Atlas of Ophthalmology

Diabetic Retinopathy with Microaneurysms in Deep but not in Superficial Retinal Layer (Colour Image Posterior Pole)

Diabetic Retinopathy with Microaneurysms in Deep but not in Superficial Retinal Layer (Colour Image Posterior Pole)
Colour Photography Posterior Pole: no retinal hemorrhages, no glaucomatous optic nerve atrophy. Patient: 69 years of age, male, BCVA 0.63 at OD, 0.63 at OS, IOP 20/31 mmHg. Ocular Medical History: pseudoexfoliation material at anterior lens capsule, increased intraocular pressure in OS in secondary ocular hypertension in pseudoexfoliation syndrome. General Medical History: diabetes. Main Complaint: blur at OS. Purpose: to explore the structural features in deep and superficial retinal layer of diabetic retinopathy using optical coherence tomography angiography (OCT-A) and Fluorescence Angiography (FFA). Methods: Colour Photography Posterior Pole, Fluorescence Angiography, Triton OCT, Triton OCT-Angiography Findings: Colour Photography Posterior Pole: no retinal hemorrhages, no glaucomatous optic nerve atrophy. Triton OCT, ring scan: regular retinal nerve fiber thickness. FFA (0:39 s): several microaneurysms, one parafoveolar retinal hemorrhage. Triton OCT-Angiography, Deep Retinal Layer: impaired capillary perfusion with several microaneurysms. Triton OCT-Angiography, Superficial Retinal Layer: increased foveolar avascular zone, no microaneurysms. Triton OCT-Angiography, Choriocapillaris: mainly regular capillary perfusion in choriocapillaris, less focal drop outs. Mosaic, FFA, Triton OCT-Angiography of Deep Retinal Layer: some microaneurysms confirmed by FFA are not visualized by OCTA, and some other microaneurysms confirmed by OCTA could not be visualized by FFA. Discussion: Microaneurysms are defined as hyperfluorescent spots in the early and/or late phases of Fluorescence Angiography. Hamada M et al (1) found 90% of microaneurysms in the deep plexus. Ishibazawa A et al. (1) and Couturier et al. (2) reported an incomplete agreement between microaneurysms shown on FFA and those shown on OCTA. Several explanations are possible for why microaneurysms were not depicted by OCTA en face images but in FFA and vice versa: absence of blood flow due to microaneurysm closure, microaneurysms with open lumens but without blood flow, and thickened microaneurysm walls inhibiting the detection of flow signals. Literature: 1. Hamada M, Ohkoshi K, Inagaki K, Ebihara N, Murakami A. Visualization of microaneurysms using optical coherence tomography angiography: comparison of OCTA en face, OCT B-scan, OCT en face, FA, and IA images. Jpn J Ophthalmol. 2018 Mar;62(2):168-175. 2. Ishibazawa A, Nagaoka T, Takahashi A, Omae T, Tani T, Sogawa K, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study. Am J Ophthalmol. 2015;160:35–44. 3. Couturier A, Mané V, Bonnin S, Erginay A, Massin P, Gaudric A, et al. Capillary plexus anomalies in diabetic retinopathy on optical coherence tomography angiography. Retina. 2015;35:2384–91.
Michelson, Georg, Prof. Dr. med., Interdisciplinary Center of Preventive Ophthalmic Medicine and Imaging, Friedrich-Alexander University, Erlangen, Erlangen, Germany
E11.319
Systemerkrankungen -> Endocrinne Disorders -> Diabetes Mellitus (see under tissues involved) -> Diabetes Mellitus, Retina -> Diabetic Retinopathy, Nonproliferative -> Diabetic Retinopathy with Microaneurysms in Deep but not in Superficial Retinal Layer (Triton OCT-A, Colour Image Posterior Pole, FFA)
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