Fayed Alaa E, Gabra Mira A, Fikry Ramy R, Estawro Rania
Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo university, Giza, Egypt.
Oxford Eye Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
Eye (Lond). 2025 May 6. doi: 10.1038/s41433-025-03806-1.
To evaluate the role of retinal and choriocapillaris blood flow in the development of diabetic foveal neovascularization (DFN) using optical coherence tomography angiography (OCTA).
Eyes with proliferative diabetic retinopathy (PDR) and DFN underwent OCTA imaging; defined as surface retinal neovascularization within the central foveal 1 mm diameter circle. 3 × 3 and 6 × 6 mm choriocapillaris and superficial and deep retinal capillary plexus (SCP and DCP) slabs were extracted to evaluate adjusted flow index (AFI) as a surrogate for blood flow. For choriocapillaris flow; total, subfoveal and extrafoveal AFI were assessed, while only total AFI was calculated for SCP and DCP. These findings were compared to healthy controls and eyes with PDR with no DFN.
18 eyes of 18 patients were included in each of the 3 groups: healthy controls, PDR with and without DFN. Choriocapillaris AFI was significantly lower in PDR with DFN than healthy controls in all but the 6 × 6 mm extrafoveal AFI (p < 0.01). PDR with DFN also showed a lower AFI compared to eyes without DFN, but only in the 3 × 3 mm total and subfoveal AFI (p = 0.01). SCP and DCP AFI were not statistically significant.
Our findings suggest that choroidal hypoperfusion may be a potential driving factor for the development of DFN. The detection of these changes in the smaller scans of the total and subfoveal areas suggests a rather exaggerated and localized subfoveal distribution of ischaemia. Larger longitudinal studies are needed to explore the use of subfoveal choroidal AFI as a prognostic sign for DFN.
使用光学相干断层扫描血管造影（OCTA）评估视网膜和脉络膜毛细血管血流在糖尿病性黄斑新生血管（DFN）发生发展中的作用。
对患有增殖性糖尿病视网膜病变（PDR）和DFN的眼睛进行OCTA成像；定义为黄斑中心直径1毫米圆内的视网膜表面新生血管。提取3×3和6×6毫米的脉络膜毛细血管以及视网膜浅、深毛细血管丛（SCP和DCP）层块，以评估调整血流指数（AFI）作为血流的替代指标。对于脉络膜毛细血管血流，评估总、黄斑下和黄斑外AFI，而对于SCP和DCP仅计算总AFI。将这些结果与健康对照以及患有PDR但无DFN的眼睛进行比较。
3组中每组均纳入18例患者的18只眼睛：健康对照、伴有和不伴有DFN的PDR。除6×6毫米黄斑外AFI外，伴有DFN 的PDR患者的脉络膜毛细血管AFI在所有测量中均显著低于健康对照（p<0.01）。与无DFN的眼睛相比，伴有DFN的PDR患者的AFI也较低，但仅在3×3毫米的总AFI和黄斑下AFI中（p = 0.01）。SCP和DCP的AFI无统计学意义。
我们的研究结果表明脉络膜灌注不足可能是DFN发生发展的潜在驱动因素。在总区域和黄斑下区域的较小扫描中检测到这些变化表明黄斑下缺血分布较为夸张且局限。需要进行更大规模的纵向研究，以探索将黄斑下脉络膜AFI用作DFN的预后指标。
