Shaikh Nawazish F, Vohra Rajpal, Balaji Akshaya, Azad Shorya V, Chawla Rohan, Kumar Vinod, Venkatesh Pradeep, Kumar Atul
Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2021 Nov;69(11):3218-3224. doi: 10.4103/ijo.IJO_1267_21.
To determine the utility of optical coherence tomography-angiography (OCT-A) in diabetic retinopathy (DR) and comparison versus fluorescein angiography (FA) in vision-threatening diabetic retinopathy (VTDR).
In this cross-sectional observational study, 60 eyes with no DR (NDR), 60 eyes with non-proliferative diabetic retinopathy (NPDR), and 60 eyes with proliferative diabetic retinopathy (PDR) underwent OCT-A. FA was done in VTDR. OCT-A of the NDR eyes was analyzed by two independent retina specialists. Vessel density (VD) (mm/mm), perfusion density (PD) (%), and foveal avascular zone (FAZ) (mm) area was analyzed among the groups. Montage angiography with vitreoretinal interface (VRI) segmentation was done in PDR. A qualitative comparison was done between OCT-A and FA for features of DR.
OCT-A detected 16.66% of the eyes with microaneurysm and 57.5% of the patients with capillary non-perfusion (CNP) areas in the NDR group. The inter-grader coefficient between the two observers was 0.820 for microaneurysm and 0.880 for CNP. The mean VD in NDR, NPDR, and PDR was 16.865, 13.983, and 11.643 mm/mm. The mean PD in NDR, NPDR, and PDR was 30.595, 26.853, and 23.193%. The VD and PD values were statistically significant (P < 0.001). The mean FAZ area was not statistically significant (NPDR and PDR) (P > 0.05). The VRI showed elevated neovascularization in four eyes. OCT-A delineated microaneurysm and FAZ in 97/97 eyes who underwent FA. The FA failed to delineate FAZ in 2/37 NPDR eyes and 13/60 PDR eyes. The CNP areas (OCT-A) were detectable in all eyes. The FA demonstrated CNP areas in 17/37 and 36/60 eyes in NPDR and PDR, respectively. The FA could show peripheral CNP.
The OCT-A helps in the early diagnosis of DR by providing vascular indices which are consistent with disease progression. OCT-A is non-invasive and ideal for follow-up. FA is a dynamic test with a larger field of view.
确定光学相干断层扫描血管造影（OCT-A）在糖尿病视网膜病变（DR）中的应用价值，并与荧光素血管造影（FA）在威胁视力的糖尿病视网膜病变（VTDR）中的应用进行比较。
在这项横断面观察性研究中，60只无DR（NDR）眼、60只非增殖性糖尿病视网膜病变（NPDR）眼和60只增殖性糖尿病视网膜病变（PDR）眼接受了OCT-A检查。对VTDR患者进行了FA检查。由两位独立的视网膜专科医生对NDR组眼的OCT-A图像进行分析。分析各组间的血管密度（VD）（mm/mm）、灌注密度（PD）（%）和黄斑无血管区（FAZ）（mm）面积。对PDR患者进行了玻璃体视网膜界面（VRI）分割的蒙太奇血管造影。对OCT-A和FA在DR特征方面进行了定性比较。
在NDR组中，OCT-A检测到16.66%的眼有微动脉瘤，57.5%的患者有毛细血管无灌注（CNP）区。两位观察者之间微动脉瘤的分级间系数为0.820，CNP为0.880。NDR、NPDR和PDR组的平均VD分别为16.865、13.983和11.643 mm/mm。NDR、NPDR和PDR组的平均PD分别为30.595%、26.853%和23.193%。VD和PD值具有统计学意义（P<0.001）。平均FAZ面积无统计学意义（NPDR和PDR）（P>0.05）。VRI显示4只眼中新生血管增多。在接受FA检查的97/97只眼中，OCT-A清晰显示了微动脉瘤和FAZ。在37只NPDR眼中，有2只、60只PDR眼中有13只FA未能清晰显示FAZ。所有眼中均可检测到CNP区（OCT-A）。在NPDR组和PDR组中，FA分别在17/37只眼和36/60只眼中显示了CNP区。FA可以显示周边CNP。
OCT-A通过提供与疾病进展一致的血管指标，有助于DR的早期诊断。OCT-A是非侵入性的，非常适合随访。FA是一种视野更大的动态检查。
