May 31, 2019 Conference


Differential Association of Macular Superficial versus Deep Vascular Density with Microaneurysms and Nonperfusion in Diabetic Retinopathy

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Dr. Mohamed Elmasry, Joslin Diabetes Center (Presenter)
Dr. Konstantina Sampani, Joslin Diabetes Center/Harvard Medical School
Cloy Pitoc, Philippine Eye Research Institute
Alan Fleming, Optos Plc
gavin robertson, Optos Plc
Dr. Paolo Silva, Joslin Diabetes Center
Dr. Lloyd Paul Aiello, Joslin Diabetes Center
Dr. Jennifer K. Sun, Joslin Diabetes Center

Methods: Same day optical coherence tomography angiography (OCTA) and ultrawide field fluorescein
angiography (UWFFA) images were obtained from eyes of diabetic patients. Global NP and NP index (NPI),
and specific posterior pole (PP, central 10mm diameter zone), mid-periphery (MP, 10-15mm) and far periphery
(FP, >15mm) zones were evaluated. Retinal MA were manually annotated and quantified on UWFFA. OCTA
3x3 mm images were processed with projection artifact removal software (Angiovue ver 2017.1.0.151).
Automated segmentation of superficial (SCP) and deep (DCP) capillary plexuses provided VD for the whole
image and parafoveal macular quadrants.
Results: A total of 54 eyes of 34 patients with mean±SD age 48.4±14.2 years, HbA1c 8.1±0.6%, diabetes
duration 25.3±10.0 years, with 48.1% female, and 57.4% type 1 diabetes were imaged. DR distribution was
mild 5 (9.3%), moderate 16 (29.6%), and severe 17 (31.5%) nonproliferative DR and proliferative DR 16
(29.6%). MA# and NPI increased with increasing DR severity (p<0.001). Local MA# correlated with NPI in the
PP (r=0.77, p<0.001), MP (r=0.79, p<0.001) and FP (r=0.62, p<0.001). No relationship was found between
global SCP VD and MA# or NPI. However, temporal (T) and inferior (I) SCP VD was correlated with PP NPI (T:
r =-0.46, p<0.001, I: r=-0.36, p=0.008). There was an inverse association between global DCP VD and PP and
MP MA# (MP: r=-0.49, p<0.001, PP: r=-0.38, p=0.005) as well as global NPI (MP: r-0.39, p<0.001, PP: r=-0.39,
p=0.003) and FP NPI (r=-0.34, p=0.01). All DCP quadrants correlated with PP MA#. DCP-S, PP and MP while
DCP-S correlated with FP MA#. DCP T and I VD were correlated with PP NPI (T: r=--0.41, p<0.002, I: r=-0.39,
p=0.003) and T VD correlated with MP and FP NPI (r=-0.43, p=0.002 and r=-0.37, p=0.007).

Conclusions: These findings suggest that macular superficial versus deep vascular plexuses have differential
associations with posterior versus peripheral MAs and nonperfusion in diabetes. Correlation with peripheral
retinal pathology also varies between macular plexus quadrants. Further studies may provide further insight
into how specific zones within OCTA macular scans reflect or predict disease activity beyond the posterior