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Juan Ignacio Bianchi, Rodrigo Matsui, Daniela Castro; Description of Capillary Macroaneurysms in diabetic macular edema with Optical Coherence Tomography Angiography. Invest. Ophthalmol. Vis. Sci. 2017;58(8):955.
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© ARVO (1962-2015); The Authors (2016-present)
Microaneurysms represents a hallmark of diabetic retinopathy, and sometimes they increase in diameter with parietal thickening, moment when we call capillary macroaneurysms (MAs). Indocyanine green angiography (ICGA) and Spectral domain optical coherence tomography (SD-OCT) improve the detection of these lesions compared with Fluorescein angiography. Optical coherence tomography angiography (OCTA) is a novel non-invasive technique capable of imaging retinal vasculature. The aim of this study is to describe the MAs in patients with diabetic macular edema with OCTA.
Cross sectional study of 15 MAs in 12 subjects with diabetic macular edema. ICGA and SD-OCT were used for detection and colocalization of the MAs. A 3mmx3mm (or 6mmx6mm if needed) swept-source OCTA above de area of the MAs was performed.The MAs flow signal was interpreted after we make a manual segmentation on B-scan by adjusting the upper and lower limit of the MA with the the segmentation lines.
Mean age of subjects was 61.5 (±11) years. All MAs were localized with a mean distance of 3024μm (±1520) to the foveal center. 14/15 MAs (93%) were associated with perilesional hard exudates and 9/15 (60%) had surrounding retinal edema. The mean retinal thickness above the MAs was 437μm (±120).All MAs appear like round hyperfluorescent homogeneous lesion on ICGA, and in SD-OCT under the form of a vascular structure with a hyperreflective wall surrounding a lumen containing hyperreflective (12) or hyporreflective material (3). En-face OCT imaging detected 93% of MAs, under a hyperreflective lesion. The mean size of MAs was 228μm (±65) height and 276μm (±92) wide. Mean wall thickness was 35μm (±10).Out of a total of 13 valuables MAs, OCTA detected 11 (85%), with a hyperreflective (8) or hyporreflective (3) flow signal.
The strong association between the development of MAs and the presence of hard exudates can be explain the chronicity of diabetic macular edema, since the MAs are big areas of blood-retinal barrier rupture. We need strategies to treat chronic macular edema before involving the foveal center. ICGA and SD-OCT are more sensitive than OCTA for detection of MAs, but the combination of this techniques may optimize the detection and therefore the treatment. Here, we report preliminary results of the MAs clinical features detected by OCTA and their correlation with multimodal imaging.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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