Comparison between Findings in Optical Coherence Tomography Angiography and in Fluorescein Angiography in Patients with Diabetic Retinopathy

Abstract

<b><i>Objective:</i></b> To compare typical findings of diabetic retinopathy in optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). <b><i>Subjects/Methods:</i></b> 42 patients were enrolled in this study. We performed FA and obtained en face 3 × 3 mm OCTA images of the macular region. The count of microaneurysms (MAs) and the size of the foveal avascular zone (FAZ) were compared. The assessability of the imaging modalities was graded in each eye. <b><i>Results:</i></b> 53 eyes of 42 patients with a mean age of 61 years were included. 36/53 eyes revealed nonproliferative diabetic retinopathy, 17/53 eyes had proliferative diabetic retinopathy. The mean size of the FAZ was 0.39 mm<sup>2</sup> in FA and 0.42 mm<sup>2</sup> in OCTA. The mean MA count was 14 in FA and 13 in OCTA. The assessability was favorable to OCTA in 38–41/53 eyes regarding the FAZ and favorable to FA in 45–49/53 eyes regarding MAs. <b><i>Conclusion:</i></b> We found a good agreement for the size of the FAZ and a weak agreement regarding the count of MAs in both imaging modalities. The readers favored OCTA for the assessment of the FAZ and FA for the assessment of MAs. Complementary use of FA and OCTA ensures the best diagnostic approach in patients with diabetic retinopathy.

Quantification of diabetic macular ischemia: Assessing agreement and reproducibility between Optical coherence tomography angiography and Fluorescein angiography

“…suggest that the OCTA may be used for the diagnosis of diabetic macular ischemia, once validated in a larger population. 11,21 The grade of macular ischemia contributes to DR worsening; even more than systemic factors,…”

“…10 However, it requires specific supplies, trained personnel and it is a time-consuming method, requiring up to 10 minutes for acquisition. 11 Moreover, it is an invasive technique that involves venipuncture of dye with documented side effects like nausea, vomiting, yellow pigmentation of skin and urine, and, in rare cases, anaphylaxis and death. 10 The recent development of Optical Coherence Tomography Angiography (OCTA) offers an alternative to FA, as a noninvasive three-dimensional cross-sectional imaging of retinal vasculature.…”

“…Furthermore, early changes provoked by retinal diseases, as remodeling of the FAZ, vascular tortuosity, narrowing of capillary lumen and capillary dilation, cannot be seen in the FA as in the OCTA. 11 Although the clinical application of OCTA is still limited in DMI by factors like segmentation errors, and the lack of ideal automatic algorithms to resolve these, the need for good patient fixation, sensitivity to minor eye movements, the lack of optimal algorithms that correct these motion artefacts, and discrepancy between measurements using different commercial devices, suggests that OCTA may be the gold standard for DMI within the next few years. 14 Therefore, the purpose of this study was to assess…”

Evaluation der automatisierten Messung von ischämischen Veränderungen der Makula bei diabetischer Makulopathie

“…Frühe Veränderungen, die in der OCTA bei Patienten mit nicht proliferativer DR (NPDR) zu beobachten sind, sind vaskuläre Umbauten an der Grenze zur FAZ, vaskuläre Tortuosität, Verengung der Kapillarlumen und Kapillardilatation. Diese Änderungen sind in der FA nicht so gut zu sehen aufgrund der Fluoresceinextravasation und der Maskierung durch die Hintergrundfluoreszenz [11]. Mit der OCTA können bislang vor allem zentrale Netzhautareale zuverlässig und detailliert untersucht werden, wohingegen mit der FA durch Weitwinkelaufnahmen auch periphere Netzhautareale untersucht werden können und periphere nicht perfundierte Areale und periphere Neovaskularisationen erkannt werden können.…”

“…Die beiden Verfahren sollten daher komplementär eingesetzt werden. Wir konnten in früheren Arbeiten zeigen, dass die FAZ als typischer Marker einer diabetischen Makulopathie in der OCTA mithilfe einer manuellen Ausmessung besser ausgewertet werden kann als in der FA [6,12]. Fortschritte der Verarbeitungssoftware der von uns genutzten OCTA-Geräte erlauben inzwischen unter anderem auch eine automatisierte Ausmessung der FAZ hinsichtlich der Fläche, des Umfangs und des Zirkularitätsindexes im superfiziellen retinalen Gefäßplexus.…”