Cole Eye Institute, Cleveland Clinic, Cleveland, USA.
Federal University of São Paulo, São Paulo, Brazil.
Br J Ophthalmol. 2019 Apr;103(4):452-456. doi: 10.1136/bjophthalmol-2018-311903. Epub 2018 May 23.
BACKGROUND/AIMS: Split-spectrum amplitude decorrelation angiography for spectral-domain optical coherence tomography has enabled detailed, non-invasive assessment of vascular flow. This study evaluates choriocapillaris and retinal capillary perfusion density (CPD) in diabetic eyes using optical coherence tomography angiography (OCTA).
Records of 136 eyes that underwent OCTA imaging at a single institution were reviewed. Eyes were grouped as non-diabetic controls (37 eyes), patients with diabetes mellitus (DM) without diabetic retinopathy (DM without DR, 31 eyes), non-proliferative diabetic retinopathy (NPDR, 41 eyes) and proliferative diabetic retinopathy (PDR, 27 eyes). Quantitative CPD analyses were performed on OCTA images for assessing perfusion density of the choriocapillaris and retinal plexus for all patients and compared between groups.
Eyes with NPDR and PDR showed significantly decreased choriocapillaris CPD compared with controls, while DM eyes without DR did not show significant change. Choriocapillaris whole-image CPD was decreased by 8.3% in eyes with NPDR (p<0.01) and decreased by 7.1% in eyes with PDR (p<0.01). Choriocapillaris parafoveal CPD was decreased by 8.9% in eyes with NPDR (p<0.01) and decreased by 8.2% in eyes with PDR (p<0.01). Compared with controls, only eyes with PDR showed significantly decreased retinal CPD, as well as significantly increased foveal avascular zone (FAZ) area. In those patients, retinal whole-image CPD was decreased by 9.7% (p<0.01), retinal foveal CPD was decreased by 20.5% (p<0.01) and retinal parafoveal CPD was decreased by 11.4% (p<0.01). FAZ area was increased by 50.9% (p<0.01).
Choriocapillaris and retinal CPD are reduced in diabetic retinopathy, while FAZ area is increased in eyes with PDR. Vascular changes captured by new imaging modalities can further characterise diabetic choroidopathy.
背景/目的：频域光相干断层扫描的谱域光相干断层扫描的分谱幅度去相关血管造影术实现了对血管流量的详细、无创评估。本研究通过光相干断层扫描血管造影术（OCTA）评估糖尿病眼中的脉络膜毛细血管和视网膜毛细血管灌注密度（CPD）。
回顾了在一家机构进行 OCTA 成像的 136 只眼的记录。将眼睛分为非糖尿病对照组（37 只眼）、无糖尿病性视网膜病变的糖尿病患者（DM 无 DR，31 只眼）、非增生性糖尿病性视网膜病变（NPDR，41 只眼）和增生性糖尿病性视网膜病变（PDR，27 只眼）。对所有患者的 OCTA 图像进行定量 CPD 分析，比较各组之间的灌注密度。
NPDR 和 PDR 眼的脉络膜毛细血管 CPD 明显低于对照组，而 DM 无 DR 眼无明显变化。NPDR 眼的脉络膜全像 CPD 下降 8.3%（p<0.01），PDR 眼下降 7.1%（p<0.01）。NPDR 眼脉络膜旁中心 CPD 下降 8.9%（p<0.01），PDR 眼下降 8.2%（p<0.01）。与对照组相比，只有 PDR 眼的视网膜 CPD 明显下降，且黄斑无血管区（FAZ）面积明显增大。在这些患者中，视网膜全像 CPD 下降 9.7%（p<0.01），视网膜中央凹 CPD 下降 20.5%（p<0.01），视网膜旁中心凹 CPD 下降 11.4%（p<0.01）。FAZ 面积增加了 50.9%（p<0.01）。
糖尿病视网膜病变患者脉络膜毛细血管和视网膜 CPD 减少，而 PDR 眼 FAZ 面积增加。新成像方式捕获的血管变化可以进一步描述糖尿病性脉络膜病变。
