ABSTRACT
OBJECTIVES: To study the changes in vessel densities (VD) stratified by vessel diameter in the retinal superficial and deep vascular complexes (SVC/DVC) using optical coherence tomography angiography (OCTA) images obtained from people with diabetes and age-matched healthy controls. METHODS: We quantified the VD based on vessel diameter categorized as <10, 10-20 and >20 µm in the SVC/DVC obtained on 3 × 3 mm2 OCTA scans using a deep learning-based segmentation and vascular graph extraction tool in people with diabetes and age-matched healthy controls. RESULTS: OCTA images obtained from 854 eyes of 854 subjects were divided into 5 groups: healthy controls (n = 555); people with diabetes with no diabetic retinopathy (DR, n = 90), mild and moderate non-proliferative DR (NPDR) (n = 96), severe NPDR (n = 42) and proliferative DR (PDR) (n = 71). Both SVC and DVC showed significant decrease in VD with increasing DR severity (p < 0.001). The largest difference was observed in the <10 µm vessels of the SVC between healthy controls and no DR (13.9% lower in no DR, p < 0.001). Progressive decrease in <10 µm vessels of the SVC and DVC was seen with increasing DR severity (p < 0.001). However, 10-20 µm vessels only showed decline in the DVC, but not the SVC (p < 0.001) and there was no change observed in the >20 µm vessels in either plexus. CONCLUSIONS: Our findings suggest that OCTA is able to demonstrate a distinct vulnerability of the smallest retinal vessels in both plexuses that worsens with increasing severity of DR.
Subject(s)
Diabetic Retinopathy , Fluorescein Angiography , Retinal Vessels , Severity of Illness Index , Tomography, Optical Coherence , Humans , Diabetic Retinopathy/diagnostic imaging , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/pathology , Diabetic Retinopathy/physiopathology , Retinal Vessels/diagnostic imaging , Retinal Vessels/pathology , Female , Male , Tomography, Optical Coherence/methods , Middle Aged , Fluorescein Angiography/methods , Aged , Retrospective Studies , Fundus Oculi , AdultABSTRACT
BACKGROUND: Acute exudative polymorphous vitelliform maculopathy is a presumed retinal pigment epithelium abnormality that has been reported in patients with neoplasms and under certain classes of drugs. The pathophysiology remains unclear, despite the typical clinical features. PURPOSE: To report two cases of acute exudative polymorphous vitelliform maculopathy occurring after vaccination with a COVID-19 vaccine. CASE REPORTS: Two adult patients presented with visual disturbance after inoculation with a COVID-19 vaccine. The patients were otherwise healthy and have no family history of retinal dystrophies. Both cases exhibited the following features on multimodal imaging: multifocal hyporeflective lesions involving the macula, elongated photoreceptors, accumulated vitelliform material exhibiting autofluorescence, and lack of fluorescein dye leakage. Evidence of retinal pigment epithelium dysfunction was confirmed by electrooculography. CONCLUSION: Two cases of acute exudative polymorphous vitelliform maculopathy occurring after COVID-19 vaccination were reported. A relationship between the vaccine and the retinal pigment epithelial abnormality development that led to acute exudative polymorphous vitelliform maculopathy was postulate, possibly through autoantibodies against the severe acute respiratory syndrome coronavirus 2 virus structural surface glycoprotein antigens that cross react with the normal retinal pigment epithelial cells.
