Feasibility and Clinical Utility of Wide-Field Optical Coherence Tomography Angiography Compared to Ultrawide-Field Fluorescein Angiography in Patients with Diabetic Retinopathy

Abstract

Purpose To test the diagnostic performance of a novel wide-field swept-source optical coherence tomography angiography (WF-OCTA) device in detecting retinal non-perfusion (NP) and neovascularization (NV) in eyes with diabetic retinopathy (DR) and to compare this with the standard-of-care imaging method, ultrawide-field fluorescein angiography (UWFFA).

Methods Prospective, observational, cross-sectional single-center study evaluating patients with DR imaged with WF-OCTA (Xephilio OCT-S1; Canon Inc., Tokyo, Japan) and UWFFA (Optos California; Optos plc, Dunfermline, United Kingdom). WF-OCTA images of the superficial capillary plexus (SCP) consisted of single capture 23 × 20 mm scans centered on the fovea. In UWFFA and WF-OCTA, qualitative and quantitative measurements were assessed to analyze retinal NP and NV. Vessel density (VD) in WF-OCTA and ischemic index (ISI) in UWFFA were calculated. Qualitatively, the presence of NV and NP was assessed in both WF-OCTA (posterior pole/midperipheral retina) and UWFFA (posterior pole/midperipheral retina/far peripheral retina).

Results Ten consecutive patients with variable DR severity stages (17 eyes) were evaluated. Two eyes had to be excluded due to low quality of the WF-OCTA images. Therefore, 15 eyes were included for final analysis. Mean age was 57 years (± SD: 15.2) and the male : female ratio was 4 : 6. UWFFA identified retinal NP in 11 eyes (73%). Posterior pole NP was present in eight eyes, midperiphery NP was present in eight eyes, and far periphery NP was present in seven eyes. Retinal NV was detected in four eyes using UWFFA (two eyes with only midperiphery NV). WF-OCTA detected retinal NP in 11 eyes (9 cases with both posterior pole and midperiphery NP). NV was detected in three eyes (two with posterior pole and midperipheral NV, four with only midperipheral NV). Mean VD evaluated using WF-OCTA of the SCP was 0.40 (± SD: 0.1), and mean ISI in UWFFA was 0.09 (± SD: 1.3). Spearmanʼs test did not show a significant correlation between the ISI in UWFFA and VD in WF-OCTA (p = 0.803).

Conclusions Noninvasive WF-OCTA has great potential for the management of patients with DR. This new imaging modality might be useful in daily clinical routine in order to lower the number of invasive examinations. However, in a small percentage of patients, OCTA images cannot be reliably graded for the presence of NP and NV. In these cases, conventional FA needs to be performed.

Zusammenfassung

Ziel Die klinische Anwendbarkeit der optischen Weitwinkel-Kohärenztomografie-Angiografie (WF-OCTA) mit der Ultra-Weitwinkel-Fluoreszenzangiografie (UWFFA) in Patienten mit diabetischer Retinopathie (DR) zu vergleichen. Hierfür wurden WF-OCTA- und UWFFA-Aufnahmen quantitativ und qualitativ bez. retinaler Neovaskularisationen (NV) und retinaler nicht perfundierter Bereiche (NP) analysiert.

Methoden Prospektive, beobachtende Querschnittstudie, in der Patienten mit DR mittels WF-OCTA (Xephilio OCT-S1; Canon Inc. Tokyo, Japan) und UWFFA (Optos California; Optos plc, Edinburgh, United Kingdom) untersucht worden sind. Die WF-OCTA-Bilder des oberflächlichen Kapillarplexus (SCP) bestanden aus 23 × 20 mm großen Einzelaufnahmen, die auf die Fovea zentriert waren. Quantitativ wurde in den WF-OCTA-Aufnahmen die Gefäßdichte (VD) berechnet, in den UWFFA-Aufnahmen der Ischämie-Index (ISI). Qualitativ (Q) wurde das Vorhandensein von NV und NP sowohl in der WF-OCTA (hinterer Pol/mittlere periphere Netzhaut) als auch in der UWFFA (hinterer Pol/mittlere periphere Netzhaut/ferne periphere Netzhaut) beurteilt.

Resultate 17 Augen von 10 Patienten mit unterschiedlichen DR-Stadien wurden untersucht. Zwei Augen mussten aufgrund ungenügender Qualität der WF-OCTA-Aufnahmen ausgeschlossen werden, sodass für die finale Analyse 15 Augen inkludiert wurden. Das mittlere Alter betrug 58,9 Jahre (± SD: 15,4), das Mann-Frau-Verhältnis lag bei 4 : 6. Mittels UWFFA wurde in 11 Augen (73%) NP detektiert. Nicht perfundierte Bereiche am posterioren Pol wurden in 8 Augen gesehen, NP in der mittleren Peripherie gab es in 8 Augen und NP in der weiten Peripherie waren in 7 Augen präsent. Retinale NV wurden in 4 Augen mittels UWFFA erkannt, davon waren 2 Augen mit NV in der mittleren Peripherie und 2 Augen mit NV in der mittleren und weiten Peripherie. WF-OCTA detektierte 11 Augen mit NP am hinteren Pol, und/oder mittleren Peripherie, 9 Augen hatten NP am posterioren Pol und in der mittleren Peripherie. Mittlere VD des SCP betrug 0,40 (± SD: 0,1), mittlerer ISI in UWFFA war 0,09 (± SD: 1,3). Der Spearman-Test zeigte keine signifikante Korrelation zwischen VD in WF-OCTA- und ISI in UWFFA-Aufnahmen (p = 0,803).

Schlussfolgerung Nicht invasive WF-OCTA bietet ein großes Potenzial für das Management von Patienten mit DR. Diese neue Modalität der OCTA kann im klinischen Alltag hilfreich sein, um die Anzahl invasiver Aufnahmen zu reduzieren. Bei einem kleinen Prozentsatz werden NP und NV in OCTA-Bildern nicht zuverlässig detektiert, sodass in diesen Fällen UWFFA weiterhin notwendig sein wird.

Key words

ultrawide-field fluorescein angiography - wide-field optical coherence tomography angiography - retina - retinal imaging - diabetic retinopathy

Schlüsselwörter

Netzhaut - Weitwinkel - retinale Bildgebung - optische Kohärenztomografie-Angiografie - Fluoreszenzangiografie - diabetische Retinopathie

Publication History

Received: 15 October 2022

Accepted: 31 January 2023

Article published online:
25 April 2023

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