Comparative Quantitative Analysis of Retinal Superficial Capillary Plexus in Patients with Retinal Vein Occlusion and Unaffected Fellow Eyes

Purpose: To evaluate optical coherence tomography angiography (OCT-A) data obtained from the superficial retinal capillary plexus of patients with retinal vein occlusion and comparative analysis with data registered from unaffected fellow eyes. Methods: The examined patients were classified into 2 groups: group 1—eyes with established retinal vein occlusion (n = 29) and group 2—unaffected fellow eyes of patients with retinal vein occlusion (n = 24). The scanning protocol “Angiography 3 × 3 mm” of Zeiss Cirrus HD-OCT 6000, AngioPlex Metrix was used to evaluate the retinal superficial capillary plexus. The analyzed parameters were vascular density and perfusion density, as well as the area, perimeter, and circularity of the foveolar avascular zone (FAZ). Results: The comparative analysis of FAZ parameters at the superficial capillary plexus (SCP) between group 1 (eyes with retinal vein occlusion) and group 2 (unaffected fellow eyes) showed significant results for the three parameters, respectively area (p = 0.003), perimeter (p ≤ 0.001), and circularity (p = 0.011) of FAZ. The comparative analysis of the vascular network at SCP in patients with diagnosed retinal vein occlusion and unaffected fellow eyes showed significant results for vascular density (VD) in the central (p = 0.038) and inner (p ≤ 0.001) zones as well as total VD (p ≤ 0.001) were statistically significant. Moreover, the results obtained in the study of vascular perfusion (VP) indicated significant results in the inner zone (p ≤ 0.001) and total VP (p = 0.001). Vascular perfusion in the central zone (p = 0.116) was the only parameter not to meet significant results. Conclusion: The current study observed a significant enlargement of the FAZ and loss of its circularity, along with a reduction in vascular network parameters at the superficial retinal capillary plexus level.

Repeatability and Reproducibility of Quantitative Assessment of the Retinal Microvasculature Using Optical Coherence Tomography Angiography Based on Optical Microangiography

Objective The aim of this study was to determine the repeatability and reproducibility of optical coherence tomography angiography（OCTA） based on optical microangiography（OMAG） measurements of macular vessels in normal eyes. Methods In this prospective cohort study, 40 eyes of 40 healthy volunteers underwent repeated OCTA（Cirrus HD-OCT 5000 angiography system, Carl Zeiss Meditec, Inc.） scans on two separate visit days. On each visit day, the eyes were scanned three times. The following parameters were used to quantitatively describe the OCTA images of the superficial vascular network： vessel area density（VAD）, vessel skeleton density（VSD）, vessel diameter index（VDI）, vessel perimeter index（VPI）, vessel complexity index（VCI）, flux, and foveal avascular zone（FAZ）. Coefficient of variation（CV） and intraclass correlation coefficient（ICC） were calculated for evaluating intravisit and intervisit repeatability, as well as interobserver reproducibility. Results The measurements showed high repeatability [CVs ≤ 4.2%（intravisit） and ≤ 4.6%（intervisit）] and interobserver reproducibility（ICCs ≥ 0.923） for all parameters. Conclusion This study demonstrated good repeatability and reproducibility of OCTA based on OMAG for the measurement of superficial vessel parameters in normal eyes.

Determining the imaging plane of a retinal capillary layer in adaptive optical imaging

Even in the early stage,endocrine metabolism disease may lead to micro aneurysms in retinal capillaries whose diameters are less than 10 μm.However,the fundus cameras used in clinic diagnosis can only obtain images of vessels larger than 20 μm in diameter.The human retina is a thin and multiple layer tissue,and the layer of capillaries less than10 μm in diameter only exists in the inner nuclear layer.The layer thickness of capillaries less than 10 μm in diameter is about 40 μm and the distance range to rod＆cone cell surface is tens of micrometers,which varies from person to person.Therefore,determining reasonable capillary layer（CL） position in different human eyes is very difficult.In this paper,we propose a method to determine the position of retinal CL based on the rod＆cone cell layer.The public positions of CL are recognized with 15 subjects from 40 to 59 years old,and the imaging planes of CL are calculated by the effective focal length of the human eye.High resolution retinal capillary imaging results obtained from 17 subjects with a liquid crystal adaptive optics system（LCAOS） validate our method.All of the subjects＇ CLs have public positions from 127 μm to 147 μm from the rod＆cone cell layer,which is influenced by the depth of focus.

Changes of retinal vessel density in low to moderate myopic eyes with orthokeratology evaluated by optical coherence tomography angiography

AIM:To explore the effect of orthokeratology(OK)fitting on retinal vessel density in low to moderate myopia adolescents by using optical coherence tomography angiography.METHODS:Children aged 10 to 14y with a cycloplegic spherical equivalent refraction of−0.50 diopter(D)to−5.00 D and astigmatism with more than−1.50 D were recruited.The enrolled adolescents were divided into OK group and spectacle group.During regular followup,adolescents were measured respectively at pre-wear,1,3,and 6mo after treatment.The follow-up included uncorrected distance visual acuity(UDVA),axial length(AL),superficial capillary plexus density(SCPD),deep capillary plexus density(DCPD),central retinal thickness(CRT),foveal avascular zone area(FAZ-A),foveal avascular zone perimeter(FAZ-P)and foveal vessel density in a 300-μmwide region around foveal avascular zone(FD-300).The collected data were analyzed using statistical methods.RESULTS:By one month,SCPD significantly increased in the fovea and superior retina,and DCPD significantly increased inferiorly in OK group compared to spectacle group(P<0.05).By three months,there were significant increases in SCPD in the fovea and inferior retina,and DCPD in the parafovea,superior,and inferior retina in OK group(P<0.05),while the increase in SCPD and DCPD in the fovea were observed by six months(P<0.05).The FD-300 significantly increased at every follow-up in OK group compared to spectacle group(P<0.05).No significant differences in the CRT,FAZ-A and FAZ-P and FD-300 were observed between two groups(P>0.05).OK group showed a significant improvement in UDVA after wearing OK,compared to spectacle group(P<0.01),while the AL did not show a significant difference between two groups(P>0.05).CONCLUSION:Short-term OK worn can increase local retinal vessel density in adolescents with low-to-moderate myopia.

