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Yin C, Zhang S, Guo D, Qin J, Lou H, Zhang G. Diagnostic value of choroidal vascular density in predicting the progression of diabetic retinopathy. Sci Rep 2025; 15:15671. [PMID: 40325093 PMCID: PMC12053639 DOI: 10.1038/s41598-025-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Accepted: 04/29/2025] [Indexed: 05/07/2025] Open
Abstract
By utilizing widefield swept-source optical coherence tomography angiography (WSS-OCTA) to quantify choroidal vascular density (VD) in order to identify early fundus changes in diabetic patients and to predict the progression of diabetic retinopathy (DR). A total of 101 eyes, including patients with type 2 diabetes mellitus and controls, were included in the cross-sectional study. Diabetic patients were stratified into three groups based on disease severity: non-DR (NDR), nonproliferative DR (NPDR), and proliferative DR (PDR). Fundus images obtained through WSS-OCTA were segmented into nine 2 mm × 2 mm regions centered on the macula: supratemporal (ST), superior (S), supranasal (SN), temporal (T), central macular area (C), nasal (N), inferotemporal (IT), inferior (I), and inferonasal (IN). Changes in choroidal VD in the choriocapillaris (CC) and mid-large choroidal vasculature (MLCV) layers were evaluated in each region among patients with DR. Additionally, the diagnostic value of choroidal VD in distinguishing different stages of DR was assessed using the area under the receiver operating characteristic (ROC) curve. In comparison to the NDR group, the VD of MLCV (S) was found to decrease significantly in the NPDR group. Furthermore, the VD of CC (S) was significantly lower in the PDR group compared to the NPDR group. The VD of MLCV (IN) demonstrated potential in distinguishing between healthy eyes and those with NDR. Additionally, the VD of CC (SN) and MLCV (S, SN, C, I) showed relatively high area under the curve (AUC) values in discriminating between NDR and NPDR. Lastly, the VD of CC (S) exhibited good diagnostic accuracy in distinguishing between NPDR and PDR patients. As DR advances, MLCV and CC are sequentially compromised to varying degrees. In clinical diagnosis, the VD of the IN region in the MLCV layer serves as a more sensitive early imaging biomarker for detecting preclinical DR, while a decrease in the VD of the S region in the CC layer indicates the onset of PDR.
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Affiliation(s)
- Chuanjie Yin
- Department of Ophthalmology, Qingdao Eighth People's Hospital, Shandong Second Medical University, Qingdao, 266100, Shandong Province, China
| | - Shanshan Zhang
- Department of Ophthalmology, Qingdao Eighth People's Hospital, Shandong Second Medical University, Qingdao, 266100, Shandong Province, China
| | - Dong Guo
- Department of Ophthalmology, Weifang Aier Eye Hospital, Weifang, 261000, Shandong Province, China
| | - Jianmin Qin
- Department of Ophthalmology, Qingdao Eighth People's Hospital, Shandong Second Medical University, Qingdao, 266100, Shandong Province, China
| | - Huadong Lou
- Department of Ophthalmology, Qingdao Eighth People's Hospital, Shandong Second Medical University, Qingdao, 266100, Shandong Province, China.
| | - Guowen Zhang
- Department of Ophthalmology, Qingdao Eighth People's Hospital, Shandong Second Medical University, Qingdao, 266100, Shandong Province, China
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Feo A, Ramtohul P, Govetto A, Borrelli E, Sacconi R, Corradetti G, Querques G, Romano MR, Rosenfeld PJ, Spaide RF, Freund KB, Sadda S, Sarraf D. En face OCT: Breakthroughs in understanding the pathoanatomy of retinal disease and clinical applications. Prog Retin Eye Res 2025; 106:101351. [PMID: 40054600 DOI: 10.1016/j.preteyeres.2025.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 03/03/2025] [Accepted: 03/04/2025] [Indexed: 03/16/2025]
Abstract
En face optical coherence tomography (OCT) is a practical and informative imaging modality to noninvasively visualize distinct retinal and choroidal layers by providing coronal images using boundary-specific segmentation. Ongoing research with this method is generating breakthroughs in the illustration of new perspectives of retinal disease. The clinical value of en face OCT as an advanced retinal imaging tool is growing steadily and it has unveiled many new insights into the pathoanatomy of retinal disorders. Moreover, this modality can capture various en face OCT biomarkers that correspond to different cell or tissue subtypes, which were previously only identified through histological or electron microscopy methods, underscoring the significance of this technique in providing valuable pathoanatomical information. In this comprehensive review, we will systematically summarize the en face OCT findings across a broad spectrum of retinal diseases, including disorders of the vitreoretinal interface and retinal vascular system (e.g. paracentral acute middle maculopathy or PAMM and diabetic retinopathy), in addition to the en face OCT features of other conditions such as age-related macular degeneration, pachychoroid disease spectrum, myopic degeneration, uveitis and inflammatory disorders, inherited retinal dystrophies, and drug toxicity. We will discuss and highlight the unique clinical and pathoanatomical findings uncovered with en face OCT of each these diseases mentioned above.
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Affiliation(s)
- Alessandro Feo
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California of Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele-Milan, 20072, Italy
| | - Prithvi Ramtohul
- Ophthalmology Department, Hopital Nord, Aix-Marseille University, Marseille, France; Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - Andrea Govetto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele-Milan, 20072, Italy; Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Turin, Italy; Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele-Milan, 20072, Italy; Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | - SriniVas Sadda
- Department of Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California of Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States.
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Yuan M, Romano F, Ding X, Garcia M, Garg I, Overbey KM, Bennett C, Ploumi I, Stettler I, Lains I, Vingopoulos F, Rodriguez J, Patel NA, Kim LA, Vavvas DG, Husain D, Miller JW, Miller JB. Clinical and imaging characteristics associated with foveal neovascularization in proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2025; 263:679-687. [PMID: 39542876 DOI: 10.1007/s00417-024-06660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/29/2024] [Accepted: 10/03/2024] [Indexed: 11/17/2024] Open
Abstract
PURPOSE To assess the prevalence of foveal neovascularization (FNV) and its associated clinical features in proliferative diabetic retinopathy (PDR) eyes. METHODS Cross-sectional observational study. Participants underwent ultra-widefield photography, optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA). FNV was defined as a hyperreflective lesion breaching the internal limiting membrane and displaying flow signal on OCTA, within 1-mm of foveal avascular zone. Vascular metrics were obtained from the ARI Network portal. Ischemic index (ISI) and inner choroid flow deficit percentage were calculated using FIJI from 12 × 12 and 6 × 6-mm scans, respectively. Logistic regression models were used to compare eyes with and without FNV. RESULTS We included 249 eyes of 164 patients (age: 58 [50-65] years). FNV was identified in 20 eyes (8%). Univariate logistic regression revealed significant associations between FNV and younger age (p = 0.03), higher maximal HbA1c (p = 0.04), worse visual acuity (VA) (p = 0.01), presence of disorganization of retinal inner layers (DRIL) (p = 0.01), no macular posterior vitreous detachment (PVD) (p = 0.03), neovascularization elsewhere (NVE) and at the disc (NVD) (p = 0.01 and p = 0.001), and greater ISI (p = 0.04). In multivariable analysis, a significant association remained between FNV and worse VA (p = 0.04), NVD (p < 0.001), DRIL (p < 0.001), and absence of macular PVD (p = 0.01). No associations were found with SS-OCTA vascular metrics. CONCLUSIONS This study provides a comprehensive characterization of FNV in PDR. FNV was identified in 8% of our cohort, being more prevalent in younger patients with severe PDR, as evidenced by NVD and DRIL presence. The absence of macular PVD may explain its association with younger age. KEY MESSAGES What is known • Neovascularization at the fovea occurs rarely in proliferative diabetic retinopathy. • OCT and OCT-angiography can be used to evaluate foveal neovascularization, which may be associated with choroidal vascular abnormalities. What is new • Foveal neovascularization was seen in 8% of eyes with proliferative diabetic retinopathy in this cohort. • Risk factors for foveal neovascularization included younger age, absence of macular posterior vitreous detachment, presence of neovascularization of the disc, and presence of disorganization of retinal inner layers. • We did not identify an association between foveal neovascularization and choroidal perfusion abnormalities in this study.
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Affiliation(s)
- Melissa Yuan
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Francesco Romano
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Xinyi Ding
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mauricio Garcia
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Cade Bennett
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ioanna Ploumi
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Isabella Stettler
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ines Lains
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jocelyn Rodriguez
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A Patel
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Yang W, Ren R, Xie Y, Wang J, Guan H, Ji M. Diabetic uveopathy. Surv Ophthalmol 2025; 70:47-53. [PMID: 39265739 DOI: 10.1016/j.survophthal.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/30/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
Diabetes can involve several ocular structures -- including the cornea, lens, and retina -- and cause vascular and neural changes in these tissues. Although retinopathy is the most common ocular complication of diabetes, uveopathy can also be observed. This includes vascular, neural, muscular, and basement membrane changes. The main clinical manifestations of diabetic uveopathy are anterior uveitis and abnormal pupillary dynamics. Fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography are ideal for the imaging of vascular changes of the iris and choroid, while dynamic pupillometry is a simple screening tool to detect neuropathy. Additionally, ultrasound biomicroscopy can provide clear images of the ciliary body. Iris abnormalities, primarily angiopathy and neuropathy, can appear as alterations in vascular diameter, neovascularization, and abnormal pupillary dynamics. Choroidal abnormalities primarily affect blood vessels, including alterations in vascular diameter, microaneurysm formation, and neovascularization. The abnormal manifestations in the ciliary body include a decrease in vessel count, alterations in their diameter, isolated angiomatous dilatation, and diffuse thickening of the basal membrane of the pigment epithelium.
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Affiliation(s)
- Wenyu Yang
- Eye Institute, Affiliated Hospital of Nantong University, China; Medical School of Nantong University, China
| | - Ruoxin Ren
- Eye Institute, Affiliated Hospital of Nantong University, China; Dalian Medical University, China
| | - Yi Xie
- Eye Institute, Affiliated Hospital of Nantong University, China; Medical School of Nantong University, China
| | - Junhui Wang
- Eye Institute, Affiliated Hospital of Nantong University, China; Dalian Medical University, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, China.
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Sen S, Khalid H, Udaya P, Raman R, Rajendram R, ElHousseini Z, Nicholson L, Kannan NB, Ramasamy K, Kumaragurupari T. Ultrastructural imaging biomarkers in diabetic macular edema: A major review. Indian J Ophthalmol 2025; 73:S7-S23. [PMID: 39723865 PMCID: PMC11834929 DOI: 10.4103/ijo.ijo_878_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 10/02/2024] [Accepted: 10/10/2024] [Indexed: 12/28/2024] Open
Abstract
Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy and causes significant morbidity in patients. Anti-vascular endothelial growth factor (VEGF) agents are the mainstay of treatment for DME, with steroid implants being used for the treatment of anti-VEGF resistant eyes. Over the years, several classification systems have been devised to describe the patterns of DME using optical coherence tomography (OCT). With the advent of effective treatments, it has become imperative that imaging cues are not merely used for classifying the disease but also as biomarkers for prognostication of disease activity and treatment response. In this aspect, newer imaging findings such as hyperreflective dots, photoreceptor integrity, and disorganization of retinal inner layers have been characterized in detail by several authors. Macular perfusion analysis using OCT angiography is the latest in the armamentarium for imaging DME. In this narrative review, we have summarized all relevant literature related to the ultrastructural imaging-based biomarkers of DME and their correlation to treatment.
