Evaluation of the correlation between quantitative measurement of the foveal avascular zone and retinal vessel density and outer retinal disruptions in diabetic patients

Background/aim: The aim of the current study was to evaluate the correlation between the integrity of the outer retinal layers onoptical coherence tomography (OCT) and objective parameters of retinal microvascular perfusion on optical coherence tomographyangiography (OCTA).Materials and methods: A total of 105 eyes of 54 diabetic patients were included in the study. Integrity of the outer retinal layersincluding the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) was assessed by spectral-domainoptical coherence tomography. The foveal avascular zone (FAZ) area and vessel density (VD) measurements in the superficial capillaryplexus (SCP) and deep capillary plexus (DCP) in all the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were evaluatedby OCTA. Associations between the quantitative measurement of the FAZ and retinal VD measurements and outer retinal disruptionswere evaluated.Results: The FAZ area was correlated with outer retinal layer disruption both in the superficial plexus (r = 0.244, 0.228, 0.212, P = 0.013,0.02, 0.031 for the ELM, EZ, and IZ, respectively) and the deep capillary plexus (r = 0.298, 0.234, 0.197, P = 0.002, 0.019, 0.048 for theELM, EZ, and IZ, respectively). A significant relationship was also found between the VD measurements in the SCP and DCP in ETDRSsectors and the outer retinal layers disruption.Conclusion: The results of the current study show a significant relationship between the quantitative OCTA parameters and the integrityof the outer retinal layers. This finding reveals a correlation between retinal capillary nonperfusion and outer retinal disruption in eyeswith diabetic retinopathy.

PDF

___

1. Cuenca N, Ortuno-Lizaran I, Pinilla I. Cellular characterization of OCT and outer retinal bands using specific immunohistochemistry markers and clinical implications. Ophthalmology 2018; 125 (3): 407-422. doi: 10.1016/j. ophtha.2017.09.016
2. Spaide RF, Curcio CA. Anatomical correlates to the bands seen in the outer retina by optical coherence tomography: literature review and model. Retina 2011; 31 (8):1609-1619. doi: 10.1097/ IAE.0b013e3182247535
3. Muftuoglu IK, Mendoza N, Gaber R, Alam M, You Q et al. Integrity of outer retinal layers after resolution of central involved diabetic macular edema. Retina 2017; 37 (11): 2015- 2024. doi: 10.1097/IAE.0000000000001459
4. Battaglia Parodi M, Iacono P, Scaramuzzi M, Bandello F. Outer retinal layer changes after dexamethasone implant for central retinal vein occlusion. Retina 2017; 37 (10): 1888-1895. doi: 10.1097/IAE.0000000000001429
5. Yu DY, Cringle SJ. Oxygen distribution and consumption within the retina in vascularised and avascular retinas and in animal models of retinal disease. Progress in Retinal and Eye Research 2001; 20 (2): 175-208. doi: 10.1016/S1350- 9462(00)00027-6
6. Linsenmeier RA, Braun RD. Oxygen distribution and consumption in the cat retina during normoxia and hypoxemia. Journal of General Physiology 1992; 99 (2): 177-197. doi: 10.1085/jgp.99.2.177
7. Nesper PL, Scarinci F, Fawzi AA. Adaptive optics reveals photoreceptor abnormalities in diabetic macular ischemia. PLoS One 2017; 12 (1): e0169926. doi: 10.1371/journal. pone.0169926
8. Linsenmeier RA, Padnick-Silver L. Metabolic dependence of photoreceptors on the choroid in the normal and detached retina. Investigative Ophthalmology & Visual Science 2000; 41 (10): 3117-3123.
9. Birol G, Wang S, Budzynski E, Wangsa-Wirawan ND, Linsenmeier RA. Oxygen distribution and consumption in the macaque retina. American Journal of Physiology-Heart and Circulatory Physiology 2007; 293 (3): H1696-H1704. doi: 10.1152/ajpheart.00221.2007
10. Yi J, Liu W, Chen S, Backman V, Sheibani N et al. Visible light optical coherence tomography measures retinal oxygen metabolic response to systemic oxygenation. Light: Science & Applications 2015; 4 (9): e334. doi: 10.1038/lsa.2015.107
11. Scarinci F, Jampol LM, Linsenmeier RA, Fawzi AA. Association of diabetic macular nonperfusion with outer retinal disruption on optical coherence tomography. JAMA Ophthalmology 2015; 133 (9): 1036-1044. doi: 10.1001/jamaophthalmol.2015.2183
12. Scarinci F, Nesper PL, Fawzi AA. Deep retinal capillary nonperfusion is associated with photoreceptor disruption in diabetic macular ischemia. American Journal of Ophthalmology 2016; 168: 129-138. doi: 10.1016/j.ajo.2016.05.002
13. Jia Y, Tan O, Tokayer J, Potsaid B, Wang Y et al. Split-spectrum amplitude decorrelation angiography with optical coherence tomography. Optics Express 2012; 20 (4): 4710-4725. doi: 10.1364/OE.20.004710
14. Coscas F, Sellam A, Glacet-Bernard A, Jung C, Goudot M et al. Normative data for vascular density in superficial and deep capillary plexuses of healthy adults assessed by optical coherence tomography angiography. Investigative Ophthalmology & Visual Science 2016; 57 (9): OCT211- OCT223. doi: 10.1167/iovs.15-18793
15. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy: ETDRS report number 9. Ophthalmology 1991; 98 (5): 766-785. doi: 10.1016/S0161-6420(13)38011-7
16. Benitez-Herreros J, Lopez-Guajardo L, Camara-Gonzalez C, Vazquez-Blanco M, Castro-Rebollo M. Association between macular perfusion and photoreceptor layer status in diabetic macular edema. Retina 2015; 35 (2): 288-293. doi: 10.1097/ IAE.0000000000000299
17. Dmuchowska DA, Krasnicki P, Mariak Z. Can optical coherence tomography replace fluorescein angiography in detection of ischemic diabetic maculopathy? Graefe’s Archive for Clinical and Experimental Ophthalmology 2014; 252 (5): 731-738. doi: 10.1007/s00417-013-2518-x
18. Lee DH, Kim JT, Jung DW, Joe SG, Yoon YH. The relationship between foveal ischemia and spectral-domain optical coherence tomography findings in ischemic diabetic macular edema. Investigative Ophthalmology & Visual Science 2013; 54 (2): 1080-1085. doi: 10.1167/iovs.12-10503
19. Cheng D, Shen M, Zhuang X, Lin D, Dai M et al. Inner retinal microvasculature damage correlates with outer retinal disruption during remission in Behçet’s posterior uveitis by optical coherence tomography angiography. Investigative Ophthalmology & Visual Science 2018; 59 (3): 1295-1304. doi: 10.1167/iovs.17-23113
20. Jauregui R, Park KS, Duong JK, Mahajan VB, Tsang SH. Quantitative progression of retinitis pigmentosa by optical coherence tomography angiography. Scientific Reports 2018; 8 (1): 13130. doi: 10.1038/s41598-018-31488-1