Relationship between macular perfusion and lesion distribution in diabetic retinopathy

Navid Manafi; Deniz Oncel; Aditya Verma; Giulia Corradetti; Shin Kadomoto; Alireza Mahmoudi; Ahmed Roshdy Alagorie; Naresh Kumar Yadav; Rajeev R Pappuru; Adnan Tufail; Houri Esmaeilkhanian; Muneeswar G Nittala; Rajiv Raman; Srinivas Sadda

doi:10.1038/s41433-024-03105-1

Relationship between macular perfusion and lesion distribution in diabetic retinopathy

Eye (Lond). 2024 May 9. doi: 10.1038/s41433-024-03105-1. Online ahead of print.

Authors

Navid Manafi^{1

2}, Deniz Oncel³, Aditya Verma^{1

4}, Giulia Corradetti^{1

2}, Shin Kadomoto^{1

2}, Alireza Mahmoudi^{1

2}, Ahmed Roshdy Alagorie^{1

2

5}, Naresh Kumar Yadav⁶, Rajeev R Pappuru⁶, Adnan Tufail⁷, Houri Esmaeilkhanian^{1

2}, Muneeswar G Nittala^{1

2}, Rajiv Raman⁸, Srinivas Sadda^{9

10}

Affiliations

¹ Doheny Eye Institute, Pasadena, CA, USA.
² Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
³ Loyola University, Chicago, Stritch School of Medicine, Chicago, IL, 60153, USA.
⁴ Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA.
⁵ Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt.
⁶ Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India.
⁷ Moorfields Eye Hospital NHS Foundation Trust, London, London, UK.
⁸ Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
⁹ Doheny Eye Institute, Pasadena, CA, USA. ssadda@doheny.org.
¹⁰ Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA. ssadda@doheny.org.

PMID: 38724702
DOI: 10.1038/s41433-024-03105-1

Abstract

Background/objectives: To assess the relationship between macular vessel density metrics and foveal avascular zone (FAZ) characteristics on optical coherence tomography angiography (OCTA) and lesion distribution in eyes with diabetic retinopathy (DR).

Subjects/methods: Patients with DR who underwent both Optos ultrawidefield (UWF) pseudocolor imaging and macular OCTA (Cirrus Angioplex, 6 × 6 mm) were included in this cross-sectional observational study. The distribution of DR lesions was assessed by comparing each of the peripheral ETDRS extended fields (3-7) against their corresponding ETDRS field, hence eyes were defined as either having predominantly peripheral lesions (PPL) or predominantly central lesions (PCL). En face OCTA images from the superficial and deep capillary plexuses (SCP and DCP) were then analysed using Image J software. Perfusion density (PD), vessel length density (VLD), and fractal dimensions (FD) were calculated following binarization and skeletonization of the images.

Results: Out of 344 eyes, 116 (33.72%) eyes had PPL and 228 (66.28%) eyes had PCL. For all DRSS levels, VLD, PD, and FD were not significantly different between eyes with PPL and PCL. The FAZ in eyes with PPL, however, was found to be more circular in shape compared to eyes with PCL (p = 0.037).

Conclusion: Although the presence of PPL has been associated with a higher risk for diabetic retinopathy progression, the macular perfusion is similar in eyes with PPL and PCL. The FAZ is more circular in eyes with PPL, but the clinical relevance of this difference remains to be defined.