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Affiliation(s)
- Sagnik Sen
- Department of Medical Retina, Moorfields Eye Hospital, London, UK
- Department of Vitreoretina, St Thomas Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Vitreoretina, Aravind Eye Hospital, Madurai, India
| | - Hagar Khalid
- Department of Medical Retina, Moorfields Eye Hospital, London, UK
- Department of Ophthalmology, Tanta University, Egypt
| | - Prithviraj Udaya
- Department of Vitreoretina, Aravind Eye Hospital, Madurai, India
| | - Rajiv Raman
- Department of Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ranjan Rajendram
- Department of Medical Retina, Moorfields Eye Hospital, London, UK
| | - Zein ElHousseini
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Luke Nicholson
- Department of Medical Retina, Moorfields Eye Hospital, London, UK
| | | | - Kim Ramasamy
- Department of Vitreoretina, Aravind Eye Hospital, Madurai, India
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Parravano M, Fragiotta S, Costanzo E, Picconi F, Giorno P, De Geronimo D, Giannini D, Varano M, Parisi V, Ziccardi L. Metabolic, Microvascular, and Structural Predictors of Long-Term Functional Changes Evaluated by Multifocal Electroretinogram in Type 1 Diabetes. Biomedicines 2024; 12:2614. [PMID: 39595178 PMCID: PMC11592090 DOI: 10.3390/biomedicines12112614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 11/10/2024] [Accepted: 11/13/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND This study aimed to analyze the potential pathogenic connection between metabolic factors, photoreceptor cell rearrangements, retinal microvascular perfusion, and functional parameters through multifocal electroretinography (mfERG) in type 1 diabetes mellitus (DM1). METHODS This prospective observational cohort study enrolled DM1 patients (40.5 ± 9.1 years) with mild nonproliferative diabetic retinopathy followed for 4 years. Patients were subjected to multimodal imaging, which included color fundus photography, optical coherence tomography (OCT), OCT angiography, adaptive optics (AO), and mfERG. OCTA slabs were analyzed using ImageJ software (software version 2.3.0/1.53f) to calculate perfusion density (PD) at both superficial (SCP) and deep (DCP) capillary plexuses, as well as flow deficit percentage (FD%) at the choriocapillaris (CC). To calculate cone metrics on AO at the parafovea, including cone density (CD), linear dispersion index (LDi), and heterogeneity packing index (Hpi%) in the parafovea, the images were post-processed using a MATLAB algorithm. The mfERG P1 implicit time (IT) and N1-P1 response amplitude density (RAD) from R1 (foveal area), R2 (parafoveal area), and the unified rings R1 + R2 were evaluated. RESULTS A total of 22 patients (22 eyes) were enrolled. No significant differences were noted in central mfERG amplitude and implicit time-averaged values (p > 0.05, all). The main factor influencing R1 IT was HbA1c, while R1 RAD was affected by Hpi and CC FD%. R1 + R2 IT was influenced by Hpi, LDi (p > 0.001, all), and modifications in the perfusion density in the SCP (p < 0.001) and DCP (p = 0.03) at the parafovea. In contrast, R1 + R2 RAD were associated with HbA1c (p = 0.02) and Hpi (p < 0.001). CONCLUSIONS Microvascular changes and glucometabolic factors are key elements influencing the long-term morphofunctional alterations at the photoreceptor level in DM1.
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Affiliation(s)
- Mariacristina Parravano
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
- Departmental Faculty of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, NESMOS Department, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Eliana Costanzo
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Isola Tiberina Gemelli Isola, 00186 Rome, Italy;
| | - Paola Giorno
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Daniele De Geronimo
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Daniela Giannini
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Monica Varano
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Vincenzo Parisi
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
| | - Lucia Ziccardi
- IRCCS-Fondazione Bietti, 00198 Rome, Italy; (E.C.); (P.G.); (D.D.G.); (D.G.); (M.V.); (V.P.); (L.Z.)
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Ma DJ, Kim SM, Choi JM. Associations of Retinal Vessel Geometry and Optical Coherence Tomography Angiography Metrics With Choroidal Metrics in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2024; 65:31. [PMID: 39546295 PMCID: PMC11580292 DOI: 10.1167/iovs.65.13.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 10/21/2024] [Indexed: 11/17/2024] Open
Abstract
Purpose To elucidate the mechanism underlying changes in choroidal metrics (choroidal thickness [CT], choroidal vascularity index [CVI], and choriocapillaris [CC] flow deficit [FD]) observed in diabetic retinopathy (DR) and examine the association of choroidal metrics with both retinal vessel geometry and optical coherence tomography angiography (OCTA) metrics. Methods Overall, 133 eyes of 133 patients were analyzed retrospectively. Retinal vessel geometry parameters were assessed using semiautomated software. The OCTA metrics and CT were calculated using automated algorithms provided by the manufacturer, whereas the CVI and CC-FD were calculated using ImageJ software from the binarized choroid B-scan image and the CC slab provided by the manufacturer, respectively. To assess the associations among choroidal metrics, retinal vessel geometry, and OCTA metrics, multivariable regression analyses were performed while controlling for clinical features and DR severity. Results In the multivariable linear regression analysis, CT (β = -399.84; P = 0.014) and CVI (β = -2.34; P = 0.021) showed significant associations with the arteriole-venule ratio, which is a ratio of central retinal arteriolar equivalent caliber with respect to central retinal venular equivalent caliber. The CC-FD showed a significant association with the fractal dimension of retinal arteriolar network (β = -2.90; P = 0.040). In contrast, the OCTA metrics showed no significant association with the choroidal metrics. Conclusions The CT, CVI, and CC-FD in patients with DR were associated with retinal arteriolar geometry parameters rather than OCTA metrics, which indicates an association between choroidal changes and hemodynamic alterations in retinal arterioles and venules.
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Affiliation(s)
- Dae Joong Ma
- Department of Ophthalmology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seong Mi Kim
- Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Jeju-do, Republic of Korea
| | - Ji Min Choi
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
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Chen Y, Xian H, Liu M, Dong X, Du S. Regional assessment of choroidal vascularity index in patients with pre- and early-stage diabetic retinopathy using ultra-wide-field OCTA. Front Med (Lausanne) 2024; 11:1490831. [PMID: 39512617 PMCID: PMC11540705 DOI: 10.3389/fmed.2024.1490831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 10/14/2024] [Indexed: 11/15/2024] Open
Abstract
Purpose To characterize the regional variations of choroidal vascularity index (CVI) in patients with diabetes mellitus (DM) using ultra-wide-field optical coherence tomography angiography (UWF-OCTA) and identify their correlations with the onset of diabetic retinopathy (DR). Methods This cross-sectional, monocular-sampling study recruited 141 participants from four age-matched groups: no DM (NDM), no DR with early DM (EDM) and late DM (LDM), and mild-moderate non-proliferative diabetic retinopathy (mNPDR). UWF-OCTA was employed for circular scans centered on the fovea. CVI in the central region (0-1 mm) and four quadrants of the concentric rings with different ranges (1-3, 3-6, 6-9, 9-12, 12-15, 15-18 mm) was obtained for analysis together with their demographic and clinical data. The Area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic efficacy for mNPDR and compared using the DeLong test. Results The average CVI was lower in patients with mNPDR compared to other groups across all regions. Although there was no significant difference in DM duration between the LDM and mNPDR groups, a notable variance in CVI was observed, particularly (p = 0.0004) in the temporal quadrant of the 15-18 mm range (T18). CVI in T18 region was negatively correlated with creatinine levels, while positively correlated with body mass index and estimated glomerular filtration rate (ps < 0.05). The CVI in the T18 region demonstrated superior diagnostic efficacy (AUC = 0.755), and when combined with those in other regions and clinical data, the AUC rose to 0.907, which was significantly better (p = 0.0280) than using clinical data alone. Conclusion Reduced CVI was observed in the most peripheral region, highly predictive for mNPDR and associated with the declining renal function, thus enhancing the potential of UWF-OCTA to integrate into DM management and promote early DR screening.
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Affiliation(s)
- Yulei Chen
- Department of Ophthalmology, Dongguan Tungwah Hospital, Dongguan, China
- Dongguan Key Laboratory of Eye and Systemic Diseases, Dongguan, China
| | - Haoxiong Xian
- Department of Ophthalmology, Dongguan Tungwah Hospital, Dongguan, China
- First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Minghui Liu
- Department of Ophthalmology, Dongguan Tungwah Hospital, Dongguan, China
- First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xiuqing Dong
- Department of Ophthalmology, Dongguan Tungwah Hospital, Dongguan, China
- Dongguan Key Laboratory of Eye and Systemic Diseases, Dongguan, China
| | - Shaolin Du
- Department of Ophthalmology, Dongguan Tungwah Hospital, Dongguan, China
- Dongguan Key Laboratory of Eye and Systemic Diseases, Dongguan, China
- First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
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Lei CY, Xie JY, Ran QB, Zhang MX. Non-linear relationship between age and subfoveal choroidal thickness in Chinese patients with proliferative diabetic retinopathy. World J Diabetes 2024; 15:1903-1915. [PMID: 39280183 PMCID: PMC11372635 DOI: 10.4239/wjd.v15.i9.1903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness (SFCT) in proliferative diabetic retinopathy (PDR). AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR. METHODS This was a cross-sectional retrospective study. The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR. Con-tralateral eyes that met the criteria were included in the study. All necessary laboratory tests were performed at the time of admission. Central macular thickness (CMT) and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography. CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software. RESULTS The final analysis included a total of 234 individuals with PDR. The average age was 55.60 years old ± 10.03 years old, and 57.69% of the population was male. Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR [β = -2.44, 95% confidence interval (95%CI): -3.46 to -1.42; P < 0.0001]. In the fully adjusted model, the correlation between SFCT and age remained steady (β = -1.68, 95%CI: -2.97 to -0.39; P = 0.0117). Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear, with an inflection point at 54 years of age. CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness. The non-linear link between SFCT and age in PDR patients should be taken into account.
