Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Klin Monbl Augenheilkd. 2023 Apr;240(4):490-495. doi: 10.1055/a-2031-2657. Epub 2023 Apr 25.
To test the diagnostic performance of a novel wide-field swept-source optical coherence tomography angiography (WF-OCTA) device in detecting retinal non-perfusion (NP) and neovascularization (NV) in eyes with diabetic retinopathy (DR) and to compare this with the standard-of-care imaging method, ultrawide-field fluorescein angiography (UWFFA).
Prospective, observational, cross-sectional single-center study evaluating patients with DR imaged with WF-OCTA (Xephilio OCT-S1; Canon Inc., Tokyo, Japan) and UWFFA (Optos California; Optos plc, Dunfermline, United Kingdom). WF-OCTA images of the superficial capillary plexus (SCP) consisted of single capture 23 × 20 mm scans centered on the fovea. In UWFFA and WF-OCTA, qualitative and quantitative measurements were assessed to analyze retinal NP and NV. Vessel density (VD) in WF-OCTA and ischemic index (ISI) in UWFFA were calculated. Qualitatively, the presence of NV and NP was assessed in both WF-OCTA (posterior pole/midperipheral retina) and UWFFA (posterior pole/midperipheral retina/far peripheral retina).
Ten consecutive patients with variable DR severity stages (17 eyes) were evaluated. Two eyes had to be excluded due to low quality of the WF-OCTA images. Therefore, 15 eyes were included for final analysis. Mean age was 57 years (± SD: 15.2) and the male : female ratio was 4 : 6. UWFFA identified retinal NP in 11 eyes (73%). Posterior pole NP was present in eight eyes, midperiphery NP was present in eight eyes, and far periphery NP was present in seven eyes. Retinal NV was detected in four eyes using UWFFA (two eyes with only midperiphery NV). WF-OCTA detected retinal NP in 11 eyes (9 cases with both posterior pole and midperiphery NP). NV was detected in three eyes (two with posterior pole and midperipheral NV, four with only midperipheral NV). Mean VD evaluated using WF-OCTA of the SCP was 0.40 (± SD: 0.1), and mean ISI in UWFFA was 0.09 (± SD: 1.3). Spearman's test did not show a significant correlation between the ISI in UWFFA and VD in WF-OCTA (p = 0.803).
Noninvasive WF-OCTA has great potential for the management of patients with DR. This new imaging modality might be useful in daily clinical routine in order to lower the number of invasive examinations. However, in a small percentage of patients, OCTA images cannot be reliably graded for the presence of NP and NV. In these cases, conventional FA needs to be performed.
测试一种新型宽视野扫频源光相干断层扫描血管造影（WF-OCTA）设备在检测糖尿病视网膜病变（DR）患者视网膜无灌注（NP）和新生血管（NV）中的诊断性能，并将其与标准护理成像方法——超广角荧光素血管造影（UWFFA）进行比较。
前瞻性、观察性、单中心研究，对接受 WF-OCTA（Xephilio OCT-S1；佳能公司，东京，日本）和 UWFFA（Optos California；Optos plc，邓弗姆林，英国）成像的 DR 患者进行评估。WF-OCTA 图像的浅层毛细血管丛（SCP）由以黄斑为中心的单次采集 23×20mm 扫描组成。在 UWFFA 和 WF-OCTA 中，对视网膜 NP 和 NV 进行了定性和定量评估。在 WF-OCTA 中计算血管密度（VD），在 UWFFA 中计算缺血指数（ISI）。在 WF-OCTA（后极/中周部视网膜）和 UWFFA（后极/中周部视网膜/远周部视网膜）中对 NV 和 NP 的存在进行了定性评估。
评估了 10 名具有不同严重程度 DR 阶段的连续患者（17 只眼）。由于 WF-OCTA 图像质量低，有 2 只眼被排除在外。因此，最终分析纳入了 15 只眼。平均年龄为 57 岁（±15.2），男女比例为 4：6。UWFFA 在 11 只眼中（73%）发现了视网膜 NP。8 只眼存在后极 NP，8 只眼存在中周部 NP，7 只眼存在远周部 NP。UWFFA 检测到 4 只眼中存在视网膜 NV（2 只眼中只有中周部 NV）。WF-OCTA 在 11 只眼中（9 例同时存在后极和中周部 NP）发现了视网膜 NP。在 3 只眼中发现了 NV（2 只眼中同时存在后极和中周部 NV，4 只眼中仅存在中周部 NV）。使用 WF-OCTA 评估 SCP 的平均 VD 为 0.40（±15.2），在 UWFFA 中的平均 ISI 为 0.09（±1.3）。Spearman 检验显示 UWFFA 中的 ISI 与 WF-OCTA 中的 VD 之间没有显著相关性（p=0.803）。
无创 WF-OCTA 具有管理 DR 患者的巨大潜力。这种新的成像方式在日常临床工作中可能有助于减少侵入性检查的次数。然而，在一小部分患者中，OCTA 图像不能可靠地分级存在 NP 和 NV。在这些情况下，需要进行传统的 FA。
