Department of Ophthalmology, Lariboisière Hospital, AP-HP, Université Paris 7 - Sorbonne Paris Cité, Paris, France.
Department of Ophthalmology, Lariboisière Hospital, AP-HP, Université Paris 7 - Sorbonne Paris Cité, Paris, France.
Ophthalmology. 2019 Dec;126(12):1685-1694. doi: 10.1016/j.ophtha.2019.06.022. Epub 2019 Jun 26.
To assess change in retinal nonperfusion (NP) after anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) using 2 different imaging modalities: swept-source widefield (SS-WF) OCT angiography (OCTA) and ultra-widefield (UWF) fluorescein angiography (FA).
Observational case series.
Ten eyes of 9 patients with severe nonproliferative diabetic retinopathy (NPDR) or proliferative DR (PDR) initiating 3 monthly anti-VEGF intravitreal injections for DME.
All eyes were imaged with UWF color fundus photographs (CFPs), UWF FA, and SS-WF OCTA at baseline (M0) and 1 month after the third anti-VEGF injection (M3). All images were aligned and divided into 16 boxes for analysis of NP areas by 2 blinded retina specialists.
The number of discrepancies between SS-WF OCTA and UWF FA regarding the detection of NP areas and small vessels passing through NP areas; assessment of DR severity on UWF CFP; and change in each NP area between M0 and M3: number of boxes/eye with presence of at least 1 NP area, number of arterioles or venules that disappeared or reappeared, and number of NP areas in which capillaries disappeared or reappeared.
The diabetic retinopathy (DR) severity score improved by at least 1 stage in 8 of 10 eyes, with a significant decrease in the mean number of microaneurysms and retinal hemorrhages on UWF CFP at M3 versus M0 (n = 40±28 vs. 121±57; P = 0.0020) and regression of fundus neovascularization when present. All NP areas detected on FA were seen on SS-WF OCTA, but additional NP areas were detected on SS-WF OCTA at M0 in 29% (46/160) of boxes. No reperfusion of arterioles or venules was observed at M3 on FA or SS-WF OCTA. Retinal capillaries were only visible on OCTA, and no reperfusion in NP areas was observed even when a reduction in dark areas was visible on FA.
No reperfusion of vessels or capillary network was detected in NP areas using 2 imaging techniques, UWF FA and SS-WF OCTA, in eyes with DR after 3 anti-VEGF injections. The detection rate of NP areas was higher with SS-WF OCTA than with UWF FA.
使用两种不同的成像模式，即扫频源宽视野（SS-WF）OCT 血管造影（OCTA）和超广角（UWF）荧光素血管造影（FA），评估糖尿病性黄斑水肿（DME）患者接受抗血管内皮生长因子（VEGF）治疗后的视网膜无灌注（NP）变化。
观察性病例系列。
9 名患者的 10 只眼，患有严重非增生性糖尿病性视网膜病变（NPDR）或增生性 DR（PDR），开始每月接受 3 次抗 VEGF 玻璃体内注射治疗 DME。
所有眼睛均在基线（M0）和第三次抗 VEGF 注射后 1 个月（M3）进行超广角彩色眼底照片（CFP）、超广角 FA 和 SS-WF OCTA 成像。由 2 位盲法视网膜专家对所有图像进行配准和分为 16 个方框，以分析 NP 区域。
SS-WF OCTA 与 UWF FA 在检测 NP 区域和穿过 NP 区域的小血管方面的差异数；超广角 CFP 上 DR 严重程度的评估；以及 M0 至 M3 之间每个 NP 区域的变化：每只眼存在至少 1 个 NP 区域的方框数、消失或重现的动脉或静脉数以及毛细血管消失或重现的 NP 区域数。
10 只眼中的 8 只眼的糖尿病视网膜病变（DR）严重程度评分至少提高了 1 级，超广角 CFP 上的平均微动脉瘤和视网膜出血数量在 M3 时较 M0 显著减少（n=40±28 对 121±57；P=0.0020），当存在眼底新生血管时，其消退。FA 上检测到的所有 NP 区域均在 SS-WF OCTA 上可见，但在 M0 时 SS-WF OCTA 上在 29%（46/160）的方框中还检测到其他 NP 区域。在 FA 或 SS-WF OCTA 上均未观察到 M3 时的动脉或静脉再灌注。视网膜毛细血管仅在 OCTA 上可见，即使 FA 上可见暗区减少，也未观察到 NP 区域的再灌注。
在 3 次抗 VEGF 注射后，DR 眼中使用 UWF FA 和 SS-WF OCTA 两种成像技术均未检测到血管或毛细血管网络的再灌注。SS-WF OCTA 比 UWF FA 检测 NP 区域的检出率更高。
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