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Affiliation(s)
- Chun-Yan Lei
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiang-Ying Xie
- Sichuan University Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qi-Bo Ran
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Mei-Xia Zhang
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Bijon J, Ramtohul P, Naysan J, Freund KB. CAVITARY CHOROIDAL NEVUS SHOWING THICKNESS FLUCTUATIONS IN RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR DIABETIC MACULAR EDEMA: A CASE REPORT. Retin Cases Brief Rep 2024; 18:593-597. [PMID: 37490774 DOI: 10.1097/icb.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE The purpose of this study was to report the multimodal imaging features of a cavitary choroidal nevus showing thickness fluctuations that mirrored the response of diabetic macular edema (DME) to intravitreal antivascular endothelial growth factor (VEGF) therapy. METHODS This is a retrospective case report. Multimodal imaging findings including fundus photography, optical coherence tomography (OCT), fluorescein and indocyanine green angiography, OCT-angiography (OCTA), and B-scan ultrasonography were analyzed. RESULTS A woman in her 80s with a cavitary choroidal nevus and DME was treated with intravitreal anti-VEGF therapy using a pro re nata regimen over 5 years. The choroidal nevus showed thickness fluctuations paralleling the response of DME to anti-VEGF therapy. Worsening of the DME was associated with marked increased choroidal lesion thickness on OCT. Conversely, resolution of DME after intravitreal anti-VEGF injections was followed by choroidal lesion flattening on OCT. Variations of the choroidal lesion thickness were mainly dependent on changes of intralesional hyporeflective caverns on OCT. CONCLUSION Our report shows thickness variations of a cavitary choroidal nevus that paralleled the clinical course of DME treated with intravitreal anti-VEGF therapy. To the best of our knowledge, this is the first report on volume variations of a cavitary choroidal nevus after anti-VEGF therapy.
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Affiliation(s)
- Jacques Bijon
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York; and
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Jonathan Naysan
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York; and
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11
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Abbasi Mehrabadi A, Sadeghi J, Shoeibi N, Heravian Shandiz J, Motamed Shariati M, Derakhshan A, Yazdani N. Macular choroidal thickness in keratoconus. Clin Exp Optom 2024:1-6. [PMID: 39189829 DOI: 10.1080/08164622.2024.2393189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
CLINICAL RELEVANCE Expanding practitioner knowledge regarding potential changes in ocular structure of keratoconic eyes will improve the eye care practice and patient management. BACKGROUND This study aimed to compare the difference in choroidal thickness between keratoconus patients and two control groups of myopic-astigmatism and emmetropic subjects. METHODS A case-control study was undertaken which included 50 patients with keratoconus, 50 with myopic-astigmatism, 30 with emmetropia aged between 18 and 39 years. Choroidal thickness was measured at three different locations, including the subfoveal, nasal, and temporal (750 micrometres) to the fovea, using a spectral-domain optical coherence tomography with an enhanced depth imaging technique. RESULTS The mean spherical equivalents were 0.03 ± 0.05, -3.00 ± 0.2, and -3.00 ± 0.3 dioptre in emmetropic, myopic-astigmatism and keratoconus subjects, respectively. The choroid was significantly thicker in keratoconus patients than in myopic-astigmatism and emmetropic subjects in the subfoveal (396 ± 14, 314 ± 12, and 320 ± 18 μm, respectively, p < 0.001), temporal (405 ± 14, 317 ± 12, and 328 ± 19 μm, respectively, p < 0.001) and nasal (376 ± 14, 285 ± 12, and 311 ± 18 μm, respectively; p < 0.001). CONCLUSION Choroidal thickness is increased in keratoconus. The exact mechanism for choroidal thickening in individuals with keratoconus is unknown, but inflammatory responses could be the reason.
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Affiliation(s)
| | - Javad Sadeghi
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Akbar Derakhshan
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negareh Yazdani
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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Üçer MB, Cevher S. Analysis of the Choroidal Structure in the Early Stage of Type 2 Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2024; 55:392-399. [PMID: 38648425 DOI: 10.3928/23258160-20240408-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to evaluate the choroidal structure in the early stage of Type 2 diabetic retinopathy (DR). MATERIALS AND METHODS The study included patients with nonproliferative diabetic retinopathy (NPDR) without edema (n = 30, NPDR group), patients with diabetes without retinopathy (n = 30, No DR group), and healthy subjects (n = 33, control group). Choroidal thickness (CT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were evaluated. RESULTS The hypertension (HT) rate was highest in patients with NPDR (63.3%), and lowest in the control group (27.3%). Subfoveal, nasal, temporal CT, TCA, and LA were thinner in patients with diabetes compared to the control group for both patients with and without HT, although not significantly. CTs, TCA, LA, and SA were lower in hypertensive patients than patients without HT in all groups. CVI and LA/SA were significantly lower in NPDR group compared to the controls for both patients with and without HT. CONCLUSION In patients with diabetes and before clinical retinopathy develops, the thinning of the CT and CVI begins. A decrease in CVI continues as the retinopathy progresses. HT appears to be a factor that can reduce CT, TCA, LA, and SA. [Ophthalmic Surg Lasers Imaging Retina 2024;55:392-399.].
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Akbarpour M, Jalali MM, Alizadeh Y, Nemati S, Akbari M, Dourandeesh M. The Association Between Choroidal Thickness and Meniere's Disease: A Cross-Sectional Study. Laryngoscope 2024; 134:1889-1893. [PMID: 37916786 DOI: 10.1002/lary.31136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/01/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To evaluate and compare choroidal thickness (CT) between patients with Meniere's disease (MD) and a control group. METHODS This case-control analytical study was conducted on 37 subjects with MD and 37 healthy subjects. Subfoveal CT (SCT), large choroidal vessel (LCV) layer thickness, and mean subfoveal LCV thickness/mean SCT ratio were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) in the eyes on the MD side (ipsilateral), the contralateral eyes, and the control group. RESULTS A statistically significant difference was observed in the mean SCT values between the ipsilateral and control groups after adjustment for age, sex, and migraine (p = 0.04). Moreover, there was a statistically significant difference between the mean subfoveal LCV thickness values and the mean subfoveal LCV thickness/mean SCT ratio between the ipsilateral and control groups (p = 0.006, and p < 0.001, respectively). Patients with a duration of disease over three years had a greater mean subfoveal LCV thickness/mean SCT ratio (67.35 ± 11.56 and 60.66 ± 11.27, respectively), which was statistically insignificant (p = 0.08). CONCLUSION We found a thicker choroid and Haller layer, and a greater subfoveal LCV thickness/SCT ratio on the MD side compared to the controls. Furthermore, patients with a greater duration of disease had a lower subfoveal LCV thickness/SCT ratio. These findings may reflect the role of the trigeminal vascular system (TVS) and neurovascular pathophysiology in MD patients. More extensive studies are required to reach more definitive conclusions about the association between CT and MD. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1889-1893, 2024.
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Affiliation(s)
- Maliheh Akbarpour
- Department of Otorhinolaryngology, School of Medicine, Otorhinolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir Mohammad Jalali
- Department of Otorhinolaryngology, School of Medicine, Otorhinolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousef Alizadeh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Department of Otorhinolaryngology, School of Medicine, Otorhinolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mitra Akbari
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Dourandeesh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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14
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Cui Y, Feng D, Wu C, Wang P, Cui R, Wang X, Chang W, Shang W, Zhao B, Liu J, Qin X. Quantitative assessment of OCT and OCTA parameters in diabetic retinopathy with and without macular edema: single-center cross-sectional analysis. Front Endocrinol (Lausanne) 2024; 14:1275200. [PMID: 38523868 PMCID: PMC10960358 DOI: 10.3389/fendo.2023.1275200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 03/26/2024] Open
Abstract
Aim The retinal and choroidal parameters were analyzed to understand the impairment of microcirculation of both retina and choroid in patients with diabetic retinopathy (DR). Methods Fifty-five treatment-naive non-proliferative diabetic retinopathy (NPDR) patients (75 eyes) with type 2 diabetes mellitus (T2DM), including 28 patients (36 eyes) with diabetic macular edema (DME) and 27 patients (39 eyes) without DME, and 25 healthy subjects (47 eyes) were enrolled in this study. The following parameters of DR patients with and without DME were evaluated: the foveal avascular zone area (FAZ-a), FAZ perimeter (FAZ-p), FAZ circularity index (FAZ-CI), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow area percentage, superficial capillary plexus (SCP), and deep capillary plexus (DCP). Results SCP, DCP, and the percentage of choriocapillaris flow area were significantly different between DR patients with and without DME. The DR patients presented lower LA, CVI, and FAZ-CI compared to those of healthy controls (all p < 0.05). The percentage of choriocapillaris flow area in DR patients with and without DME was significantly lower than that in healthy controls (p < 0.05). SCP and DCP were significantly correlated with FAZ-a and FAZ-p but presented insignificant associations with FAZ-CI. Conclusions Optical coherence tomography (OCT) and OCT angiography (OCTA) parameters, such as LA, CVI, FAZ-CI, and the percentage of choriocapillaris flow area, were reduced compared to those in controls, indicating that the microcirculations of the retina and choroid in the macular area were impaired in DR patients with DME and without DME.
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Affiliation(s)
- Yanyan Cui
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
| | | | | | - Ping Wang
- Ophthalmological Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ruoxi Cui
- Nanchang University Queen Mary School, Nanchang, China
| | - Xiaokun Wang
- Civil Aviation Medical Center of CAAC Northeast Regional Administration, Shenyang, China
| | - Weiwei Chang
- Department of Ophthalmology, Affiliated Hospital of Jining Medical University, Jining, China
| | | | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuejiao Qin
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, China
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15
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Raciborska A, Sidorczuk P, Konopińska J, Dmuchowska DA. Interocular Symmetry of Choroidal Parameters in Patients with Diabetic Retinopathy with and without Diabetic Macular Edema. J Clin Med 2023; 13:176. [PMID: 38202183 PMCID: PMC10779809 DOI: 10.3390/jcm13010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
This study focuses on the interocular comparison of choroidal parameters in diabetic patients with diabetic retinopathy (DR) with and without diabetic macular edema (DME), as well as in patients with unilateral DME (present in only one eye). The aim of this study was to determine the symmetry in order to obtain better insights into the pathophysiology of diabetic choroidopathy. This retrospective single-center cross-sectional study included 170 eyes from 85 patients (61 with DR and 24 controls), divided into subgroups depending on the presence of DME. The patients underwent fluorescein angiography and spectral domain optical coherence tomography examination, and the analysis included various choroidal parameters: choroidal thickness, volume, and the choroidal vascularity index (CVI). In terms of the choroidal thickness, one eye of a patient with DR, regardless of the presence, absence, or unilaterality of DME, may be treated as representative for that patient. CVI proved symmetrical for controls and patients with DR without DME. However, there was some asymmetry of CVI in patients with bilateral or unilateral DME. There was no straightforward relationship between choroidopathy and DME. Other mechanisms were also involved in the pathogenesis.
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Affiliation(s)
| | | | | | - Diana Anna Dmuchowska
- Ophthalmology Department, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276 Bialystok, Poland; (A.R.); (J.K.)
