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Yoon, Woo, and Woo: Optical Coherence Tomography Angiography According to Severity of Diabetic Retinopathy
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(6): 653-662.

Published online: 16 June 2017

DOI: https://doi.org/10.3341/jkos.2017.58.6.653

Optical Coherence Tomography Angiography According to Severity of Diabetic Retinopathy

Yo Sep Yoon, MD, Jong Eun Woo, MD, Je Moon Woo, MD, PhD

Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Address reprint requests to Je Moon Woo, MD, PhD. Department of Ophthalmology, Ulsan University Hospital, #877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea. Tel: 82-52-250-7177, Fax: 82-52-250-7174, limbus68@naver.com

Received 23 February 2017       Revised 4 May 2017       Accepted 29 May 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the extent of macular microvascular changes in diabetic retinopathy according to progression of diabetic retinopathy using optical coherence tomography angiography (OCTA).

Methods

We retrospectively analyzed 46 diabetic patients and 10 normal patients who underwent OCTA. Diabetic patients were classified as mild, moderate, severe non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) according to international clinical diabetic retinopathy severity classification fundus findings. OCTA was performed on a 3 × 3 mm region centered on the fovea and parafoveal areas to measure the width of the fovea avascular zone (FAZ) of the superficial and deep capillary plexuses.

Results

Among the control group, NPDR, and PDR, the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the FAZ increased with progression of diabetic retinopathy. In the SCP (p<0.001) and DCP (p<0.001), there was a significant difference in size between the NPDR and PDR groups. In the NPDR group, there were meaningful differences in SCP (p=0.011) and DCP (p=0.038) size between the moderate and severe NPDR groups.

Conclusions

In this study, OCTA was used to measure the FAZ, and we aimed to determine if there was a significant difference in FAZ between the NPDR and the PDR groups and between the moderate and severe NPDR groups in terms of the degree of progression of diabetic retinopathy. The results suggest that the size of the FAZ could be a marker of progression of diabetic retinopathy, and noninvasive OCTA can be used to confirm such progression.

Keywords: Diabetic retinopathy, Foveal avascular zone, Optical coherence tomography angiography

Figures and Tables

Figure 1

Manual drawing of the foveal avascular zone boundary using intrinsic measure area software. (A) Example of manual drawing of 3 × 3 mm optical coherence tomography angiogram in superficial capillary plexuses in a non-proliferative diabetic retinopathy (NPDR) patient. (B) Example of manual drawing of 3 × 3 mm optical coherence tomography angiogram in deep capillary plexuses in a NPDR patient.

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Figure 2

Manual drawing of the foveal avascular zone (FAZ) boundary. (A, B) FAZ of the SCP and DCP in no diabetic retinopathy patients. (C, D) FAZ of the SCP and DCP in mild non-proliferative diabetic retinopathy (NPDR) patients. (E, F) FAZ of the SCP and DCP in moderate NPDR patients. (G, H) FAZ of the SCP and DCP in severe NPDR patients. (I, J) FAZ of the SCP and DCP in proliferative diabetic retinopathy patients.

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Figure 3

Comparison of fovea avascular zone (FAZ) area between non-proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. Boxplot showing the fovea avascular zone area in the superficial capillary plexuses (SCPs) and deep capillary plexuses (DCPs) in patients with no diabetic retinopathy (DR), NPDR and PDR.

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Figure 4

Comparison of fovea avascular zone (FAZ) area according to the severity of diabetic retinopathy (DR). Boxplot showing the fovea avascular zone area in the superficial capillary plexuses (SCPs) and deep capillary plexuses (DCPs) in patients with mild, moderate, severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

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Table 1

Baseline characteristics of all patients

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Values are presented as mean ± SD or n (%) unless otherwise indicated.

DR = diabetic retinopathy; NPDR = non-proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; DM = diabetes mellitus; HTN = hypertension; IOP = intraocular pressure.

*Mann-Whitney U-test: Mean age, Mean duration of DM, Chi-square test: Male, HTN; †Comparison between No DR and NPDR group; ‡Comparison between No DR and PDR group; §Comparison between NPDR and PDR group; ΠComparison between mild NPDR and moderate NPDR group; #Comparison between mild NPDR and severe NPDR group; **Comparison between moderate NPDR and severe NPDR group.

Table 2

Comparison of FAZ area by severity of DR

jkos-58-653-i002

Values are presented as mean ± SD or n (%) unless otherwise indicated.

FAZ = fovea avascular zone; DR = diabetic retinopathy; NPDR = non-proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; SCP = superficial capillary plexus; DCP = deep capillary plexus.

*Mann-Whitney U-test; †Comparison between No DR and NPDR group; ‡Comparison between No DR and PDR group; §Comparison between NPDR and PDR group; ΠComparison between mild NPDR and moderate NPDR group; #Comparison between mild NPDR and severe NPDR group; **Comparison between moderate NPDR and severe NPDR group; ††Comparison between severe NPDR group and PDR group; ‡‡Wilcoxon signed rank test.

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