Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 2: 166 - 172

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.02.007

Clinical research

Detection of vessel density changes in eyes of patients with diabetic retinopathy and diabetic macular edema using optical coherence tomography angiography

  • Han-ying WANG ,
  • Yan JIANG ,
  • Ching-yi WANG ,
  • Xin SHI ,
  • Tian NIU ,
  • Xin-dan XING ,
  • Yin-chen SHEN ,
  • Chong CHEN ,
  • Kun LIU
Expand
  • Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University; National Clinical Research Center for Eye Diseases; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai Engineering Center for Visual Science and Photomedicine; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China

Received date: 2020-04-01

  Online published: 2021-02-28

Supported by

National Key Research and Development Program of China(2016YFC0904800);National Science and Technology Major Project of China(2017ZX09304010);National Natural Science Foundation of China(81870667);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20161426)

Fold

Abstract

Objective

·To observe the features of diabetic retinopathy (DR) at different stages, which is accompanied/not accompanied by diabetic macular edema (DME), using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and to determine related risk factors and potential OCTA imaging biomarkers of DR progression.

Methods

·Ninety DR patients from Shanghai General Hospital, Shanghai Jiao Tong University were divided into four groups according to early treatment of diabetic retinopathy study (ETDRS) grading standard (mild, moderate, severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy groups), or two groups according to the presence of DME or not. OCTA metrics, including superficial vessel density, deep vessel density and foveal avascular zone area were compared. Logistic regression was used to exclude confounding factors. Imaging changes related to DR severity and DME occurrence, as well as other factors including gender, age, history of underlying diseases, use of antihypertensive drugs and blood indicators were searched.

Results

·Lower age of the onset of diabetes (P=0.042, 95%CI -0.057－-0.001) and lower deep vessel density (P=0.040, 95%CI -0.066－-0.002) were significantly associated with DR progression. The absence of hyperlipidemia was a protective factor for the progression of DR disease (P=0.027, 95%CI -3.001－-0.176). The incidence of DME increased with the severity of DR (P=0.004), and the occurrence of disorganization of retinal inner layers was significantly related to DME (P=0.000). No alteration in vessel density was observed between patients with DME and those without DME.

Conclusion

·The progression of DR may be closely related to the vessel density of deep retinal vessels, which may become an imaging biomarker to predict the development of DR.

Key words： diabetic retinopathy (DR); optical coherence tomography angiography (OCTA); vascular density; diabetic macular edema (DME)

Cite this article

Han-ying WANG , Yan JIANG , Ching-yi WANG , Xin SHI , Tian NIU , Xin-dan XING , Yin-chen SHEN , Chong CHEN , Kun LIU . Detection of vessel density changes in eyes of patients with diabetic retinopathy and diabetic macular edema using optical coherence tomography angiography[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(2) : 166 -172 . DOI: 10.3969/j.issn.1674-8115.2021.02.007

