Application value of optical coherence tomography angiography in diagnosis of the non-proliferative diabetic retinopathy

Abstract

Abstract:

ObjectiveTo analyze the application value of optical coherence tomography angiography (OCTA) in the diagnosis of non-proliferative diabetic retinopathy (NPDR).MethodsA total of 122 patients with or without diabetic retinopathy who has the history of diabetes mellitus were consecutively enrolled from January 2021 to June 2023. All the patients were examined with fundus fluorescein angiography (FFA) followed by OCTA. According to the results of FFA, the patients were divided into four groups: control（non-OCTA）, mild, moderate and severe NPDR groups. OCTA indice included central macular thickness（CMT）， vascular density (VD), perfusion density (PD), foveal avascular zone area(FAZ-A), foveal avascular zone perimeter (FAZ-P), and foveal avascular zone circularity index (FAZ-CI) along with central macular thickness (CMT). The differences in quantitative levels of OCTA parameters were assessed with one-way analysis of variance or non-parametric test, and the risk for NPDR development and severity by OCTA parameters were evaluated with multiple Logistic regression modeling analysis.The diagnostic values of single OCTA parameter or in combination for NPDR were evaluated with receiver operating characteristic (ROC) curve and area under curve (AUC) analysis methods.ResultsVDs in the NPDR groups were significantly lower than that of control group, showing obvious decrease in severe NPDR group compared to the mild and the moderate groups (P<0.05). PD in moderate and severe NPDR groups were significantly lower than that of control group (P<0.05). PD in severe NPDR group was lower than those of mild and moderate NPDR groups. FAZ-A in the mild, moderate and severe NPDR groups were significantly lower than that of control group (P<0.05), but no difference was observed among the three NPDR groups. FAZ-P in the mild, moderate and severe NPDR groups were significantly lower than those of control group (P<0.05), but no difference was observed among these NPDR groups. There was no statistical difference in FAZ-CI between groups. Multiple logistic regression analysis showed that CMT increase, VD and FAZ-P decrease were accociated with NPRD (P=0.03, <0.001 and 0.001), while CMT increase and VD decrease were independent risk factors for NPDR severity (P=0.01, <0.001). ROC curve analysis showed that CMT(>260.00 μm), VD (<16.55/mm²) and FAZ-P (<2.15 mm) were of significant independent diagnostic value for NPDR (AUC=0.63, 0.78 and 0.70), among which the diagnostic efficiency of VD was significantly higher than that of CMT (P=0.02), and no statistical difference of diagnostic efficacy between CMT and VD or FAZ-P (P>0.05). A combination of CMT, VD and FAZ-P showed higher diagnostic value than any single measurement (AUC=0.86, allP<0.05).ConclusionsThe OCTA parameters CMT, VD and FAZ-P alone show significant independent diagnostic values for NPDR, and combination of three indices have more efficacy.Integrating the vascular parameters with macular morphology of OCTA measurement might effectively improve clinical diagnosis of NDPR.

Key words:Optical coherence tomography angiography,Fundus Fluorescein angiography,Diabetic retinopathy

CLC Number:

R445.9
R774

ZHANG Qiong, WU Yanlin, HU Qiwei, ZHANG Zewei, HUANG Shouyue. Application value of optical coherence tomography angiography in diagnosis of the non-proliferative diabetic retinopathy[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(01): 67-76.

Figures/Tables12

Classification	Clinical features
No retinopathy	No microvascular lesions
NPDR
Mild	Microaneurysms only
Moderate	Microaneurysms and other microvascular lesions, but not severe NPDR
Severe	More than 20 intraretinal hemorrhages in four quadrants; or venous beading in two or more quadrants; or IRMA in one or more quadrant, but not proliferative diabetic retinopathy

Table 1

Figure 1

Figure 2

Figure 3

Characteristics	Total (n=122)	No retinopathy (n=41)	Mild NPDR (n=26)	Moderate NPDR (n=26)	Severe NPDR (n=29)	Pvalue
Age (year)	55.1±1.2	56.9±1.1	52.2±1.1	55.3±1.5	54.8±1.1	0.48
Gender (male)	86 (70.5%)	29 (70.7%)	20(76.9%)	19 (73.1%)	18 (62.1%)	0.66
BCVA	0.80 (0.40)	0.90 (0.30)	0.95 (0.20)	0.70 (0.35)	0.70 (0.35)	<0.001
IOP (mmHg)	15.00±1.82	14.77±1.44	14.93±1.64	15.58±2.27	14.89±1.98	0.33

