The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography

et al. 2017

Ophthalmic Res

Purpose: To perform a qualitative and quantitative assessment of the foveal microvasculature in eyes with diabetic maculopathy using optical coherence tomography angiography (OCT-A). Methods: Retrospective case series of 48 eyes with diabetic maculopathy and 47 healthy eyes evaluated by Spectralis OCT-A. Perifoveal arcade disruptions, linear vascular dilations, microaneurysms, intraretinal microvascular abnormalities and flow-void areas were qualitatively analyzed on OCT angiograms both for the superficial (SCP) and deep (DCP) capillary plexuses. A fully automated microstructural analysis of the foveal avascular zone (FAZ) metrics, vascular and avascular surfaces was performed. Quantitative values from diabetic patients were compared with those of healthy subjects. Results: A moderate agreement between SCP and DCP in terms of diabetes-induced vascular lesions in the qualitative assessment was shown. The comparative quantitative analysis between SCP and DCP in diabetic patients revealed a statistically significant difference (p < 0.05) in terms of FAZ perimeter and FAZ surface. No statistically significant difference was shown in total vascular and avascular surfaces. A statistically significant difference between the diabetic and control groups was noticed both for SCP and DCP considering FAZ metrics and vascular surfaces. Conclusions: A qualitative and quantitative OCT-A approach on retinal vascular perfusion may offer an objective and reliable method for monitoring disease progression in diabetic retinopathy.

Section: Discussionmentioning

confidence: 99%

Retinal Microvasculature in Nonproliferative Diabetic Retinopathy: Automated Quantitative Optical Coherence Tomography Angiography Assessment

Lupidi

et al. 2017

Ophthalmic Res

“…13 ). The median number of intravitreal injections needed to achieve the BCVA gain was 9 (interquartile range 8-11) in the aflibercept group, 10 (8-12) in the bevacizumab group and 10 (8)(9)(10)(11) in the ranibizumab group. The greatest mean reduction in CRT was 169 ± 139 μm for eyes treated with aflibercept, while the CRT was reduced by 101 ± 121 μm for bevacizumab and 147 ± 134 μm for ranibizumab (intravitreal injections needed to achieve the BCVA gain was 9 [interquartile range [8][9][10][11] in the aflibercept group, 10 [8][9][10][11][12] in the bevacizumab group, and 10 [8][9][10][11] in the ranibizumab group) supporting a superior efficacy of aflibercept.…”

Section: Anti-vegf Agents Bevacizumabmentioning

confidence: 99%

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

García-Arumí²,

et al. 2017

Diabetic retinal disease is envisioned to become the plague of the coming decades with a steep increase of worldwide diabetes incidence followed by a substantial rise in retinal disease. Improvements in diagnostic and therapeutic care have to cope with this dilemma in a clinically and socioeconomically efficient manner. Laser treatment has found a less destructive competitor in pharmacological treatments. As a consequence of recent rigorous clinical trials, laser photocoagulation is no longer recommended for the treatment of diabetic macular edema (DME), and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids have maintained a role in the management of chronically persistent DME. The paradigm shifts in therapy are accompanied by a substantial break-through in diagnostics. The following guidance for the management of DME has been composed from the best updated knowledge of leading experts in Europe and represents another volume in the series of EURETINA recommendations for the management of retinal disease.

“…Moderate macular ischemia (MMI) is characterized by the enlargement of the foveal avascular zone, by the disruption of the perifoveal capillary arcade, and by retinal capillary loss in other, noncontiguous areas of the macula (capillary dropout) [7] ( Fig. 10 ).…”

Section: Moderate Macular Ischemiamentioning

confidence: 99%

Optical Coherence Tomography Angiography in Diabetic Maculopathy

Lupidi

Management of Diabetic Retinopathy

2017

Fluorescein angiography (FA) and indocyanine green angiography have provided information about the normal retinal and choroidal anatomy, nearly comparable to histological findings. These tests have been fundamental in the evaluation of all retinal and choroidal vascular diseases and have allowed clinicians to define and diagnose several pathological conditions. FA became the "gold standard" in retinal imaging due to the capacity to visualize the retinal capillary bed and its changes, both in the macular area and in the periphery. Although the fluorescence of the injected dye enabled improved visualization of retinal capillaries, not all the different layers of the retinal capillary network could be visualized in this bi-dimensional examination, mainly because of the light scattering phenomenon. By calculating the difference between static and non-static tissues, optical coherence tomography angiography (OCT-A) allows a depth-resolved visualization of the retinal and choroidal microvasculature. Given that the main moving elements in the ocular fundus are contained in blood vessels, determining a vascular decorrelation signal enables visualization of the 3-dimensional retinal and choroidal vascular networks without the intravenous dye injection, reducing therefore the risk of potential adverse events. Since OCT-A is perfectly co-registered with its structural OCT, both morphological findings, such as macular edema, and functional ones, like capillary drop-out, may be clearly evaluated on a single dye-free examination. Proficient detection of the different findings in diabetic maculopathy on OCT-A can result in a rapid analysis of the examination, and in the capacity to distinguish truly decorrelated structures (perfused vessels) from artifacts. Moreover, a complete morpho-functional assessment may help in determining both the origin and the clinical activity of a given vascular disease.