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William Binotti, Andre C Romano; Optical Coherence Tomography Angiography Parameters to Determine Progression in Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):92.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography angiography (OCTA) has shown important capillary alterations of the macula in diabetic retinopathy (DR). Although they are significant when compared to non-diabetic patients, their role in the progression of disease is not clear yet. Herein, we performed a retrospective, observational clinical study analyzing the superficial and deep retinal capillary plexus in OCTA of different DR stages to determine progression.
A total of 57 DR eyes of 39 patients with clinical data were analyzed. Patients were divided clinically into mild, moderate, severe and proliferative DR. The foveal avascular zone (FAZ), flow area (Fl) and vessel density (VD) of the superficial and deep layers in both 3x3 and 6x6 scans from Avanti XR AngioVue (Optovue Inc., Freemont, CA) were studied. The mean, standard deviations and analysis of variance (ANOVA) were performed. For accuracy using the ROC curve we divided the eyes into 2 groups: low risk (mild and moderate DR) and high risk (severe and proliferative DR). The area under the curve, sensitivity, specificity, positive predictive value and negative predictive value were calculated.
The mean age was 55.8 (±14.1) years with 21.1%, 21.1%, 29.8% and 28.0% of patients in the mild, moderate, severe and proliferative DR groups, respectively. In the deep layer, the FAZ significantly increased and both the Fl and VD significantly decreased as disease progressed, in both scans (p<0.5). In the superficial layer, the variation was similar, but with marginal significance. In general, there was a better accuracy in the deep plexus parameters compared to the superficial plexus, independently of the parameter or scan size (p≤0.01).
OCTA has shown that as DR progresses FAZ increases and Fl and VD decreases with greater significance in the 3x3 mm scan at the deep retinal capillary plexus (p<0.01). Furthermore, greater accuracy in diagnosing high risk DR patients was found at the deep plexus layer. These results show that OCTA has the potential to significantly alter management and outcome in DR patients due to the precision and quantitative data provided, especially in the deep retinal plexus, where it appears to be more sensitive to vascular changes in DR.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
DR OCTA 3x3 scans of the A) superficial retinal capillary with B) FAZ, C) Fl and D) VD
DR OCTA 3x3 scans of the A) deep retinal capillary with B) FAZ, C) Fl and D) VD
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