NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ophthalmol Retina. 2020 Feb;4(2):164-174. doi: 10.1016/j.oret.2019.09.004. Epub 2019 Sep 11.
To present the routine use of OCT and OCT angiography (OCTA) for the objective diagnosis and monitoring of proliferative diabetic retinopathy (PDR).
Retrospective, observational case series.
Patients with diabetic retinopathy imaged using a standardized PDR protocol.
Patients routinely imaged with a standardized PDR protocol between March 2017 and January 2019 were included. This included a 12×9-mm structural OCT volume centered on the macula and a 6×6-mm OCTA scan centered on the optic nerve head obtained using a Topcon swept-source system (DRI OCT-1 Triton, Topcon, Tokyo, Japan). Ultra-widefield fluorescein angiography (FA) was also performed when clinically indicated. The ground truth for each case was determined by merging the findings from biomicroscopy and imaging modalities to generate the maximum level of detection for each finding.
Detection rates of new-onset, regression, and reactivation of neovascularization of the disc (NVD) and neovascularization elsewhere (NVE) using different modalities (biomicroscopy/color photography, structural OCT, B-scan OCTA, en face OCTA). Detection of progression of tractional retinal detachment (TRD).
A total of 383 eyes of 204 patients were evaluated. After excluding patients without PDR or with insufficient image quality, 47 eyes of 35 patients were included. For the detection of new-onset NVD and NVE, structural OCT had the highest detection rate (100%) of all modalities. However, for the detection of regression or reactivation of neovascularization (NV), B-scan OCTA had the highest detection rate (100%). Structural OCT detected regression only in 45.5% of cases, resulting in a low detection rate of reactivation (12.5%). Among 10 eyes with TRD, OCT detected fovea-threatening TRD during follow-up in 7 eyes, resulting in vitrectomy.
This study demonstrates the utility of novel multimodal imaging in the daily management of patients with PDR. Posterior pole structural OCT had the best detection rate for NV, and B-scan OCTA showed the most potential for objective monitoring of disease after treatment.
介绍 OCT 和 OCT 血管造影（OCTA）在增殖型糖尿病视网膜病变（PDR）的客观诊断和监测中的常规应用。
回顾性、观察性病例系列。
使用标准化 PDR 方案成像的糖尿病视网膜病变患者。
纳入 2017 年 3 月至 2019 年 1 月期间使用标准化 PDR 方案常规成像的患者。这包括使用 Topcon 扫频源系统（DRI OCT-1 Triton，Topcon，东京，日本）在黄斑中心获得的 12×9mm 结构 OCT 容积和视神经头中心的 6×6mm OCTA 扫描。当临床需要时，还进行超广角荧光素血管造影（FA）。每个病例的真实情况是通过合并生物显微镜和成像方式的结果来确定的，以产生每个发现的最大检测水平。
不同方式（生物显微镜/彩色摄影、结构 OCT、B 扫描 OCTA、面 OCTA）对新出现、消退和再激活的视盘新生血管（NVD）和其他部位新生血管（NVE）的检出率。牵引性视网膜脱离（TRD）进展的检出率。
共评估了 204 名患者的 383 只眼。排除无 PDR 或图像质量不足的患者后，纳入 35 名患者的 47 只眼。对于新出现的 NVD 和 NVE 的检测，结构 OCT 在所有方式中具有最高的检出率（100%）。然而，对于 NV 的消退或再激活的检测，B 扫描 OCTA 具有最高的检出率（100%）。结构 OCT 仅在 45.5%的病例中检测到消退，导致再激活的检出率较低（12.5%）。在 10 只 TRD 眼中，OCT 在随访中发现 7 只眼中存在黄斑区威胁性 TRD，导致玻璃体切割术。
本研究证明了新型多模态成像在 PDR 患者日常管理中的应用价值。后极部结构 OCT 对 NV 的检出率最高，B 扫描 OCTA 对治疗后疾病的客观监测最有潜力。
