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The foveal avascular zone(FAZ)is the most sensitive region of the retina, which is interconnected by the macular capillary plexus. Its morphology can indirectly reflect the alterations of macular microcirculation. With strong repeatability and reliability, optical coherence tomography angiography(OCTA)can non-invasively visualize and quantify the FAZ. The great value of OCTA makes it an important supplemental examination tool in ophthalmology and other professions. The area and perimeter of FAZ have been demonstrated to be an effective clinical diagnostic indicator in high myopia, diabetic retinopathy, glaucoma and other ocular diseases. In recent years, the geometry of FAZ has also proven to have clinical value. The parameters describing the geometry of FAZ, such as circularity index, acircularity index and axial ratio, provide a new perspective for ocular disease research. The comprehensive investigation of the morphological characteristics of the FAZ is helpful to explore the pathological mechanism of the occurrence and development of ocular diseases, predict preclinical changes, make pathological stages of the disease precise, and provide a theoretical basis for monitoring the disease's progression and assessing patients' visual prognosis.
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Purpose: The primary objective of the study was to assess the macular retinal vessel density, subfoveal choroidal thickness, and retinal layer metrics by optical coherence tomography angiography (OCTA), enhanced?depth imaging optical coherence tomography (EDI?OCT), and spectral domain optical coherence tomography (SD?OCT), respectively, in recovered COVID?19 patients and its comparison with the same in control subjects. The secondary objective was to evaluate differences in OCTA parameters in relation with the severity of COVID?19 disease and administration of corticosteroids. Methods: A case–control study was performed that included patients who had recovered from COVID?19 and age?matched healthy controls. Complete ocular examination including OCTA, SD?OCT, and EDI?OCT were performed three months following the diagnosis. Results: Three hundred sixty eyes of 180 subjects were enrolled between the two groups. A decreased mean foveal avascular zone area in both superficial capillary plexuses (P = 0.03) and deep capillary plexuses (P < 0.01), reduced average ganglion cell layer?inner plexiform layer thickness (P = 0.04), and increased subfoveal choroidal thickness (P < 0.001) were observed among cases in comparison to the control group. A significant correlation was found between sectoral macular vessel density in relation to disease severity and a decrease in vessel density with greater severity of the disease. Conclusion: OCTA detected retinal microvascular alterations following SARS?CoV?2 infection in subjects with the absence of any clinical ocular manifestation or systemic thrombotic events. These parameters could be used to help identify patients with a higher incidence of systemic thromboembolism on longer follow?ups and identify the impact of corticosteroids on retinal architecture.
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Purpose: The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non?proliferative diabetic retinopathy (NPDR). Methods: In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT?1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ?CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Results: Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ?CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. Conclusion: A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.
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Objective:To observe the clinical features of nine foveal hypoplasia (FVH) patients in a family.Methods:A retrospective clinical study. In August 2018, nine patients with FVH from a family diagnosed in Qilu Hospital of Shandong University (Qingdao) were included in this study. Detailed medical history of the proband was collected. Best corrected visual acuity (BCVA), slit-lamp, cycloplegic refraction, fundus color photography, optical coherence tomography (OCT) and OCT angiography (OCTA) were performed on the proband. The peripheral venous blood of V7 (family member), the proband and the proband's parents were collected for DNA extraction, and gene detection was performed.Results:The proband, a four-year-old girl, had poor vision with BCVA of 0.4 in both eyes. OCT showed absence of foveal pit, absence of outer segment lengthening, absence of outer nuclear layer widening and incursion of inner retinal layers. The proband's mother was 32 years old, and macular foveal reflection was not observed in her eyes. OCT and OCTA examination showed no foveal pit and foveal avascular zone in both eyes. Both eyes of the proband and her mother were diagnosed with Thomas grade 4 FVH. The other seven patients also had no foveal pit, and could be categorized into Thomas grade 3 or 4. No significant pathogenic genes and mutation sites were detected in the proband through whole genome sequencing, and no copy number variation or chromosomal abnormality associated with the phenotype of the proband was detected. After seven months of amblyopia treatment, the proband's BCVA had improved to 0.5 in the right eye and 0.6 in the left eye, while the BCVA did not change after 2 years of follow-up.Conclusion:Nine FVH patients in this family had no foveal pit with similar OCT images, and their visual acuity was affected from lightly to severely. Early amblyopia training is helpful to improve the visual acuity of child patients.
