Visualization of 3 Distinct Retinal Plexuses by Projection-Resolved Optical Coherence Tomography Angiography in Diabetic Retinopathy

Abstract

IMPORTANCE Projection artifacts in optical coherence tomography angiography (OCTA) blur the retinal vascular plexuses together and limit visualization of the individual plexuses.OBJECTIVE To describe projection-resolved (PR) OCTA in eyes with diabetic retinopathy (DR) and healthy eyes. DESIGN, SETTING, AND PARTICIPANTSIn this case-control study, patients with DR and healthy controls were enrolled in this observational study from January 26, 2015, to December 4, 2015, at a tertiary academic center. Spectral-domain, 70-kHz OCT obtained 3 × 3-mm macular scans. The PR algorithm suppressed projection artifacts. A semiautomated segmentation algorithm divided PR-OCTA into superficial, intermediate, and deep retinal plexuses. Two masked graders examined 3-layer PR-OCTA and combined angiograms for nonperfusion and abnormal capillaries. MAIN OUTCOMES AND MEASURES Retinal nonperfusion and capillary abnormalities and the diagnostic accuracy of detecting DR.RESULTS Twenty-nine eyes of 15 healthy individuals (mean [SD] age, 36.2 [13.4] years; 11 women) and 47 eyes of 29 patients with DR (mean [SD] age, 55.5 [11.9]; 10 women) underwent imaging. PR-OCTA revealed 3 distinct retinal plexuses in their known anatomical locations in all eyes. The intermediate and deep plexuses of healthy eyes revealed capillary networks of uniform density and caliber, whereas the superficial plexus revealed vessels in the familiar centripetal branching pattern. In eyes with DR, 3-layer PR-OCTA disclosed incongruent areas of nonperfusion and varied vessel caliber and density in the deeper plexuses. Masked grading of capillary nonperfusion on 3-layer PR-OCTA detected DR with 100% sensitivity (95% CI, 90.8%-100%) and 100% specificity (95% CI, 85.4%-100%). With unsegmented retinal angiograms, the sensitivity and specificity were 78.7% (95% CI, 63.9%-88.8%) and 100% (95% CI, 85.4%-100%), respectively (P = .002 for sensitivity). On 3-layer PR-OCTA, sensitivity was 72.2% (95% CI, 54.6%-85.2%) for severe nonproliferative DR and proliferative DR eyes with generalized nonperfusion in 2 or more individual plexuses, but on combined angiogram, sensitivity was 25.0% (95% CI, 12.7%-42.5%) for generalized nonperfusion (P < .001). PR-OCTA disclosed dilated vessels in the intermediate and deep plexuses in 23 eyes (100%) with proliferative DR, 13 eyes (100%) with severe nonproliferative DR, 8 eyes (73%) with mild to moderate nonproliferative DR, and 0 control eyes.CONCLUSIONS AND RELEVANCE By presenting 3 retinal vascular plexuses distinctly, PR-OCTA reveals capillary abnormalities in deeper layers with clarity and may distinguish DR from healthy eyes and severe DR from mild DR with greater accuracy compared with conventional OCTA.

Diabeteses kisér-károsodás vizsgálata optikai koherencia tomográfián alapuló angiográfiával

“…Ugyanakkor az OCT-angiográfia nem alkalmas az erekből történő folyadékszivárgás vizualizálására, és jelenleg nem képes a perifériás retinaterületek leképezésére sem [37]. Jelen tanulmányunkban a macula területén a felszíni kapillárisér-hálózat sűrűségét elemeztük, miután a mély kapillárisér-hálózat sűrűségének vizsgálata jelenleg még nem kellően megbízható a projekciós műtermé-kek miatt [38,39].…”

Automated detection of dilated capillaries on optical coherence tomography angiography

“…An experienced masked grader qualitatively examined the en face DCP angiograms [7]. The dilated capillaries were localized using a modified Early Treatment of Diabetic Retinopathy Study (ETDRS) grid [24], dividing the 3 × 3 mm angiogram into a central 500 micron circle, and the remaining area into superior, inferior, nasal, and temporal quadrants.…”

“…We previously showed that applying PR-OCTA to visualize the individual layers, the sensitivity of detecting DR and determining its severity with automated algorithms can be improved [7].…”

“…A feature that was strongly associated with severe DR was dilated capillaries in the deep retinal plexuses [7]. However, manual grading of this feature is tedious and unlikely to be used by clinicians in everyday practice.…”

Angiographic and structural imaging using high axial resolution fiber-based visible-light OCT

“…It enables a high sensitivity, high speed and non-invasive way to acquire the cross-sectional reflectivity profile of a sample [5,6]. Besides information on the layer structure, optical coherence tomography angiography (OCTA) algorithms [7,8] allow depth-resolved visualization of the retinal and choroidal blood circulation [9][10][11] and identification of abnormal vascular and blood flow changes [12] in ocular diseases such as glaucoma [13][14][15], age-related macular degeneration [16,17], and diabetic retinopathy [18,19]. Additionally, OCT has become a powerful research tool for 3D imaging of complex myocardial activities in early-stage embryonic hearts with high spatial and temporal resolution.…”