Abstract
The relationship between choroidal and retinal microvascular changes has not yet been well described, and there were limited data on diagnostic ability of optical coherence tomography (OCT)-derived vascular parameters for determining diabetic retinopathy (DR) progression. We quantitatively analyzed OCT-derived vascular parameters at superficial (SCP) and deep retinal capillary plexus (DCP), and choroid. We assessed foveal avascular zone (FAZ), vessel density, vessel length density, and choroidal vascularity index in conjunction with DR stage. In this study, patients with diabetes and healthy controls were retrospectively analyzed. One-hundred seventy-four eyes were divided into six groups as follows: Healthy controls, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR. There were significant quantitative changes in retinal and choroidal vascular parameters with DR progression. The FAZ area and perimeter correlated positively with worsening DR severity; the FAZ circularity index, retinal vessel density, retinal vessel length density, and choroidal vascularity index correlated negatively with worsening severity. Among these, FAZ circulatory index demonstrated good diagnostic performance for DR. Our results cautiously suggest that functional circulatory disturbances in retinal and choroidal vasculatures occur before DR presents. As DR progresses, DCP retinal microvasculature changes precede SCP changes.
Highlights
Optical coherence tomography (OCT) angiography is a noninvasive, dye-free imaging modality that can evaluate the retinal microvasculature by capturing the dynamic motion of erythrocytes[1]
The highest areas under the curve (AUC) were similar to those of the foveal avascular zone (FAZ) circulatory indexes at the SCP (AUC = 0.896; 95% CI, 0.831–0.962) and deep retinal capillary plexus (DCP) (AUC = 0.898; 95% CI, 0.834–0.962) in discriminating no diabetic retinopathy (DR) from other DR stages
We observed the highest AUCs for discriminating early DR from advanced DR in the FAZ circulatory index at the SCP (AUC = 0.773; 95% CI, 0.694–0.853) and DCP (AUC = 0.764; 95% CI, 0.679–0.848)
Summary
Optical coherence tomography (OCT) angiography is a noninvasive, dye-free imaging modality that can evaluate the retinal microvasculature by capturing the dynamic motion of erythrocytes[1]. OCT angiography has many advantages over conventional fluorescein angiography (FA) It can optically dissect and visualize flows in various layers of the retina and obtain high-resolution images[1]. In patients with diabetes mellitus (DM), studies reported modifications of the foveal avascular zone (FAZ), perfusion density, and fractal dimension (vascular complexity). We used OCT to evaluate the choroidal changes in patients with DM, and we concluded that the diabetic choroidopathy precedes the retinopathy[8]. There were limited data analyzing OCT-derived vascular parameters to evaluate diabetic retinopathy and choroidopathy together. The purpose of our study was to quantitatively assess retinal and choroidal microvascular changes in patients with DM in conjunction with DR stage and to evaluate diagnostic ability for determining DR progression.
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