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AIM: To evaluate the macular microcirculation changes in patients with diabetic retinopathy(DR)by optical coherence tomography angiography(OCTA), and correlate the risk factors that may affect the macular microcirculation, so as to provide a clinical basis for early screening, diagnosis and therapeutic intervention for DR.METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1～3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all P<0.017), and the VD of the parafoveal was decreased in each quadrant(P<0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(P<0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(P<0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(P<0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(P<0.05), while total cholesterol and central macular thickness had no significant correlation with VD(P>0.05).CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.
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AIM:To investigate the changes in the macular microvasculature in eyes with central retinal artery occlusion(CRAO)and paracentral acute middle maculopathy(PAMM).METHODS: Retrospective study. A total of 27 cases(27 eyes)who diagnosed with CRAO-PAMM and 29 patients(29 eyes)diagnosed as CRAO but with no PAMM were hospitalized in our hospital from January 2020 to December 2021. There were 33 normal people(33 eyes)who underwent physical examination in our hospital selected as control group. Optical coherence tomography angiography(OCTA)was used to measure retinal blood flow and thickness parameters in the 3 mm×3 mm area of the macula. The correlation among macular retinal blood flow density, retinal thickness, foveal avascular zone(FAZ)area, FAZ perimeter, acircularity index(AI), flow density in a 300-μm-wide region around the FAZ(FD-300)and lesion area, best corrected visual acuity(BCVA)in the CRAO-PAMM group was analyzed.RESULTS: Among the three groups, there were significant differences in the overall and parafoveal blood flow density of superficial capillary layer(SCP)and deep capillary layer(DCP), foveal thickness, FAZ area, FAZ perimeter, AI and FD-300(all P<0.05). In the CRAO-PAMM group, the lesion area was negatively correlated with DCP overall and parafoveal blood flow density(r=-0.569, P=0.002; r=-0.543, P=0.004), and positively correlated with the parafoveal thickness(r=0.606, P=0.001); BCVA(LogMAR)was negatively correlated with DCP foveal and parafoveal blood flow density(r=-0.433, P=0.024; r=-0.515, P=0.006), and positively correlated with FAZ area, perimeter and lesion area(r=0.484, P=0.011; r=0.531, P=0.004; r=0.417, P=0.030).CONCLUSION:Patients with CRAO and PAMM have lower macular blood flow density, heavier macular edema and poorer visual acuity, and BCVA may be influenced by both lesion area and FAZ area.
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High myopia is a state of refractive error with myopia over -6.00D. High myopia is typically accompanied by multiple fundus lesions, thus making patients with high myopia suffer from varying degrees of impairment in visual function. As an emerging auxiliary way in ophthalmology, optical coherence tomography angiography(OCTA)can efficiently and non-invasively obtain microvascular stratified images of the retina and choroid and quantitatively analyze blood flow signals. Since the advent of OCTA, there have been numerous studies observing fundus changes in those with high myopia through OCTA. In this paper, some studies in which OCTA is applied to obtain retinal and choroidal thickness from patients with high myopia are reviewed, with a view to revealing the correlation between high myopia and the parameters such as retinal thickness, choroidal thickness, vessel density and the area of the foveal avascular zone and providing novel ideas to deeply investigate the mechanism of high myopia and delay the occurrence and development of high myopia.
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Purpose: To observe the effects of caffeine intake on vessel densities in macular and peripapillary regions and to analyze the correlations of vascular properties of these two interlinked regions in healthy volunteers using optical coherence tomography angiography (OCTA). Methods: In this prospective randomized, double?masked, placebo?controlled study, 120 participants were grouped into two groups: sixty subjects as a study group, which received caffeine and sixty subjects as a placebo group, which received a placebo. OCTA imaging was performed at baseline and 1 h after drug intake. Changes in macular and radial peripapillary capillary (RPC) vessel densities (VD) and foveal avascular zone (FAZ) parameters and correlation of these parameters were analyzed. Results: Baseline macular and RPC VD and FAZ parameters showed no significant difference between study and placebo groups (P > 0.05 for all). VD parameters in all segments of superficial and deep macular regions and peripapillary region showed a statistically significant decrease after caffeine intake (P < 0.001 for all). All macular superficial VD parameters showed a positive correlation with deep perifovea VD (P < 0.05 for all). Also, superficial perifovea VD was positively correlated with all deep macular VD parameters except deep fovea VD (P < 0.05 for all). Conclusion: We show that caffeine causes a decrease in macular and peripapillary vessel densities in healthy subjects, and correlations were observed between macular and peripapillary VD parameters. We believe that future studies are needed to support the effect of caffeine on peripapillary VD and the idea of using deep perifovea VD as the main parameter to estimate superficial macular parameters.
