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Magdalena Niestrata-Ortiz, Witold Stankiewicz, Piotr Fichna, Krystyna Pecold, Marcin Stopa; Enlargement of foveal avascular zone in diabetic children without diabetic retinopathy shown by OCT angiography.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2793.
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© ARVO (1962-2015); The Authors (2016-present)
Recent studies using OCT angiography (OCTA) in adult diabetics have shown changes in the foveal avascular zone (FAZ) prior to the development of diabetic retinopathy (DR) and increase in FAZ area with progressing DR severity. The purpose of this study was to evaluate FAZ in children with diabetes (DM) using OCTA.
We examined 112 type 1 diabetic children without DR aged 6-18 years and 30 age-matched controls using Topcon OCT Angiography. Children with pre-existing vitreoretinal diseases were excluded. The FAZ in superficial (SCP) and deep capillary plexus (DCP) was manually delineated and the surface area automatically calculated by Topcon software. The study group was divided into 3 subgroups depending on DM duration Group 1: less than 5 years (n=40), Group 2: 5-10 years (n=42), Group 3: more than 10 years (n=30). DCP and SCP FAZ areas were compared between subgroups and controls using Student t-test and ANOVA in Statistica software.
The mean DCP FAZ surface area in the study group (n=112), 520.4μm2 (SD 160.0μm2), was significantly larger than in the control group, 408.6μm2 (SD 114.9μm2) (p=0.0005). The mean SCP FAZ area in the study group, 302.7μm2 (SD 119.2), was larger than in the control group, 284.4μm2 (SD 123.2), yet, not significantly (p=0.46). The difference between the DCP and SCP FAZ surface area in diabetics, 217.6μm2 (SD 100.8μm2), was significantly larger than in control group, 124.2μm2 (SD 72.8 μm2) (p<0.0001). The mean DCP FAZ increased with DM duration from 502.2μm2 (SD 137.8) in Group 1 to 523.9μm2 (SD 159.2) in Group 2 and 539.7μm2 (SD 189.1) in Group 3. Significant differences were found between control group and Group 1 (p=0.0120), Group 2 (p=0.0019) and Group 3 (p=0.0011). The difference between DCP and SCP FAZ areas in the control group was also significantly smaller than in Group 1 (p<0.006), Group 2 (p<0.0001) and Group 3 (p<0.0001) and differences were noted within study group with Group 1 differing significantly from Group 2 (p<0.03) and Group 3 (p<0.05).
Changes occur in the FAZ of diabetic children prior to the development of DR, particularly in DCP, and progress with increasing DM duration. OCTA as a non-invasive tool for imaging retinal microvasculature can be valuable for earlier disease detection. However, further prospective studies are required to elucidate the predictive role of FAZ parameters in DR development.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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