Table 2

Table 3

Variations analysis of OCTA measures among different groups

Indice	Total (n=122)	No retinopathy (n=41)	Mild NPDR (n=26)	Moderate NPDR (n=26)	Severe NPDR (n=29)	Pvalue
SSI	8.00 (1.00)	8.00 (2.00)	8.00 (0.25)	8.00 (1.00)	8.00 (1.00)	0.40
CMT (μm)	249.61±25.74	241.27±24.55	251.54±27.20	250.04±19.79	259.28±28.12	0.03
VD	15.76±1.78	16.92±1.27	16.24±1.23	15.61±1.10	13.81±1.70	<0.001
PD	0.38±0.06	0.41±0.06	0.39±0.03	0.37±0.04	0.34±0.05	<0.001
FAZ-A	0.27±0.12	0.34±0.10	0.25±0.12	0.24±0.13	0.23±0.12	<0.001
FAZ-P	2.22±0.66	2.54±0.54	2.09±0.62	2.17±0.74	1.95±0.64	0.001
FAZ-CI	0.66±0.11	0.67±0.12	0.69±0.11	0.63±0.12	0.66±0.09	0.29

Table 3

Indice	Controlvs Mild NPDR	Controlvs Moderate NPDR	Controlvs Severe NPDR	Mildvs Modera NPDR	Mildvs Severe NPDR	Moderatevs Severe NPDR
CMT	0.110	0.170	0.0040	0.830	0.260	0.180
VD	0.040	<0.001	<0.001	0.100	<0.001	<0.001
PD	0.090	0.001	<0.001	0.140	<0.001	0.010
FAZ-A	0.003	0.001	<0.001	0.700	0.520	0.800
FAZ-P	0.010	0.020	<0.001	0.650	0.410	0.200

Table 4

Table 5

Indice related with NPDR development in OCTA measures

	Indice	Estimate	SE	Pvalue	95% CI
	Indice	Estimate	SE	Pvalue	Lower	Upper
Step 1	CMT	0.03	0.01	0.02	1.00	1.05
	VD	-0.60	0.26	0.02	0.33	0.92
	PD	-16.93	9.83	0.09	0.00	10.32
	FAZ-A	-4.14	5.25	0.43	0.00	463.35
	FAZ-P	-0.95	1.04	0.36	0.05	2.93
	Constant	14.36	4.96	0.004
Step 2	CMT	0.02	0.01	0.03	1.00	1.05
	VD	-0.95	0.22	<0.001	0.25	0.60
	FAZ-P	-1.40	0.49	0.001	0.11	0.58
	Constant	13.41	4.34	0.002

Table 5

	Characteristics	Estimate	SE	Pvalue	95% CI
Step1	CMT	0.02	0.01	0.01	0.01	0.04
VD	-0.79	0.21	<0.001	-1.21	-0.38
PD	-7.46	7.07	0.29	-21.32	6.40
FAZ-A	-3.66	3.85	0.34	-11.20	3.89
FAZ-P	-0.05	0.71	0.94	-1.43	1.33
Step 2	CMT	0.02	0.01	0.01	0.00	0.04
VD	-1.03	0.15	<0.001	-1.32	-0.73

Table 6

Characteristics	AUC	Pvalue	Best cutoff value
CMT	0.63	0.02	260.00	0.26	85.4%	40.7%
VD	0.78	<0.001	16.55	0.46	61.0%	85.2%
FAZ-P	0.70	<0.001	2.15	0.41	82.9%	58.0%
CMT+VD+FAZ-P (Predicted probability)	0.86	<0.001	54.1%	0.58	70.7%	87.7%

Table 7

Figure 4

Indice	CMT	VD	FAZ-P	CMT+VD+FAZ-P
CMT	-	-	-	-
VD	0.02	-	-	-
FAZ-P	0.26	0.23	-	-
CMT+VD+FAZ-P	<0.001	0.02	<0.001	-

Table 8

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