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Objective:To quantitatively assess the macular and choroidal capillary vessel density and foveal avascular zone (FAZ) variables in untreated central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV) patients and healthy people using optical coherence tomography angiography (OCTA), and to investigate their correlation with retinal thickness and choroidal thickness.Methods:A cross-sectional study was adopted.Fifty-five eyes of 55 Chinese adults, including 20 eyes with untreated unilateral CSC, 16 eyes with untreated unilateral PCV and 19 eyes of healthy controls, were enrolled from January 2018 to June 2021 in Shenzhen Aier Eye Hospital Affiliated to Jinan University.The 6 mm×6 mm scanning of Optovue OCTA was carried out in all the subjects.The superficial retinal vessel density (SRVD), deep retinal vessel density (DRVD), outer retinal vessel density (ORVD) and choroidal capillary vessel density (CCVD), FAZ area, FAZ perimeter and vessel density in a 300-μm-wide annular region around FAZ were measured by ReVue software of Optovue OCTA.Central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were assessed by Optovue OCTA HD scan.Correlation between CFT, SFCT and OCTA variable, FAZ variables were evaluated by Pearson liner correlation analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shenzhen Aier Eye Hospital Affiliated to Jinan University (No.AIERKY6236-1). Written informed consent was obtained from each subject prior to entering the cohort.Results:There were significant differences in the foveal, parafoveal and perifoveal SRVD among the three groups ( F=6.344, 9.006, 5.617; all at P<0.01). Compared with healthy control group, the foveal, parafoveal and perifoveal SRVD in CSC group as well as the foveal SRVD in PCV group were significantly increased (all at P<0.01). Compared with CSC group, the parafoveal and perifoveal SRVD were significantly decreased in PCV group (both at P<0.01). There were significantly differences in the parafoveal DRVD among the three groups ( F=3.383, P<0.05). Compared with healthy control group, the parafoveal DRVD of CSC and PCV groups was increased significantly (both at P<0.05). There were significant differences in the ORVD and CCVD among the three groups ( F=16.931, 19.412; both at P<0.001). Compared with healthy control group, the ORVD and CCVD in CSC group and the CCVD in PCV group were decreased significantly (all at P<0.001). Compared with the PVC group, the ORVD was significantly decreased in CSC group ( P<0.001). A significantly difference was found in CFT among the three groups ( F=20.495, P<0.001). Compared with healthy control and PCV group, the CFT was significantly increased in CSC group (both at P<0.001). No significant difference was found in SFCT, FAZ area, FAZ perimeter and vessel density of the 300-μm-wide annular region around FAZ among the three groups ( F=1.083, 0.906, 0.819, 1.530; all at P>0.05). Negative correlations were found between parafoveal DRVD, ORVD and CFT in CSC eyes ( r=-0.555, -0.516; both at P<0.05), and a significant negative correlation was found between ORVD and CFT in PCV eyes ( r=-0.585, P<0.05). No significant correlation was found between OCTA variables (SRVD, DRVD, ORVD, CCVD), FAZ parameters (FAZ area, FAZ perimeter and vessel density of the 300-μm-wide annular region around FAZ) and SFCT in the three groups (all at P>0.05). Conclusions:Hyperaemia in the superficial capillary of macular fovea and atrophy of choroidal capillaries may be the same pathogenesis between CSC and PCV.The vessel density of outer retinal layer is a common independent influencing factor of CFT between the two diseases.
