Correlation Between Cystoid Spaces in Chronic Diabetic Macular Edema and Capillary Nonperfusion Detected by Optical Coherence Tomography Angiography

Mané, Valérie; Dupas, B.; Gaudric, Alain; Bonnin, Sophie; Pedinielli, Alexandre; Bousquet, Elodie; Erginay, Ali; Tadayoni, Ramin; Couturier, Aude

doi:10.1097/iae.0000000000001289

Cited by 74 publications

(82 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, Spaide et al 40 showed that anti-VEGF therapy results in resolution of edema without changes in the nonperfusion area. Mané et al 41 have also indicated that anti-VEGFassociated reperfusion is unlikely to occur but the capillaries already present above the cystoid spaces became visible in eyes with resolved DME. Based on the current study, we speculate that in eyes with macular edema with well-established areas of capillary dropout before treatment, the retinal capillaries may not return even after resolution of the edema.…”

Section: Discussionmentioning

confidence: 99%

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Winegarner

Wakabayashi

Fukushima

et al. 2018

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

PURPOSE. To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes.METHODS. The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed.RESULTS. The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R 2 ¼ 0.524, P < 0.001 and R 2 ¼ 0.457, P < 0.001, respectively) and at 12 months (R 2 ¼ 0.521, P < 0.001 and R 2 ¼ 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P ¼ 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P ¼ 0.02) after treatment.CONCLUSIONS. Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Winegarner

Wakabayashi

Fukushima

et al. 2018

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

show abstract

“…Several studies also suggest that OCTA parameter alterations in the deep vascular layer are affected more severely than in the superficial vascular layer in NPDR [10, 11, 14-16, 17, 21, 23, 26]. OCTA parameters at the deep vascular layer were most significantly affected in patients with DME [4, 29-32]. …”

Section: Discussion/conclusionmentioning

confidence: 99%

“…In a study involving patients with DME, all cases had lost the regular vascular pattern in the deep vascular layer [29]. Decorrelation signal-void areas around intraretinal cystoid spaces were present in 71% of the cases in the superficial vascular layer and in 96% of the cases in the deep vascular layer.…”

Section: Octa Parameters In the Superficial Deep And/or Intermediatmentioning

confidence: 99%

Implication of Deep-Vascular-Layer Alteration Detected by Optical Coherence Tomography Angiography for the Pathogenesis of Diabetic Retinopathy

Dimitrova¹,

Chihara²

2019

Ophthalmologica

View full text Add to dashboard Cite

The aim of this narrative mini review is to analyze optical coherence tomography angiography (OCTA) parameters from reports that involved both superficial and deep vascular layers in patients with diabetes and to assess their relevance for the pathogenesis of diabetic retinopathy (DR). Papers published from January 2015 to August 2018 describing the use of OCTA in diabetes were identified and reviewed through a Medline/PubMed search. OCTA studies suggest that parameters are altered in patients with diabetes in all retinal vascular layers. From all included studies that evaluated both the superficial and the deep vascular layer, a number of studies suggested that the deep vascular layer was affected at an earlier stage of DR. OCTA parameter alterations were more prominent in the deep vascular layer than in the superficial vascular layer in patients with DR, and deep-vascular-layer alterations were most evident in patients with diabetic macular edema. Regarding that retinal venules originate from the deep vascular layer of the retina, alteration of OCTA parameters at the deep vascular layer in diabetic patients may imply a predominant affection of the venous side of the retinal vascular system in the pathogenesis of DR.

show abstract

“…26,27 Capillary density of both plexuses is correlated to visual loss in diabetic retinopathy, 28 branch retinal vein occlusion, 29,30 and idiopathic macular telangiectasia type 1 (MacTel1). 31 In addition, several investigators have shown that decreased perfusion is more frequent in the deep than superficial plexus, in central or branch vein occlusion, 32-34 diabetic retinopathy, 35 and MacTel1. 36 In resolved branch retinal vein occlusion, deep plexus nonperfusion has recently been identified as a more critical determinant of BCVA than superficial plexus nonperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…36 Deep plexus disruption could also result from tissue displacement by cystoid edema cavities, but the possibility of small interconnected capillaries forming this plexus to be stretched by edema is unlikely. 35,36 Finally, it could also result from shadowing or edema-related signal artifacts. 33,36,37 Here, the causal relationship between edema formation and deep plexus alteration was possibly indicated by the stronger correlation of CMT (and CMT change) with deep plexus changes, assessed by grading, vascular density, and local fractal dimension, than with superficial plexus changes (see Table 4).…”

Section: Discussionmentioning

confidence: 99%

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Matet

Daruich

Zografos

2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

PURPOSE. To analyze microvascular and structural changes in radiation maculopathy and their influence on visual acuity (VA), using optical coherence tomography (OCT) and OCT angiography (OCTA).METHODS. This was a retrospective analysis of consecutive patients with radiation maculopathy, 12 months or more after proton-beam irradiation for uveal melanoma, imaged with fluorescein angiography, OCT, and OCTA. Clinical parameters potentially affecting VA were recorded, including OCTA-derived metrics: foveal avascular zone (FAZ) area, vascular density, and local fractal dimension of the superficial (SCP) and deep capillary plexuses (DCP). Nonirradiated fellow eyes served as controls. RESULTS.Ninety-three patients were included. FAZ was larger, while SCP/DCP capillary density and local fractal dimension were lower in the 35 irradiated than in the 35 fellow eyes (P < 0.0001). Microvascular alterations graded on fluorescein angiography (minimally damaged/ disrupted/disorganized) were correlated to FAZ area and SCP/DCP density on OCTA (P < 0.01). By univariate analysis, worse VA was associated to macular detachment at presentation (P ¼ 0.024), total macular irradiation (P ¼ 0.0008), higher central macular thickness (CMT) (P ¼ 0.019), higher absolute CMT variation (P < 0.0001), cystoid edema (P ¼ 0.030), ellipsoid zone disruption (P ¼ 0.002), larger FAZ (P < 0.0001), lower SCP (P ¼ 0.001) and DCP capillary density (P < 0.0001), and lower SCP (P ¼ 0.009) and DCP local fractal dimension (P < 0.0001). Two multivariate models with either capillary density or fractal dimension as covariate showed that younger age (P ¼ 0.014/0.017), ellipsoid zone disruption (P ¼ 0.034/0.019), larger FAZ (P ¼ 0.0006/0.002), and lower DCP density (P ¼ 0.008) or DCP fractal dimension (P ¼ 0.012), respectively, were associated with worse VA.CONCLUSIONS. VA of eyes with radiation maculopathy is influenced by structural and microvascular factors identified with OCTA, including FAZ area and DCP integrity.

show abstract

Correlation Between Cystoid Spaces in Chronic Diabetic Macular Edema and Capillary Nonperfusion Detected by Optical Coherence Tomography Angiography

Abstract: In chronic DCME, cystoid spaces were located within capillary dropout areas. No reperfusion occurred after DCME resolution. The impact of the severity of this nonperfusion on the risk of recurrence of DCME remains to be clarified.

Cited by 74 publications

References 19 publications

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion

Implication of Deep-Vascular-Layer Alteration Detected by Optical Coherence Tomography Angiography for the Pathogenesis of Diabetic Retinopathy

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Contact Info

Product

Resources

About