Optical coherence tomography angiography and fundus fluorescein angiography in diabetic macular ischemia

Abstract

Background Diabetic macular ischemia (DMI) has not received attention despite its importance. The presence of DMI in the context of diabetic maculopathy affects visual acuity and changes management decisions. Aim This study was done to evaluate optical coherence tomography angiography (OCTA) in the detection of macular ischemia compared with fluorescein angiography (FFA). Patients and methods This prospective study was done on 70 eyes (50 eyes of diabetic patients who were diagnosed of macular ischemia by OCTA and 20 control eyes of healthy subjects matched for age and sex) at the outpatient clinic of the Ophthalmology Department, Tanta University, during the period from November 2017 to October 2018. Results In this study, OCTA and FFA were able to detect macular ischemia in all patients, and in most cases, macular ischemia was more evident on OCTA imaging compared with FFA. The two OCTA parameters that were used in this study to evaluate the degree of macular perfusion and ischemia [FAZ area (mm)2 and VDZ% for both superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP)] were found to have a statistically significant difference between patient and control groups. Moreover, we used FAZ area (mm)2 to evaluate macular ischemia in FFA images. Conclusion OCTA allows early diagnosis of DMI. Unlike FFA, OCTA allows us to evaluate ischemia in SCP and DCP with high-resolution images and allows detection of retinal and choroidal structures, and its images are not affected by leaking vessels. It is better in the evaluation of FAZ area measurements.