Prevalence of Focal Inner, Middle, and Combined Retinal Thinning in Diabetic Patients and Its Relationship With Systemic and Ocular Parameters

Preti, Rony Carlos; Iovino, Claudio; Abalem, Maria Fernanda; Garcia, Rafael; Santos, Helen Nazareth Veloso dos; Sakuno, Gustavo; Au, Adrian; Cunha, Leonardo Provetti; Zacharias, Leandro Cabral; Monteiro, Mário Luiz Ribeiro; Sadda, Srinivas R; Sarraf, David

doi:10.1167/tvst.10.2.26

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…Superficial plexus dropout in patients with diabetes has been found to correlate with focal thinning of the inner retina on structural OCT B-scan, 14 as shown in Figs. 4B and E. We hypothesize that a protocol involving both inspection of macular OCT thickness maps and B-scans in conjunction with superficial plexi en-face slabs may boost diagnostic accuracy when evaluating normal tension glaucoma suspects who have concomitant diabetes and retinal nerve fiber layer loss.…”

Section: Discussionmentioning

confidence: 93%

“…13 Although focusing on the superficial plexus dodges projection artifact, the clinician should still be aware that items such as floaters can cause shadow artifacts. 23 Superficial plexus dropout in patients with diabetes has been found to correlate with focal thinning of the inner retina on structural OCT B-scan, 14 as shown in Figs. 4B and E.…”

Section: Discussionmentioning

confidence: 97%

“…[11][12][13] Research has suggested that diabetic retinal neurodegeneration and vasoregression co-occur, with retinal ischemia associated with focal thinning on OCT B-scans. 14,15 Further, diabetes is associated with progressive retinal nerve fiber and ganglion cell thinning at a rate that rivals moderate progression rates in glaucoma. 3 The eyes in this case series were chosen based on the combination of having diabetes plus optic nerve appearance suggestive of glaucoma.…”

mentioning

confidence: 99%

“…Diabetic retinal ischemia can cause progressive ganglion cell and retinal nerve fiber layer loss with divergent phenotypes related to cotton wool spots, paracentral acute middle maculopathy, and diabetic vasoregression, which features progressive obliteration of retinal capillary beds 11–13 . Research has suggested that diabetic retinal neurodegeneration and vasoregression co-occur, with retinal ischemia associated with focal thinning on OCT B-scans 14,15 . Further, diabetes is associated with progressive retinal nerve fiber and ganglion cell thinning at a rate that rivals moderate progression rates in glaucoma 3 .…”

mentioning

confidence: 99%

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Case series: Superficial plexus en face may aid distinction of retinal nerve fiber layer loss from diabetic retinal ischemia versus glaucoma

Hynes,

Short

2024

Optom Vis Sci

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SIGNIFICANCE In normal tension glaucoma suspects with diabetes, inspection of superficial plexus capillary dropout patterns on optical coherence tomography–angiography (OCT-A) may help differentiate retinal nerve fiber layer (RNFL) and ganglion cell loss due to retinal ischemia from glaucoma. PURPOSE This study aimed to demonstrate that the pattern and degree of capillary bed dropout in early glaucoma appear different on OCT-A superficial plexus en-face slabs compared with retinal ischemia. RNFL loss associated with retinal ischemia in diabetic patients may be explained and accounted for by overlying the RNFL deviation map on a superficial plexus en-face montage. CASE REPORTS Three middle-aged White men with diabetes mellitus showed cup-to-disc ratios of approximately 0.7 and RNFL and ganglion thinning. Each patient had several Cirrus OCT and OCT-A scans taken of the posterior pole. The OCT-A en-face images demonstrated specific patterns of superficial capillary dropout. The appearance of superficial plexus capillary dropout in one case of glaucoma is contrasted against two cases of retinal ischemia. CONCLUSIONS Early glaucoma appears to be associated with incomplete capillary bed dropout that extends from macular regions to the disc in a wedge- or arc-shaped pattern. Diabetic retinal ischemia appears to be associated with well-defined patchy and polygonal pockets of complete capillary bed obliteration that may not extend back to the disc. If an RNFL deviation map is superimposed over the superficial plexus en-face montage, areas of RNFL loss may correlate with and thus be well accounted for by areas of retinal ischemia in cases with RNFL thinning likely from ischemia. This approach may supplement inspection of OCT B-scans for focal retinal thinning when trying to differentiate RNFL and ganglion cell loss from retinal ischemia versus glaucoma in patients with diabetes. Formal research studies are needed to validate our observations and proposed use of OCT-A together with OCT in these patients.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Case series: Superficial plexus en face may aid distinction of retinal nerve fiber layer loss from diabetic retinal ischemia versus glaucoma

Hynes,

Short

2024

Optom Vis Sci

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“…Optical coherence tomography of the macula was entirely within normal limits in both eyes and there was no evidence of macular edema or inner or middle retinal thinning 2 ( Fig. 3 ).…”

Section: Case Reportmentioning

confidence: 89%