OCT Angiography Metrics Predict Progression of Diabetic Retinopathy and Development of Diabetic Macular Edema

Sun, Zihan; Tang, Fang; Wong, Raymond Siu Ming; Lok, Jerry; Szeto, Simon; Chan, Jason C. K.; Chan, Carmen K. M.; Tham, Clement C.; Ng, David C.; Cheung, Carol Y.

doi:10.1016/j.ophtha.2019.06.016

Cited by 202 publications

(171 citation statements)

References 56 publications

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“…Several studies suggest that a reduction of VD at SCP and DCP may precede the retinal alterations through fundus examination; in particular, impairment of DCP represents a biomarker for both early diagnosis of DR and risk of progression [31]. We observed significant microvascular abnormalities in patients without other comorbidities such as hypertension and dyslipidemia, and therefore we considered that the microvascular abnormalities may be associated only with metabolic dysregulation in diabetes [32].…”

Section: Morphological (Sd-oct Octa and Ao) Datamentioning

confidence: 88%

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

et al. 2020

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Introduction: This study aimed to evaluate the effect of treatment with eye drops containing citicoline and vitamin B 12 on changes in function of the inner retina, morphology of the inner and outer retina, and microvascular condition in patients with type 1 diabetes (DM1) with mild signs of non-proliferative diabetic retinopathy (NPDR) during 3 years of follow-up. Methods: A pilot study with prospective, randomized, and double-masked design was conducted to address the aims. Twenty patients with DM1 were enrolled and randomly divided into two groups: the DC group comprising patients treated with citicoline and vitamin B 12 eye drops (10 patients; mean age ± standard deviation, 46.86 ± 8.78 years) and the DP group comprising those treated with placebo (10 patients; mean age ± standard deviation, 47.89 ± 7.74 years). In the DC group, one eye of each patient was treated with citicoline and vitamin B 12 eye drops (OMK2 Ò , Omikron Italia srl, Italy, 3 drops/day), while in the DP group, it was treated with placebo (eye drops containing hypromellose 0.3%, 3 drops/day) for a 3-year period. In both groups, Humphrey Matrix frequency doubling technology (FDT), spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA), and adaptive optics (AO) were applied at baseline and 12, 24, and 36 months of the follow-up period. Results: In the results of follow-up evaluation, the DC and DP groups were significantly different: Significant reduction in function in terms of 10-2 FDT mean sensitivity and in morphology reflected by an increase in inner nuclear layer thickness and decrease in other plexiform layer thickness and foveal vessel density were observed in the DP group, while no such significant changes were observed in the DC group in the long term. Conclusions: This pilot study indicated that patients with DM1 with mild signs of diabetic retinopathy (DR) who underwent treatment with citicoline and vitamin B 12 eye drops for a 3-year duration achieved stabilization or decreased rate of functional impairment, neuroretinal degeneration, and microvascular damage. Trial Registration: ClinicalTrials.gov identifier, NCT04009980.

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Section: Morphological (Sd-oct Octa and Ao) Datamentioning

confidence: 88%

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

et al. 2020

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“…Despite this, OCT-A artifacts are common, particularly the projection artifacts, which are the fluctuating shadows cast by the flowing blood cells in the overlying retinal vessels projecting to the deeper layers [6,7]. However, the preexisting studies, which apply OCT-A to investigate the correlation of quantitative DCP metrics with DR and visual acuity (VA), have not effectively addressed in their findings the issue of projection artifacts [8][9][10][11]. Failure to consider this disruption in the vessel networks affects the accurate interpretation of DCP.…”

Section: Introductionmentioning

confidence: 99%

Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes

et al. 2020

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Background: To test clinically relevant factors associated with quantitative artifact-free deep capillary plexus (DCP) metrics in patients with diabetes mellitus (DM). Methods: 563 eligible eyes (221 with no diabetic retinopathy [DR], 135 with mild DR, 130 with moderate DR, and 77 with severe DR) from 334 subjects underwent optical coherence tomography-angiography (OCT-A) with a swept-source OCT (Triton DRI-OCT, Topcon, Inc., Tokyo, Japan). Strict criteria were applied to exclude from analysis those DCP images with artifacts and of poor quality, including projection artifacts, motion artifacts, blurriness, signal loss, B-scan segmentation error, or low-quality score. A customized MATLAB program was then used to quantify DCP morphology from the artifact-free DCP images by calculating three metrics: foveal avascular zone (FAZ), vessel density (VD), and fractal dimension (FD). Results: 166 (29.5%) eyes were excluded after quality control, leaving in the analysis 397 eyes (170 with no DR, 101 with mild DR, 90 with moderate DR, 36 with severe DR) from 250 subjects. In the multiple regression models, larger FAZ area was associated with more severe DR (β = 0.687; p = 0.037), shorter axial length (AL) (β = − 0.171; p = 0.003), thinner subfoveal choroid thickness (β = − 0.122; p = 0.031), and lower body mass index (BMI) (β = − 0.090; p = 0.047). Lower VD was associated with more severe DR (β = − 0.842; p = 0.001), shorter AL (β = 0.107; p = 0.039), and poorer visual acuity (VA) (β = − 0.133; p = 0.021). Lower FD was associated with more severe DR (β = − 0.891; p < 0.001) and with older age (β = − 0.142; p = 0.004). Conclusions: Quantitative artifact-free DCP metrics are associated with VA, DR severity, AL, subfoveal choroidal thickness, age, and BMI in diabetic patients. The effects of ocular and systemic factors should be considered for meaningful interpretations of DCP changes in DM patients.

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“…▪ Die Schwere der Retinopathie lässt sich mittels OCT-A am genauesten quantifizieren, wenn Arteriolen, Venolen und die kapilläre Mikrozirkulation in Kombination beurteilt werden [125]. Eine größere foveale avaskuläre Zone, eine geringere Gefäßdichte und fraktale Dimension des tiefen Gefäßplexus ("deep vascular plexus") können über bekannte Risikofaktoren hinaus ein Progressionsrisiko anzeigen [126]; eine geringere Gefäßdichte des oberflächlichen Plexus ("superficial vascular plexus") wurde vor Entwicklung eines DMÖ gesehen. Eine höhere Dichte des oberflächlichen Plexus erhöhte auch die Wahrscheinlichkeit eines Visusanstiegs unter der Therapie [127].…”

Section: Indikationsstellungunclassified

Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems

2020

Klin Monatsbl Augenheilkd

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OCT Angiography Metrics Predict Progression of Diabetic Retinopathy and Development of Diabetic Macular Edema

Cited by 202 publications

References 56 publications

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes

Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems

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