Structural en face optical coherence tomography imaging for identification of leaky microaneurysms in diabetic macular edema

International Ophthalmology - Tập 40 - Trang 787-794 - 2019
Dmitrii S. Maltsev1, Alexei N. Kulikov1, Maria A. Burnasheva1, Alina A. Kazak1, Jay Chhablani2
1Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
2UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA

Tóm tắt

To study the correspondence between fluorescein angiography (FA) and structural en face optical coherence tomography (OCT) in the identification of leaky microaneurysms in diabetic macular edema (DME). Fourteen eyes of eight patients with DME (6 males and 2 females, mean age 67.3 ± 8.5) were included. For all eyes, a 6 × 6 mm structural en face image of the middle retina was obtained and superimposed on a FA image. The reflectivity, capsulation, and association with intraretinal cystic fluid (IRCF) of microaneurysms on en face were evaluated depending on their leaky status on FA. Out of the 320 leaky microaneurysms evaluated, 280 (89.0 ± 8.2%) coincided with those on en face OCT image. Twenty-nine (10.6 ± 6.9%) and 20 (6.5 ± 7.8%) out of all leaky microaneurysms were hyperreflective and demonstrated capsular appearance, respectively. A majority of leaky microaneurysms (97.9 ± 3.2%) were associated with IRCF. From 146 microaneurysms which were found only on en face images, 130 (88.2% ± 15.7%) were hyperreflective, 33 (23.9% ± 15.6%) demonstrated capsular structure, and 13 (9.2% ± 15.0%) demonstrated no associated IRCF. After exclusion of microaneurysms of the inner retina, 95.4 ± 5.4% of leaky microaneurysms were identified on en face image. En face imaging demonstrated 83.5% sensitivity and 89.4% specificity (the area under the curve 0.87) in the identification of leaky microaneurysms. Structural en face imaging is comparable to FA in identification of leaky microaneurysms in diabetic macular edema. Moderate reflectivity, the absence of capsular structure, and neighboring intraretinal cystic fluid indicate leaky microaneurysms.

Tài liệu tham khảo

Early Treatment Diabetic Retinopathy Study Research Group (1995) Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Arch Ophthalmol 113(9):1144–1155 Aiello LP, Edwards AR, Beck RW, Diabetic Retinopathy Clinical Research Network et al (2010) Factors associated with improvement and worsening of visual acuity 2 years after focal/grid photocoagulation for diabetic macular edema. Ophthalmology 117(5):946–953 Lee SN, Chhablani J, Chan CK et al (2013) Characterization of microaneurysm closure after focal laser photocoagulation in diabetic macular edema. Am J Ophthalmol 155(5):905–912 Brown DM, Schmidt-Erfurth U, Do DV et al (2015) Intravitreal Aflibercept for Diabetic Macular Edema: 100-week results from the VISTA and VIVID studies. Ophthalmology 122(10):2044–2052 Boiko EV, Maltsev DS (2017) Combination of navigated macular laser photocoagulation and anti-VEGF therapy: precise treatment for macular edema under dry retinal conditions. J Ophthalmol 2017:7656418 Maltsev DS, Kulikov AN, Uplanchiwar B et al (2018) Direct navigated laser photocoagulation as primary treatment for retinal arterial macroaneurysms. Int J Retina Vitr 4:28 Kozak I, Oster SF, Cortes MA et al (2011) Clinical evaluation and treatment accuracy in diabetic macular edema using navigated laser photocoagulator NAVILAS. Ophthalmology 118(6):1119–1124 Early Treatment Diabetic Retinopathy Study Research Group (1991) Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Ophthalmology 98(5 Suppl):807–822 Yannuzzi LA, Rohrer KT, Tindel L et al (1986) Fluorescein angiography complication survey. Ophthalmology 93(5):611–617 Kwiterovich KA, Maguire MG, Murphy RP et al (1991) Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 98(7):1139–1142 Nagiel A, Sadda SR, Sarraf D (2015) A promising future for optical coherence tomography angiography. JAMA Ophthalmol 133(6):629–630 Schreur V, Domanian A, Liefers B et al (2019) Morphological and topographical appearance of microaneurysms on optical coherence tomography angiography. Br J Ophthalmol 103:630–635 Spaide RF, Klancnik JM Jr, Cooney MJ (2015) Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol 133(1):45–50 Wang H, Chhablani J, Freeman WR et al (2012) Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography. Am J Ophthalmol 153(5):861–867 Ito H, Horii T, Nishijima K et al (2013) Association between fluorescein leakage and optical coherence tomographic characteristics of microaneurysms in diabetic retinopathy. Retina 33(4):732–739 Hasegawa N, Nozaki M, Takase N et al (2016) New insights into microaneurysms in the deep capillary plexus detected by optical coherence tomography angiography in diabetic macular edema. Investig Ophthalmol Vis Sci 57(9):348–355 Soliman W, Sander B, Hasler PW, Larsen M (2008) Correlation between intraretinal changes in diabetic macular oedema seen in fluorescein angiography and optical coherence tomography. Acta Ophthalmol 86(1):34–39 Reznicek L, Kernt M, Haritoglou C et al (2011) Correlation of leaking microaneurysms with retinal thickening in diabetic retinopathy. Int J Ophthalmol 4(3):269–271 Blair NP, Shahidi M, Lai WW, Zelkha R (2008) Correlation between microaneurysms and retinal thickness in diabetic macular edema. Retina 28(8):1097–1103