Widefield OCT-Angiography and Fluorescein Angiography Assessments of Nonperfusion in Diabetic Retinopathy and Edema Treated with Anti-Vascular Endothelial Growth Factor
Widefield OCT-Angiography and Fluorescein Angiography Assessments of Nonperfusion in Diabetic Retinopathy and Edema Treated with Anti-Vascular Endothelial Growth Factor
复制标题
DOI：
10.1016/j.ophtha.2019.06.022
复制
发表时间：
2019-12-01
期刊：
影响因子：
13.7
通讯作者：
Tadayoni, Ramin
中科院分区：
文献类型：
--
作者：
Couturier, Aude;Rey, Pierre-Antoine;Tadayoni, Ramin
目的：使用两种不同的成像方式：扫频源宽视野（SS-WF）OCT血管造影（OCTA）和超宽视野（UWF）荧光素血管造影（FA），评估抗血管内皮生长因子（VEGF）治疗糖尿病性黄斑水肿（DME）后视网膜无灌注（NP）的变化。设计：观察性病例系列。参与者：9名患有严重非增殖性糖尿病视网膜病变（NPDR）或增殖性DR（PDR）的患者的10只眼睛开始3个月的抗VEGF玻璃体内注射治疗DME。在基线（M0）和第三次抗VEGF注射后1个月（M3），对所有眼睛进行UWF彩色眼底照片（CFP）、UWF FA和SS-WF OCTA成像。所有图像对齐并分成16个框，由2名盲法视网膜专家分析NP区域。主要结果测量：SS-WF OCTA和UWF FA之间关于NP区域和穿过NP区域的小血管检测的差异数量; UWF CFP上DR严重程度的评估;以及M0和M3之间每个NP区域的变化：至少存在1个NP区域的盒/眼数量、消失或重新出现的小动脉或小静脉数量以及毛细血管消失或重新出现的NP区域数量。糖尿病视网膜病变（DR）严重程度评分在10只眼中的8只眼中至少改善了1个阶段，与M0相比，M3时UWF CFP上微动脉瘤和视网膜血管瘤的平均数量显著减少（n = 40 +/- 28 vs. 121 +/- 57; P = 0.0020）和眼底新生血管消退（如果存在）。在SS-WF OCTA上观察到FA上检出的所有NP区域，但在M0时，在29%（46/160）的盒中在SS-WF OCTA上检出了额外的NP区域。在FA或SS-WF OCTA上，M3时未观察到小动脉或小静脉再灌注。视网膜毛细血管仅可见OCTA，没有再灌注NP地区观察到，即使在黑暗的地区减少时可见的FA.Conclusions：没有再灌注的血管或毛细血管网络检测NP地区使用2成像技术，UWF FA和SS-WF OCTA，在DR的眼睛后3抗VEGF注射。SS-WF OCTA对NP区的检出率高于UWF FA。(C)2019年美国眼科学会
Purpose: To assess change in retinal nonperfusion (NP) after anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) using 2 different imaging modalities: swept-source widefield (SS-WF) OCT angiography (OCTA) and ultra-widefield (UWF) fluorescein angiography (FA).Design: Observational case series.Participants: Ten eyes of 9 patients with severe nonproliferative diabetic retinopathy (NPDR) or proliferative DR (PDR) initiating 3 monthly anti-VEGF intravitreal injections for DME.Methods: All eyes were imaged with UWF color fundus photographs (CFPs), UWF FA, and SS-WF OCTA at baseline (M0) and 1 month after the third anti-VEGF injection (M3). All images were aligned and divided into 16 boxes for analysis of NP areas by 2 blinded retina specialists.Main Outcome Measures: The number of discrepancies between SS-WF OCTA and UWF FA regarding the detection of NP areas and small vessels passing through NP areas; assessment of DR severity on UWF CFP; and change in each NP area between M0 and M3: number of boxes/eye with presence of at least 1 NP area, number of arterioles or venules that disappeared or reappeared, and number of NP areas in which capillaries disappeared or reappeared.Results: The diabetic retinopathy (DR) severity score improved by at least 1 stage in 8 of 10 eyes, with a significant decrease in the mean number of microaneurysms and retinal hemorrhages on UWF CFP at M3 versus M0 (n = 40 +/- 28 vs. 121 +/- 57; P = 0.0020) and regression of fundus neovascularization when present. All NP areas detected on FA were seen on SS-WF OCTA, but additional NP areas were detected on SS-WF OCTA at M0 in 29% (46/160) of boxes. No reperfusion of arterioles or venules was observed at M3 on FA or SS-WF OCTA. Retinal capillaries were only visible on OCTA, and no reperfusion in NP areas was observed even when a reduction in dark areas was visible on FA.Conclusions: No reperfusion of vessels or capillary network was detected in NP areas using 2 imaging techniques, UWF FA and SS-WF OCTA, in eyes with DR after 3 anti-VEGF injections. The detection rate of NP areas was higher with SS-WF OCTA than with UWF FA. (C) 2019 by the American Academy of Ophthalmology