The consistency and reproducibility of macular perfusion parameters in early diabetic retinopathy using optical coherence tomography angiography_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Xiangning , Zhao Jiawei , Li Shuting , Du Xinhua ,  Wu Qiang

Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China;

Corresponding author：

Wu Qiang, Email: qiang.wu@shsmu.edu.cn

Keywords：

Diabetic retinopathy; Tomography, optical coherence; Reproducibility of results; Macular perfusion parameters

DOI：

10.3760/cma.j.issn.1005-1015.2018.04.003

Video：

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Abstract Full text Figures/Tables Video References Cited by

ObejctiveTo investigate the consistency and reproducibility of macular perfusion parameters in early diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA).MethodsA prospective cross-sectional observational study. Forty-six patients (46 eyes) diagnosed with mild nonproliferative DR were included in this study. There were 24 males and 22 females, with the mean age of 59.16±10.32 years. Two macular scan sizes of 3 mm×3 mm and 6 mm×6 mm were performed by the same operator, and the same test was performed by another operator. The superficial retinal layer (SRL) and deep retinal layer (DRL) in the foveal avascular zone (FAZ) and vessel density (VD) were quantified. The consistency of the two scan sizes and the reproducibility of the same scan size were also evaluated. The consistency was determined by the intraclass correlation coefficient (ICC). If the intraclass correlation coefficient (ICC)＞0.80, consistency was good; if 0.4≤ICC＜0.8, consistency was general; if ICC＜0.40, consistency was poor.ResultsIn the 3 mm×3 mm and 6 mm×6 mm scanning sizes, the mean results of the two examiners were calculated. The FAZ of SRL were 0.39±0.13 mm² and 0.42±0.15 mm², FAZ of DRL were 0.74±0.22 mm² and 0.89±0.23 mm². The VD of SRL were (32.23±2.86)% and (31.91±3.01)%, VD of DRL were (43.73±4.64)% and (45.12±5.49)%. The consistency analysis showed that the ICC of SRL-FAZ and DRL-FAZ were 0.920 and 0.812, respectively; the ICC of VD were 0.833 and 0.830, respectively. The consistency was good. The reproducibility analysis of different examiners in the same scan size was better in the consistency of SRL FAZ and VD.ConclusionOCTA in two scanning sizes to measure FAZ and VD of early DR has good consistency and reproducibility.

Citation： Wang Xiangning, Zhao Jiawei, Li Shuting, Du Xinhua, Wu Qiang. The consistency and reproducibility of macular perfusion parameters in early diabetic retinopathy using optical coherence tomography angiography. Chinese Journal of Ocular Fundus Diseases, 2018, 34(4): 323-327. doi: 10.3760/cma.j.issn.1005-1015.2018.04.003 Copy

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2.	Al-Sheikh M, Akil H, Pfau M, et al. Swept-source oct angiography imaging of the foveal avascular zone and macular capillary network density in diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2016, 57(8): 3907-3913. DOI: 10.1167/iovs.16-19570.
3.	Tarassoly K, Miraftabi A, SoltanSanjari M, et al. The relationship between foveal avascular zone area, vessel density, and cystoid changes in diabetic retinopathy, an optical coherence tomography angiography study[J/OL]. Retina, 2017, 2017: E1[2017-06-29]. https://insights.ovid.com/pubmed?pmid=28665869. DOI: 10.1097/IAE.0000000000001755.[published online ahead of print].
4.	Wilkinson CP, Ferris FR, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682.
5.	Garcia-Martin E, Pinilla I, Idoipe M, et al. Intra and interoperator reproducibility of retinal nerve fibre and macular thickness measurements using Cirrus Fourier-domain OCT[J]. Acta Ophthalmol, 2011, 89(1): 23-29. DOI: 10.1111/j.1755-3768.2010.02045.x.
6.	Shahlaee A, Pefkianaki M, Hsu J, et al. Measurement of foveal avascular zone dimensions and its reliability in healthy eyes using optical coherence tomography angiography[J]. Am J Ophthalmol, 2016, 161: 50-55.doi: 10.1016/j.ajo.2015.09.026.
7.	Hendrickson A. A morphological comparison of foveal development in man and monkey[J]. Eye (Lond), 1992, 6(Pt 2): 136-144.
8.	Bresnick GH, Condit R, Syrjala S, et al. Abnormalities of the foveal avascular zone in diabetic retinopathy[J]. Arch Ophthalmol, 1984, 102(9): 1286-1293.
9.	Kim DY, Fingler J, Zawadzki RJ, et al. Noninvasive imaging of the foveal avascular zone with high-speed, phase-variance optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2012, 53(1): 85-92. DOI: 10.1167/iovs.11-8249.
10.	Tam J, Dhamdhere KP, Tiruveedhula P, et al. Subclinical capillary changes in non-proliferative diabetic retinopathy[J]. Optom Vis Sci, 2012, 89(5): 692-703. DOI: 10.1097/OPX.0b013e3182548b07.
11.	Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J]. Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
12.	Conrath J, Giorgi R, Raccah D, et al. Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment[J]. Eye (Lond), 2005, 19(3): 322-326. DOI: 10.1038/sj.eye.6701456.
13.	Di G, Weihong Y, Xiao Z, et al. A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(5): 873-879. DOI: 10.1007/s00417-015-3143-7.
14.	Dong J, Jia YD, Wu Q, et al. Interchangeability and reliability of macular perfusion parameter measurements using optical coherence tomography angiography[J]. Br J Ophthalmol, 2017, 101 (11): 1542-1549. DOI: 10.1136/bjophthalmol-2016-309441.
15.	Cao D, Yang D, Huang Z, et al. Optical coherence tomography angiography discerns preclinical diabetic retinopathy in eyes of patients with type 2 diabetes without clinical diabetic retinopathy[J]. Acta Diabetol, 2018, 55(5): 469-477. DOI: 10.1007/s00592-018-1115-1.
16.	魏文斌, 曾司彦. 重视光相干断层扫描血流成像的临床应用及其图像的判读[J]. 中华实验眼科杂志, 2017, 35(10): 865-870DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001.Wen WB, Zeng SY.Paying attention to the clinical application and image interpretation in optical coherence tomography angiography [J]. Chin J Exp Ophthalmol, 2017, 35(10): 865-870. DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001.
17.	Guo J, She X, Liu X, et al. Repeatability and reproducibility of foveal avascular zone area measurements using AngioPlex spectral domain optical coherence tomography angiography in healthy subjects[J]. Ophthalmologica, 2017, 237(1): 21-28. DOI: 10.1159/000453112.
18.	Al-Sheikh M, Tepelus TC, Nazikyan T, et al. Repeatability of automated vessel density measurements using optical coherence tomography angiography[J]. Br J Ophthalmol, 2017, 101 (4): 449-452. DOI: 10.1136/bjophthalmol-2016-308764.