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Deng X, Li Z, Li Z, Zhou Q, Lan Y. Changes in the choroid detected by ultrawide-field optical coherence tomography angiography in type 2 diabetes mellitus patients without diabetic retinopathy. Photodiagnosis Photodyn Ther 2023; 44:103823. [PMID: 37783258 DOI: 10.1016/j.pdpdt.2023.103823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Abstract
AIM The study objective was to investigate the choroidal changes in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR). METHODS This was a cross-sectional study. Controls without diabetes and T2DM patients without DR (NDR) were included. Ultrawide-field (24 × 20 mm2) optical coherence tomography angiography (OCTA) was performed to analyse choroidal thickness and vessel density. All OCTA images were divided into 3 × 3 grids. The grid centre was considered the central area, while the rest was defined as the peripheral area. RESULTS No differences between groups were observed in the flow density of the choriocapillaris (CC), choroidal thickness (ChT) and choroidal vascular index (CVI) of the large and medium choroidal vessel (LMCV) in the central area. In the eight peripheral areas, the mean flow density of the CC did not differ between the groups, while the mean CVI and ChT were decreased in the NDR group (P< 0.05). In each peripheral area, the mean CVI and ChT were decreased in the NDR group (P< 0.05, except in the infratemporal area and nasal area for ChT and in the infratemporal area for CVI). In the correlation analysis, both mean peripheral CVI and ChT correlated with age and the duration of diabetes. CONCLUSION Early choroidal lesions tended to be peripheral in the LMCV in patients with diabetes without DR and correlated with age and the duration of diabetes.
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Affiliation(s)
- Xiaowen Deng
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhenping Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qihang Zhou
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Lei C, Ran Q, Duan J, Zhang M. The Association Between Lipid Profile and Subfoveal Choroidal Thickness in Chinese Patients with Proliferative Diabetic Retinopathy Secondary to Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:2477-2489. [PMID: 37608850 PMCID: PMC10441652 DOI: 10.2147/dmso.s419794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Extensive studies have studied the factors associated with subfoveal choroidal thickness (SFCT). However, studies of the association between lipid profile and SFCT in patients with proliferative diabetic retinopathy (PDR) in type 2 diabetes remain limited. Thus, we aimed to investigate the relationship between lipid profile and SFCT in patients with PDR. Materials and Methods This was a retrospective cross-sectional study. The included participants were inpatients who underwent vitrectomy for PDR with type 2 diabetes and contralateral eyes of PDR patients meeting the criteria. Multivariate linear regression analysis was used to determine the independent association between lipid profile and SFCT. Results A total of 131 participants with PDR were enrolled in the final analysis. The average age of the participants was 55.76 ± 9.88 years, and the average SFCT was 276.10 ± 92.92 μm. Multivariate linear regression model results showed that in the fully adjusted model, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) had a negative association with SFCT (β = -16.51, 95% CI: -29.57, -3.46; P = 0.0148; β = -42.65, 95% CI: -82.60, -2.70; P = 0.0390; β = -17.89, 95% CI: -33.24, -2.54; P = 0.0245, respectively), while triglyceride was not significantly associated with SFCT (β = 5.23, 95% CI: -18.57, 29.02; P = 0.6678). Furthermore, the results of stratified analysis showed that except for triglyceride, the trends of total cholesterol, HDL-C, LDL-C, and SFCT were consistent among different stratifications in participants. Conclusion The cholesterol profile had a significant negative association with SFCT in Chinese PDR patients, but triglyceride was not significantly associated with SFCT. This suggests that these systemic imbalances contribute to choroidal changes, and often coexist in diabetic patients.
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Affiliation(s)
- Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qibo Ran
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Scuderi L, Fragiotta S, Di Pippo M, Abdolrahimzadeh S. The Role of Diabetic Choroidopathy in the Pathogenesis and Progression of Diabetic Retinopathy. Int J Mol Sci 2023; 24:10167. [PMID: 37373315 DOI: 10.3390/ijms241210167] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetic choroidopathy was first described on histopathological specimens of diabetic eyes. This alteration was characterized by the accumulation of PAS-positive material within the intracapillary stroma. Inflammation and polymorphonuclear neutrophils (PMNs) activation are crucial elements in choriocapillaris impairment. The evidence of diabetic choroidopathy in vivo was confirmed with multimodal imaging, which provides key quantitative and qualitative features to characterize the choroidal involvement. The choroid can be virtually affected in each vascular layer, from Haller's layer to the choriocapillaris. However, the damage on the outer retina and photoreceptor cells is essentially driven by a choriocapillaris deficiency, which can be assessed through optical coherence tomography angiography (OCTA). The identification of characteristic features of diabetic choroidopathy can be significant for understanding the potential pathogenic and prognostic implications in diabetic retinopathy.
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Affiliation(s)
- Luca Scuderi
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
- UOC Ophthalmology, Department of Surgical Areas, S.M. Goretti Hospital, 04100 Latina, Italy
| | - Mariachiara Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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Deng X, Li Z, Zeng P, Liang J, Wang J, Lan Y. The Association between Decreased Choriocapillary Flow and Electroretinogram Impairments in Patients with Diabetes. Photodiagnosis Photodyn Ther 2023; 42:103547. [PMID: 37003594 DOI: 10.1016/j.pdpdt.2023.103547] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To evaluate the association between choriocapillary flow (CCF) and electroretinogram (ERG) in patients with diabetes. METHOD This was a cross-sectional study. Patients with type 2 diabetes and healthy controls who had undergone both flicker ERG and optical coherence tomography angiography (OCTA) were included, while patients with severe diabetic retinopathy (DR) and macular edema were excluded. Correlations among OCTA and ERG parameters were conducted by generalized linear mixed models (GLMM). RESULT One hundred ninety-four eyes of 102 patients with diabetes and fifty-six eyes of 28 controls were included. The implicit time of 30-Hz flicker ERG successively increased, while the amplitudes, inner-retina vessel density and CCF were decreased from the control to the nondiabetic retinopathy (NDR) to DR group. In patients with diabetes, all GLMM models of ERG parameters had statistically significance (P<0.05), and CCF was correlated with ERG parameters (coefficient index=-0.601, P< 0.001 with 16 Td-s implicit time; coefficient index=-0.687, P< 0.001 with 32 Td-s implicit time; coefficient index=0.933, P=0.035 with 32 Td-s amplitude) and the thickness of retinal pigment epithelium, while in the GLMM model of CCF, it was correlated with the thickness of retinal pigment epithelium and the level of glycosylated hemoglobin(both P= 0.001). CONCLUSION CCF decreased in patients with diabetes, and it was related with ERG. Choroidopathy and its functional impairment in the retina may occur very early in patients with diabetes by influencing the outer retina.
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Affiliation(s)
- Xiaowen Deng
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Peng Zeng
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Jiaqi Liang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Jing Wang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China.
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20
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Li F, Liu L, Rao CH, Gao J. Comparison of Chorioretinal Parameters in Diabetic Retinopathy with or without Pan-Retinal Photocoagulation Using Ultrawide-Field Swept-Source Optical Coherence Tomography Angiography. Ophthalmic Res 2023; 66:538-549. [PMID: 36709752 DOI: 10.1159/000529335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To compare structural and vascular parameters in the central and peripheral retina and choroid of eyes diagnosed with severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) with or without pan-retinal photocoagulation (PRP) using ultrawide-field swept-source optical coherence tomography angiography (SS-OCTA). METHODS All participants underwent SS-OCTA imaging centered on the fovea. Retinal and choroidal thickness, vessel density of the superficial capillary plexus (SCP), deep capillary plexus (DCP), choroidal capillary plexus (CCP), and choroidal Sattler's and Haller's layer (CSHL) were analyzed in nine grids using built-in angiography analysis software. RESULTS A total of 82 eyes from 82 participants were enrolled in this study, including 40 eyes diagnosed with severe NPDR or PDR without PRP and 42 eyes with PRP. Retinal thickness in part grids was higher in eyes with PRP than in eyes without PRP. Vessel density of the SCP in nasal-superior (p = 0.003) grid was lower in eyes with PRP than in eyes without PRP. No significant difference was found in the vessel density of the DCP between the two groups (all p > 0.05). The choroidal thickness and vessel density of the CSHL of all grids were significantly lower in eyes with PRP than in eyes without PRP (all p < 0.05). A statistically significant decrease in vessel density in CCP was found in the superior (p = 0.043), nasal-superior grid (p = 0.003), macular grid (p < 0.001), and optic disc grid (p = 0.001) of eyes with PRP, compared to eyes without PRP. A significant decrease in the vessel density of CSHL was observed in all grids of PDR eyes with PRP compared to PDR eyes without PRP (all p < 0.05). Significant decrease in choroidal thickness was observed in most grids of PDR eyes with PRP, except for macular grid (p = 0.090) and optic disc grid (p = 0.057). CONCLUSION Structural and vascular parameters in the central and peripheral retinal and choroidal layers in eyes diagnosed with severe NPDR or PDR with or without PRP could be quantified using a ultrawide-field SS-OCTA. Eyes with PRP showed a significant decrease in choroidal thickness and vessel density of CCP and CSHL, compared with eyes without PRP. This trend was more obvious in eyes with PDR.
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Affiliation(s)
- Fang Li
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lun Liu
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cai-Hua Rao
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian Gao
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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21
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Khalatyan AS, Yusef YN. [Choroidal changes in patients with diabetes mellitus]. Vestn Oftalmol 2023; 139:158-165. [PMID: 38235643 DOI: 10.17116/oftalma2023139061158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and considered one of the leading causes of vision loss worldwide. The choroid supplies blood to the retina, photoreceptors and the retinal pigment epithelium, it is essential for metabolic exchange in the retina. Many experimental studies have reported that choroidal pathology in diabetic patients may play a role in the development of DR. Choroidal thickness (CT) can be used to assess the vascularization of the choroid. Choroidal vascularity index (CVI) is also used as a marker in assessment of choroidal vascularization. Many studies have been conducted to evaluate choroidal changes in various eye diseases. However, the data on CT in DM patients, especially in those with DR, are conflicting. Thus, the choroidal status in diabetic patients with or without DR remains controversial. In this systematic review we analyze a number of articles dedicated to the relationship between structural changes in the choroid in patients with diabetes mellitus and diabetic retinopathy of different stages, paying particular attention to choroidal thickness and certain other parameters that allow assessment of choroidal changes.
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Affiliation(s)
- A S Khalatyan
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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22
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Orduna-Hospital E, Arcas-Carbonell M, Sanchez-Cano A, Pinilla I, Consejo A. Speckle Contrast as Retinal Tissue Integrity Biomarker in Patients with Type 1 Diabetes Mellitus with No Retinopathy. J Pers Med 2022; 12:jpm12111807. [PMID: 36579516 PMCID: PMC9693211 DOI: 10.3390/jpm12111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To study the retinal and choroidal layers in type 1 diabetes mellitus (DM1) without diabetic retinopathy (DR), using speckle contrast of optical coherence tomography (OCT) images as a tissue biomarker in comparison with healthy subjects. METHODS OCT Spectralis images of 148 eyes, 84 from DM1 patients without DR signs, and 64 belonging to the control group, were collected. The speckle contrast and thickness of the inner retinal layer (IRL), the outer retinal layer (ORL), and the choroidal layer in the nasal parafoveal area (N3), were prospectively analyzed. RESULTS A statistically significant difference (p = 0.001) in the IRL thickness between groups was observed, being thicker in the DM1 group. There were no differences in the ORL and choroidal thicknesses between groups. A statistically significant difference (p = 0.02) in the IRL speckle contrast was obtained, being lower in the DM1 group. The maximum speckle contrast was reached in the ORL for both groups, although in the DM1 group, it occurs closer to the choroid, at 64 ± 8 μm (p = 0.008). CONCLUSIONS Statistically significant differences were found in speckle contrast and thickness between the control and the DM1 group, suggesting an IRL alteration of DM1 patients, supporting the retinal neurodegeneration before DR signs are observed.
