Optical Coherence Tomography and Fundus Fluorescein Angiography in Diabetic Retinopathy

Author(s):  
Kenneth Li ◽  
Ian Wong
Author(s):  
Ketaki Rajurkar ◽  
Meenakshi Thakar ◽  
Priyadarshi Gupta ◽  
Anju Rastogi

Abstract Purpose To study the macular features in Eales disease patients observed with fundus fluorescein angiography (FA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods A cross-sectional study was done on treatment naïve 31 eyes (23 patients) with Eales disease. Baseline parameters such as Best-corrected visual acuity (BCVA), slit-lamp bio microscopy (SLB), indirect ophthalmoscopy, FA, spectral-domain OCT {quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT} and OCTA were performed. Any media opacity precluding the above investigations was excluded. Results Macular findings comprised of- epiretinal membrane, macular exudation, full thickness macular hole, sub internal limiting membrane bleed, cystoid macular oedema, neurosensory detachment and retinal thickening. Sixteen (51.6%) of our patients had macular changes as seen on all modalities together. SLB and indirect ophthalmoscopy missed macular findings in 50% patients and FA in 18.8% patients. OCT and OCTA diagnosed all macular findings. On comparison of mean BCVA in patients with macular involvement on FA, OCT and OCTA, compared to those without macular involvement, patients with macular involvement had lower BCVA (p 0.000, 0.01 and 0.001 respectively). Thus, FA missed many patients who had significant macular involvement and hence less vision. Conclusion Eales disease though described in literature as classically being peripheral retina disease process, also has macular involvement. OCT and OCTA are useful guides to evaluation of macular involvement in these patients. The latter seems to be superior to FA in detecting macular abnormalities in this ailment. OCTA is non-invasive and shows deep capillary plexus changes which are not shown by any other modality.


Author(s):  
Sarita Jacob ◽  
Ramesh R. Sivaraj

Imaging in diabetic retinopathy (DR) has developed over the years and the advantages are multifold. Various imaging modalities are currently available, which is of great diagnostic and prognostic value in the management of DR. Optical coherence tomography (OCT) has revolutionized the management of diabetic maculopathy. OCT has now become indispensable for initiating and assessing diabetic macular oedema (DMO) while on treatment with intravitreal injections. Recent introduction of optical coherence tomography angiography (OCTA) has significantly reduced the need for fundus fluorescein angiography (FFA) for macular ischaemia and proliferative retinopathy. Ultra-wide field (UWF) imaging modalities for colour fundus and UWF FFA are very useful to document and assess overall retinal state highlighting the periphery. Bscan ultrasonography of the fundus is an useful tool to assess retinal status in proliferative DR with vitreous haemorrhage.


Even though the diagnosis depends on clinical examination, in cases with branch retinal vein occlusion (BRVO), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) provide unique data for follow-up, management and prognosis. In FFA, delay of laminar flow phase in the involved branch, hyperfluorescence due to leakage from the vessel wall in the late phases, hypofluorescence due to the blockage by hemorrhage, and soft exudates, and hyperfluorescence due to macular edema can be detected. In OCT, macular thickening, cystic spaces, serous retinal detachment, hyperreflective dots, disorganization of the outer retinal layers – particularly the photoreceptor inner and outer segments line and the external limiting membrane – can be seen. OCTA reveals non-perfusion, particularly in the deep capillary plexus.


Diabetic retinopathy is an important public health issue as its prevalence has been increasing every year. It is one of the major causes of visual loss which can be preventable with early diagnosis and appropriate treatment. The fundus examination must be done in detail using mydriatics, and digital images must be recorded in all diabetic patients with special emphasis on the disease type (type I and type II), duration, and prognosis. Fluorescein angiography (FA) is a gold standard invasive retinal imaging technique for the diagnosis, monitoring, and evaluating the response of the treatment in diabetic patients, but FA has limitations due to possible side effects. Optical coherence tomography angiography (OCTA) is a recent, non-invasive, dye-free imaging technique that can be used in every visit. It has the capability to image all retinal and choroidal vascular layers (segmentation) and quantify macular ischemia in a short period of time which is beneficial for the patient, and the ophthalmologist. The aim of this review is to address the findings, advantages, and disadvantages of FA and OCTA in patients with diabetic retinopathy and diabetic macular edema.


2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Abdul Sami Memon ◽  
Nasir Ahmed Memon ◽  
Pir Salim Mahar

Objective: To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA). Methods: A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography angiography (SS-OCTA). Then face wide field SS-OCTA images and co registered structural optical coherence tomography (OCT) with flow overlay were used to distinguish the features of IRMA and retinal NVs. Results: Forty-two eyes (21 patients) were examined clinically. Fourteen eyes had moderate NPDR, 15 had severe NPDR and 13 eyes had changes consistent with PDR. After clinical diagnosis, we included 28 eyes in our study based on inclusion criteria. These 28 eyes went through SS-OCTA evaluation and we observed 15 cases with PDR and 13 with severe NPDR changes. The OCTA and clinical diagnosis were similar except in 2 eyes, which is critical but not statically significant showing the importance of this noninvasive technology. Conclusions: Widefield OCTA can work as an alternative to fundus fluorescein angiography (FFA) in the diagnosis of diabetic retinopathy (DR). As it is a non-invasive and depth encoded technique so can be used frequently to monitor the retinal changes and their progression. doi: https://doi.org/10.12669/pjms.38.1.3891 How to cite this:Memon AS, Memon NA, Mahar PS. Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy. Pak J Med Sci. 2022;38(1):---------.  doi: https://doi.org/10.12669/pjms.38.1.3891 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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