Quantification of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography and Its Relationship with Visual Acuity

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• 作者：Wasim A. Samara ; MD ; Abtin Shahlaee ; MD ; Murtaza K. Adam ; MD ; M. Ali Khan ; MD ; Allen Chiang ; MD ; Joseph I. Maguire ; MD ; Jason Hsu ; MD ; Allen C. Ho ; MD ; ^{acho@midatlanticretina.com}
• 关键词：DME ; diabetic macular edema ; DMI ; diabetic macular ischemia ; DR ; diabetic retinopathy ; FA ; fluorescein angiography ; FAZ ; foveal avascular zone ; logMAR ; logarithm of the minimum angle of resolution ; NPDR ; nonproliferative diabetic retinopathy ; OCTA ; optical coherence tomography angiography ; PDR ; proliferative diabetic retinopathy ; SD OCT ; spectral-domain optical coherence tomography ; SSI ; signal strength index ; VAD ; vessel area density ; VLD ; vessel length density
• 刊名：Ophthalmology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：124
• 期：2
• 页码：235-244
• 全文大小：3789 K
• 卷排序：124

文摘

To quantify foveal avascular zone (FAZ) area and macular vascular density objectively using optical coherence tomography angiography (OCTA) and to examine correlations with visual acuity in eyes with diabetic retinopathy (DR) in the absence of diabetic macular edema.DesignRetrospective observational case series.ParticipantsEighty-four eyes from 55 patients with DR and 34 control eyes from 27 age-matched healthy participants.MethodsAll eyes underwent OCTA (RTVue-XR Avanti; Optovue, Inc, Fremont, CA). Integrated automated algorithms were used to quantify FAZ area and macular vascular density.Main Outcome MeasuresFAZ area, vessel area density (VAD), vessel length density (VLD), and visual acuity.ResultsIn each study eye, DR was classified as mild nonproliferative DR (NPDR; n = 32 [38%]), moderate-to-severe NPDR (n = 31 [37%]), or proliferative DR (n = 21 [25%]). Mean FAZ area was greater in diabetic eyes compared with control eyes both in the superficial (0.427 mm2 vs. 0.275 mm2; P < 0.001) and deep (0.616 mm2 vs. 0.372 mm2; P < 0.001) vascular networks. Mean VAD was lower in diabetic eyes compared with control eyes in both the superficial (49.44% vs. 55.09%; P < 0.001) and deep (56.65% vs. 61.32%; P < 0.001) networks. Mean VLD was also lower in diabetic eyes compared with control eyes in both the superficial (17.68 mm−1 vs. 21.55 mm−1; P < 0.001) and deep (21.19 mm−1 vs. 24.38 mm−1; P < 0.001) networks. In all eyes, there was a statistically significant negative correlation between the logarithm of the minimum angle of resolution (logMAR) visual acuity and the vascular density in both the superficial (VAD, ρ = −0.52; VLD, ρ = −0.54; P < 0.001) and deep (VAD, ρ = −0.50; VLD, ρ = −0.50; P < 0.001) networks. A positive correlation was found between logMAR visual acuity and FAZ area in both the superficial (ρ = 0.29; P < 0.01) and deep (ρ = 0.48; P < 0.001) networks.ConclusionsAutomated quantitative algorithms allow for objective assessment of retinal vascular changes in eyes with DR that are correlated to visual acuity. These methods may prove useful in monitoring disease progression and identifying parameters that affect visual function.