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Affiliation(s)
- Elvira Orduna-Hospital
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Correspondence:
| | | | - Ana Sanchez-Cano
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
| | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
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23
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Da Silva MO, Chaves AECDC, Gobbato GC, Lavinsky F, Schaan BD, Lavinsky D. Early choroidal changes detected by swept-source OCT in type 2 diabetes and their association with diabetic kidney disease. BMJ Open Diabetes Res Care 2022; 10:10/6/e002938. [PMID: 36418057 PMCID: PMC9685254 DOI: 10.1136/bmjdrc-2022-002938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Microvascular changes in eye and kidney shares some common factors in diabetes mellitus (DM). The purpose was to evaluate choroidal thickness (CT) and choriocapillaris (CC) density in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD) using swept-source optical coherence tomography (SS-OCT). RESEARCH DESIGN AND METHODS A cross-sectional study was conducted with patients with T2D with mild or no diabetic retinopathy (DR) and non-diabetic controls. CT was measured with SS-OCT, and CC vascular density was measured with OCT angiography. These parameters were compared with inner retinal layers thickness in patients with and without DKD and non-diabetic controls. RESULTS Ninety-three eyes from patients with T2D and 34 eyes from controls volunteers were included. Within the T2D group, 56 eyes with DKD and 37 eyes from patients with no diabetic kidney disease were examined. A statistically significant reduction of CT was observed in patients with DKD compared with controls, with no difference in CC density. There was an association between ganglion cell layer and central choroidal thickness reduction in the DKD group. CONCLUSIONS Patients with T2D with DKD showed a decrease in CT with no difference in CC density compared with non-diabetic controls. This thinning might be related to vascular changes of choroidal layers such as Haller's and Sattler's with preservation of CC density, which is crucial for outer retina and retinal pigment epithelium health. Longitudinal studies are warranted to determine the association of choroidal changes with the pathogenesis of diabetes, and its association with early DKD and progression to more severe DR.
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Affiliation(s)
- Monica Oliveira Da Silva
- Departament of Ophtalmology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology post graduation program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Anne Elise Cruz do Carmo Chaves
- Departament of Ophtalmology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology post graduation program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Glauber Correa Gobbato
- Departament of Ophtalmology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | - Fabio Lavinsky
- Departament of Ophtalmology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Medical School, Unisinos, Sao Leopoldo, Brazil
| | - Beatriz D'Agord Schaan
- Endocrinology post graduation program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Departament of Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Lavinsky
- Departament of Ophtalmology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology post graduation program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Fernández-Espinosa G, Orduna-Hospital E, Boned-Murillo A, Diaz-Barreda MD, Sanchez-Cano A, Sopeña-Pinilla M, Pinilla I. Choroidal and Retinal Thicknesses in Type 2 Diabetes Mellitus with Moderate Diabetic Retinopathy Measured by Swept Source OCT. Biomedicines 2022; 10:biomedicines10092314. [PMID: 36140415 PMCID: PMC9496206 DOI: 10.3390/biomedicines10092314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) and to correlate with changes in retinal thickness (RT) with swept-source OCT (SS-OCT) compared to healthy subjects. Methods: Fifty-four DM2 patients with moderate DR without diabetic macular edema (DME) and 73 age-matched healthy subjects were evaluated using SS-OCT to measure changes in total RT and CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid. Results: The mean age was 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Total RT showed statistically significant differences in the temporal inner area, with higher values in the DM2 group (p = 0.010). CT did not show differences between the groups. There was a significant negative correlation between RT and age in all of the outer ETDRS areas and a positive significant correlation in the central area for the DM2 group. There was also a negative significant correlation between CT and age in all of the ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner, p = 0.028; nasal inner, p= 0.003). Conclusion: DM2 patients with moderate DR have no changes with regard to CT. Both CT and RT decreased with age in DM2, showing a negative correlation between these factors in the central and horizontal parafoveal areas of the ETDRS grid.
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Affiliation(s)
| | - Elvira Orduna-Hospital
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (E.O.-H.); (I.P.)
| | - Ana Boned-Murillo
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Maria Dolores Diaz-Barreda
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Ana Sanchez-Cano
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Sopeña-Pinilla
- Department of Ophthalmology, Miguel-Servet University Hospital, 50009 Zaragoza, Spain
| | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (E.O.-H.); (I.P.)
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25
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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Obadă O, Pantalon AD, Rusu-Zota G, Hăisan A, Lupuşoru SI, Chiseliţă D. Choroidal Assessment in Patients with Type 2 Diabetes Mellitus and Non-Proliferative Diabetic Retinopathy by Swept-Source Ocular Coherence Tomography and Image Binarization. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070918. [PMID: 35888637 PMCID: PMC9319764 DOI: 10.3390/medicina58070918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate choroidal structure and vascularity indices in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Sixty-three eyes from sixty-three patients were evaluated: 21 from healthy subjects, 20 with diabetes mellitus (DM) and no diabetic retinopathy (DR), and 22 with DM and non-proliferative diabetic retinopathy without diabetic macular edema (DME). Each patient underwent ocular examination, macular swept-source ocular coherence tomography (SS-OCT) imaging, glycemic control, and systemic high blood pressure (HBP) evaluation. Subfoveal choroidal thickness (SF-CT) was manually assessed on a line scan. Line scan OCT images were exported to ImageJ program. The areas under a 1.5, 3 and 6 mm horizontal line centered on the fovea were assessed by converting the OCT images to binary images, and total choroidal area (TCA), luminal area (LA), stromal area (SA), LA:SA ratio, and choroidal vascularity index (CVI) were evaluated. SF-CT and choroidal parameters were compared between groups, and correlations with ocular and systemic factors were analyzed. Results: SF-CT, TCA, LA, and SA were similar between groups. CVIs were significantly different between groups for all three studied areas (CVI-1.5: 66.21% vs. 66.06% vs. 63.74%, p = 0.003; CVI-3: 65.88% vs. 66.46% vs. 63.79%, p = 0.008; CVI-6: 64.79% vs. 65.40% vs. 63.61%, p = 0.032). NPDR patients had significantly lower CVIs compared to DM patients (p < 0.05). No association of choroidal parameters with glycemic control, DM duration and HBP was found significant (p < 0.05). Conclusions: Choroidal assessment by SS-OCT and image binarization in healthy subjects, subjects with DM without DR, and subjects with DM and NPDR indicated that CVI changes were identifiable and significant in early DR. The lack of association with ocular and systemic factors suggest that CVIs are reliable assessment parameters of choroidal vascular structure.
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Affiliation(s)
- Otilia Obadă
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
- Department of Ophthalmology, “Saint Spiridon” Clinical Emergency Hospital, 1 Independenţei Street, 700111 Iaşi, Romania
- Correspondence: (O.O.); (A.D.P.)
| | - Anca Delia Pantalon
- Department of Ophthalmology, “Saint Spiridon” Clinical Emergency Hospital, 1 Independenţei Street, 700111 Iaşi, Romania
- Correspondence: (O.O.); (A.D.P.)
| | - Gabriela Rusu-Zota
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
| | - Anca Hăisan
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy,16 Universităţii Street, 700115 Iaşi, Romania;
| | - Smaranda Ioana Lupuşoru
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
| | - Dorin Chiseliţă
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universităţii Street, 700115 Iaşi, Romania;
- Oftaprof Ophthalmology Clinic, 54 Stejar Street, 700327 Iaşi, Romania
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Correlation between Choroidal Vascularity Index and Outer Retina in Patients with Diabetic Retinopathy. J Clin Med 2022; 11:jcm11133882. [PMID: 35807164 PMCID: PMC9267134 DOI: 10.3390/jcm11133882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
The choroid supplies blood to the outer retina. We quantified outer retinal and choroidal parameters to understand better the pathogenesis of diabetic retinopathy (DR) and diabetic macular edema (DME). The retrospective cross-sectional single-center study included 210 eyes from 139 diabetic patients and 76 eyes from 52 healthy controls. Spectral-domain optical coherence tomography (OCT) was carried out with a Spectralis HRA + OCT imaging device. The outer retinal layer (ORL), outer nuclear layer (ONL), and choroidal thicknesses were assessed along with the choroidal vascularity index (CVI). The presence of DR, whether with DME or without, was associated with choroidal thinning (p < 0.001). Compared with the controls, patients with DR without DME presented with lower ORL and ONL thickness (p < 0.001), whereas those with DR and DME had higher values of both parameters (p < 0.001). Significant correlations between outer retinal and choroidal parameters were found only in patients with DR without DME (ORL with choroidal thickness: p = 0.003, rho = 0.34; ORL with CVI: p < 0.001, rho = 0.49, ONL with CVI: p < 0.027, rho = 0.25). No correlations between choroidal and outer retinal parameters were observed in the controls and patients with DR and concomitant DME. Aside from diabetic choroidopathy, other pathogenic mechanisms seem to predominate in the latter group.
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Automatic choroid layer segmentation in OCT images via context efficient adaptive network. APPL INTELL 2022. [DOI: 10.1007/s10489-022-03723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kung EW, Chan VT, Tang Z, Yang D, Sun Z, Wang YM, Chan C, Kwan MC, Shi J, Cheung CY. Alterations in the Choroidal Sublayers in Relationship to Severity and Progression of Diabetic Retinopathy: A Swept-Source OCT Study. OPHTHALMOLOGY SCIENCE 2022; 2:100130. [PMID: 36249687 PMCID: PMC9560641 DOI: 10.1016/j.xops.2022.100130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022]
Abstract
Purpose To examine the association of baseline choroidal sublayers metrics with the risk of diabetic retinopathy (DR) progression over 2 years, with adjustment for confounding factors that affect choroidal measurements. Design Prospective, observational cohort study. Participants One hundred three eyes from 62 patients with diabetes mellitus (DM). Methods Patients were followed up at 6-month intervals for at least 2 years. Choroidal metrics including choroidal area, choroidal thickness (CT), and choroidal vascularity index were measured for both (1) the choriocapillaris plus Sattler's layer and (2) the Haller's layer within the subfoveal and parafoveal region. Cox proportional models were constructed to estimate the relationship between baseline choroidal metrics and DR progression, adjusted for intereye correlation, established risk factors (i.e., duration of DM, glycated hemoglobin [HbA1c] level, body mass index [BMI], use of insulin, and mean arterial blood pressure [MABP]) and confounding factors of choroidal measurements (i.e., age and axial length). Additional predictive value of choroidal metrics was assessed using the C-statistic. Main Outcome Measures Hazard ratios (HRs) calculated by Cox proportional hazards model to demonstrate the associations between baseline choroidal metrics and DR progression. Results After adjusting for age, axial length, and intereye correlation, choroidal metrics in Haller's layer at baseline that were associated with a higher risk of DR progression included increases in subfoveal choroidal area (HR, 2.033; 95% confidence interval [CI], 1.179-3.505; P = 0.011), subfoveal plus parafoveal choroidal area (HR, 1.909; 95% CI, 1.096-3.326; P = 0.022), subfoveal CT (HR, 2.032; 95% CI, 1.181-3.498; P = 0.010), and subfoveal plus parafoveal CT (HR, 1.908; 95% CI, 1.097-3.319; P = 0.022). These associations remained statistically significant after additionally adjusting for duration of DM, HbA1c level, BMI, use of insulin, and MABP. Addition of these choroidal metrics significantly improved the discrimination for DR progression when compared with established risk factors alone (e.g., duration of DM and HbA1c; increase in C-statistic ranged from 8.08% to 9.67% [P < 0.05]). Conclusions Eyes with a larger choroidal area and CT in Haller's layer at baseline were associated with a higher risk of DR progression over 2 years.