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Objective:To analyze the change of macular microcirculation in early diabetic patients and its correlation with visual acuity.Methods:A cross-sectional study was performed.Seventy-five eyes from 75 patients with non-diabetic retinopathy (NDR) and 33 eyes from 33 patients with non-proliferative diabetic retinopathy (NPDR) were included in Subei People's Hospital Affiliated to Yangzhou University from December 2019 to September 2020.The patients were divided into the NDR group and NPDR group according to their condition.Another 35 eyes from 35 healthy subjects served as the control group.Optical coherence tomography angiography (OCTA) images were acquired over 3 mm×3 mm regions centered on the fovea using RTVue XR OCTA device and the data were quantified with Angio Vue software.The area, perimeter and acircularity index (AI) of the macular foveal avascular zone (FAZ), the grading of abnormal superficial and deep FAZ contour, as well as the vessel density of superficial capillary plexuses (SCP), deep capillary plexuses (DCP) and a 300 μm ring area beside FAZ (FD300) were analyzed and compared among the three groups.The correlations between these indexes and visual acuity were analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Subei People's Hospital affiliated to Yangzhou University (No.2018KY-167). Written informed consent was obtained from each subject prior to any medical examination.Results:No statistically significant differences were found in the FAZ area, FAZ perimeter and AI among the three groups ( F=1.948, P=0.146; F=2.632, P=0.075; H=5.582, P=0.061). The proportions of superficial and deep FAZ contour abnormality were 54.5%(18/33) and 87.9%(29/33) in the NPDR group, 37.3%(28/75) and 70.7%(53/75) in the NDR group, 22.9%(8/35) and 42.9%(15/35) in the control group, respectively, the proportions of superficial and deep FAZ contour abnormality in the NPDR group were significantly higher than those in the control group (both at P<0.05). With the aggravation of the condition, there were more eyes with high grades of abnormal superficial and deep FAZ contours ( χ2=9.827, 9.030; all at P<0.05). The vessel density of parafoveal DCP was (52.50[50.70, 54.80]), (50.40[48.40, 52.60]), (48.30[43.60, 51.55])%, and the vessel density of DCP was (49.90[47.70, 51.80]), (47.30[45.20, 50.10]), (45.80[41.30, 48.60])% in the control group, NDR group and NPDR group respectively, and there were statistically significant differences among the three groups ( H=21.719, 21.652; both at P<0.001), and statistically significant differences were found in pairwise comparisons among the three groups (all at P<0.05). The vessel densities of foveal SCP, foveal DCP and FD300 in the NPDR group were significantly lower than those in the control group (all at P<0.05). There was no statistically significant difference in vessel densities of parafoveal SCP and SCP found in the overall comparison among the three groups ( H=5.290, 5.534; both at P>0.05). In diabetic mellitus patients, there were negative correlations between the vessel density of parafoveal SCP and LogMAR best corrected visual acuity (BCVA), and between the vessel density of SCP and LogMAR BCVA ( rs=-0.305, -0.330; both at P<0.05), and there was a positive correlation between the superficial FAZ contour grading and LogMAR BCVA ( rs=0.353, P<0.05). Conclusions:Abnormal parafoveal DCP and DCP vessel density, as well as FAZ contour, appear in diabetic mellitus patients before the occurrence of visible fundus lesion, and the vessel density of parafoveal SCP and SCP, and superficial FAZ contour grading in diabetic mellitus patients are correlated with visual acuity.OCTA can help monitor disease progression and identify microcirculation parameters that affect visual function.
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@#AIM: To observe the changes of retina superficial capillary plexus densities and aqueous humor factors in patients with diabetic macular edema(DME)before and after conbercept injection, and to explore the effect of conbercept on macular microcirculation in DME patients. <p>METHODS: A prospective case-control study was conducted. Totally 11 eyes of 10 patients diagnosed as DME in the Ophthalmology Department of the First Affiliated Hospital of Hainan Medical University from December 2019 to December 2020 were collected as DME group, 15 cataract patients without systemic basic diseases and fundus oculi diseases were collected as cataract group, and 20 age-and sex-matched healthy people with normal vision were collected as control group. All patients in DME group were treated by intravitreal injection of conbercept once a month for a total of 6 times. The retinal perfusion densities of the superficial capillary plexus(PSCP), retinal vessel densities of the superficial capillary plexus(VSCP), foveal avascular zone(FAZ), central macular thickness(CMT)and best corrected visual acuity(BCVA)were compared between the control group and DME patients before operation. The aqueous humor factors in cataract group and DME group were measured by multiplex flow immunoassay. The differences of aqueous humor factors in cataract group and DME group were compared. The changes of VSCP, PSCP, FAZ, CMT, BCVA and factors of aqueous humor in DME group after 6 conbercept injections were compared.<p>RESULTS: There were significant differences in PSCP, VSCP, FAZ area, BCVA and CMT between DME group and control group before operation(P<0.01); there were significant differences in angiopoietin-like protein 4(ANGPTL4), vascular endothelial growth factor(VEGF), interleukin-6(IL-6), interleukin-8(IL-8)in aqueous humor of DME group and cataract group before operation(P<0.001); PCSP and BCVA were increased and CMT were decreased in DME group after continuous conbercept injection for 6mo(all P<0.05); the concentrations of ANGPTL4, VEGF and IL-6 in aqueous humor of DME group decreased significantly(all P<0.05); patients injected with 1mo conbercept in the DME group had the most obvious improvement of BCVA and PSCP as well as the most obvious decline of CMT; while the ANGPTL4, VEGF and IL-6 in aqueous humor concentration had the most obvious decrease when they were injected with 1mo conbercept; VEGF in aqueous humor was positively correlated with the absolute value of CMT. <p>CONCLUSION: Conbercept injection in DME patients can improve retinal ischemia, reduce the concentration of VEGF and related factors in aqueous humor, effectively increase BCVA and relieve macular edema.
