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Kazuya Morino, Tomoaki Murakami, Tatsuya Yoshitake, Yoko Dodo, Masahiro Fujimoto, shota yasukura, Akitaka Tsujikawa; Characteristics of Diabetic Capillary Nonperfusion in Extramacular White Spots on Optical Coherence Tomography Angiography. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5338.
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© ARVO (1962-2015); The Authors (2016-present)
Nonperfusion area (NPA) is a clinically significant lesion in diabetic retinopathy (DR), but its pathological mechanism is poorly understood. In this study, we investigated the three-dimensional capillary nonperfusion in macular and extramacular white spots on optical coherence tomography angiography (OCTA) images.
We retrospectively reviewed 107 eyes of 64 patients with treatment-naïve DR, for whom 12×12mm OCTA images centered on the optic disc and ultrawide field photographs were obtained using PLEX Elite 9000 (Carl Zeiss Meditec) and Optos200Tx (Optos), respectively. White spots on fundus photographs including typical cotton-wool spots corresponded to hyperreflective lesions in the superficial en-face OCT images, whose extents and locations were characterized. We further investigated the relationship between such structure OCT findings and three-dimensional characteristics of NPAs on OCTA images, e.g., lamellar NPAs and NPAs extensive to the peripheral side. The results are expressed as the median (interquartile range [IQR]).
We saw 136 hyperreflective lesions (19 and 117 lesions in the macular and extramacular areas, respectively) in structure OCT images in 49 eyes. Hyperreflective lesions in the extramacular areas were significantly greater (0.10mm2[0.06-0.25] vs. 0.25mm2 [0.16-0.49], P<0.001), more frequently extended to the outer plexiform layer (26.3% vs 66.7%, P<0.001) , and were less frequently accompanied with nerve fiber layer defect (100% vs 15.4%, P<0.001) than those in the macular areas. Most white spots (91.5%) in the extramacular areas corresponded to the NPAs in the whole retinal layers on OCTA images, whereas the capillary nonperfusion was limited to the superficial layer in most spots (89.5%) in the macula (P<0.001). Extramacular white spots were more frequently accompanied with NPA extending to the peripheral side on OCTA images (5.3% vs 66.7%, P<0.001).
The comparative study between OCT and OCTA images demonstrates that most of extramacular white spots correspond to the NPA in all retinal layers on OCTA images and are distinguished from typical cotton-wool spots with the lamellar NPA in the superficial layer in DR.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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