Identification of microvascular and morphological alterations in eyes with central retinal non-perfusion.

Dorottya Hajdu,Ursula Schmidt-Erfurth,Orsolya Angeli,Reinhard Told,Stefan Sacu,Guenther Weigert,Andreas Pollreisz,Ireneusz Grulkowski

doi:10.1371/journal.pone.0241753

Abstract

PurposeTo evaluate the characteristics and morphological alterations in central retinal ischemia caused by diabetic retinopathy (DR) or retinal vein occlusion (RVO) as seen in optical coherence tomography angiography (OCTA) and their relationship to visual acuity.MethodsSwept-source optical coherence tomography (SSOCT) and OCTA (Topcon, Triton) data of patients with central involving retinal ischemia were analyzed in this cross-sectional study. The following parameters were evaluated: vessel parameters, foveal avascular zone (FAZ), intraretinal cysts (IRC), microaneurysms (MA), vascular collaterals in the superficial (SCP) and deep plexuses (DCP), hyperreflective foci (HRF), epiretinal membrane (ERM), external limiting membrane (ELM) and ellipsoid zone (EZ) disruption, as well as the disorganization of retinal inner layers (DRIL). Best-corrected visual acuity (BCVA), age, gender, disease duration and ocular history were also recorded.Results44 eyes of 44 patients (22 with RVO, 22 with DR) were analyzed. The mean age was 60.55 ± 11.38 years and mean BCVA 0.86 ± 0.36 (Snellen, 6m). No significant difference was found between DR subgroups (non proliferative vs. proliferative). Between RVO subgroups (CRVO vs. BRVO) a significant difference was found in term of collateral vessel of the DCP (p = 0.014). A pooled DR and RVO group were created and compared. Significantly more MAs (p = 0.007) and ERM (p = 0.007) were found in the DR group. Statistically significant negative correlation was demonstrated between FAZ and BCVA (p = 0.45) when analyzing all patients with retinal ischemia.ConclusionThis study has shown that the best predictor of visual outcome in center involved ischemic diseases is the size of FAZ. Besides the presence of MAs and ERM, all other OCT and OCTA parameters were present in a similar extent in DR and RVO group despite the completely different disease origins. Our results suggest that as soon as retinal ischemia in the macular region is present, it has a similar appearance and visual outcome independently of the underlying disease.

Highlights

Retinal ischemia is a common ophthalmological pathology with many different complications that can cause visual impairment and may eventually lead to blindness
This study has shown that the best predictor of visual outcome in center involved ischemic diseases is the size of foveal avascular zone (FAZ)
Besides the presence of MAs and epiretinal membrane (ERM), all other optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters were present in a similar extent in diabetic retinopathy (DR) and retinal vein occlusion (RVO) group despite the completely different disease origins

Summary

Introduction

Retinal ischemia is a common ophthalmological pathology with many different complications that can cause visual impairment and may eventually lead to blindness. In retinal diseases with chronic vascular obstructions, it is difficult to predict the development of ischemia and the functional outcome [1]. Several optical coherence tomography (OCT) features such as external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, hyperreflective foci (HRF) and disorganization of retinal inner layers (DRIL) were described as predictors of retinal ischemia. They were found to be associated with visual acuity [3]. Consistent relationship between foveal avascular zone (FAZ) enlargement and visual function decrease was shown in multiple studies based on patients with DR and RVO [4, 5]

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