Characteristics of Neovascularization in Early Stages of Proliferative Diabetic Retinopathy by Optical Coherence Tomography Angiography

Pan, Jiandong; Chen, Ding; Yang, Xiaoling; Zou, Ruitao; Zhao, Kuo; Cheng, Dan; Huang, Shenghai; Zhou, Tingye; Ye, Yang; Chen, Feng

doi:10.1016/j.ajo.2018.05.018

Cited by 77 publications

(75 citation statements)

References 27 publications

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“…The current results could also be linked to the origins of neovascularization elsewhere (NVE) and intraretinal microvascular abnormalities (IRMAs) reported most recently by Pan et al 34 using OCTA in PDR eyes. They classified NVEs into three types: originating from the venous side, capillary networks, and IRMAs.…”

Section: Discussionsupporting

confidence: 71%

Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

Ishibazawa

Pretto

Alibhai

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Ishibazawa A, De Pretto LR, Alibhai AY, et al. Retinal nonperfusion relationship to arteries or veins observed on widefield optical coherence tomography angiography in diabetic retinopathy. Invest Ophthalmol Vis Sci. 2019;60:4310-4318. https:// doi.org/10.1167/iovs.19-26653 PURPOSE.To evaluate whether retinal capillary nonperfusion is found predominantly adjacent to arteries or veins in eyes with diabetic retinopathy (DR). METHODS.Sixty-three eyes from 44 patients with proliferative DR (PDR) or non-PDR (NPDR) were included. Images (12 3 12-mm) foveal-centered optical coherence tomography (OCT) angiography (OCTA) images were taken using the Zeiss Plex Elite 9000. In 37 eyes, widefield montages with five fixation points were also obtained. A semiautomatic algorithm that detects nonperfusion in full-retina OCT slabs was developed, and the percentages of capillary nonperfusion within the total image area were calculated. Retinal arteries and veins were manually traced. Based on the shortest distance, nonperfusion pixels were labeled as either arterial-side or venous-side. Arterial-adjacent and venous-adjacent nonperfusion and the A/V ratio (arterial-adjacent nonperfusion divided by venous-adjacent nonperfusion) were quantified.RESULTS. Twenty-two eyes with moderate NPDR, 16 eyes with severe NPDR, and 25 eyes with PDR were scanned. Total nonperfusion area in PDR (median: 8.93%) was greater than in moderate NPDR (3.49%, P < 0.01). Arterial-adjacent nonperfusion was greater than venousadjacent nonperfusion for all stages of DR (P < 0.001). The median A/V ratios were 1.93 in moderate NPDR, 1.84 in severe NPDR, and 1.78 in PDR. The A/V ratio was negatively correlated with the total nonperfusion area (r ¼ À0.600, P < 0.0001). The results from the widefield montages showed similar patterns.CONCLUSIONS. OCTA images with arteries and veins traced allowed us to estimate the nonperfusion distribution. In DR, smaller nonperfusion tends to be arterial-adjacent, while larger nonperfusion tends toward veins.

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Section: Discussionsupporting

confidence: 71%

Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

Ishibazawa

Pretto

Alibhai

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…With newer advancements such as swept-source OCTA, the speed and resolution of image acquisition is greatly advanced, rendering highly detailed images of the retinal and choroidal vasculature. Prior studies have shown novel and useful applications of this technology to detect choroidal neovascularization, neovascular growth in proliferative diabetic retinopathy, or analyze in detail choroidal architecture 13, 14, 15…”

Section: Discussionmentioning

confidence: 99%

Familial retinal arteriolar tortuosity and quantification of vascular tortuosity using swept-source optical coherence tomography angiography

