Deep capillary plexus impairment in patients with type 1 diabetes mellitus with no signs of diabetic retinopathy revealed using optical coherence tomography angiography

Scarinci, Fabio; Picconi, Fabiana; Giorno, Paola; Boccassini, Barbara; Geronimo, Daniele De; Varano, Monica; Frontoni, Simona; Parravano, Mariacristina

doi:10.1111/aos.13510

Cited by 61 publications

(40 citation statements)

References 6 publications

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“… 9 , 10 Only 15% of eyes in the current study had severe NPDR, which may explain why this parameter was particularly significant at differentiating eyes with NPDR and PDR. Furthermore, the same parameter was recently shown to be an important indicator of microvascular changes in early DR. 28 , 29 Finally, acircularity index has been shown to be highly sensitive to early DR changes. 14 Based on these previous studies, it is therefore not surprising that these parameters, in combination, could differentiate eyes with NoDR and any DR as well as eyes with NPDR and PDR.…”

Section: Discussionmentioning

confidence: 99%

Statistical Model of Optical Coherence Tomography Angiography Parameters That Correlate With Severity of Diabetic Retinopathy

Ashraf

Nesper

Jampol

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PurposeTo determine whether combining quantitative optical coherence tomography angiography (OCTA) parameters can achieve high sensitivity and specificity to distinguish eyes with nonproliferative diabetic retinopathy (NPDR) from those with proliferative diabetic retinopathy (PDR) as well as eyes with diabetes and no DR (NoDR) from those with clinical DR (any DR).MethodsThis cross-sectional study included 28 eyes (17 patients) with NoDR, 54 eyes (34 patients) with NPDR, and 56 eyes (36 patients) with PDR. OCTA images were processed to quantify the foveal avascular zone (FAZ) area, acircularity, vessel density, skeletonized vessel density, fractal dimension, and intersections and average vessel diameter for the superficial (SCP) and the deep capillary plexus (DCP). Binary logistic regression models were used to identify the OCTA parameters that best distinguished DR severity groups. The area (AUC) under the receiver operating characteristic (ROC) curves, and sensitivity and specificity were calculated for each model.ResultsThe regression model identified the SCP FAZ area, DCP vessel density, and acircularity as parameters that best distinguished between DR severity groups. ROC curves for NPDR versus PDR had an AUC of 0.845 (P < 0.001) and sensitivity and specificity of 86% and 70%, respectively. ROC curves for NoDR versus any DR showed an AUC of 0.946 (P < 0.001) with sensitivity of 89% and specificity of 96%, with comparable results when explored in males and females separately.ConclusionsWe identified a set of OCTA parameters with high sensitivity and specificity for distinguishing between groups based on DR severity, suggesting potential clinical application for OCTA as a screening tool for DR.

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Section: Discussionmentioning

confidence: 99%

Statistical Model of Optical Coherence Tomography Angiography Parameters That Correlate With Severity of Diabetic Retinopathy

Ashraf

Nesper

Jampol

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…Several studies also suggest that OCTA parameter alterations in the deep vascular layer are affected more severely than in the superficial vascular layer in NPDR [10, 11, 14-16, 17, 21, 23, 26]. OCTA parameters at the deep vascular layer were most significantly affected in patients with DME [4, 29-32].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Patients with type 1 diabetes without DR had an increased FAZ area in the deep vascular layer compared to patients with type 2 diabetes without DR [6]. Some studies found a significantly decreased vessel density in both superficial and deep vascular layers in patients without DR [7, 9]; however, in three other reports, vessel density was significantly reduced only in the deep vascular layer [10-12]. Fractal dimension was also significantly reduced in both superficial and deep vascular layers of patients with type 2 diabetes without DR [13].…”

Section: Octa Parameters In the Superficial Deep And/or Intermediatmentioning

confidence: 99%

Implication of Deep-Vascular-Layer Alteration Detected by Optical Coherence Tomography Angiography for the Pathogenesis of Diabetic Retinopathy