DIFFERENT RESPONSES OF CHORIOCAPILLARY ENDOTHELIAL CELLS AND RETINAL CAPILLARY ENDOTHELIAL CELLS TO MITOGENIC AND VASOACTIVE FACTORS

The responses of choriocapillary endothelial cells(CCE) and retinal capillary endothelial cells(RCE) in culture,in terms of phosphoinositide(PI) breakdown and cellular mitogenesis, to retinal pigment epithelial cell(RPE)-conditioned medium and vasoactive agents have been compared. RPE-conditioned medium did not induce PI breakdown in either type of cell. However, it stimulated DNA synthesis in CCE but not in RCE. Bradykinin(BDK) acted as both a fast signaling and a slow mitogenic factor on CCE, but BDK did not affect PI turnover or DNA synthesis in RCE. In contrast, thrombin stimulated PI turnover in RCE but not in CCE, though it did not induce 3H-thymidine incorporation into either type of cell. These differences in cellular functions between CCE and RCE following stimulation suggest that induction of DNA synthesis and receptor-mediated PI turnover by external factors is determined, at least in part, by the origin of the capillary endothelial cell. Therefore, extrapolation to CCE pathophysiology from experiments using endothelial cells from other capillary origins may not be valid.

Changes in retinal capillary density in female with type 2 diabetes and gestational diabetes——an analysis based on OCTA technology

AIM:To evaluate alterations in conjunctival vascular density(CVD)and macular capillary density(MCD)in female patients with type 2 diabetes mellitus(T2DM)and gestational diabetes mellitus(GDM)using optical coherence tomography angiography(OCTA).METHODS:A total of 60 female participants were recruited,comprising 20 patients with T2DM,20 patients with GDM,and 20 healthy age-matched controls(HCs).OCTA was used to assess superficial and deep retinal and conjunctival capillary plexuses.Subsequently,changes in MCD were analyzed using a circular segmentation method(C1-C6),a hemispheric quadrant segmentation method[superior right(SR),superior left(SL),inferior left(IL),and inferior right(IR)],and the early treatment diabetic retinopathy study(ETDRS)segmentation method(S,I,R,L).RESULTS:OCTA unequivocally demonstrated that the variations in CVD among HCs,T2DM,and GDM groups were statistically significant(P<0.001).In the superficial retinal capillary plexus(sRCP),significant differences were observed in the densities of total microvascular(TMI),microvasculature(MIR),and macrovascular(MAR)between patients with T2DM and HCs(P<0.05).Furthermore,the GDM group exhibited a more substantial reduction in MIR density compared to the T2DM group(P<0.01).In the deep retinal capillary plexus(dRCP),significant differences in the densities of TMI and MIR were identified between the T2DM group and HCs(P<0.05),with a notable difference in TMI density also observed between the GDM and T2DM groups(P<0.01).In the receiver operating characteristic(ROC)curve analysis,the area under the ROC curve(AUC)for TMI in sRCP between the T2DM group and HCs was 0.975,with a 95%confidence interval(CI)of 0.941–1.The AUC for MIR was highest in dRCP,with an AUC value of 0.914 and a 95%CI ranging from 0.847 to 0.981.In comparing the GDM and T2DM groups,the AUC for I region was maximized in sRCP,achieving a value of 0.978 with a 95%CI of 0.953–1.Additionally,the AUC for R region was maximized in dRCP,reaching a value of 0.99 with a 95%CI of 0.975 to 1.CONCLUSION:The sRCP and dRCP densities show higher diagnostic sensitivity for T2DM and GDM.OCTA holds potential as a significant instrument for the early diagnosis and differentiation of T2DM and GDM.

Associated risk factors in the early stage of diabetic retinopathy

Background:To investigate the retinal capillary density(RCD)of the macula using optical coherence tomography angiography(OCT-A)in type 2 diabetic patients and to further determine the association with risk factors.Methods:A total of 212 eyes from 212 subjects were recruited;subjects included diabetics with no retinopathy(NDR,n=90 eyes),diabetics with mild retinopathy DR(MDR,n=36 eyes),and healthy participants(Control,n=86 eyes).All participants underwent OCT-A scanning.RCD was quantified by superficial and deep retinal capillary layers(SRCL and DRCL)from OCT-A images.Results:RCD in SRCL and DRCL was lower in NDR(P<0.001)as well as in MDR(P<0.001)when compared with control eyes.Diabetic patients were subdivided according to individual risk factors,complications related to diabetes,and hyperglycemia.Diabetic patients showed lower RCD in both the SRCL and DRCL when compared with healthy controls.Diabetics with age>55y,HbA1c>7%had significantly reduced DRCL(P<0.05)when compared with the other group of diabetics(age<55y,HbA1c<7%).Diabetics with a blood urea nitrogen(BUN)>8.2 mmol/L had significantly reduced SRCL and DRCL when compared to the other group of diabetics.Conclusions:Risk factors including older age,higher level of HbA1c,LDL-C and BUN,were associated with lower RCDs found in type 2 diabetic patients with and without mild DR by OCT-A.The impairment of retinal capillary by OCT-A may play a key role in the early monitoring of management in diabetes.