Garg Itika, Uwakwe Chibuike, Le Rongrong, Lu Edward S, Cui Ying, Wai Karen M, Katz Raviv, Zhu Ying, Moon Jade Y, Li Chloe Y, Laíns Inês, Eliott Dean, Elze Tobias, Kim Leo A, Wu David M, Miller Joan W, Husain Deeba, Vavvas Demetrios G, Miller John B
Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA.
Harvard Retinal Imaging Lab, Boston, MA, USA.
Ophthalmol Sci. 2022 Jun;2(2). doi: 10.1016/j.xops.2022.100144. Epub 2022 Mar 18.
To study the wider field swept-source optical coherence tomography angiography (WF SS-OCTA) metrics, especially non-perfusion area (NPA), in the diagnosing and staging of DR.
Cross-sectional observational study (November 2018-September 2020).
473 eyes of 286 patients (69 eyes of 49 control patients and 404 eyes of 237 diabetic patients).
We imaged using 6mm×6mm and 12mm×12mm angiograms on WF SS-OCTA. Images were analyzed using the ARI Network and FIJI ImageJ. Mixed effects multiple regression models and receiver operator characteristic analysis was used for statistical analyses.
Quantitative metrics such as vessel density (VD); vessel skeletonized density (VSD); foveal avascular zone (FAZ) area, circularity, and perimeter; and NPA in DR and their relative performance for its diagnosis and grading.
Among patients with diabetes (median age 59 years), 51 eyes had no DR, 185 eyes (88 mild, 97 moderate-severe) had non-proliferative DR (NPDR); and 168 eyes had proliferative DR (PDR). Trend analysis revealed a progressive decline in superficial capillary plexus (SCP) VD and VSD, and increased NPA with increasing DR severity. Additionally, there was a significant reduction in deep capillary plexus (DCP) VD and VSD in early DR (mild NPDR), but the progressive reduction in advanced DR stages was not significant. NPA was the best parameter to diagnose DR (AUC:0.96), whereas all parameters combined on both angiograms efficiently diagnosed (AUC:0.97) and differentiated between DR stages (AUC range:0.83-0.97). The presence of diabetic macular edema was associated with reduced SCP and DCP VD and VSD within mild NPDR eyes, whereas an increased VD and VSD in SCP among moderate-severe NPDR group.
Our work highlights the importance of NPA, which can be more readily and easily measured with WF SS-OCTA compared to fluorescein angiography. It is additionally quick and non-invasive, and hence can be an important adjunct for DR diagnosis and management. In our study, a combination of all OCTA metrics on both 6mm×6mm and 12mm×12mm angiograms had the best diagnostic accuracy for DR and its severity. Further longitudinal studies are needed to assess NPA as a biomarker for progression or regression of DR severity.
研究超广角扫频源光学相干断层扫描血管造影（WF SS-OCTA）指标，尤其是无灌注区（NPA），在糖尿病视网膜病变（DR）诊断及分期中的应用。
横断面观察性研究（2018年11月至2020年9月）。
286例患者的473只眼（49例对照患者的69只眼和237例糖尿病患者的404只眼）。
我们使用WF SS-OCTA获取6mm×6mm和12mm×12mm的血管造影图像。图像采用ARI Network和FIJI ImageJ进行分析。采用混合效应多元回归模型和受试者工作特征分析进行统计分析。
定量指标，如血管密度（VD）；血管骨架化密度（VSD）；黄斑无血管区（FAZ）面积、圆度和周长；DR中的NPA及其在诊断和分级中的相对性能。
在糖尿病患者（中位年龄59岁）中，51只眼无DR，185只眼（88只轻度、97只中度至重度）患有非增殖性DR（NPDR）；168只眼患有增殖性DR（PDR）。趋势分析显示，随着DR严重程度增加，浅表毛细血管丛（SCP）的VD和VSD逐渐下降，NPA增加。此外，早期DR（轻度NPDR）时深层毛细血管丛（DCP）的VD和VSD显著降低，但在DR晚期的逐渐降低并不显著。NPA是诊断DR的最佳参数（曲线下面积[AUC]：0.96），而两种血管造影图上的所有参数联合使用能有效诊断（AUC：0.97）并区分DR分期（AUC范围：0.83 - 0.97）。糖尿病性黄斑水肿的存在与轻度NPDR眼中SCP和DCP的VD及VSD降低相关，而中度至重度NPDR组中SCP的VD和VSD增加。
我们的研究强调了NPA的重要性，与荧光素血管造影相比，使用WF SS-OCTA可以更便捷地测量NPA。它还具有快速且无创的特点，因此可以成为DR诊断和管理的重要辅助手段。在我们的研究中，6mm×6mm和12mm×12mm血管造影图上所有OCTA指标的组合对DR及其严重程度具有最佳诊断准确性。需要进一步的纵向研究来评估NPA作为DR严重程度进展或消退的生物标志物。
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