Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore.
Invest Ophthalmol Vis Sci. 2021 Jan 4;62(1):9. doi: 10.1167/iovs.62.1.9.
To prospectively evaluate whether diabetic macular ischemia detected with coherence tomography angiography (OCTA) is associated with change in functional outcomes over a period of one year.
This is a one-year prospective, observational study that included 56 eyes with varying levels of diabetic retinopathy. All participants underwent best corrected visual acuity evaluation, swept-source OCTA and microperimetry at baseline and repeated at one year. Parafoveal vessel densities (VD) and foveal avascular zone (FAZ) areas were generated from OCTA in the superficial and deep vascular plexuses. The influence of baseline and change in OCTA parameters on change in visual acuity and retinal sensitivity over one year was evaluated.
Over the one-year follow-up period, 16% (9) of eyes had at least one line worsening in BCVA and 7% (4) of eyes had at least 5% decrease in retinal sensitivity compared to baseline. Diabetic retinopathy progressed in 12.5%. Mean superficial vascular plexus (SVP) FAZ area increased (0.32 ± 0.15 to 0.39 ± 0.18 mm2, P = 0.003) and parafoveal VD in deep vascular plexus (DVP) decreased (49.8 ± 3.7% to 48.8 ± 2.9%, P = 0.040) at one year compared to baseline. In the multivariate regression analysis, larger baseline DVP FAZ area was associated with worsening of BCVA over one year (β = 0.16 logMAR per mm2, 95% CI 0.02 to 0.31, P = 0.032). In addition, larger decreases in SVP VD (β = -4.18 db per 10% decrease, 95% CI -6.55 to -1.80, P = 0.002) was associated with worsening of retinal sensitivity over one year.
Progression of parafoveal microvasculature changes over one year can be detected using OCTA. Larger baseline DVP FAZ area on OCTA is predictive of worsening in visual outcomes, and larger decreases in SVP VD were associated with worsening of retinal sensitivity over a course of one year in diabetic individuals.
前瞻性评估相干断层扫描血管造影术（OCTA）检测到的糖尿病性黄斑缺血与一年内功能结果的变化是否相关。
这是一项为期一年的前瞻性观察性研究，共纳入 56 只眼，其糖尿病视网膜病变程度不同。所有参与者均接受最佳矫正视力评估、扫频源 OCTA 和微视野检查，基线时和一年后重复检查。从 OCTA 中生成浅层和深层血管丛的旁黄斑血管密度（VD）和黄斑无血管区（FAZ）面积。评估基线和 OCTA 参数变化对一年内视力和视网膜敏感性变化的影响。
在一年的随访期间，16%（9 只眼）的眼至少有一行 BCVA 恶化，7%（4 只眼）的眼的视网膜敏感性至少下降了 5%。糖尿病视网膜病变进展 12.5%。浅层血管丛（SVP）FAZ 面积增加（0.32±0.15 至 0.39±0.18mm2，P=0.003），深层血管丛（DVP）旁黄斑 VD 减少（49.8±3.7%至 48.8±2.9%，P=0.040），与基线相比，一年后。多元回归分析显示，较大的基线 DVP FAZ 面积与一年后 BCVA 恶化相关（β=0.16 对数 MAR 每 mm2，95%CI 0.02 至 0.31，P=0.032）。此外，SVP VD 较大的减少（β=-4.18db 每 10%减少，95%CI-6.55 至-1.80，P=0.002）与一年后视网膜敏感性恶化相关。
使用 OCTA 可以检测到一年中旁黄斑微血管变化的进展。OCTA 上较大的基线 DVP FAZ 面积可预测视力结果恶化，而 SVP VD 的较大减少与糖尿病患者一年中视网膜敏感性的恶化相关。