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@#AIM: To investigate the application value of optical coherence tomography angiography(OCTA)in observing retinal microvasculature in patients with diabetic retinopathy(DR). METHODS: Prospective research. The 84 patients(98 eyes)with DR admitted to our hospital during 2017-06/2019-12 were selected as the study group, and were further divided into non-proliferative DR group and proliferative DR group according to the degree of DR. Another 60 cases(68 eyes)with simple diabetes mellitus who underwent physical examination in our hospital during the same period were selected as the control group. The OCTA was used to quantitatively analyze the microvessels in the retinal macular area of the subject, and the built-in analysis software was used to obtain the blood flow density(SCP, DCP)of the superficial and deep parafoveal retina, the area and circumference of the foveal avascular zone(FAZ), the roundness index, full-thickness retinal blood flow density(FD-300). The differences of quantitative indexes, the correlation between OCTA parameters and DR severity and the diagnostic value of DR were compared.RESULTS: The study group's FD-300, SCP and DCP were lower than those of the control group(<i>t</i>=6.476, 8.907, 5.078; all <i>P</i><0.05), while the FAZ circumference and the roundness index were higher than those of the control group(<i>t</i>=4.380, 10.542; all <i>P</i><0.05). The FD-300, SCP and DCP of the proliferative DR group were lower than those of the non-proliferative DR group(<i>t</i>=2.668, 3.408, 3.103; all <i>P</i><0.05), while the FAZ circumference and the roundness index were higher than those of the non-proliferative DR group(<i>t</i>=2.550, 5.563; all <i>P</i><0.05). Pearson correlation analysis shows that FD-300, SCP, DCP were negatively correlated with disease severity(<i>r</i>= -0.485, -0.546, -0.522; all <i>P</i><0.05), FAZ circumference and morphological index were positively correlated with disease severity(<i>r</i>=0.426, 0.443; all <i>P</i><0.05). ROC curve analysis showed that the area under the curve for FD-300, SCP, DCP, FAZ circumference, and FAZ morphological index to diagnose DR were 0.835(95%<i>CI:</i> 0.722-0.947), 0.806(95%<i>CI</i>: 0.701-0.911), 0.849(95%<i>CI</i>: 0.770-0.928), 0.768(95%<i>CI</i>: 0.641-0.896), 0.742(95%<i>CI</i>: 0.633-0.850), respectively. CONCLUSION: OCTA can clearly monitor the morphology of superficial and deep capillaries in the macular area of patients with DR. The quantitative index of blood flow density is negatively correlated with the severity of the disease, which has high clinical value for the diagnosis of DR.
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@#AIM: To evaluate the differences of macular vascular network measured by optical coherence tomography angiography(OCTA)between severe non-proliferative diabetic retinopathy(S-NPDR)eyes and health eyes, and explore the changes of these OCTA characteristics in patients with S-NPDR before and after panretinal photocoagulation(PRP).<p>METHODS: This was a prospective study including 31 eyes from 18 consecutive patients with S-NPDR and 31 eyes of healthy subjects. We measured macular vascular density and foveal avascular zone(FAZ)area and volume by an OCTA device.<p>RESULTS: Compared to the normal control group, in superficial retinal capillary plexus(SCP), macular vascular density decreased in S-NPDR group, except foveal vascular density unchanged. Consistently, in deep retinal capillary plexus(DCP), macular vascular density was also lower in S-NPDR group. In addition, FAZ area and volume expanded in S-NPDR eyes. At 6mo post-PRP in S-NPDR eyes, foveal SCP and DCP densities increased significantly, while FAZ area and volume decreased. At 3mo post-PRP, only foveal vascular density in DCP increased. The changes of foveal SCP and DCP densities as well as FAZ area and volume were not statically significant at 1mo post-PRP.<p>CONCLUSION: Macular vascular network was impaired in S-NPDR assessed by OCTA. Although OCTA parameters were not significantly affected by PRP in 1 and 3mo period, at 6mo follow-up parameters became significant after PRP.
