Progression of Diabetic Microaneurysms According to the Internal Reflectivity on Structural Optical Coherence Tomography and Visibility on Optical Coherence Tomography Angiography

Parravano, Mariacristina; Geronimo, Daniele De; Scarinci, Fabio; Virgili, Gianni; Querques, Lea; Varano, Monica; Bandello, Francesco; Querques, Giuseppe

doi:10.1016/j.ajo.2018.09.031

Cited by 30 publications

(32 citation statements)

References 30 publications

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“…Taken together, these studies suggest that, even though 2D en face OCTA images were demonstrated to be helpful for displaying MAs in diabetic eyes 12–16 , this visualization might be at least limited in offering a comprehensive characterization of MAs.…”

Section: Discussionmentioning

confidence: 92%

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In vivo rotational three-dimensional OCTA analysis of microaneurysms in the human diabetic retina

Borrelli

Sacconi

Brambati

et al. 2019

Sci Rep

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The aim of this study was to explore whether rotational three-dimensional (3D) visualization of optical coherence tomography angiography (OCTA) volume data may yield valuable information regarding diabetic retinal microaneurysm (MA) characteristics. In this retrospective, observational study, we collected data from 20 patients (20 eyes) with diabetic retinopathy. Subjects were imaged with the SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). The OCTA volume data were processed with a volume projection removal algorithm and then exported to imageJ in order to obtain a 3D visualization of the analyzed MAs. The rotational three-dimensional OCTA images were qualitatively and quantitatively investigated. A total of 52 MAs were included in the analysis. On rotational 3D OCTA images, the number of vessels associated with each MA varied between 1 and 4, and most MAs (59.6%) were associated with 2 vessels. Moreover, in 20 MAs (38.4%) these vessels seem to originate from the SCP, while 26 MAs (50.0%) had associated vessels originating from the DVC, and 6 MAs had associated vessels arising from both the SCP and DVC (11.6%). Most MAs (31/52) had a ‘saccular’ shape. The number of retinal layers occupied by each MA ranged between 1 and 3 and the inner nuclear layer was the retinal layer most frequently occupied by MAs. In conclusion, this study used an algorithm to obtain rotational three-dimensional visualization of retinal MAs. The MAs’ architecture is complex and 3D visualization may clarify the true vascular origin of these lesions, which is often mistaken using en face OCTA images.

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Section: Discussionmentioning

confidence: 92%

“…Notably, different OCTA studies confirmed previous histopathological evidences that MAs are mainly localized in the deeper retinal layers 12–14 . In addition, MAs’ characteristics were demonstrated to be relevant as prognostic factors for treatment response in eyes with diabetic macular edema (DME) 15,16 .…”

Section: Introductionmentioning

confidence: 99%

In vivo rotational three-dimensional OCTA analysis of microaneurysms in the human diabetic retina

Borrelli

Sacconi

Brambati

et al. 2019

Sci Rep

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“… 32 It has been speculated that hyper-reflective MAs could have a higher inflammatory component resulting in early and acute blood-retinal barrier impairment. 33 MCs have a key role in the regulation of retinal homeostasis and their activation in response to neuroinflammatory local changes can influence the blood-retinal barrier function at the level of intermediate capillary plexus and DCP (all located and interconnected with the bodies of MCs at the level of the INL). 34 Thus, improvement of MC function can have a beneficial effect also at the DCP level, 26 , 35 with consequent reduction in the number of MAs.…”

Section: Discussionmentioning

confidence: 99%

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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The aim of this study was to evaluate 1-year quantitative changes in specific inflammatory parameters on optical coherence tomography (OCT) / optical coherence tomography angiography (OCTA) in diabetic macular edema (DME) treated with subthreshold micropulse laser (SMPL). Methods: Thirty-seven patients / eyes with previously treatment-naïve DME treated with SMPL were prospectively evaluated at 3, 6, and 12 months. Fifteen fellow eyes with only microaneurysms (MAS) not eligible for treatment were controls. Evaluated OCT / OCTA parameters included: central macular thickness (CMT); hyper-reflective retinal spots (HRS); disorganization of inner retinal layers (DRILs); MA in the superficial / deep capillary plexuses (SCP/DCP); cysts in the area at the SCP / DCP; and macular perfusion parameters (MATLAB, version 2017b). Results: In the treated group, mean best corrected visual acuity (BCVA) progressively increased from 69.4 ± 12.0 to 76.0 ± 9.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (P < 0.001) at 12 months; HRS decreased from baseline (80.75 ± 20.41) at 3 (73.81 ± 17.1, P = 0.002), 6 (69.16 ± 16.48, P < 0.0001), and 12 months (66.29 ± 18.53, P < 0.0001). MA decreased at 3 months in the DCP (P = 0.015), at 6 and 12 months in both plexuses (P ≤ 0.0007). BCVA, HRS, and MA remained stable in the controls during all follow-ups. DRIL was present in 18 of 37 patients at baseline and progressively decreased from 557.0 ± 238.7 to 387.1 ± 282.1 μm (P = 0.01). The area of cyst decreased both in the SCP (P = 0.03) and the DCP (P = 0.02). CMT and perfusion parameters did not change. Conclusions: SMPL reduced the number of HRS (sign of activated microglia cells in the retina), MA, DRIL extension, and the area of cysts. Further studies are needed to confirm these preliminary data on the anti-inflammatory effect of SMPL, and to explore the mechanism of action. Translational Relevance: The follow-up of OCT/OCTA noninvasive biomarkers offers a unique insight in the mechanism of laser action, suggesting an anti-inflammatory effect of SMPL.

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“…On OCTA scans, MAs appear as saccular or fusiform capillary outpunching. [25][26][27] The size and appearance of MAs were demonstrated to be variable between consecutive visits, and the disappearance was stated to be a good prognostic factor. On contrary, the anti-vascular endothelial growth factor (VEGF) and steroid intravitreal therapies did not hesitate in short-term modifications of MAs.…”

Section: Retinal Vesselsmentioning

confidence: 99%

Optical coherence tomography angiography in diabetes: A review

Battista

Borrelli

Sacconi

et al. 2020

European Journal of Ophthalmology

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Diabetic retinopathy is a common diabetes complication representing a heavy burden in terms of visual impairment and heath expenditure. Optical coherence tomography angiography is a relatively new imaging method and has proven to be a powerful tool in the analysis of diabetic retinopathy common features, including microaneurysms, intraretinal microvascular abnormalities, or neovascularization, as well as in research field, challenging the gold standard of fluorescein angiography. Many studies underlined the vascular impairment observed through optical coherence tomography angiography and its typical parameters such as vessel length density, foveal avascular zone, and fractal dimension. Choriocapillaris involvement in the pathogenesis of diabetic retinopathy is an interesting point, derived from the analysis of this plexus using optical coherence tomography angiography. In conclusion, optical coherence tomography angiography, which is not free of limitations, such as motion artifacts or segmentation errors, has become an indispensable technique in adding more information to our understanding of diabetic retinopathy.

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Progression of Diabetic Microaneurysms According to the Internal Reflectivity on Structural Optical Coherence Tomography and Visibility on Optical Coherence Tomography Angiography

Cited by 30 publications

References 30 publications

In vivo rotational three-dimensional OCTA analysis of microaneurysms in the human diabetic retina

In vivo rotational three-dimensional OCTA analysis of microaneurysms in the human diabetic retina

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Optical coherence tomography angiography in diabetes: A review

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