Department of Ophthalmology, Centre hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France.
Department of Ophthalmology, Hôpital Simone Veil, Eaubonne, France.
Int Ophthalmol. 2020 Jul;40(7):1625-1640. doi: 10.1007/s10792-020-01330-7. Epub 2020 Mar 21.
To describe the features of cotton wool spots (CWSs) in diabetic retinopathy (DR) by using spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT angiography).
We retrospectively studied patients with DR who presented CWSs and had been imaged by SD-OCT angiography. The retinal layer localisation and dimensions of the CWSs were assessed on SD-OCT, while the decorrelation signal generated by the CWSs and the vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus around the CWSs and in the macula were assessed on OCT angiography.
A total of 87 eyes of 57 DR patients were included. All CWSs were located in the retinal nerve fibre layer and exhibited a decorrelation signal on OCT angiography. In 68 eyes (78.1%), hyporeflective cavities appearing as cysts in the CWS were noted, especially when were peripheral and large (P < 0.0001). The thickness averaged 211.8 ± 80.02 mm and was positively influenced by recent diabetes history, glycaemic dysregulation, posterior pole localisation and a high VD of the SCP around the CWS, while the surface area averaged 0.33 ± 0.24 mm and was influenced only by a low VD of the SCP around the CWS (P < 0.001). In 72 eyes (82.7%), the non-perfused areas were predominant in the periphery of the CWS.
The features of CWSs are influenced by systemic factors, such as history and severity of diabetes, in association with local factors, such as localisation and retinal ischaemia. The peripheral localisation of ischaemia confirms the hypothesis that CWSs are sentinel lesions.
通过频域光相干断层扫描（SD-OCT）和光相干断层扫描血管造影（OCT 血管造影）描述糖尿病视网膜病变（DR）中棉絮斑（CWS）的特征。
我们回顾性研究了表现出 CWS 并已通过 SD-OCT 血管造影成像的 DR 患者。在 SD-OCT 上评估 CWS 的视网膜层定位和尺寸，而在 OCT 血管造影上评估 CWS 产生的去相关信号以及 CWS 周围和黄斑浅层毛细血管丛（SCP）和深层毛细血管丛的血管密度（VD）。
共纳入 57 例 DR 患者的 87 只眼。所有 CWS 均位于神经纤维层，并在 OCT 血管造影上显示出去相关信号。在 68 只眼（78.1%）中，注意到 CWS 中的低反射腔，表现为囊肿，尤其是在周边且较大时（P<0.0001）。厚度平均为 211.8±80.02mm，受近期糖尿病史、血糖调节不良、后极部定位和 CWS 周围 SCP 高 VD 的影响，而表面积平均为 0.33±0.24mm，仅受 CWS 周围 SCP 低 VD 的影响（P<0.001）。在 72 只眼（82.7%）中，无灌注区主要位于 CWS 的周边。
CWS 的特征受全身因素（如糖尿病病史和严重程度）的影响，与局部因素（如定位和视网膜缺血）相关。缺血的周边定位证实了 CWS 是哨兵病变的假说。