Dimitrova¹,

Chihara²

2019

Ophthalmologica

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The aim of this narrative mini review is to analyze optical coherence tomography angiography (OCTA) parameters from reports that involved both superficial and deep vascular layers in patients with diabetes and to assess their relevance for the pathogenesis of diabetic retinopathy (DR). Papers published from January 2015 to August 2018 describing the use of OCTA in diabetes were identified and reviewed through a Medline/PubMed search. OCTA studies suggest that parameters are altered in patients with diabetes in all retinal vascular layers. From all included studies that evaluated both the superficial and the deep vascular layer, a number of studies suggested that the deep vascular layer was affected at an earlier stage of DR. OCTA parameter alterations were more prominent in the deep vascular layer than in the superficial vascular layer in patients with DR, and deep-vascular-layer alterations were most evident in patients with diabetic macular edema. Regarding that retinal venules originate from the deep vascular layer of the retina, alteration of OCTA parameters at the deep vascular layer in diabetic patients may imply a predominant affection of the venous side of the retinal vascular system in the pathogenesis of DR.

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“…The morphological changes of single retinal layers including thinning of the RGC layer and retinal fiber nerve layer (RNFL) were detected by spectral domain optical coherence tomography (SD-OCT) [8,9], and these represent potential biomarkers of neurodegeneration in DR. Several studies using optical coherence tomography angiography (OCTA) indicated that parafoveal vessel density is reduced at the level of the deep capillary plexus (DCP) in patients with DM1 and in those with type 2 diabetes with absence of or mild DR [12][13][14][15][16], which suggests that microvascular involvement may be observed before appearance of any vascular alteration on the fundus examination. In addition, adaptive optics (AO) revealed morphological changes of the photoreceptor in patients with mild signs of DR, in particular a reduction of perifoveal photoreceptor density in vivo, increase of distance between the cones, and irregular packing arrangement compared to that of the normal cone [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

et al. 2020

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Introduction: This study aimed to evaluate the effect of treatment with eye drops containing citicoline and vitamin B 12 on changes in function of the inner retina, morphology of the inner and outer retina, and microvascular condition in patients with type 1 diabetes (DM1) with mild signs of non-proliferative diabetic retinopathy (NPDR) during 3 years of follow-up. Methods: A pilot study with prospective, randomized, and double-masked design was conducted to address the aims. Twenty patients with DM1 were enrolled and randomly divided into two groups: the DC group comprising patients treated with citicoline and vitamin B 12 eye drops (10 patients; mean age ± standard deviation, 46.86 ± 8.78 years) and the DP group comprising those treated with placebo (10 patients; mean age ± standard deviation, 47.89 ± 7.74 years). In the DC group, one eye of each patient was treated with citicoline and vitamin B 12 eye drops (OMK2 Ò , Omikron Italia srl, Italy, 3 drops/day), while in the DP group, it was treated with placebo (eye drops containing hypromellose 0.3%, 3 drops/day) for a 3-year period. In both groups, Humphrey Matrix frequency doubling technology (FDT), spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA), and adaptive optics (AO) were applied at baseline and 12, 24, and 36 months of the follow-up period. Results: In the results of follow-up evaluation, the DC and DP groups were significantly different: Significant reduction in function in terms of 10-2 FDT mean sensitivity and in morphology reflected by an increase in inner nuclear layer thickness and decrease in other plexiform layer thickness and foveal vessel density were observed in the DP group, while no such significant changes were observed in the DC group in the long term. Conclusions: This pilot study indicated that patients with DM1 with mild signs of diabetic retinopathy (DR) who underwent treatment with citicoline and vitamin B 12 eye drops for a 3-year duration achieved stabilization or decreased rate of functional impairment, neuroretinal degeneration, and microvascular damage. Trial Registration: ClinicalTrials.gov identifier, NCT04009980.

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Deep capillary plexus impairment in patients with type 1 diabetes mellitus with no signs of diabetic retinopathy revealed using optical coherence tomography angiography

Cited by 61 publications

References 6 publications

Statistical Model of Optical Coherence Tomography Angiography Parameters That Correlate With Severity of Diabetic Retinopathy

Statistical Model of Optical Coherence Tomography Angiography Parameters That Correlate With Severity of Diabetic Retinopathy

Implication of Deep-Vascular-Layer Alteration Detected by Optical Coherence Tomography Angiography for the Pathogenesis of Diabetic Retinopathy

Citicoline and Vitamin B12 Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes

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