Diabetic vascular hyperpermeability: optical coherence tomography angiography and functional loss assessments of relationships among retinal vasculature changes

Abstract

Our study assessed the influence of vascular permeability on vascular flow density (FD)-correlated retinal sensitivity (RS) in DR. In this cross-sectional, prospective, consecutive study, RS in the extrafoveal macula of DR patient was measured by microperimetry. FD was measured in the total, superficial, and deep capillary plexus layers (TCP, SCP, and DCP) by optical coherence tomography angiography. All measurement points were classified into four categories according to intensity of fluorescein leakage and FD, and the RS reduction was compared. A stratified analysis by retinal thickness (RT) was also performed. Fourteen eyes (14 patients) were enrolled. FDs at 207 RS measurement points were analyzable. For TCP, SCP and DCP, the leakage did not decrease RS at points where FD was maintained. The greater the leakage, the smaller the RS reduction at points with low FD in TCP (P = .020). Points with high leakage showed a significant smaller RS reduction than points with low leakage (P = .001 for TCP, P = .040 for SCP, and P = .046 for DCP) only in areas with low RT and low FD. Our results suggested that vascular hyperpermeability may inhibit the RS reduction in the non-edematous ischemic diabetic retina.

Optical coherence tomography angiography in diabetic retinopathy

“…To date, it is unclear whether there is a correlation between OCT metrics and microperimetry outputs in patients with diabetic eye disease ( Sachdev et al, 2019 ); recent work identified a correlation between OCTA-assessed vessel density (but not FAZ area) and microperimetry-assessed retinal sensitivity in eyes with advanced DR, but not in eyes with lower grades of severity ( Levine et al, 2022 ) and in eyes with retinitis pigmentosa ( Hagag et al, 2019 ). By using microperimetry and OCTA quantitative flow density, Arima et al showed that vascular hyperpermeability may inhibit the retinal sensitivity reduction in the non-edematous ischemic diabetic retina ( Arima et al, 2021 ). These findings highlight the potential value of combining these innovative tools for a more comprehensive understanding of the functional and structural implications of diabetic eye diseases.…”