References

1 Wolter JR. Diabetic retinopathy[J]. Am J Ophthalmol, 1961, 51(5): 1123/251-1141/269.
2 Resnikoff S, Pascolini D, Etya'Ale D, et al. Global data on visual impairment in the year 2002[J]. Bull World Heal Organ, 2004, 82(11): 844-851.
3 Gangwani RA, Lian JX, McGhee SM, et al. Diabetic retinopathy screening: global and local perspective[J]. Hong Kong Med J, 2016, 22(5): 486-495.
4 Alasil T, Keane PA, Updike JF, et al. Relationship between optical coherence tomography retinal parameters and visual acuity in diabetic macular edema[J]. Ophthalmology, 2010, 117(12): 2379-2386.
5 Ito SI, Miyamoto N, Ishida K, et al. Association between external limiting membrane status and visual acuity in diabetic macular oedema[J]. Br J Ophthalmol, 2013, 97(2): 228-232.
6 Maheshwary AS, Oster SF, Yuson RMS, et al. The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema[J]. Am J Ophthalmol, 2010, 150(1): 63-67.e1.
7 Forooghian F, Stetson PF, Meyer SA, et al. Relationship between photoreceptor outer segment length and visual acuity in diabetic macular edema[J]. Retin Phila Pa, 2010, 30(1): 63-70.
8 Uji A, Murakami T, Nishijima K, et al. Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema[J]. Am J Ophthalmol, 2012, 153(4): 710-717.e1.
9 Deák GG, Bolz M, Ritter M, et al. A systematic correlation between morphology and functional alterations in diabetic macular edema[J]. Invest Ophthalmol Vis Sci, 2010, 51(12): 6710.
10 Sun JK, Radwan SH, Soliman AZ, et al. Neural retinal disorganization as a robust marker of visual acuity in current and resolved diabetic macular edema[J]. Diabetes, 2015, 64(7): 2560-2570.
11 Tan BY, Chua J, Lin E, et al. Quantitative microvascular analysis with wide-field optical coherence tomography angiography in eyes with diabetic retinopathy[J]. JAMA Netw Open, 2020, 3(1): e1919469.
12 Sun ZH, Tang FY, Wong R, et al. OCT angiography metrics predict progression of diabetic retinopathy and development of diabetic macular edema[J]. Ophthalmology, 2019, 126(12): 1675-1684.
13 钱丽君, 马健, 尹厚发, 等. 非增殖性糖尿病视网膜病变的程度与视网膜血流指数相关性研究[J]. 中华全科医学, 2018, 16(11): 1784-1786, 1803.
14 杨庭骅. 糖尿病性视网膜病变患者黄斑区视网膜血流密度的改变[D]. 济南: 山东大学, 2019.
15 Wilkinson C, Ⅲ Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682.
16 Friedman SM, Almukhtar TH, Baker CW, et al. Topical nepafenec in eyes with noncentral diabetic macular edema[J]. Retina, 2015, 35(5): 944-956.
17 Ng SM, Ayoola OO, McGuigan MP, et al. A multicentre study evaluating the risk and prevalence of diabetic retinopathy in children and young people with type 1 diabetes mellitus[J]. Diabetes Metab Syndr: Clin Res Rev, 2019, 13(1): 744-746.
18 Hammes HP, Kerner W, Hofer S, et al. Diabetic retinopathy in type 1 diabetes: a contemporary analysis of 8 784 patients[J]. Diabetologia, 2011, 54(8): 1977-1984.
19 Hletala K, Harjutsalo V, Forsblom C, et al. Age at onset and the risk of proliferative retinopathy in type 1 diabetes[J]. Diabetes Care, 2010, 33(6): 1315-1319.
20 Kullberg CE, Abrahamsson M, Arnqvist HJ, et al. Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with type 1 diabetes[J]. Diabet Med, 2002, 19(11): 924-931.
21 Zou WJ, Ni LS, Lu QY, et al. Diabetes onset at 31?45 years of age is associated with an increased risk of diabetic retinopathy in type 2 diabetes[J]. Sci Rep, 2016, 6: 38113.
22 Song PG, Yu JY, Chan KY, et al. Prevalence, risk factors and burden of diabetic retinopathy in China: a systematic review and meta-analysis[J]. J Glob Heal, 2018, 8(1): 010803.
23 Varma R, Bressler NM, Doan QV, et al. Prevalence of and risk factors for diabetic macular edema in the United States[J]. JAMA Ophthalmol, 2014, 132(11): 1334.
24 Kim EJ, Lin WV, Rodriguez SM, et al. Treatment of diabetic macular edema[J]. Curr Diab Rep, 2019, 19(9): 68.
25 Tan PEZ, Yu PK, Balaratnasingam C, et al. Quantitative confocal imaging of the retinal microvasculature in the human retina[J]. Invest Ophthalmol Vis Sci, 2012, 53(9): 5728.
26 Chan G, Balaratnasingam C, Yu PK, et al. Quantitative morphometry of perifoveal capillary networks in the human retina[J]. Invest Ophthalmol Vis Sci, 2012, 53(9): 5502.
27 Borrelli E, Sacconi R, Brambati M, et al. In vivo rotational three-dimensional OCTA analysis of microaneurysms in the human diabetic retina[J]. Sci Rep, 2019, 9: 16789.
28 Early Treatment Diabetic Retinopathy Study Research Group. Fluorescein angiographic risk factors for progression of diabetic retinopathy ETDRS report number 13[J]. Ophthalmology, 1991, 98(5): 834-840.
29 Onishi AC, Nesper PL, Roberts PK, et al. Importance of considering the middle capillary plexus on OCT angiography in diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2018, 59(5): 2167.
30 AttaAllah HR, Mohamed AAM, Ali MA. Macular vessels density in diabetic retinopathy: quantitative assessment using optical coherence tomography angiography[J]. Int Ophthalmol, 2019, 39(8): 1845-1859.
31 Spaide RF. Retinal vascular cystoid macular edema[J]. Retina, 2016, 36(10): 1823-1842.
32 Fayed AE, Abdelbaki AM, El Zawahry OM, et al. Optical coherence tomography angiography reveals progressive worsening of retinal vascular geometry in diabetic retinopathy and improved geometry after panretinal photocoagulation[J]. PLoS One, 2019, 14(12): e0226629.
33 Pelosini L, Hull CC, Boyce JF, et al. Optical coherence tomography may be used to predict visual acuity in patients with macular edema[J]. Invest Ophthalmol Vis Sci, 2011, 52(5): 2741.
Options
Outlines

/

〈 〉