Abstract
Background/aimThe aim of the current study was to evaluate the correlation between the integrity of the outer retinal layers on optical coherence tomography (OCT) and objective parameters of retinal microvascular perfusion on optical coherence tomography angiography (OCTA).Materials and methods A total of 105 eyes of 54 diabetic patients were included in the study. Integrity of the outer retinal layers including the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) was assessed by spectral-domain optical coherence tomography. The foveal avascular zone (FAZ) area and vessel density (VD) measurements in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in all the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were evaluated by OCTA. Associations between the quantitative measurement of the FAZ and retinal VD measurements and outer retinal disruptions were evaluated.Results The FAZ area was correlated with outer retinal layer disruption both in the superficial plexus (r = 0.244, 0.228, 0.212, P = 0.013, 0.02, 0.031 for the ELM, EZ, and IZ, respectively) and the deep capillary plexus (r = 0.298, 0.234, 0.197, P = 0.002, 0.019, 0.048 for the ELM, EZ, and IZ, respectively). A significant relationship was also found between the VD measurements in the SCP and DCP in ETDRS sectors and the outer retinal layers disruption.ConclusionThe results of the current study show a significant relationship between the quantitative OCTA parameters and the integrity of the outer retinal layers. This finding reveals a correlation between retinal capillary nonperfusion and outer retinal disruption in eyes with diabetic retinopathy.
Highlights
The outer retina includes foveal photoreceptors and their connections to the Müller cells and retinal pigment epithelium cells [1]
The foveal avascular zone (FAZ) area was correlated with outer retinal layer disruption both in the superficial plexus (r = 0.244, 0.228, 0.212, P = 0.013, 0.02, 0.031 for the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ), respectively) and the deep capillary plexus (r = 0.298, 0.234, 0.197, P = 0.002, 0.019, 0.048 for the ELM, EZ, and IZ, respectively)
A significant relationship was found between the vessel density (VD) measurements in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in Early Treatment Diabetic Retinopathy Study (ETDRS) sectors and the outer retinal layers disruption
Summary
The outer retina includes foveal photoreceptors and their connections to the Müller cells and retinal pigment epithelium cells [1]. The external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) are the first three hyperreflective bands of the outer retina in optical coherence tomography (OCT) sections and are frequently used in the evaluation of foveal photoreceptor health and integrity [2]. The foveal photoreceptor cells have a high demand for oxygen and nutrients [5]. The role of the retinal circulation in photoreceptor oxygenation may increase in hypoxic conditions [10]. This has led to the notion that retinal perfusion destruction may damage the photoreceptor morphology and integrity in chronic hypoxic conditions such as diabetes. There are studies showing photoreceptor damage in cases with deep capillary plexus (DCP) defects
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