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Evaluation of the effect of the severity of diabetic retinopathy on microvascular abnormalities and vascular density using optical coherence tomography angiography

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Abstract

Purpose

To quantify and to study the relationship between retinal microvascular changes and different stages of diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA).

Methods

This prospective observational study included the eyes of patients with different stages of DR. OCTA was performed in all eyes using a 9 × 9 mm protocol. We analyzed the superficial and deep retinal capillary plexuses, for the following OCTA parameters: number of microaneurysms (MA), number of intraretinal microvascular abnormalities (IRMA), the total surface of capillary non-perfusion (CNP) areas, and vascular density (VD). The association between those parameters and the severity of DR was studied.

Results

A total of 70 eyes of 45 patients were included. The number of MA in the superficial capillary plexus (SCP) showed a significant association with DR severity (p = 0.03). The number of IRMA and the total surface of CNP areas were associated with the severity of DR in both plexuses (p = 0.019 in the SCP and p = 0.044 in the DCP for IRMA; p < 0.001 in the SCP and p = 0.001 in the DCP for CNP areas). The VD decreased significantly with the severity of DR in the DCP (p = 0.04).

Conclusions

The number of vascular abnormalities and the surface of CNP areas were significantly associated with the severity of DR. The decrease in vascular density in the DCP with increasing disease severity suggests that the DCP is more vulnerable to vascular changes than the SCP. Those parameters might be tools for a future DR severity scale based on OCTA.

Highlights

In addition to its capability of detecting vascular changes in DR non-invasively, OCTA may also serve as a valuable tool to graduate DR.

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Authors and Affiliations

  1. Department of Ophthalmology, Charles Nicolle University Hospital of Tunis, Boulevard du 9-Avril 1938, 1006, Tunis, Tunisia

    Héla Kaoual, Imène Zhioua Braham, Mejdi Boukari & Raja Zhioua

Authors
  1. Héla Kaoual
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  2. Imène Zhioua Braham
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  3. Mejdi Boukari
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  4. Raja Zhioua
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Contributions

All authors have contributed significantly to this work. H.KAOUAL and I.ZHIOUA BRAHAM contributed to data collection, and in writing the article, M.BOUKARI contributed to data collection, and R.ZHIOUA, head of the department, contributed to work and writing supervision. All the cited authors agree with the content of the manuscript.

Corresponding author

Correspondence to Héla Kaoual.

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Conflict of interest

The authors have no funding or conflicts of interest to disclose.

Ethical standards

This study has been reviewed by the ethics committee of Charles Nicolle hospital of Tunis and has therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.

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All persons involved gave their informed consent prior to their inclusion in the study.

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This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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Kaoual, H., Zhioua Braham, I., Boukari, M. et al. Evaluation of the effect of the severity of diabetic retinopathy on microvascular abnormalities and vascular density using optical coherence tomography angiography. Acta Diabetol 58, 1683–1688 (2021). https://doi.org/10.1007/s00592-021-01774-y

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  • DOI: https://doi.org/10.1007/s00592-021-01774-y

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