Photodiagnosis and photodynamic therapy · 2025
Observation of choroidal blood flow parameters in patients with diabetic retinopathy based on ultra-widefield SS-OCTA.
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Gao Zhiyu, Zhang Fan
Аннотация
OBJECTIVE: Use ultra-wide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA) to observe choroidal blood flow parameters in diabetic patients to aid clinical monitoring of diabetic retinopathy (DR).
METHODS: In this retrospective cross-sectional study, 203 participants (243 eyes) with type 2 diabetes mellitus and healthy controls were recruited. Diabetic patients were graded according to their severity: diabetes but without diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Utilizing UWF-SS-OCTA examination, comprehensive data collection of choroidal capillary blood flow density (VD-CC), choroidal medium-and large-vessel blood flow density (VD-LMVC), and choroidal vascular index (CVI) was conducted, encompassing both overall and 3 × 3 zoning analyses.
RESULTS: Best corrected visual acuity (BCVA) declined with increasing DR severity, significantly so in PDR (P < 0.05). Diabetic patients showed lower VD-LMVC and CVI than healthy controls (P < 0.05), while VD-CC showed no significant difference. VD-LMVC and CVI decreased with DR progression and were negatively correlated with DM duration, BCVA, HbA1c, and DR grade, particularly in the temporal region (P < 0.05). CVI correlated linearly with age, DR severity, VD-LMVC, and VD-CC, with DR grade being the strongest predictor (β'=-0.523, P < 0.001). CVI (AUC=93.2 %) demonstrated superior diagnostic value for DR compared to VD-LMVC (AUC=89.2 %) and VD-CC (AUC=88.7 %).
CONCLUSION: Choroidal hypoperfusion is a characteristic of DR. Choroidal blood flow density in patients with DR predominantly affects the medium- and large- vessel layers. The CVI shows a progressive decline as DR advances, with perfusion loss possibly initiating in the temporal subregions. Among the evaluated parameters, CVI demonstrates superior diagnostic utility over VD-CC and VD-LMVC for supporting DR diagnosis. However, all three parameters exhibit limited sensitivity in staging disease severity. CVI holds promise as a potential biomarker for monitoring DR progression.
METHODS: In this retrospective cross-sectional study, 203 participants (243 eyes) with type 2 diabetes mellitus and healthy controls were recruited. Diabetic patients were graded according to their severity: diabetes but without diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Utilizing UWF-SS-OCTA examination, comprehensive data collection of choroidal capillary blood flow density (VD-CC), choroidal medium-and large-vessel blood flow density (VD-LMVC), and choroidal vascular index (CVI) was conducted, encompassing both overall and 3 × 3 zoning analyses.
RESULTS: Best corrected visual acuity (BCVA) declined with increasing DR severity, significantly so in PDR (P < 0.05). Diabetic patients showed lower VD-LMVC and CVI than healthy controls (P < 0.05), while VD-CC showed no significant difference. VD-LMVC and CVI decreased with DR progression and were negatively correlated with DM duration, BCVA, HbA1c, and DR grade, particularly in the temporal region (P < 0.05). CVI correlated linearly with age, DR severity, VD-LMVC, and VD-CC, with DR grade being the strongest predictor (β'=-0.523, P < 0.001). CVI (AUC=93.2 %) demonstrated superior diagnostic value for DR compared to VD-LMVC (AUC=89.2 %) and VD-CC (AUC=88.7 %).
CONCLUSION: Choroidal hypoperfusion is a characteristic of DR. Choroidal blood flow density in patients with DR predominantly affects the medium- and large- vessel layers. The CVI shows a progressive decline as DR advances, with perfusion loss possibly initiating in the temporal subregions. Among the evaluated parameters, CVI demonstrates superior diagnostic utility over VD-CC and VD-LMVC for supporting DR diagnosis. However, all three parameters exhibit limited sensitivity in staging disease severity. CVI holds promise as a potential biomarker for monitoring DR progression.