Abstract
BackgroundThe aim of our study was to investigate a possible association between macular perfusion status and retinal ischemia and leakage up to far peripheral retinal areas in eyes with early to advanced stages of diabetic retinopathy (DR).MethodsIn a retrospective, cross sectional analysis ultrawide field (UWF) color fundus photos (Optos, Optomap California) were graded for DR severity. Foveal avascular zone (FAZ) and vessel density from the superficial (SCP) and deep capillary plexus (DCP) were assessed on optical coherence tomography angiography (OCTA) scans (Topcon, DRI-OCT Triton). UWF angiography images were used to quantify leakage/ischemic index and number of microaneurysms (MA). Age, gender, disease duration, type of diabetes, HbA1C, hypertension, complications of diabetes and ocular history were recorded. Univariate mixed models and Spearman correlation analysis were used for statistical testing.Results24 eyes of 17 laser-naive diabetic patients with different stages of DR were analyzed. The mean age was 59.56 ± 8.46 years and the mean disease duration 19.65 ± 12.25 years. No statistically significant associations between FAZ size, macular vessel density of SCP/DCP and peripheral retinal ischemia, leakage and MA number were demonstrated. Higher stages of DR were associated with ischemic index (estimate [95% CI]: 13.04 [1.5; 24.5], p = 0.033) and MA count (estimate [95% CI]: 43.7 [15.6; 71.8], p = 0.01), but no association with leakage index was observed. Only weak correlations between DR severity and anamnestic data were found.ConclusionRetinal ischemic index and the amount of MAs assessed on UWFA up to peripheral areas are indicators of DR severity but not related to microvascular perfusion status in the macular region. Significance and timely sequence of macular vessel density in DR progression may need to be re-evaluated in future studies.
Highlights
The aim of our study was to investigate a possible association between macular perfusion status and retinal ischemia and leakage up to far peripheral retinal areas in eyes with early to advanced stages of diabetic retin‐ opathy (DR)
Swept-source OCT (SSOCT)/‐A analysis Patients were examined with Topcon DRI-Optical coherence tomography (OCT) Triton swept-source OCT/-A (Topcon, Japan) after pupil dilatation (Tropicamide, Mydriaticum) using 6 × 6 mm volumetric flow-scans centered on the fovea
Mean vessel density was defined as the mean of Results A total of 48 eyes from 33 consecutive diabetic patients presenting at the Department of Ophthalmology at the Medical University of Vienna between August 2018 and June 2019 met the inclusion criteria including same day optical coherence tomography angiography (OCTA) and Ultrawide field angiography (UWFA) imaging and were analyzed in this study
Summary
The aim of our study was to investigate a possible association between macular perfusion status and retinal ischemia and leakage up to far peripheral retinal areas in eyes with early to advanced stages of diabetic retin‐ opathy (DR). Histological studies show basement membrane disorder of the small vessels, loss of pericytes and obliteration of the precapillary arterioles associated with retinal capillary atrophy, leading to local capillary and arteriolar occlusions [4, 5]. These abnormalities cause circulatory disturbances primarily at the midperiphery due to distinct anatomical conditions of the intermediate capillary plexus (ICP), which gradually decreases from the fovea towards the periphery and becoming undetectable from 8 mm eccentricity potentially due to decreasing metabolic demand of the thinning retina [6]. The presence of peripheral retinal lesions has been found to be associated with increased risk of DR progression [3, 9]
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