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Objective:To observe the changes of macular morphology and best corrected visual acuity (BCVA) in children with retinopathy of prematurity (ROP) after single treatment of laser photocoagulation or intravitreal injection of ranibizumab (IVR) by optical coherence tomography angiography (OCTA).Methods:A cross sectional study was conducted.Fourteen cases (23 eyes) of ROP children with a treatment history aged 4-10 years were enrolled as the ROP group in Shenzhen Eye Hospital from April to August 2018, with 8 cases (16 eyes) of age-matched full-term children as control group.Among the ROP group, 9 cases (14 eyes) receiving photocoagulation were set as the photocoagulation group and 5 cases (9 eyes) receiving IVR as the injection group.The 3 mm×3 mm scanning mode of OCTA was adopted to measure the area of foveal avascular zone (FAZ), FAZ morphological index, superficial retinal vascular density (VD) and superficial retinal perfusion density (PD), and the B-scan mode was used to determine the central foveal thickness (CFT). BCVA of all children was recorded and analyzed.This study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Shenzhen Eye Hospital (No.b-03). Written informed consent was obtained from guardians prior to any examination.Results:Compared with the control group, there was smaller area of FAZ, more irregular FAZ morphology and thicker CFT in the ROP group.The central fovea of macula in the laser photocoagulation group was shallow and almost indiscernible, and FAZ morphology was irregular.The FAZ area, FAZ morphological index, VD and PD in the ROP group were (0.09±0.08) mm 2, 0.51±0.25, (19.18±2.50)mm/mm 2 and 0.35±0.04, respectively, which were significantly lower than (0.32±0.08)mm 2, 0.68±0.07, (20.94±0.93)mm/mm 2, 0.38±0.02, respectively in the control group ( t=-8.03, -3.14, -3.02, -2.52; all at P<0.05). The CFT in the ROP group was (215.00±21.32) μm, which was significantly thicker than (164.29±20.20) μm in the control group ( t=8.91, P<0.05). There was no statistical difference in BCVA between the two groups ( t=0.16, P=0.87). The CET in the laser photocoagulation group was significantly thicker than that in the injection group ( t=3.50, P=0.01). Conclusions:There are obvious morphology changes of macula in ROP children with single treatment history of laser photocoagulation or IVR, while the BCVA is not significantly affected by the treatment.
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@#AIM: To observe vascular density and foveal avascular zone(FAZ)in macular area for diabetic macular edema(DME)with optical coherence tomography angiography(OCTA)when before and after intravitreal injection of rainbizumab.<p>METHODS: For the 45 DME patients(52 eyes)whose diagnosis were confirmed by ophthalmic clinical examination, their sick eyes were examined by OCTA with macular area 3x3mm scanning range model when before and 1wk after intravitreal injection of rainbizumab, and obtain vascular density of superficial capillary plexus(SCP), deep capillary plexus(DCP), and the number of microaneurysm and the area, perimeter and the roundness index in FAZ, and do block matching <i>t</i>-test.<p>RESULTS: There was no statistical difference for the vascular density of SCP before and after treatment(<i>t</i>=1.635, <i>P</i>=0.10). Vascular density(46.59%±4.91%)of DCP after treatment were more than before treatment(42.47%±4.16%), and it was statistically significant difference(<i>t</i>=1.014, <i>P</i>=0.02). There was no statistical difference for the number of microaneurysm in SCP when before and after treatment(<i>t</i>=1.623, <i>P</i>=0.21); But the number of microaneurysm(6.10±0.67)in DCP after treatment decreased obviously than before treatment(8.21±0.41),and the difference was statistically significant(<i>t</i>=1.124, <i>P</i>=0.01). The area and perimeter of FAZ after treatment increased than before treatment, but there was no statistical difference(<i>P</i>>0.05); The roundness index of FAZ after treatment was lower than before treatment,and there was also no statistical difference(<i>P</i>>0.05).<p>CONCLUSION: The capillary circulation in DCP increased in short term for sick eyes of DME after intravitreal injection of rainbizumab, and the number of microaneurysm in DCP reduced, but the change in SCP is not obvious. At the same time, the area, perimeter and the roundness index of FAZ had no significant meaning of clinical observation for DME with injection of rainbizumab.