1. Lee J, Rosen R.Optical coherence tomography angiography in diabetes[J]. Curr Diab Rep, 2016, 16(12): 123. DOI: 10.1007/s11892-016-0811-x.
2. Al-Sheikh M, Akil H, Pfau M, et al. Swept-source oct angiography imaging of the foveal avascular zone and macular capillary network density in diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2016, 57(8): 3907-3913. DOI: 10.1167/iovs.16-19570.
3. Tarassoly K, Miraftabi A, SoltanSanjari M, et al. The relationship between foveal avascular zone area, vessel density, and cystoid changes in diabetic retinopathy, an optical coherence tomography angiography study[J/OL]. Retina, 2017, 2017: E1[2017-06-29]. https://insights.ovid.com/pubmed?pmid=28665869. DOI: 10.1097/IAE.0000000000001755.[published online ahead of print].
4. Wilkinson CP, Ferris FR, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682.
5. Garcia-Martin E, Pinilla I, Idoipe M, et al. Intra and interoperator reproducibility of retinal nerve fibre and macular thickness measurements using Cirrus Fourier-domain OCT[J]. Acta Ophthalmol, 2011, 89(1): 23-29. DOI: 10.1111/j.1755-3768.2010.02045.x.
6. Shahlaee A, Pefkianaki M, Hsu J, et al. Measurement of foveal avascular zone dimensions and its reliability in healthy eyes using optical coherence tomography angiography[J]. Am J Ophthalmol, 2016, 161: 50-55.doi: 10.1016/j.ajo.2015.09.026.
7. Hendrickson A. A morphological comparison of foveal development in man and monkey[J]. Eye (Lond), 1992, 6(Pt 2): 136-144.
8. Bresnick GH, Condit R, Syrjala S, et al. Abnormalities of the foveal avascular zone in diabetic retinopathy[J]. Arch Ophthalmol, 1984, 102(9): 1286-1293.
9. Kim DY, Fingler J, Zawadzki RJ, et al. Noninvasive imaging of the foveal avascular zone with high-speed, phase-variance optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2012, 53(1): 85-92. DOI: 10.1167/iovs.11-8249.
10. Tam J, Dhamdhere KP, Tiruveedhula P, et al. Subclinical capillary changes in non-proliferative diabetic retinopathy[J]. Optom Vis Sci, 2012, 89(5): 692-703. DOI: 10.1097/OPX.0b013e3182548b07.
11. Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J]. Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
12. Conrath J, Giorgi R, Raccah D, et al. Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment[J]. Eye (Lond), 2005, 19(3): 322-326. DOI: 10.1038/sj.eye.6701456.
13. Di G, Weihong Y, Xiao Z, et al. A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(5): 873-879. DOI: 10.1007/s00417-015-3143-7.
14. Dong J, Jia YD, Wu Q, et al. Interchangeability and reliability of macular perfusion parameter measurements using optical coherence tomography angiography[J]. Br J Ophthalmol, 2017, 101 (11): 1542-1549. DOI: 10.1136/bjophthalmol-2016-309441.
15. Cao D, Yang D, Huang Z, et al. Optical coherence tomography angiography discerns preclinical diabetic retinopathy in eyes of patients with type 2 diabetes without clinical diabetic retinopathy[J]. Acta Diabetol, 2018, 55(5): 469-477. DOI: 10.1007/s00592-018-1115-1.
16. 魏文斌, 曾司彦. 重视光相干断层扫描血流成像的临床应用及其图像的判读[J]. 中华实验眼科杂志, 2017, 35(10): 865-870DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001.Wen WB, Zeng SY.Paying attention to the clinical application and image interpretation in optical coherence tomography angiography [J]. Chin J Exp Ophthalmol, 2017, 35(10): 865-870. DOI: 10.3760/cma.j.issn.2095-0160.2017.10.001.
17. Guo J, She X, Liu X, et al. Repeatability and reproducibility of foveal avascular zone area measurements using AngioPlex spectral domain optical coherence tomography angiography in healthy subjects[J]. Ophthalmologica, 2017, 237(1): 21-28. DOI: 10.1159/000453112.
18. Al-Sheikh M, Tepelus TC, Nazikyan T, et al. Repeatability of automated vessel density measurements using optical coherence tomography angiography[J]. Br J Ophthalmol, 2017, 101 (4): 449-452. DOI: 10.1136/bjophthalmol-2016-308764.

Chinese Journal of Ocular Fundus Diseases

The consistency and reproducibility of macular perfusion parameters in early diabetic retinopathy using optical coherence tomography angiography

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