Department of Ophthalmology, Ulm University Hospital, Ulm, Germany.
Ophthalmologica. 2021;244(3):258-264. doi: 10.1159/000516525. Epub 2021 Apr 26.
To characterize preretinal neovascularizations (NV) and their corresponding branching routes in proliferative diabetic retinopathy (PDR) with optical coherence tomography angiography (OCTA) and compare the findings with fluorescein angiography (FA).
In patients with PDR, angiograms were acquired with spectral-domain OCTA (CIRRUS 5000, OCTA AngioPlexTMCarl Zeiss Meditec, Inc.) and FA (Zeiss FF450PlusIR fundus camera or Spectralis HRA-OCT SLO, Heidelberg Engineering Inc.) and were consecutively evaluated. Neovascularization of the disc (NVD) and neovascularization elsewhere (NVE) were analyzed with 6 × 6 and 8 × 8 mm OCTA flow images and B-scans with flow registration. Segmentations of the vitreoretinal interface (VRI) and superficial retina were performed for analysis. Two independent investigators examined OCTA findings and compared them to corresponding FA.
Forty-two eyes of 30 patients with PDR were analyzed. A total of 76 NV with their corresponding proliferation routes were visualized and characterized, with 55 (72.4%) proliferating along the posterior hyaloid membrane (PHM), 14 (18.4%) along the epiretinal membrane, and 7 (9.2%) along the fibrovascular membrane. The posterior vitreous was partially detached in 37 of 42 eyes (88.1%), completely detached in 1 of 42 eyes (2.4%), and adherent in 1 of 42 eyes (2.4%). In 38 of 42 cases, OCTA was superior (n = 23) or equivalent (n = 15) to FA in detecting NV and provided a more detailed information of the neovascular vessels. In 4 of 42 study eyes, OCTA was inferior to FA.
OCTA is a useful tool to detect NV in PDR. In comparison to FA, OCTA has the advantages that it is noninvasive and the image capture takes only seconds. We were able to identify all NV and characterize their corresponding proliferation routes in the VRI, the superficial retina slab, or the B-scan with flow registration. Through evading the masking effect of dye leakage in FA, OCTA is capable of better visualization of NV. FA, however, remains essential for the detection of all NV, since OCTA supplies a smaller detection field. Additionally, we identified the PHM as the main proliferating route of diabetic NV (72.4%), marking it as an important structure for sprouting vessels in neoangiogenesis in PDR.
利用光相干断层扫描血管造影术（OCTA）对增生性糖尿病视网膜病变（PDR）中的视网膜前新生血管（NV）及其分支路径进行特征描述，并与荧光素血管造影术（FA）进行比较。
对 PDR 患者进行频域 OCTA（CIRRUS 5000，OCTA AngioPlexTMCarl Zeiss Meditec，Inc.）和 FA（Zeiss FF450PlusIR 眼底相机或 Spectralis HRA-OCT SLO，Heidelberg Engineering Inc.）造影，并连续评估。使用 6×6 和 8×8mm OCTA 流量图像和带有流量注册的 B 扫描对盘状 NV（NVD）和其他部位 NV（NVE）进行分析。对玻璃体视网膜界面（VRI）和浅层视网膜进行分割以进行分析。两名独立的研究者检查了 OCTA 结果，并将其与相应的 FA 进行了比较。
分析了 30 名患者的 42 只眼。共观察到并描述了 76 个 NV 及其相应的增殖路径，其中 55 个（72.4%）沿后玻璃体膜（PHM）增殖，14 个（18.4%）沿视网膜内膜增殖，7 个（9.2%）沿纤维血管膜增殖。42 只眼中有 37 只（88.1%）后玻璃体部分脱离，1 只（2.4%）完全脱离，1 只（2.4%）粘连。在 38 例中，OCTA 在检测 NV 方面优于（n=23）或等同于（n=15）FA，并提供了更详细的新生血管信息。在 4 只眼中，OCTA 不如 FA。
OCTA 是一种用于检测 PDR 中 NV 的有用工具。与 FA 相比，OCTA 具有非侵入性和图像采集只需几秒钟的优点。我们能够在 VRI、浅层视网膜板或带有流量注册的 B 扫描中识别所有 NV 并对其相应的增殖路径进行特征描述。通过避免 FA 中染料渗漏的掩蔽效应，OCTA 能够更好地可视化 NV。然而，FA 对于检测所有 NV 仍然是必不可少的，因为 OCTA 提供的检测区域较小。此外，我们发现 PHM 是糖尿病性 NV 的主要增殖途径（72.4%），这表明 PHM 是 PDR 中新生血管形成中发芽血管的重要结构。
