Anatomical changes in retinal capillary plexus evaluate by OCTA in DM patients

Author: Ana Boned Murillo (Spain)

Co-authors: Maria Dolores Diaz Barreda, Maria Sopeña Pinilla, Guisela Fernandez Espinosa, Elvira Orduna Hospital, Isabel Bartolomé Sese, Isabel Pinilla Lozano

Purpose

To evaluate anatomical changes in superficial capillary (SCP) and deep capillary (DCP) retinal plexuses, as well as choriocapillaris (CC) ischemia in DM patients without diabetic retinopathy (DR) or with mild and moderate DR without diabetic macular edema (DME) using Optical coherence tomography angiography (OCTA) (DRI-Triton SS-OCT).

Setting/Venue

OCTA can detect vascular abnormalities in DR, not only in the retinal and CC perfusion but also in the capillary morphology. Microaneurysms, areas of perfusion loss, abnormalities in the foveal avascular zona (FAZ) morphology or ischemia can be found in the DM patients. OCTA allows the detection of early microvascular changes in DM, even before they are clinically evident.

Methods

We performed a single-center cross-sectional descriptive study including 90 eyes of 34 DM patients with long evolution DM (over 10 years) but without DR changes and 54 patients with mild or moderate DR without DME. All participants underwent an ophthalmic examination that refraction and OCTA using Deep Range Imaging (DRI)-Triton swept source (SS)-OCT.

Results

Mean age was 63.82±8.56 and 63±13.21 years in long term DM without DR changes and DR one respectively. In patients with long evolution DM but without DR FAZ anomalies were observed in SCP and DCP (55% and 5% respectively), and microaneurysms were presented in SCP and DCP (35% and 47.5% respectively). Perfusion loss was detected in SCP and DCP (30% and 47.5% respectively) and ischemia was observed in SCP and DCP (60% and 37.5%). In CC, ischemia was observed in 10% of the patients. In patients with mild or moderate DR without DME OCTA anomalies were also observed. ZAF abnormalities and microaneurysms in SCP and DCP (79.6% and 81.11 respectively), perfusion loss in SCP and DCP (83.3% and 64.2% respectively) and ischemia in SCP and DCP (66.67% and 81.1% respectively) but not in CC (18.5%). Microvascular tortuosity or dilations and IRMAs were detected in 48.1% and 46.3% in SCP vs 22.6% and 20.8% in DCP respectively.

Conlusions

Long term evolution DM patients show OCTA changes in morphology. Long evolution DM patients with no DR show microaneurysms in both SCP and DCP. Changes in FAZ are more evident in the SCP due to the capillary anastomosis. Capillary dropout can be found in both plexuses. Patients with DR show more evident changes including mycroaneurisms, perfussion loss and ischemia or other vascular abnormalities.

Financial Disclosure

none