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Key Words
- BMI, body mass index
- CI, confidence interval
- CSI, choroid–sclera interface
- CT, choroidal thickness
- CVI, choroidal vascularity index
- Choroid
- DM, diabetes mellitus
- DME, diabetic macular edema
- DR progression
- DR, diabetic retinopathy
- Diabetic choroidopathy
- Diabetic retinopathy
- HR, hazard ratio
- HbA1c, glycated hemoglobin
- MABP, mean arterial blood pressure
- NPDR, nonproliferative diabetic retinopathy
- PDR, proliferative diabetic retinopathy
- SS, swept-source
- Swept-source OCT
- VA, visual acuity
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Erica W.T. Kung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Victor T.T. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C.H. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael C.H. Kwan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jian Shi
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Hirano T, Takahashi Y, Hoshiyama K, Murata T. Optical coherence tomography angiography findings before and after onset of foveal retinal neovascularization in diabetic retinopathy. Am J Ophthalmol Case Rep 2022; 26:101435. [PMID: 35243170 PMCID: PMC8861405 DOI: 10.1016/j.ajoc.2022.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a rare case of foveal retinal neovascularization (RNV) in a patient with diabetic retinopathy in whom the retinal microcirculation structure before and after the onset of the disease was evaluated using optical coherence tomography angiography (OCTA). Observations A 54-year-old woman with diabetes mellitus was referred to our department for fundus evaluation, and was diagnosed with cataract and severe non-proliferative diabetic retinopathy in the left eye. Two years after we performed cataract surgery and pan-retinal photocoagulation in the left eye, OCTA detected a previously unidentified foveal RNV arising from the perifoveal capillary network. The vitreous retinal interface slab of OCTA and cross-sectional OCT images confirmed that this foveal RNV was an aberrant vessel invading the vitreous cavity. Conclusions and Importance The findings in this case indicate that foveal RNV in diabetic retinopathy is derived from vessels outside the foveal avascular zone (FAZ), and OCTA is a useful examination for the diagnostic investigation of foveal RNV.
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Temel E, Özcan G, Yanık Ö, Demirel S, Batıoğlu F, Kar İ, Özmert E. Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. Int Ophthalmol 2022; 42:3661-3672. [PMID: 35604622 DOI: 10.1007/s10792-022-02363-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (˂ 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 μm nasal, and 1500 μm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.
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Affiliation(s)
- Emine Temel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Gökçen Özcan
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Fursova AZ, Vasilyeva MA, Tarasov MS, Zubkova MY, Derbeneva AS, Nikulich IF, Gamza YA. [Features of structural and microvascular changes of the choroid in angioretinopathy of various etiologies]. Vestn Oftalmol 2022; 138:47-56. [PMID: 35488562 DOI: 10.17116/oftalma202213802147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure. MATERIAL AND METHODS The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. RESULTS In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus. CONCLUSION Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.
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Affiliation(s)
- A Zh Fursova
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M A Vasilyeva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - M S Tarasov
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M Y Zubkova
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - A S Derbeneva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - I F Nikulich
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - Yu A Gamza
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS OF RETINAL HYPERPERMEABILITY AND CHOROIDAL INFLAMMATION AS PREDICTORS OF SHORT-TERM FUNCTIONAL AND ANATOMICAL OUTCOMES IN EYES WITH DIABETIC MACULAR EDEMA TREATED WITH INTRAVITREAL BEVACIZUMAB. Retina 2022; 42:760-766. [PMID: 35350050 DOI: 10.1097/iae.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess spectral domain optical coherence tomography biomarkers of short-term outcomes in eyes with diabetic macular edema treated with intravitreal bevacizumab. METHODS In a prospective interventional case series, 66 eyes with diabetic macular edema underwent 3 monthly intravitreal bevacizumab injections. Best-corrected visual acuity measurement and spectral domain optical coherence tomography were performed at baseline and at 3 months. Multivariate regression analysis was performed to investigate the baseline spectral domain optical coherence tomography parameters as predictors of functional and anatomical outcomes. RESULTS Patients with diabetic nephropathy had greater subfoveal choroidal thickness (300.8 ± 35.54 vs. 253.0 ± 50.07 µm, P < 0.01) and were more likely to have subretinal fluid (r = 0.26, P = 0.03) at baseline. Multivariate analysis showed that the extent of external limiting membrane disruption (P = 0.03) and the extent of disorganization of retinal inner layers (P = 0.03) at baseline were predictors of best-corrected visual acuity at 3 months, whereas the extent of disorganization of retinal inner layers (P = 0.04) and duration of diabetes mellitus (P = 0.03) were predictors of central subfield thickness at 3 months. CONCLUSION External limiting membrane disruption and disorganization of retinal inner layers, as the spectral domain optical coherence tomography biomarkers of retinal hyperpermeability, can predict short-term outcomes in diabetic macular edema eyes treated with intravitreal bevacizumab.
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Nicolini N, Tombolini B, Barresi C, Pignatelli F, Lattanzio R, Bandello F, Cicinelli MV. Assessment of Diabetic Choroidopathy Using Ultra-Widefield Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:35. [PMID: 35353150 PMCID: PMC8976931 DOI: 10.1167/tvst.11.3.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The purpose of this study was to investigate a confocal scanning laser ophthalmoscopy (cSLO) ultra-widefield (UWF) swept-source optical coherence tomography (S-SOCT) in assessment of diabetic choroidopathy and to evaluate the agreement of measurements with a spectral-domain OCT (SD-OCT) instrument. Methods We conducted a cross-sectional study of patients with diabetes evaluating the choroidal vascularity index (CVI) in the nasal, temporal, and central macula segments of a UWF SS-OCT scan centered to the fovea. UWF pseudocolored fundus images were used for diabetic retinopathy (DR) severity staging. The CVI values were compared between different degrees of severity of DR and different posterior-pole sectors with linear mixed models. Central macula CVI measurements were repeated on SD-OCT scans; the interobserver intraclass coefficient (ICC) was calculated between SS-OCT and SD-OCT. Results A total of 151 eyes of 85 patients were included. The CVI values decreased from nonproliferative DR to proliferative DR, with high-risk proliferative DR having significantly lower CVI values than moderate to severe nonproliferative DR (P = 0.03). The central macula region was the most evidently affected; the nasal sector was the least affected. The agreement between SS-OCT and SD-OCT was moderate (ICC = 0.50). Conclusions Diabetic choroidopathy progresses with worsening of DR toward proliferative disease; choroidal depletion is more prominent in the macula. Caution is recommended in comparing CVI values between different devices. Translational Relevance Choroidal vascularity informs about the severity of DR and its complications, such as macular edema. The agreement between readers and between instruments may be suboptimal in certain cases.
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Affiliation(s)
- Nicolò Nicolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Barresi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Choroidal Structural Changes of Posterior Subtenon Triamcinolone Acetonide Injection in Eyes with Refractory Diabetic Macular Edema. J Ophthalmol 2022; 2022:6882607. [PMID: 35237449 PMCID: PMC8885276 DOI: 10.1155/2022/6882607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To access the choroidal structural changes of posterior subtenon triamcinolone acetonide (PSTA) injection in eyes with refractory diabetic macular edema (DME). Methods Patients with refractory DME were enrolled and followed for 4 weeks after switching to PSTA injection. All patients underwent spectral-domain optical coherence tomography with enhanced depth imaging, and the choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were evaluated before and after switching treatments. Results After switching to PSTA treatment, the final best-corrected visual acuity and central subfield thickness in eyes with refractory DME were significantly improved compared to the baseline values (P=0.002 and P < 0.001, respectively). Both the SFCT and CVI decreased during the follow-up period, and significant decreases were observed at 4-week follow-up (P < 0.001 and P=0.012, respectively). The linear regression analysis showed a significant correlation between the baseline SFCT and the final visual outcomes (P=0.047). Conclusions The alterations of SFCT and CVI in this study suggest that the choroidal vasculature is involved in the pathogenesis of refractory DME and could be affected by PSTA treatment. SFCT rather than CVI may be a prognostic biomarker for eyes with refractory DME.
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Schreur V, Larsen MB, Sobrin L, Bhavsar AR, Hollander AI, Klevering BJ, Hoyng CB, Jong EK, Grauslund J, Peto T. Imaging diabetic retinal disease: clinical imaging requirements. Acta Ophthalmol 2022; 100:752-762. [PMID: 35142031 DOI: 10.1111/aos.15110] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/12/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Diabetic retinopathy (DR) is a sight-threatening complication of diabetes mellitus (DM) and it contributes substantially to the burden of disease globally. During the last decades, the development of multiple imaging modalities to evaluate DR, combined with emerging treatment possibilities, has led to the implementation of large-scale screening programmes resulting in improved prevention of vision loss. However, not all patients are able to participate in such programmes and not all are at equal risk of DR development and progression. In this review, we discuss the relevance of the currently available imaging modalities for the evaluation of DR: colour fundus photography (CFP), ultrawide-field photography (UWFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), OCT angiography (OCTA) and functional testing. Furthermore, we suggest where a particular imaging technique of DR may aid the evaluation of the disease in different clinical settings. Combining information from various imaging modalities may enable the design of more personalized care including the initiation of treatment and understanding the progression of disease more adequately.
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Affiliation(s)
- Vivian Schreur
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Morten B. Larsen
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School Massachusetts Eye and Ear Infirmary Boston USA
| | | | - Anneke I. Hollander
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - B. Jeroen Klevering
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Eiko K. Jong
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Jakob Grauslund
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Tunde Peto
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
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Retinal Vascularization Abnormalities Studied by Optical Coherence Tomography Angiography (OCTA) in Type 2 Diabetic Patients with Moderate Diabetic Retinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020379. [PMID: 35204470 PMCID: PMC8871460 DOI: 10.3390/diagnostics12020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p < 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p < 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group.