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Purpose: To compare foveal avascular zone (FAZ) area and circularity, ganglion cell layer (GCL) thickness, retinal perfusion density (PD), and vessel density (VD) in eyes with branch retinal vein occlusion (BRVO) after resolution of cystoid macular edema (CME) to fellow control eyes and to correlate these parameters with visual acuity (VA). Methods: SD-OCTA scans (Zeiss Angioplex; Carl Zeiss Meditec Version 10) obtained on 32 eyes with BRVO after resolution of the CME with their fellow eyes used as controls were retrospectively evaluated. Parameters analyzed were FAZ size and circularity, PD, and VD in the superficial capillary plexus measured in the Early Treatment Diabetic Retinopathy Study (ETDRS) grid pattern using the automated algorithm. GCL thickness was generated from the Macular Cube 512 × 218 protocol. VA measured on the same day as OCTA examination was recorded. Results: The mean FAZ area was greater (P = 0.01) in BRVO eyes (0.239 ± 0.108 mm2) when compared with fellow eyes (0.290 ± 0.127 mm2). The FAZ was more irregular in BRVO eyes compared with fellow eyes (circularity index = 64.6 ± 12.8% vs 71.1 ± 10.8%, respectively, P= 0.03). GCL thickness was lower in BRVO eyes compared with control eyes (67.19 ± 27.71 vs 77.79 ± 6.41 respectively, P= 0.006). The mean VD and PD were significantly lower in the ETDRS outer ring in BRVO eyes (P = 0.04 and 0.038, respectively). On comparison of the affected quadrant with the unaffected quadrant in BRVO eyes, the affected quadrant had a lower outer PD (P = 0.04), outer VD (P = 0.04), and GCL thickness (P = 0.02). There was no significant correlation of VA with FAZ, VD, or GCL thickness (P >0.05). Conclusion: FAZ is more irregular and enlarged, and GCL is thinner, in eyes with BRVO after resolution of CME especially in the affected quadrant suggesting neuronal degeneration as a sequela of BRVO. Both perfusion and VD are reduced in the quadrant affected by the BRVO demonstrating regional quantitative differences in the retinal microvasculature. These parameters may prove useful in monitoring the disease progression and treatment response.
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Objective To observe the effect of different macular edema on the area of foveal avascular zone (FAZ) and its correlation in eyes with branch retinal vein occlusion (BRVO).Methods A total of 72 patients (75 eyes) diagnosed with BRVO were included in the study.There were 40 patients males (42 eyes) and 32 females (33 eyes),with the mean age of (56.00±9.96) years.All the eyes were examined by BCVA,intraocular pressure,slit lamp microscope combined with preset lens,fundus color photography and optical coherence tomography angiography (OCTA).BRVO patients were divided into two groups according to the degree of macular edema:group M300 that was CRT ≥300 μm (38 patients,39 eyes) and group L300 that was CRT＜300 μmn (34 patients,36 eyes).The macular angiography scan protocol covered a 3 mm × 3 mm area.The parameters of macular were measured by the built-in measurement software of the system:(1) area of FAZ,perimeter ofFAZ (PERIM),avascular index ofFAZ (AI),vascular density within a width of 300 μm around the FAZ region (FD-300);(2) central retinal thickness (CRT);(3) vascular density (VD):the superficial central fovea vascular density (SFVD),the deep central fovea vascular density (DFVD),the superficial hemi-macular vascular density (SHVD),the deep hemi-macular vascular density (DHVD).Spearman test was used to test the correlation between FAZ area and other parameters in each group.Results The FAZ area in group M300 and L300 were 0.388 ± 0.166 mmn2 and 0.596± 0.512 rmm2,respectively.The results of Spearman test showed that the FAZ area of group M300 was positively correlated with PERIM and AI (r=0.932,0.591;P=0.000,0.000),negatively correlated with SFVD,DFVD and SHVD (r=-0.490,-0.429,-0.339;P=0.002,0.006,0.035).But there was no significant negative correlation between FAZ area and FD-300,CRT,DHVD in group M300 (r=-0.129,-0.053,-0.400;P=0.435,0.749,0.395).The FAZ area in group L300 was positively correlated with PERIM and AI (r=0.887,0.633;P=0.000,0.000),negatively correlated with SFVD,DFVD,SHVD and DHVD (r=-0.413,-0.643,-0.630,-0.370,-0.411;P=0.012,0.000,0.000,0.026,0.013).But there was no significant positive correlation between FAZ area and FD-300 in group L300 (r=0.093,P=0.590).Conclusion FAZ area varies with the degree of macular edema.The degree of macular edema is higher,the FAZ area is smaller.FAZ area is positively correlated with PERIM and AI significantly,and negatively correlated with SFVD,DFVD and SHVD.
