Optical Coherence Tomography Angiography Reveals Spatial Bias of Macular Capillary Dropout in Diabetic Retinopathy.

Purpose Our purpose is to evaluate the spatial bias of macular capillary dropout accompanying diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). Methods This study included 47 patients with diabetes and 29 healthy individuals who underwent OCTA. Retinal capillary flow density (FD) of 2.6 × 2.6 or 5.2 × 5.2 mm foveal area as well as the four divided areas (superior, inferior, temporal, nasal) without a foveal avascular zone (FAZ) at the superficial capillary plexus and deep capillary plexus (DCP) were measured respectively using ImageJ and NI Vision. Spatial biases of FD (orientation bias ratio and hierarchical bias ratio) and the correlation between FAZ and FD were examined. Results OCTA showed focal capillary dropout in DR patients. The orientation bias of FD was significantly higher in NPDR compared to NDR in the DCP (P = 0.03). The hierarchical bias of FD was significantly shifted to a DCP dominance with progression of DR (P < 0.01). In addition, the FD and FAZ area were significantly inversely correlated in both plexus in DR patients but not in healthy subjects (P < 0.01). Conclusions Area-divided OCTA quantification shows the appearance of spatial biases of macular capillary dropout with the onset of DR, suggesting that DR-related macular capillary dropout occurs locally and randomly. Future studies are necessary to determine the clinical relevance of the spatial pattern of capillary dropout in DR.

[1]  J H Dobree,et al.  Proliferative diabetic retinopathy. Site and size of initial lesions. , 1970, The British journal of ophthalmology.

[2]  A. Yoshida,et al.  Retinal blood flow alterations during progression of diabetic retinopathy. , 1983, Archives of ophthalmology.

[3]  Hossein Ameri,et al.  Optical Coherence Tomography Angiography of Diabetic Retinopathy in Human Subjects. , 2015, Ophthalmic surgery, lasers & imaging retina.

[4]  D TOUSSAINT,et al.  Retinal vascular patterns. IV. Diabetic retinopathy. , 1961, Archives of ophthalmology.

[5]  David Huang,et al.  Projection-resolved optical coherence tomographic angiography. , 2016, Biomedical optics express.

[6]  Marco Rispoli,et al.  IN VIVO CHARACTERIZATION OF RETINAL VASCULARIZATION MORPHOLOGY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2015, Retina.

[7]  J. Tang,et al.  Non-uniform distribution of lesions and biochemical abnormalities within the retina of diabetic humans , 2003, Current eye research.

[8]  R. Engerman Development of the macular circulation. , 1976, Investigative ophthalmology.

[9]  K Muraoka,et al.  Distribution of capillary nonperfusion in early-stage diabetic retinopathy. , 1984, Ophthalmology.

[10]  J Conrath,et al.  Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment , 2005, Eye.

[11]  M Palta,et al.  Abnormalities of the foveal avascular zone in diabetic retinopathy. , 1984, Archives of ophthalmology.

[12]  Molecular imaging reveals elevated VEGFR‐2 expression in retinal capillaries in diabetes: a novel biomarker for early diagnosis , 2014, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[13]  Eric M. Moult,et al.  Select Features of Diabetic Retinopathy on Swept-Source Optical Coherence Tomographic Angiography Compared With Fluorescein Angiography and Normal Eyes. , 2016, JAMA ophthalmology.

[14]  Y. Hata,et al.  An Overview of Diabetes and Ocular Health , 2012 .

[15]  Mayss Al-Sheikh,et al.  Swept-Source OCT Angiography Imaging of the Foveal Avascular Zone and Macular Capillary Network Density in Diabetic Retinopathy. , 2016, Investigative ophthalmology & visual science.

[16]  Florence Coscas,et al.  Normative Data for Vascular Density in Superficial and Deep Capillary Plexuses of Healthy Adults Assessed by Optical Coherence Tomography Angiography. , 2016, Investigative ophthalmology & visual science.

[17]  T. Kern,et al.  Vascular lesions in diabetes are distributed non-uniformly within the retina. , 1995, Experimental eye research.

[18]  A. Hafezi-Moghadam,et al.  Retinopathy in a novel model of metabolic syndrome and type 2 diabetes: new insight on the inflammatory paradigm , 2014, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[19]  Jeff Fingler,et al.  Phase-contrast OCT imaging of transverse flows in the mouse retina and choroid. , 2008, Investigative ophthalmology & visual science.

[20]  Lloyd Paul Aiello,et al.  Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity. , 2013, Ophthalmology.

[21]  Martin F. Kraus,et al.  Split-spectrum amplitude-decorrelation angiography with optical coherence tomography , 2012, Optics express.

[22]  Akitoshi Yoshida,et al.  Optical Coherence Tomography Angiography in Diabetic Retinopathy: A Prospective Pilot Study. , 2015, American journal of ophthalmology.

[23]  B. Klein,et al.  Global Prevalence and Major Risk Factors of Diabetic Retinopathy , 2012, Diabetes Care.

[24]  R. Spaide,et al.  Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. , 2015, JAMA ophthalmology.

[25]  Jason Hsu,et al.  Measurement of Foveal Avascular Zone Dimensions and its Reliability in Healthy Eyes Using Optical Coherence Tomography Angiography. , 2016, American journal of ophthalmology.

[26]  N. Sreejayan,et al.  Nutritional and therapeutic interventions for diabetes and metabolic syndrome , 2012 .

[27]  Aki Kato,et al.  ENLARGEMENT OF FOVEAL AVASCULAR ZONE IN DIABETIC EYES EVALUATED BY EN FACE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2015, Retina.

[28]  T. Gardner,et al.  The neurovascular unit and the pathophysiologic basis of diabetic retinopathy , 2016, Graefe's Archive for Clinical and Experimental Ophthalmology.

[29]  T. Ishibashi,et al.  Platelet Aggregation and Coagulation in the Pathogenesis of Diabetic Retinopathy in Rats , 1981, Diabetes.

[30]  Masahiro Fujimoto,et al.  Relationship between Functional and Structural Changes in Diabetic Vessels in Optical Coherence Tomography Angiography , 2016, Scientific Reports.

[31]  J. Fujimoto,et al.  IMAGE ARTIFACTS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2015, Retina.

[32]  R A Weale,et al.  On the retinal vasculature of the human fovea. , 1974, Experimental eye research.

[33]  K Muraoka,et al.  Midperipheral fundus involvement in diabetic retinopathy. , 1981, Ophthalmology.

[34]  K Miyamoto,et al.  Pathogenetic potential of leukocytes in diabetic retinopathy. , 1999, Seminars in ophthalmology.

[35]  Qienyuan Zhou,et al.  RETINAL VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN NORMALS AND DIABETIC RETINOPATHY PATIENTS , 2015, Retina.

[36]  M. Lorenzi,et al.  Accelerated death of retinal microvascular cells in human and experimental diabetic retinopathy. , 1996, The Journal of clinical investigation.

[37]  A. Harris,et al.  Contrast sensitivity loss is coupled with capillary dropout in patients with diabetes. , 1997, Investigative ophthalmology & visual science.

[38]  Lauren Branchini,et al.  DETECTION OF MICROVASCULAR CHANGES IN EYES OF PATIENTS WITH DIABETES BUT NOT CLINICAL DIABETIC RETINOPATHY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2015, Retina.