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Sevik MO, Çam F, Aykut A, Dericioğlu V, Şahin Ö. Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers. Ophthalmic Physiol Opt 2021; 42:367-375. [PMID: 34913506 DOI: 10.1111/opo.12935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effects of the Valsalva manoeuvre (VM) on the choroidal vascularity index (CVI) in healthy volunteers. METHODS This prospective, cross-sectional study included 60 eyes of 30 healthy volunteers. Enhanced depth imaging-optical coherence tomography scans of both eyes involving the fovea were taken, and a 1500 μm subfoveal choroidal area was selected for image binarization with open-access Fiji software. The binarized image was segmented into the stromal area (SA) and luminal area (LA), and CVI was calculated as the ratio (%) of LA to the total choroidal area (TCA). CVI, subfoveal choroidal thickness (SFCT), IOP, systolic and diastolic blood pressure were evaluated at rest and during the VM. RESULTS During the VM, a mean ± standard deviation increase in LA (0.02 ± 0.05 mm2 , p < 0.001) and CVI (1.72 ± 2.83%, p < 0.001) was observed, whereas SA (-0.02 ± 0.05 mm2 , p < 0.001) decreased. There was no significant change in TCA (0.00 ± 0.03 mm2 , p = 0.55) or SFCT (1.05 ± 10.92 μm, p = 0.46). There was a moderate positive correlation between the spherical equivalent refractive error (SE) and SFCT both at rest and during VM (r58 = 0.49, p < 0.0005 and r58 = 0.49, p < 0.0005, respectively). However, there was no significant correlation between SE and CVI either at rest or during VM (p = 0.11 and 0.06, respectively). In a multiple linear regression analysis, CVI was only associated with SFCT; however, SFCT was also associated with SE, both at rest and during VM (p < 0.001). CONCLUSION Valsalva manoeuvre increases CVI by choroidal vascular dilation as demonstrated by an increase in LA and a decrease in SA. Researchers should be careful about unintentional VM during examinations.
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Affiliation(s)
- Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Furkan Çam
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Dericioğlu
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
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Bartol-Puyal FDA, Isanta C, Calvo P, Méndez-Martínez S, Ruiz-Moreno Ó, Pablo L. Mapping of choriocapillaris vascular density in young and aged healthy subjects. Eur J Ophthalmol 2021; 32:2789-2800. [PMID: 34881677 DOI: 10.1177/11206721211067019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare macular vascular density (VD) of the choriocapillaris (CC) between young and aged healthy individuals. METHODS A cross-sectional study was performed enrolling young and senior healthy individuals of Caucasian race and an axial length (AL) lower than 26 mm, and without systemic or ophthalmological diseases. CC VD was imaged with DRI Triton OCTA using a 6 × 6 mm macular analysis. Internal software delimited CC boundaries and gave colour pictures, which were analysed and codified into numbers, and a grid of 30 × 30 VD values was obtained. Two-dimension (2D) and three-dimension (3D) representations were created. RESULTS 53 eyes of 53 young healthy individuals and 30 eyes of 30 senior healthy individuals were enrolled. Mean age was 27.17 ± 3.90 years, and 67.00 ± 7.41 years, respectively (p < 0.001). There were no differences in intraocular pressure (IOP) or AL (23.73 ± 0.79 mm, 23.18 ± 0.80 mm, respectively, p = 0.24). There were differences in foveal VD and in temporal perifoveal macula, but not in nasal perifoveal macula. Foveal VD was the highest in both groups. CONCLUSIONS Foveal CC VD has been found to be considerably high with this method, and it is the area which most decreases with age. Nasal perifoveal VD is not reduced in older individuals. These outcomes are opposite to other studies using different methods but they are in line with previous histological findings.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Carlos Isanta
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Pilar Calvo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Óscar Ruiz-Moreno
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain
| | - Luis Pablo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain.,Biotech Vision SLP, University of Zaragoza, Spain
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Attiku Y, He Y, Nittala MG, Sadda SR. Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries. Indian J Ophthalmol 2021; 69:2968-2976. [PMID: 34708731 PMCID: PMC8725126 DOI: 10.4103/ijo.ijo_1212_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.
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Affiliation(s)
- Yamini Attiku
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California
| | - Ye He
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | | | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Mirshahi A, Fadakar K, Mirshahi R, Khalili Pour E, Ebrahimiadib N, Ghassemi F, Khojasteh H, Bazvand F, Ghods S, Riazi-Esfahani H, Faghihi H. Alterations in choroidal vascular parameters following panretinal photocoagulation using enhanced-depth imaging optical coherence tomography in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2021; 260:459-469. [PMID: 34468831 DOI: 10.1007/s00417-021-05401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the alteration of choroid in patients with very severe non-proliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR) following panretinal photocoagulation (PRP). METHODS Thirty-nine eyes of 21 patients with very severe non-proliferative diabetic retinopathy (NPDR) (19 eyes) and early proliferative diabetic retinopathy (PDR) (20 eyes) were recruited. Enhanced-depth imaging optical coherence tomography at baseline, 1, and 6 months after PRP was employed to measure choroidal parameters including total choroidal area (TCA) and choroidal vascular index (CVI). RESULTS In eyes with very severe NPDR, subfoveal TCA decreased non-significantly at month 1, which increased significantly at month 6 (539 ± 131µm2, 502 ± 134µm2, and 598 ± 168µm2 at baseline and months 1 and 6, respectively; P = 0.003). Subfoveal CVI increased at month 1 and then decreased at month 6 (68.25 ± 3.05, 69.74 ± 3.62, and 67.84 ± 1.77 at baseline and months 1 and 6, respectively; P < 0.001). A reverse pattern occurred in eyes with early PDR, a non-significant increase in TCA at month 1 followed by a decrease at month 6 (497 ± 95µm2, 514 ± 133µm2, and 425 ± 95µm2 at baseline and months 1 and 6, respectively; P = 0.011). CVI decreased at month 1 and remained relatively stable at month 6 (69.34 ± 3.11, 68.33 ± 3.41, and 68.50 ± 5.04 at baseline, and months 1 and 6, respectively; P = 0.023). Alteration of choroidal thickness was not statistically significant in both groups. CONCLUSION Eyes with very severe NPDR and early PDR exhibit a reverse pattern regarding choroidal indices after PRP.
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Affiliation(s)
- Ahmad Mirshahi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Kaveh Fadakar
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Fariba Ghassemi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Hassan Khojasteh
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Fatemeh Bazvand
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Sepideh Ghods
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran.
| | - Hooshang Faghihi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran
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Abstract
INTRODUCTION Ischemic choroidal diseases are an underdiagnosed entity. The clinical pattern varies according to the size and the localisation of the affected vascular structure. CLINICAL PRESENTATION In eyes with occlusion of the long posterior ciliary arteries, characteristic triangular patches of choroidal ischemia (Amalric sign) are seen, which in the course of time merge into well-defined areas of atrophy of the retinal pigment epithelium. Above the non-perfused choroidal areas, hyperpigmented, grouped lines appear (Siegrist streaks). Circumscribed ischemia of smaller choroidal arterioles and capillary vessels appears as multifocal, yellowish lesions in the posterior fundus (Elschnig spots). Vortex vein occlusion becomes manifest as exudative haemorrhagic choroidal swelling in the periphery. CAUSES OF CHOROIDAL ISCHEMIA Apart from arterial hypertension as a major risk factor, some immunological disorders such as giant cell arteritis and systemic lupus erythematosus and haematological pathologies also affect choroidal perfusion. Furthermore, choroidal ischemia occurs due to local inflammation, as found in eyes with acute multifocal posterior placoid pigment epitheliopathy (APMPPE). Rarely, choroidal infarction is of iatrogenic origin or drug-induced. Recent advances in imaging, such as the introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A), have improved the visualisation of the choroidal vasculature and complement the classical angiographic procedures. In patients with age-related macular degeneration (AMD) and diabetes, some changes in choroidal blood flow and vascular structure have also been noted. While in AMD the choroidal pathologies correlate with the disease progression and the functional prognosis, the pathophysiological relationship between diabetic choroidopathy and retinopathy is currently unclear. MANAGEMENT AND CONCLUSION With regard to the limited therapeutic options for choroidal ischemia, optimisation of the cardiovascular risk profile and the management of accompanying ocular and systemic diseases are essential.
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Affiliation(s)
- Teresa Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
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Quantitative Assessment of Choroidal Parameters in Patients with Various Types of Diabetic Macular Oedema: A Single-Centre Cross-Sectional Analysis. BIOLOGY 2021; 10:biology10080725. [PMID: 34439957 PMCID: PMC8389323 DOI: 10.3390/biology10080725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
Simple Summary Choroidopathy is one of the components in the pathogenesis of diabetic macular oedema (DME). This study investigated the optical coherence tomography-based choroidal parameters: thickness, volume, choroidal vascularity index (CVI), luminal area (LA), stromal area (SA), and total choroidal area (TCA) in relation to the presence and type of DME (cystoid, diffuse, and with subretinal fluid). Diabetic choroidopathy seems to play a role in the development of DME but is less likely involved in the pathogenesis of specific types thereof. Abstract Diabetic macular oedema (DME) is an outcome of multiple, complex and not fully understood mechanisms. The aim of this study was to define the role of choroidopathy in the pathogenesis of various DME types. The retrospective cross-sectional single-centre study included 140 eyes from 105 patients with DME and 76 eyes from 52 non-diabetic controls. The eyes were stratified according to the type of DME: cystoid, diffuse, and with subretinal fluid. Optical coherence tomography-based choroidal parameters: thickness, volume, choroidal vascularity index (CVI), luminal area (LA), stromal area (SA), and total choroidal area (TCA) were compared. Eyes with DME, regardless of the type thereof, had lower choroidal thickness, volume, and CVI values than the controls. Further, the eyes with some specific DME types differed significantly from the controls in terms of LA and SA. While the eyes with various DME types did not differ significantly in terms of their choroidal thickness, volume and CVI, some between-group differences were found in LA, SA and TCA. Diabetic choroidopathy seems to play a role in the development of DME but is less likely involved in the pathogenesis of specific types thereof.
