Abstract Aim: to investigate changes in macular perfusion in patients affected by diabetic macular edema as well as to assess the feasibility of wide-field fluorescein angiography (FA) in clinical practice. Material and methods: in this retrospective cohort study Caucasian patients with type II diabetes and evidence of central involving Diabetic Macular Edema (DME) were included. All patients underwent a complete baseline ophthalmic examination and Optical Coherence Tomography (OCT) and OCT Angiography (OCTA). All patients underwent an anti-VEGF loading phase and then were treated on a bimonthly basis or with a treat and extend regimen (TER). Clinical and imaging data were collected during baseline examination, at the 12-month (M12) and 18-month visits (M18) after the first intravitreal injection. At each visit, patients received all the examinations. A group of healthy subjects matched by age and sex, without any history of ocular and systemic diseases, were enrolled as controls. Results: Overall, 44 eyes of DME patients (20 male and 24 female) and 39 eyes of controls (19 male and 20 female) were included in the study. The mean ± standard deviations (SD) age of subjects was 68.4±9.5 years in diabetes group and 64.7±9.6 years in control group. Between the two groups, no significant difference in age, refraction and IOP values were found. Quantitative comparison of OCTA measurements between DME patients at baseline and control subjects showed a statistically significant difference in all the tested sectors. Quantitative comparison of OCTA measurements in DME patients over the follow-up showed no significant changes of the vascular density in all the tested sectors. Multivariate regression analysis in all the timepoints of the study (baseline, 12-month visit and 18-month visit) showed a statistically significant association of the diabetes duration and the whole image vessel density at level of the superficial vascular plexus at baseline (p<0.001, p=0.002 and p=0.005, respectively) and an association in the deep capillary plexus at 12-month visit (p=0.027). Cohen’s k analysis in wide-field FA test was Cohen K=0.957 (strong agreement) and in the analysis of standard FA images was K=0.765 (moderate agreement) (p<0.001). Conclusion: no changes in vascular density over the 18 months follow-up period were detected. The main clinical factor associated with vascular density was the diabetes duration. Wide-field FA was associated with higher agreement between specialists.
Obiettivo: studiare i cambiamenti nella perfusione maculare nei pazienti affetti da edema maculare diabetico e valutare la fattibilità della fluorangiografia con ad ampio campo nella pratica clinica. Materiali e metodi: in questo studio di coorte retrospettivo sono stati inclusi pazienti caucasici con diabete di tipo II e evidenza di edema maculare diabetico (DME) coinvolgente il centro. Tutti i pazienti sono stati sottoposti a un esame oftalmico basale completo e a tomografia a coerenza ottica (OCT) e angiografia OCT (OCTA). Tutti i pazienti sono stati sottoposti a una fase di carico di iniezioni di anti-VEGF e poi sono stati trattati su base bimestrale o con un regime di trattamento “treat and extend”(TER). I dati clinici e di imaging sono stati raccolti durante l'esame basale, alle visite a 12 mesi (M12) e a 18 mesi (M18) dopo la prima iniezione intravitreale. A ogni visita, i pazienti hanno ricevuto tutti gli esami. Un gruppo di soggetti sani abbinati per età e sesso, senza alcuna storia di malattie oculari e sistemiche, è stato arruolato come controlli. Risultati: Nel complesso, 44 occhi di 44 pazienti con edema maculare diabetico (DME) (20 maschi e 24 femmine) e 39 occhi di controlli (19 maschi e 20 femmine) sono stati inclusi nello studio. L'età media ± deviazioni standard (DS) dei soggetti era 68,4±9,5 anni nel gruppo diabetico e 64,7±9,6 anni nel gruppo di controllo. Tra i due gruppi, non è stata trovata alcuna differenza significativa nei valori di età, rifrazione e IOP. Il confronto quantitativo delle misurazioni OCTA tra pazienti DME al basale e soggetti di controllo ha mostrato una differenza statisticamente significativa in tutti i settori testati. Il confronto quantitativo delle misurazioni OCTA nei pazienti DME durante il follow-up non ha mostrato cambiamenti significativi della densità vascolare in tutti i settori testati. L'analisi di regressione multivariata in tutti i punti temporali dello studio (baseline, visita a 12 mesi e visita a 18 mesi) ha mostrato un'associazione statisticamente significativa tra la durata del diabete e la densità dei vasi dell'intera immagine a livello del plesso vascolare superficiale al basale (rispettivamente p < 0,001, p = 0,002 e p = 0,005) e un'associazione nel plesso capillare profondo alla visita a 12 mesi (p = 0,027). L'analisi k di Cohen per le fluorangiografie a campo ampio era Cohen K = 0,957 (forte accordo) e nell'analisi delle immagini fluorangiografiche standard era K = 0,765 (accordo moderato) (p < 0,001). Conclusione: non sono state rilevate modifiche nella densità vascolare nel periodo di follow-up di 18 mesi. Il principale fattore clinico associato alla densità vascolare era la durata del diabete. La fluorangiografia ad ampio campo era associata a una maggiore concordanza tra gli specialisti.
Angiografia Tomografica a Coerenza Ottica e Fluorangiografia ad ampio campo nella Retinopatia Diabetica
CASTELLINO, NICCOLO'
2024
Abstract
Abstract Aim: to investigate changes in macular perfusion in patients affected by diabetic macular edema as well as to assess the feasibility of wide-field fluorescein angiography (FA) in clinical practice. Material and methods: in this retrospective cohort study Caucasian patients with type II diabetes and evidence of central involving Diabetic Macular Edema (DME) were included. All patients underwent a complete baseline ophthalmic examination and Optical Coherence Tomography (OCT) and OCT Angiography (OCTA). All patients underwent an anti-VEGF loading phase and then were treated on a bimonthly basis or with a treat and extend regimen (TER). Clinical and imaging data were collected during baseline examination, at the 12-month (M12) and 18-month visits (M18) after the first intravitreal injection. At each visit, patients received all the examinations. A group of healthy subjects matched by age and sex, without any history of ocular and systemic diseases, were enrolled as controls. Results: Overall, 44 eyes of DME patients (20 male and 24 female) and 39 eyes of controls (19 male and 20 female) were included in the study. The mean ± standard deviations (SD) age of subjects was 68.4±9.5 years in diabetes group and 64.7±9.6 years in control group. Between the two groups, no significant difference in age, refraction and IOP values were found. Quantitative comparison of OCTA measurements between DME patients at baseline and control subjects showed a statistically significant difference in all the tested sectors. Quantitative comparison of OCTA measurements in DME patients over the follow-up showed no significant changes of the vascular density in all the tested sectors. Multivariate regression analysis in all the timepoints of the study (baseline, 12-month visit and 18-month visit) showed a statistically significant association of the diabetes duration and the whole image vessel density at level of the superficial vascular plexus at baseline (p<0.001, p=0.002 and p=0.005, respectively) and an association in the deep capillary plexus at 12-month visit (p=0.027). Cohen’s k analysis in wide-field FA test was Cohen K=0.957 (strong agreement) and in the analysis of standard FA images was K=0.765 (moderate agreement) (p<0.001). Conclusion: no changes in vascular density over the 18 months follow-up period were detected. The main clinical factor associated with vascular density was the diabetes duration. Wide-field FA was associated with higher agreement between specialists.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/218350
URN:NBN:IT:UNICT-218350