Retinopatía diabética proliferativa ilustrada por reflectancia infrarroja

Vaz-Pereira, Sara; Monteiro-Grillo, Manuel; Engelbert, Michael

doi:10.1016/j.oftal.2018.06.023

Cited by 2 publications

(9 citation statements)

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“…NVCs had been identified through clinical examination and at least 2 types of multimodal imaging such as structural OCT, FA, color fundus photography, multicolor imaging, near-infrared reflectance, or red-free fundus photography, as in previous studies. 16,17,[29][30][31] Exclusion criteria included other causes of proliferative retinopathy such as retinal vascular occlusion, sickle cell retinopathy, ocular ischemic syndrome, or radiation retinopathy. Eyes with prior vitrectomy, or conditions that degraded image quality such as media opacities, uveitis and vitreous hemorrhage were also excluded.…”

Section: Methodsmentioning

confidence: 99%

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Vaz-Pereira¹,

Silva²,

Freund³

et al. 2020

OPTH

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To describe features of neovascularization in proliferative diabetic retinopathy (PDR) using optical coherence tomography angiography (OCTA). Methods: A retrospective case series was performed in 23 eyes from 21 patients who underwent OCTA of neovascular complexes (NVCs) due to PDR. Eyes were imaged with the DRI Triton swept-source OCTA, Avanti RTVue XR or Cirrus HD-OCT 5000 as part of routine clinical examination. Segmentation was adjusted to include vasculature between the vitreous cavity and the internal limiting membrane (ILM). The presence of NVCs was confirmed by clinical examination and multimodal imaging such as color or red-free fundus photography, fluorescein angiography, multicolor imaging or near-infrared reflectance. Results: Thirty-five NVCs were imaged, of which, 34% were neovascularization of the disc (NVD) and 66% were neovascularization elsewhere (NVE). On structural OCT B-scans, NVE appeared as medium to highly reflective tissue that breached the ILM, while NVD showed highly reflective tissue protruding from the disc in a sea fan configuration. Flow signal was seen on OCTA in all cases of NVE and in 67% of NVD lesions. Areas with minimal or absent retinal flow signal identified retinal nonperfusion areas and were found adjacent to 87% of NVE. Intraretinal microvascular abnormalities (IRMAs) were noted next to 70% of NVE. Absent flow signal was seen in 4 NVD cases showing posterior shadowing and were considered inactive. Conclusion: OCTA appears useful for imaging NVCs, IRMAs, and retinal nonperfusion areas in eyes with diabetic retinopathy. This imaging modality enables noninvasive screening and monitoring of PDR and can obviate the need for additional testing in certain clinical settings.

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Section: Methodsmentioning

confidence: 99%

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Vaz-Pereira¹,

Silva²,

Freund³

et al. 2020

OPTH

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“…Using structural OCT, NVDs were classified morphologically as sitting or protruding from the disc and the NVE as “flat”, “ forward” and “tabletop”, as previously described [ 14 , 15 ]. All NVCs were qualitatively graded in the NIR image at baseline as (1) absent, if not apparent, meaning no changes in reflectivity were noted, (2) present but inactive if the new vessel structure was apparent and of medium to high reflectivity, respectively same reflectivity of the normal fundus or brighter than the fundus, as seen in atrophic regions or in collagen/fibrotic tissue, but without perfusion, defined as the presence of a hyporeflective blood column that appeared dark as the normal retinal vessels and (3) present and active if apparent and with an identifiable hyporeflective blood column [ 25 , 28 ]. The changes at follow-up visits were documented as same status (no change), progression (additional hyporeflective vascular fronds identified) or regression (fewer hyporeflective vascular fronds identified).…”

Section: Methodsmentioning

confidence: 99%

“…The changes at follow-up visits were documented as same status (no change), progression (additional hyporeflective vascular fronds identified) or regression (fewer hyporeflective vascular fronds identified). The presence of associated fibrosis defined as hyperreflective tissue or new vitreous hemorrhage (hyporeflective) was also noted [ 25 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…It has also been of interest in other retinal diseases, although not commonly used as a regular clinical test [ 26 ]. Specifically in DR, it has been used to quantify and locate cysts in cystoid macular edema [ 5 , 27 ] and we have reported a case where NIR was useful in the evaluation and follow-up of PDR [ 28 ]. It is our impression that information of the NIR image is frequently disregarded, but that this information is useful in busy clinics, and may even obviate the need of extra testing such as fundus photography or OCTA.…”

Section: Introductionmentioning

confidence: 99%

“…It is our impression that information of the NIR image is frequently disregarded, but that this information is useful in busy clinics, and may even obviate the need of extra testing such as fundus photography or OCTA. To interpret the images in the context of PDR it is important to consider that blood is one of the main absorbers in the near-infrared spectrum and therefore retinal vessels appear dark in NIR images, while collagen and fibrotic tissue appear bright [ 25 , 28 ]. PDR is characterized by the growth of abnormal vessels which also absorb light and appear dark against a lighter fundus background [ 24 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Near-infrared reflectance imaging of neovascularization in proliferative diabetic retinopathy

2020

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Background Blood is one of the main absorbers in the near-infrared spectrum and thus retinal vessels appear dark in near-infrared reflectance (NIR) images. Proliferative diabetic retinopathy (PDR) is characterized by abnormal neovascularization which also absorbs light and appears dark against a lighter fundus background. We analyzed neovascularization in PDR using NIR imaging, by observing changes in the neovascular complexes (NVCs) contrast and reflectivity over time. Methods Retrospective case series of 20 eyes of 17 patients with PDR who underwent NIR imaging with optical coherence tomography (OCT) using the Spectralis System. NVCs presence and activity was determined using clinical, tomographic and angiographic criteria. At baseline, all NVCs were qualitatively graded in the NIR image into 3 groups (absent, present and inactive and present and active) and their evolution over time was registered as progression, regression or same status. Results Twenty-seven NVCs were imaged, of which, 52% were neovascularization of the disc (NVD) and 48% were elsewhere (NVE). Consecutive NIR images were obtained from baseline to up to 5 time-points with a mean follow-up of 3.2 ± 1.7 years. All eyes underwent laser treatment and 30% had additional intravitreal therapy. Using NIR imaging, NVCs were classified at baseline as absent, present and inactive and present and active, respectively in 11, 4 and 85% of cases. NIR identified active neovascularization as hyporeflective irregular dark vessels originating from the retinal venules in NVE or from the disc in NVD. In all groups during follow-up, progression was identified as the development of new vascular hyporeflective dark fronds while regression was shown by reduced dark perfusion. Five eyes developed a wolf’s jaw configuration with vascular hyporeflective new vessels and hyperreflective tissue from extensive fibrosis. Fibrosis was more apparent in later images, reaching 86%. In 3 cases (11%), the NVC was no longer seen in NIR, although was still identifiable on OCT over the NVC area. Conclusions NIR is a non-invasive imaging modality commonly performed alongside OCT and frequently overlooked which can be useful to evaluate NVCs in PDR. Changes in NVC contrast and reflectivity due to blood perfusion can help in the detection and monitoring of diabetic proliferative disease and aid clinicians in daily practice.

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Retinopatía diabética proliferativa ilustrada por reflectancia infrarroja

Cited by 2 publications

References 0 publications

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Near-infrared reflectance imaging of neovascularization in proliferative diabetic retinopathy

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