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Brinks J, van Dijk EHC, Klaassen I, Schlingemann RO, Kielbasa SM, Emri E, Quax PHA, Bergen AA, Meijer OC, Boon CJF. Exploring the choroidal vascular labyrinth and its molecular and structural roles in health and disease. Prog Retin Eye Res 2021; 87:100994. [PMID: 34280556 DOI: 10.1016/j.preteyeres.2021.100994] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
The choroid is a key player in maintaining ocular homeostasis and plays a role in a variety of chorioretinal diseases, many of which are poorly understood. Recent advances in the field of single-cell RNA sequencing have yielded valuable insights into the properties of choroidal endothelial cells (CECs). Here, we review the role of the choroid in various physiological and pathophysiological mechanisms, focusing on the role of CECs. We also discuss new insights regarding the phenotypic properties of CECs, CEC subpopulations, and the value of measuring transcriptomics in primary CEC cultures derived from post-mortem eyes. In addition, we discuss key phenotypic, structural, and functional differences that distinguish CECs from other endothelial cells such as retinal vascular endothelial cells. Understanding the specific clinical and molecular properties of the choroid will shed new light on the pathogenesis of the broad clinical range of chorioretinal diseases such as age-related macular degeneration, central serous chorioretinopathy and other diseases within the pachychoroid spectrum, uveitis, and diabetic choroidopathy. Although our knowledge is still relatively limited with respect to the clinical features and molecular pathways that underlie these chorioretinal diseases, we summarise new approaches and discuss future directions for gaining new insights into these sight-threatening diseases and highlight new therapeutic strategies such as pluripotent stem cell‒based technologies and gene therapy.
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Affiliation(s)
- J Brinks
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - E H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - I Klaassen
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - R O Schlingemann
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - S M Kielbasa
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - E Emri
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - P H A Quax
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Bergen
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - O C Meijer
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - C J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Kase S, Endo H, Takahashi M, Yokoi M, Ito Y, Saito M, Ishida S, Kase M. Choroidal vascular structures in diabetic patients: a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:3537-3548. [PMID: 34244824 DOI: 10.1007/s00417-021-05292-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Choroidal vascular structures are likely to be affected in diabetic patients. The aim of this study was to conduct a meta-analysis of choroidal vascular structures in diabetic eyes with no diabetic retinopathy (NDR) and healthy control eyes, which was systematically evaluated by various factors involving the measurements. METHODS This study identified clinical data from publications in PubMed and web of science until May 2020. Independent retrospective or prospective clinical studies comparing NDR and healthy control eyes regarding choroidal vascular structures were extracted. Five related studies were enrolled, cumulating in a total of 282 diabetic eyes and 511 control eyes examined in this study. Heterogeneity was statistically quantified by I2 statistics, and meta-analysis was performed using a random effects model. This study included 2 different algorisms of binarization determining the ratio of luminal areas in total choroidal areas, both of which were consolidated and called "choroidal vascular ratio." RESULTS Meta-analysis clearly showed that the choroidal vascular ratio was significantly lower in NDR eyes than in healthy control eyes (weighted mean difference = - 2.16; 95%CI: - 3.19 to - 1.13; P < 0.005). Similar results were obtained in sub-analysis based on adjustment of serum HbA1c levels and duration of diabetes. CONCLUSIONS The choroidal vascular ratio of NDR eyes was significantly lower than that of healthy control eyes. The ratio might contribute to a better understanding of the pathophysiology involved in the development of diabetic retinopathy, although there was some heterogeneity in primary analysis studies.
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Affiliation(s)
- Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Hiroaki Endo
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Mitsuo Takahashi
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Yuki Ito
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Manabu Kase
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
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Ţălu Ş, Nicoara SD. Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema. World J Diabetes 2021; 12:437-452. [PMID: 33889289 PMCID: PMC8040083 DOI: 10.4239/wjd.v12.i4.437] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/23/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic retinopathy, affecting 1 in 15 patients with diabetes mellitus (DM). The disruption of the inner blood-retina barrier (BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris, in the occurrence and evolution of DME. The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition. In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.
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Affiliation(s)
- Ştefan Ţălu
- Directorate of Research, Development and Innovation Management (DMCDI), Technical University of Cluj-Napoca, Cluj-Napoca 400020, Romania
| | - Simona Delia Nicoara
- Department of Ophthalmology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
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Zhang Y, Qin Y, Wang S, Liu Y, Li X, Sun X. Higher choroidal thickness and lower choriocapillaris blood flow signal density based on optical coherence tomography angiography in diabetics. Sci Rep 2021; 11:5799. [PMID: 33707607 PMCID: PMC7952557 DOI: 10.1038/s41598-021-85065-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
Diabetes mellitus (DM) is one of the fastest growing chronic diseases in the world and one of the main causes of vision loss. Whether or not diabetic choroidopathy (DC) is involved in the initiation and progression of diabetic ocular complications needs to be explored. We included 54 diabetic eyes from 36 diabetic patients, and 54 healthy eyes from 32 control subjects after propensity scores matching. All of the subjects were given pupil light and dark adaptation examination and optical coherence tomography angiography (OCTA). Scotopic pupil diameter (SPD), pupil contraction amplitude, and velocity of pupil contraction of the diabetic group were significantly lower than that of the healthy control group (P < 0.05).Choroidal thickness at temporal quadrant (at 750 μm) and superior quadrant (at 1500 μm and 2250 μm) increased in diabetic group compared to control group(P < 0.05).In the diabetic group, choriocapillaris blood flow signal density (CCBFSD) in the macular area (diameter = 2000 μm) were significantly decreased compared with the healthy control group (P < 0.05). Apparent changes in pupil and choroidal blood flow were observed in the diabetic patients.
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Affiliation(s)
- Yaoli Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei, China
| | - Yuanjun Qin
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei, China
| | - Shuaishuai Wang
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuyan Liu
- University of Massachusetts Amherst, Amherst, MA, USA
| | - Xinyu Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei, China
| | - Xufang Sun
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei, China.
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Betzler BK, Ding J, Wei X, Lee JM, Grewal DS, Fekrat S, Sadda SR, Zarbin MA, Agarwal A, Gupta V, Schmetterer L, Agrawal R. Choroidal vascularity index: a step towards software as a medical device. Br J Ophthalmol 2021; 106:149-155. [PMID: 33514528 DOI: 10.1136/bjophthalmol-2021-318782] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/04/2022]
Abstract
The choroidal vascularity index (CVI) is a relatively new parameter, calculated off optical coherence tomography (OCT) images, for the quantitative evaluation of choroid vascularity. It is defined as the ratio of vascular area to the total choroidal area, presented as a percentage. The choroid is an important vascular bed, often implicated in ocular and systemic conditions. Since the introduction of CVI, multiple studies have evaluated its efficacy as a tool for disease prognostication and monitoring progression, with promising results. The CVI was born out of the need for more robust and accurate evaluations of choroidal vasculature, as prior parameters such as choroidal thickness and choroidal vessel diameter had their limitations. In this review, we summarise current literature on the CVI, explain how the CVI is derived and explore its potential integration into future research and translation into clinical care. This includes the application of CVI in various disease states, and ongoing attempts to produce an automated algorithm which can calculate CVI from OCT images.
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Affiliation(s)
| | - Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xin Wei
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Jia Min Lee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinivas R Sadda
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marco A Zarbin
- Rutgers-New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Aniruddha Agarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Damian I, Roman G, Nicoară SD. Analysis of the Choroid and Its Relationship with the Outer Retina in Patients with Diabetes Mellitus Using Binarization Techniques Based on Spectral-Domain Optical Coherence Tomography. J Clin Med 2021; 10:jcm10020210. [PMID: 33435599 PMCID: PMC7826830 DOI: 10.3390/jcm10020210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/31/2022] Open
Abstract
(1) Background: We aimed to reveal the relationship between the choroid and the outer retina with optical coherence tomography (OCT) in patients with diabetes mellitus (DM) with mild or no diabetic retinopathy (DR) in order to find early biomarkers for progressing retinopathy. (2) Methods: We performed a prospective study including 61 eyes of patients with type 1 or type 2 DM and 36 eyes of healthy controls. All subjects were imaged with Spectralis OCT. The choroid was assesseed using enhanced depth imaging OCT (EDI-OCT). Binarization of subfoveal choroidal images was done with public domain software, ImageJ (version 1.53a; National Institutes of Health, Bethesda, Maryland, USA). (3) Results: Luminal area, stromal area and total choroidal area were significantly decreased in diabetic patients compared to control: 0.23 ± 0.07 vs. 0.28 ± 0.08, p = 0.012; 0.08 ± 0.03 vs. 0.10 ± 0.04, p = 0.026; 0.31 ± 0.09 vs. 0.38 ± 0.11, p = 0.008. The thickness of retinal pigment epithelium (RPE) correlated positively with the choroidal vascularity index (CVI). The correlations between outer nuclear layer (ONL), photoreceptors (PR) and foveal choroidal thickness (FChT) were moderately negative. (4) Conclusion: Thicker RPE and a thinner PR layer may be assigned the role of early biomarkers signaling the conversion time to progressing retinopathy.
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Affiliation(s)
- Ioana Damian
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania;
- Medical Doctoral School 1, University of Oradea, Universitatii Str, 410087 Oradea, Romania
| | - Gabriela Roman
- Department of Diabetes, Nutrition and Metabolic Diseases, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 V.Babes str., 400012 Cluj-Napoca, Romania;
- Diabetes Center, Emergency County Hospital Cluj, 3-5 Clinicilor Str., 400006 Cluj-Napoca, Romania
| | - Simona Delia Nicoară
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania;
- Clinic of Ophthalmology, Emergency County Hospital Cluj, 3-5 Clinicilor Str., 400006 Cluj-Napoca, Romania
- Correspondence: or
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50
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Dou N, Yu S, Tsui CK, Yang B, Lin J, Lu X, Xu Y, Wu B, Zhao J, Liang X. Choroidal Vascularity Index as a Biomarker for Visual Response to Antivascular Endothelial Growth Factor Treatment in Diabetic Macular Edema. J Diabetes Res 2021; 2021:3033219. [PMID: 34869776 PMCID: PMC8642029 DOI: 10.1155/2021/3033219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the choroidal vascularity index (CVI) as a prognostic factor for the visual efficacy of antivascular endothelial growth factor (VEGF) treatment in diabetic macular edema (DME). METHODS We retrospectively reviewed 92 DME eyes receiving anti-VEGF treatment, which were stratified as responders (≥5 letters gained) and nonresponders (<5 letters gained or lost). Baseline systematic features and optical coherence tomography features, including the CVI, adjusted ellipsoid zone (EZ) reflectivity, subretinal fluid (SRF), and disorganization of the retinal inner layers (DRIL), were evaluated between the two groups. RESULTS The baseline CVI was significantly lower in nonresponders than in responders (0.66 ± 0.05, 0.69 ± 0.05, and 0.72 ± 0.05, p = 0.014). After adjusting for other factors, the baseline CVI, DRIL, SRF, and adjusted EZ reflectivity were significantly associated with visual outcomes (CVI: odds ratio (OR) = 0.17, p = 0.006; adjusted EZ reflectivity: OR = 0.56, p = 0.007; DRIL: OR = 6.71, p = 0.001; and SRF: OR = 0.29, p = 0.008). CONCLUSION DME patients with a higher CVI, higher adjusted EZ reflectivity, the presence of SRF, and the absence of DRIL at baseline were more likely to gain >5 letters in visual acuity after anti-VEGF treatment. CVI may serve as a novel biomarker for visual response to anti-VEGF treatment in DME.
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Affiliation(s)
- Ningxin Dou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Ching-Kit Tsui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Boyu Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jianqiang Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xi Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Benjuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jinfeng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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