Detection of retinal and optic disc neovascularization in patients with stage 4 diabetic retinopathy by multidirectional optical coherence tomography angiography_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liu Changying , Wang Jie , Chen Fang , Zhao Xuzheng , Liang Li , Han Yanan

Tangshan Ophthalmological Hospital, Tangshan 063000, China;

Corresponding?author：

Liu Changying, Email: liuchangying99@163.com

Keywords：

Proliferative diabetic retinapathy/diagnosis; Tomography, optical coherence; Fluoresceinangiography

DOI：

10.3760/cma.j.cn511434-20190315-00101

Video：

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Objective To observe and analyze the detection rate of optical disc and retinal neovascularization in stage Ⅳ diabetic retinopathy by multidirectional OCT angiography (OCTA).Methods A retrospective study. From September to October 2018, 50 eyes of 46 patients with diabetic retinopathy of stage Ⅳ diagnosed in Tangshan Ophthalmological Hospital were included in the study. Among them, there were 18 males (19 eyes) and 28 females (31 eyes). The age ranged from 31 to 78 years, with an average age of 56.64±10.64 years. All patients underwent medical optometry, mydriasis fundus examination and FFA examination. All patients met the diagnostic criteria of stage Ⅳ diabetic retinopathy. All patients underwent multidirectional OCTA examination on the same day after mydriasis fundus examination and FFA examination. Angiography 6 mm × 6 mm scanning mode was selected for OCTA examination. The retinal areas of macular area, optic disc, superior nasal disc, superior optic disc, superior macular area, superior temporal macular area, temporal macular area, inferior nasal disc, inferior optic disc, inferior macular area and inferior temporal macular area were scanned respectively. All images were taken by the same physician and read by two physicians independently. Cases with inconsistent opinions between the two physicians were not included in this study. The optical disc and retinal neovascularization in patients with stage Ⅳ diabetic retinopathy were observed on FFA and multidirectional OCTA images.Results In 50 eyes, the positive number of screening optic disc neovascularization using FFA was 8 eyes, OCTA was 15 eyes (100%). In the 42 eyes without optic disc neovascularization detected by FFA, OCTA detected 7 eyes, all located on the optic disc surface. Four of the eyes were located in the optic cup, linear and branching, with an area of less than 1/4 optic disc. In 50 eyes, the positive number of screening retinal neovascularization using FFA was 50 eyes, the positive number of OCTA was 43 eyes. In 43 eyes with detected by OCTA, retinal neovascularization buds were detected in 3 eyes, but not in FFA. The retinal neovascularization not detected by OCTA was located in the mid-peripheral part of the retina, which is beyond the inspection range of multi-directional OCTA.Conclusion The positive rate of optic disc neovascularization and retinal neovascularization in stage Ⅳ DR by multidirectional OCTA is 100.0% and 86.0%, respectively.

Citation： Liu Changying, Wang Jie, Chen Fang, Zhao Xuzheng, Liang Li, Han Yanan. Detection of retinal and optic disc neovascularization in patients with stage 4 diabetic retinopathy by multidirectional optical coherence tomography angiography. Chinese Journal of Ocular Fundus Diseases, 2020, 36(5): 349-353. doi: 10.3760/cma.j.cn511434-20190315-00101 Copy

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7.	Jia Y, Bailey ST, Hwang TS, et al. Quantitative optical coherence tomography of vascular abnormalities in the living human eye[J]. Proc Natl Acad Sci USA, 2015, 112(18): 2395-2402. DOI: 10.1073/pnas.1500185112.
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9.	Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J]. Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
10.	Nagiel A, Lalane RA, Sadda SR, et al. Ultra-widefield fundus imaging: a review of clinical applications and future trends[J]. Retina, 2016, 36(4): 660-678. DOI: 10.1097/IAE.0000000000000937.
11.	Wessel MM, Nair N, Aaker GD, et al. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema[J]. Br J Ophthalmol, 2012, 96(5): 694-698. DOI: 10.1136/bjophthalmol-2011-300774.
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14.	Gao SS, Jia Y, Zhang M, et al. Optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 27-36. DOI: 10.1167/iovs.15-19043.