Saraf

Tyring

Chen

et al. 2019

American Journal of Ophthalmology Case Reports

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PurposeFamilial retinal arteriolar tortuosity (FRAT) is a rare autosomal dominant disorder that is characterized by tortuosity of the second and higher order retinal arterioles. We implement swept-source optical coherence tomography angiography (SS-OCTA) to quantify vessel tortuosity in patients with FRAT. We hypothesize that patients with FRAT will have higher retinal arteriole tortuosity when compared to controls.MethodsPatients were scanned with a SS-OCTA device (Plex Elite 9000, Carl Zeiss Meditec, Dublin, CA). Images of a 12 × 12 mm2 area centered on the fovea were processed, and retinal vessels >23.5 μm in diameter were identified. An automatic tortuosity measurement program written in MATLAB was used to assess vessel tortuosity. Branch points in the vessels were detected and used to separate the vasculature into individual segments. The tortuosity was measured by calculating the arc-chord ratio of each vessel segment, where a minimum value of 1 indicated a straight vessel and higher values corresponded to increasing tortuosity.ResultsTwo patients (4 eyes) with a known history of FRAT and six controls (12 eyes) were enrolled in the study. The mean tortuosity of all vessel segments (MTVS) in scans of FRAT eyes was on average 1.1244 [range: 1.1044–1.1438] while for control eyes it was 1.0818 [range: 1.0746–1.0872]. Average MTVS of FRAT eyes was significantly higher compared to control eyes (p = 0.03).Conclusions and ImportanceOur results are consistent with the hypothesis that patients with FRAT have higher objective measurements of tortuosity compared to controls. Broader applications of this method may be of benefit in other retinal diseases with changes in retinal vessel configuration.

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“…These eyes received insufficient PRP and were active as shown on FA image even after PRP. Pan et al 10 in their study reported the presence of NV as originating from IRMA. However, Takahashi et al 12 in their study reported that the NV was initiated as budding from venules, and the projected buds slowly grew into the NPA.…”

Section: Discussionmentioning

confidence: 95%

“…8,9 IRMAs on FA appear to flow into a vein while originating from a vein. 10 The traditional view was that IRMAs represent vascular remodeling that corresponds to the enlargement of capillary nonperfusion. However, in 1984, Muraoka and Shimizu 11 proposed the concept of intraretinal neovascularizations (IRNVs) in which revascularization of nonperfused area (NPA) was observed in nonproliferative retinopathy with subsequent proliferative changes appearing later, suggesting that some IRMAs are forme fruste of retinal NV.…”

mentioning

confidence: 99%

A Proposed Classification of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Following Panretinal Photocoagulation

Shimouchi

Ishibazawa

Ishiko

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Citation: Shimouchi A, Ishibazawa A, Ishiko S, et al. A proposed classification of intraretinal microvascular abnormalities in diabetic retinopathy following panretinal photocoagulation. Invest Ophthalmol Vis Sci. 2020;61(3):34. https://doi.org/10.1167/iovs.61.3.34 PURPOSE.To investigate the characteristics of intraretinal microvascular abnormalities (IRMAs) before and after panretinal photocoagulation (PRP) for diabetic retinopathy (DR) by using optical coherence tomography angiography (OCTA). METHODS.Forty-six eyes of 29 patients with DR were included (26 eyes with severe nonproliferative diabetic retinopathy [SNPDR] and 20 eyes with proliferative diabetic retinopathy [PDR]). En face OCTA images of IRMAs in a 6 × 6-mm area were acquired by using Cirrus 5000 with AngioPlex. The morphological changes in IRMAs were evaluated before and after PRP. The changes in the IRMAs were divided into five subtypes: unchanged; tuft regression; reperfusion; mixed (combined tuft regression/reperfusion); and worsening (new appearance of tuft). RESULTS.Unchanged IRMAs were identified in 15 SNPDR eyes and 2 PDR eyes; all neovascularization (NV) had regressed after PRP. Tufts were more frequently observed in the PDR eyes (15/20, 75%) than in the SNPDR eyes (8/26, 31%) (P = 0.003), and two tufts tended to exceed the inner limiting membrane, which showed progression to NV before PRP. The reperfusion phenomenon was observed in 7/26 SNPDR eyes and 4/20 PDR eyes, including the mixed type, and showed two vascular patterns: abnormal (dilated, tortuous, and twisted) and normal vessels. The worsening type was observed in 1/26 SNPDR eye and 2/20 PDR eyes. CONCLUSIONS.OCTA enabled classification of IRMA into more detailed types. The unchanged and reperfusion types suggested that IRMAs had aspects of remodeling. However, IRMAs with tufts were observed in 75% of the PDR eyes, and the tufts had aspects of NV.

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Characteristics of Neovascularization in Early Stages of Proliferative Diabetic Retinopathy by Optical Coherence Tomography Angiography

Cited by 77 publications

References 27 publications

Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

Familial retinal arteriolar tortuosity and quantification of vascular tortuosity using swept-source optical coherence tomography angiography

A Proposed Classification of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Following Panretinal Photocoagulation

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