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Objective To analyze the correlation between foveal avascular zone (FAZ) size and foveal morphology in patients with idiopathic macular epiretinal membrane (IMEM) using OCT angiography (OCTA).Methods A retrospective case series study contained of 54 eyes of 54 patients affected with IMEM (IEM group) and 50 eyes of 50 normal persons as the control group.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logMAR visual acuity.The FAZ areas were evaluated with OCTA in both the superficial and deep capillary plexus layers by using 3 mm × 3 mm images of the macular.The central macular thickness (CMT),inner retinal layer thickness (IRT),outer retinal layer thickness (ORT),subfoveal choroidal thickness (SFCT),and the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography.The differences of FAZ areas between the two groups were analyzed.The correlative analysis was performed to investigate the relationship between areas and foveal morphology.Results Compared with control group,the FAZ area in superficial and deep capillary plexus in the IMEM group were significantly smaller (t=-29.095,-28.743;P＜0.001,＜0.001);the mean CMT,IRT,ORT and SFCT were significantly thickening in the IMEM group (Z=-8.784,-8.524,-7.709,-7.535;P＜0.001,＜0.001,＜0.001,＜0.001).In the IMEM group,the FAZ area in superficial capillary plexus correlated inversely with the CMT,IRT,and the integrity of EZ (r=-0.464,-0.536,-0.293;P＜ 0.001,＜ 0.001,0.039),no significant correlation of superficial plexus FAZ areas with ORT and SFCT (r=-0.218,-0.165;P=0.172,0.157).The FAZ area in deep capillary plexus correlated inversely with the CMT,IRT,and the integrity of EZ (r=-0.306,-0.694,-0.468;P=0.037,＜0.001,＜0.001),no significant correlation with ORT and SFCT (r=-0.242,-0.227;P=-0.079,0.094).Conclusions The FAZ areas is significantly decreased in IMEM eyes compared with normal eyes.Both superficial and deep FAZ area are correlated with the CMT,IRT,and the integrity of EZ.
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PURPOSE: To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. METHODS: Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm2), deep VD (%) and deep AVZ area (mm2) were evaluated via optic coherence tomography angiography. RESULTS: Superficial AVZ was 0.438 ± 0.05 mm2 in the DM group, 0.246 ± 0.022 mm2 in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm2 in the DM group, and 0.342 ± 0.022 mm2 in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm2 in the DM group, and 34.86 ± 0.75 mm2 in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm2 in the DM group, and 33.47 ± 0.56 mm2 in the control group (p < 0.001). CONCLUSIONS: In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.
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Humans , Angiography , Capillaries , Diabetes Mellitus, Type 2 , Diabetic Retinopathy , Glycated Hemoglobin , Ischemia , Tomography, Optical CoherenceABSTRACT
PURPOSE: To evaluate the vessel density of macula according to analysis area in health subjects using optical coherence tomography angiography (OCTA). METHODS: We retrospectively analyzed 30 eyes of 20 healthy people who underwent OCTA. We measured vessel density (VD) according to analysis area and foveal avascular zone (FAZ) size of superficial capillary plexus (SCP) and deep capillary plexus (DCP). The analysis areas were classified as 3 × 3 mm scan area (Box), Box area excluding FAZ (Box-FAZ), fovea centered 3 mm circle area (Circle), Circle area excluding FAZ (Circle-FAZ) and area between fovea centered 1 mm circle and 3 mm circle (Ring). RESULTS: The SCP VDs were Box 34.00 ± 3.97, Box-FAZ 35.37 ± 4.09, Circle 31.70 ± 4.56, Circle-FAZ 33.34 ± 4.72, and Ring 35.22 ± 5.09. The DCP VDs were Box 30.04 ± 3.51, Circle 29.49 ± 3.57, Box-FAZ 31.59 ± 3.65, Circle-FAZ 31.46 ± 3.72, and Ring 32.60 ± 4.00. There was a significant difference according to analysis area from both SCP and DCP (p < 0.001 and p < 0.001, respectively). Comparison of the vessel density between SCP and DCP in the same analysis area were different in all areas (p < 0.001, p = 0.001, p < 0.001, p = 0.005, p = 0.001, respectively). CONCLUSIONS: This study shows different results according to analysis area when measuring VD using OCTA. Therefore, when comparing studies related to VD, it is necessary to pay attention to the analysis area in the interpretation of the results.