patients with IS. The parafovea SCP VD and RPC VD were positively correlated with GCCt and RNFLt, respectively.

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Optical coherence tomography angiography: microvascular alterations in diabetic eyes without diabetic retinopathy

Cited by 11 publications

References 0 publications

Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

Comparison of the macular vascular densities between molecularly confirmed MODY patients with GCK variants and age-matched healthy controls

Retinal Neurovascular Changes in Patients With Ischemic Stroke Investigated by Optical Coherence Tomography Angiography

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