A Proposed Classification of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Following Panretinal Photocoagulation

Overview

Journal Invest Ophthalmol Vis Sci

Specialty Ophthalmology

Date 2020 Mar 20

PMID 32191287

Citations 15

Authors

Akito Shimouchi

Akihiro Ishibazawa

Satoshi Ishiko

Tsuneaki Omae

Tomoko Ro-Mase

Yasuo Yanagi

Akitoshi Yoshida

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the characteristics of intraretinal microvascular abnormalities (IRMAs) before and after panretinal photocoagulation (PRP) for diabetic retinopathy (DR) by using optical coherence tomography angiography (OCTA).

Methods: Forty-six eyes of 29 patients with DR were included (26 eyes with severe nonproliferative diabetic retinopathy [SNPDR] and 20 eyes with proliferative diabetic retinopathy [PDR]). En face OCTA images of IRMAs in a 6 × 6-mm area were acquired by using Cirrus 5000 with AngioPlex. The morphological changes in IRMAs were evaluated before and after PRP. The changes in the IRMAs were divided into five subtypes: unchanged; tuft regression; reperfusion; mixed (combined tuft regression/reperfusion); and worsening (new appearance of tuft).

Results: Unchanged IRMAs were identified in 15 SNPDR eyes and 2 PDR eyes; all neovascularization (NV) had regressed after PRP. Tufts were more frequently observed in the PDR eyes (15/20, 75%) than in the SNPDR eyes (8/26, 31%) (P = 0.003), and two tufts tended to exceed the inner limiting membrane, which showed progression to NV before PRP. The reperfusion phenomenon was observed in 7/26 SNPDR eyes and 4/20 PDR eyes, including the mixed type, and showed two vascular patterns: abnormal (dilated, tortuous, and twisted) and normal vessels. The worsening type was observed in 1/26 SNPDR eye and 2/20 PDR eyes.

Conclusions: OCTA enabled classification of IRMA into more detailed types. The unchanged and reperfusion types suggested that IRMAs had aspects of remodeling. However, IRMAs with tufts were observed in 75% of the PDR eyes, and the tufts had aspects of NV.

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References

. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991; 98(5 Suppl):786-806. View

Schaal K, Munk M, Wyssmueller I, Berger L, Zinkernagel M, Wolf S . VASCULAR ABNORMALITIES IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WIDEFIELD IMAGING. Retina. 2017; 39(1):79-87. DOI: 10.1097/IAE.0000000000001938. View

Davis M . Vitreous contraction in proliferative diabetic retinopathy. Arch Ophthalmol. 1965; 74(6):741-51. DOI: 10.1001/archopht.1965.00970040743003. View

van Dijk H, Verbraak F, Kok P, Garvin M, Sonka M, Lee K . Decreased retinal ganglion cell layer thickness in patients with type 1 diabetes. Invest Ophthalmol Vis Sci. 2010; 51(7):3660-5. PMC: 2904016. DOI: 10.1167/iovs.09-5041. View

. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991; 98(5 Suppl):823-33. View

. Diabetic retinopathy study. Report Number 6. Design, methods, and baseline results. Report Number 7. A modification of the Airlie House classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 1981; 21(1 Pt 2):1-226. View

Smith L, Wesolowski E, McLellan A, Kostyk S, Damato R, Sullivan R . Oxygen-induced retinopathy in the mouse. Invest Ophthalmol Vis Sci. 1994; 35(1):101-11. View

Sawada O, Ichiyama Y, Obata S, Ito Y, Kakinoki M, Sawada T . Comparison between wide-angle OCT angiography and ultra-wide field fluorescein angiography for detecting non-perfusion areas and retinal neovascularization in eyes with diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2018; 256(7):1275-1280. DOI: 10.1007/s00417-018-3992-y. View

Schroder S, Palinski W, Schmid-Schonbein G . Activated monocytes and granulocytes, capillary nonperfusion, and neovascularization in diabetic retinopathy. Am J Pathol. 1991; 139(1):81-100. PMC: 1886150. View

10.

Joussen A, Poulaki V, Qin W, Kirchhof B, Mitsiades N, Wiegand S . Retinal vascular endothelial growth factor induces intercellular adhesion molecule-1 and endothelial nitric oxide synthase expression and initiates early diabetic retinal leukocyte adhesion in vivo. Am J Pathol. 2002; 160(2):501-9. PMC: 1850650. DOI: 10.1016/S0002-9440(10)64869-9. View

11.

Wilkinson C, Ferris 3rd F, Klein R, Lee P, Agardh C, Davis M . Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003; 110(9):1677-82. DOI: 10.1016/S0161-6420(03)00475-5. View

12.

. Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991; 98(5 Suppl):807-22. View

13.

Takahashi K, Kishi S, Muraoka K, Shimizu K . Reperfusion of occluded capillary beds in diabetic retinopathy. Am J Ophthalmol. 1998; 126(6):791-7. DOI: 10.1016/s0002-9394(98)00242-6. View

14.

Rosenfeld P, Durbin M, Roisman L, Zheng F, Miller A, Robbins G . ZEISS Angioplex™ Spectral Domain Optical Coherence Tomography Angiography: Technical Aspects. Dev Ophthalmol. 2016; 56:18-29. DOI: 10.1159/000442773. View

15.

Powner M, Sim D, Zhu M, Nobre-Cardoso J, Jones R, Syed A . Evaluation of Nonperfused Retinal Vessels in Ischemic Retinopathy. Invest Ophthalmol Vis Sci. 2016; 57(11):5031-5037. DOI: 10.1167/iovs.16-20007. View

16.

Ashton N . Arteriolar involvement in diabetic retinopathy. Br J Ophthalmol. 1953; 37(5):282-92. PMC: 1324102. DOI: 10.1136/bjo.37.5.282. View

17.

. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1987; 94(7):761-74. DOI: 10.1016/s0161-6420(87)33527-4. View

18.

Arnould T, Michiels C, Remacle J . Increased PMN adherence on endothelial cells after hypoxia: involvement of PAF, CD18/CD11b, and ICAM-1. Am J Physiol. 1993; 264(5 Pt 1):C1102-10. DOI: 10.1152/ajpcell.1993.264.5.C1102. View

19.

Lee C, Lee A, Sim D, Keane P, Mehta H, Zarranz-Ventura J . Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography. Am J Ophthalmol. 2014; 159(1):101-10.e1. PMC: 5006953. DOI: 10.1016/j.ajo.2014.09.041. View

20.

. Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. 1995; 113(9):1144-55. View