1. 黎曉新. 學習推廣中國糖尿病視網膜病變防治指南, 科學規范防治糖尿病視網膜病變[J]. 中華眼底病雜志, 2012, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.Li XX. Following the Chinese guideline of diabetic retinopathy in our practice[J]. Chin J Ocul Fundus Dis, 2012, 31(2): 117-120. DOI: 10.3760/cma.j.issn.1005-1015.2015.02.002.
2. Spaide RF, Klancnik JM Jr, Cooney MJ. Retinal vascu1ar layers imaged by fluorescein angiography and optical coherence tomography angiography[J]. JAMA Ophthalmol, 2015, 133(1): 45-50. DOI: 10.1001/jamaophthalmol.2014.3616.
3. 中華醫學會眼科學分會眼底病學組. 我國糖尿病視網膜病變臨床診療指南(2014年)[J]. 中華眼科雜志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Clinical guidelines of diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
4. Crawford TN, Alfaro DV 3rd, Kerrison JB, et al. Diabetic retinopathy and angiogenesis[J]. Curr Diabetes Rev, 2009, 5(1): 8-13. DOI: 10.2174/157339909787314149.
5. Han JR, Ju WK, Park IW. Spontaneous regression of ncovascularization at the disc in diabetic retinopathy[J]. Korean J Ophthalmol, 2004, 18(1): 41-46. DOI: 10.3341/kjo.2004.18.1.41.
6. Hayreh SS. The blood supply of the optic nerve head and the evaluation of it-myth and reality[J]. Prog Retin Eye Res, 2001, 20(5): 563-593. DOI: 10.1016/s1350-9462(01)00004-0.
7. Jia Y, Bailey ST, Hwang TS, et al. Quantitative optical coherence tomography of vascular abnormalities in the living human eye[J]. Proc Natl Acad Sci USA, 2015, 112(18): 2395-2402. DOI: 10.1073/pnas.1500185112.
8. Pan J, Chen D, Yang X, et al. Characteristics of neovascularization in early stages of proliferative diabetic retinopathy by optical coherence tomography angiography[J]. Am J Ophthalmol, 2018, 192: 146-156. DOI: 10.1016/j.ajo.2018.05.018.
9. Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J]. Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
10. Nagiel A, Lalane RA, Sadda SR, et al. Ultra-widefield fundus imaging: a review of clinical applications and future trends[J]. Retina, 2016, 36(4): 660-678. DOI: 10.1097/IAE.0000000000000937.
11. Wessel MM, Nair N, Aaker GD, et al. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema[J]. Br J Ophthalmol, 2012, 96(5): 694-698. DOI: 10.1136/bjophthalmol-2011-300774.
12. Schaal KB, Munk MR, Wyssmueller I, et al. Vascular abnormalities in diabetic retinopathy assessed with swept-source optical coherence tomography angiography widefield imaging [J/OL]. Retina, 2017, 2017: E1[2017-11-10]. https://insights.ovid.com/pubmed?pmid=29135803. DOI: 10.1097/IAE.0000000000001938. [publishedonline ahead of print].
13. Zhang A, Zhang Q, Chen CL, et al. Methods and algorithms for optical coherence tomography-based angiography:a review and comparison[J]. J Biomed Opt, 2015, 20(10): 100901. DOI: 10.1117/1.JBO.20.10.100901.
14. Gao SS, Jia Y, Zhang M, et al. Optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 27-36. DOI: 10.1167/iovs.15-19043.

Chinese Journal of Ocular Fundus Diseases

Detection of retinal and optic disc neovascularization in patients with stage 4 diabetic retinopathy by multidirectional optical coherence tomography angiography

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