Lupidi Marco, Gujar Ramkailash, Cerquaglia Alessio, Chablani Jay, Fruttini Daniela, Muzi Alessio, Corbucci Roberta, Fiore Tito, Coscas Florence, Coscas Gabriel, Parravano Mariacristina, Cagini Carlo
Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.
Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Genova, Italy.
Eur J Ophthalmol. 2021 Sep;31(5):2511-2519. doi: 10.1177/1120672120963451. Epub 2020 Nov 2.
To quantitatively assess retinal neovascularizations (RNVs) in proliferative diabetic retinopathy (PDR) before and after photocoagulative laser treatment (PLT) using Optical Coherence Tomography Angiography (OCT-A).
Consecutive patients with PDR were examined with fluorescein angiography (FA) and OCT-A before and after PLT. Baseline and after-treatment FA images were quantitatively analyzed to assess both the RNVs area and leakage area. On OCT-A RNVs area, vascular perfusion density (VPD), vessel length density (VLD) and fractal dimension were computed. VPD of the full-retina OCT-A underneath the RNV was determined to evaluate potential laser-induced changes in vascular perfusion.
Fifteen eyes of 13 patients with PDR were enrolled. The mean area of the RNVs was 0.47 ± 0.50 mm in the baseline OCT-A and 0.32 ± 0.40 mm in the post-treatment assessment ( = 0.0002). The mean RNV VPD of RNV was 2% ± 4% in pre-treatment and 1% ± 1% for the post-treatment ( = 0.0001). The mean VLD of RNV was 7.26 ± 1.53 at baseline and 6.64 ± 1.65 in the post treatment ( = 0.0002). A significant difference in terms of mean RNVs area and VPD reduction between eyes that needed additional treatment and those that did not (~40% vs ~20%; < 0.05), was observed. Mean VPD of full-retinal thickness OCT-angiogram was 55% ± 10% for the pre-treatment and 53% ± 8% for the post treatment scan ( = 0.02).
The quantitative OCT-A assessment of laser-induced changes of RNVs can be a useful non-invasive approach for determining treatment efficacy. A reduction of RNVs area or VPD ⩾ 40% might reveal those eyes that won't require additional treatment. Retinal perfusion impairment seemed to progress independently from the treatment.
使用光学相干断层扫描血管造影（OCT-A）定量评估增殖性糖尿病视网膜病变（PDR）患者在光凝激光治疗（PLT）前后的视网膜新生血管（RNV）情况。
对连续的PDR患者在PLT前后进行荧光素血管造影（FA）和OCT-A检查。对基线期和治疗后的FA图像进行定量分析，以评估RNV面积和渗漏面积。在OCT-A上计算RNV面积、血管灌注密度（VPD）、血管长度密度（VLD）和分形维数。测定RNV下方全视网膜OCT-A的VPD，以评估潜在的激光诱导的血管灌注变化。
纳入13例PDR患者的15只眼。基线期OCT-A中RNV的平均面积为0.47±0.50mm，治疗后评估为0.32±0.40mm（P = 0.0002）。RNV的平均RNV VPD在治疗前为2%±4%，治疗后为1%±1%（P = 0.0001）。RNV的平均VLD在基线期为7.26±1.53，治疗后为6.64±1.65（P = 0.0002）。观察到需要额外治疗的眼与不需要额外治疗的眼在平均RNV面积和VPD降低方面存在显著差异（40%对20%；P < 0.05）。全视网膜厚度OCT血管造影的平均VPD在治疗前扫描时为55%±10%，治疗后扫描时为53%±8%（P = 0.02）。
对激光诱导的RNV变化进行定量OCT-A评估可能是一种有用的非侵入性方法，用于确定治疗效果。RNV面积或VPD降低≥40%可能提示那些不需要额外治疗的眼。视网膜灌注损害似乎独立于治疗而进展。
