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Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema

Received: 31 December 2021     Accepted: 19 January 2022     Published: 25 January 2022
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Abstract

Background: Evaluating Foveal avascular zone by OCTA (Optical Coherence Tomography angiography) in diabetic patients, has a crucial role in early detection of pathophhsiological changes affecting the macular area, and has a pedective value for early retinal neuro degenerative changes. Materials and experiments: Aim: To evaluate dimensions of Foveal Avascular Zone (FAZ) at level of superficial and deep capillary plexuses (SCP/DCP) in patients with different grades of non proliferative diabetic retinopathy without Diabetic Macular Edema (DME) using OCTA. Eighty type II diabetes mellitus patients and 20 healthy control, ecxluding proliferative diabetic retinopathy and DME. Divided to four groups according to ETDRS Classification. All undewent: measurement of glycosylated hemoglobin level, standard Structural OCT for the macula and optic nerve head with OCTA for evaluation of FAZ in both SCP and DCP networks of all eyes using (Heidelberg engineering, OCT spectralis, Germany) (SD-OCT). Results: Mean FAZ in SCP in control group (0.32 ± 0.12) mm2 versus (0.44 ± 0.17) mm2 in patients` group, while FAZ IN DCP (0.23) mm2 ± 0.12 in controls versus (0.34 ± 0.16) mm2 in patients. There was a statistically significant wider FAZ in DR patients (P-value 0.003). Conclusion: Enlargement of FAZ in SCP and DCP in patients with moderate to severe NPDR without DME was detected using OCTA, Preceeded by reduction in thickness of ORL and GCC layer. This can be used to monitor the progression of the disease and to evaluate the response to treatment.

Published in International Journal of Ophthalmology & Visual Science (Volume 7, Issue 1)
DOI 10.11648/j.ijovs.20220701.12
Page(s) 6-13
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Diabetic Retinopathy, Foveal Avascular Zone, Optical Coherence Tomography Angiography

References
[1] World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.
[2] Engelgau MM, Geiss LS, Saaddine JB, et al. The evolving diabetes burden in the United States. Ann Intern Med. 2004; 140 (11): 945–50.
[3] Fong DS, Aiello L, Gardner TW, et al. Diabetic retinopathy. Diabetes Care. 2003; 26 (suppl 1): s99–s102.
[4] Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy systematic review. JAMA. 2007; 298 (8): 902–16.
[5] Saari JM, Summanen P, Kivelä T, Saari KM. Sensitivity, and specificity of digital retinal images in grading diabetic retinopathy. Acta Ophthalmic Scand. 2004; 82 (2): 126–30.
[6] Goh JK, Cheung CY, Sim SS, et al. Retinal imaging techniques for diabetic retinopathy screening. J Diabetes Sci Technol. 2016; 10 (2): 282–94.
[7] D’Aloisio R, Giglio R, Di Nicola M, De Giacinto C, Pastore MR, Tognetti D, et al. Diagnostic accuracy of digital retinal fundus image analysis in detecting diabetic maculopathy in type 2 diabetes mellitus. Ophthalmic Res. 2019; 61 (2): 100–6.
[8] Youngquist RC, Carr S, Davies DE. Optical coherence-domain reflectometry: a new optical evaluation technique. opt Lett. 1987; 12 (3): 158–60.
[9] Virgili G, Menchini F, Casazza G, et al. Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy. Cochrane Database Syst Rev. 2015; 1: CD008081.
[10] Sim DA, Keane PA, Fung S, et al. Quantitative analysis of diabetic macular ischemia using optical coherence tomographic features of diabetic macular ischemia. Invest Ophthalmic Vis Sci. 2014; 55 (1): 417–23.
[11] Fingler J, Readhead C, Schwartz DM, Fraser SE. Phase-contrast OCT imaging of transverse flows in the mouse retina and choroid. Invest Ophthalmic Vis Sci. 2008; 49 (11): 5055–9.
[12] Hagag AM, Gao SS, Jia Y, Huang D. Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology. Taiwan J Ophthalmic. 2017; 7 (3): 115–29.
[13] Ang M, Tan ACS, Cheung CMG, et al. Optical coherence tomography angiography: a review of current and future clinical applications. Graefe's Arch Clin Exp Ophthalmic. 2018; 256 (2): 237–45.
[14] Agarwal A, Grewal DS, Jaffe GJ, et al. Current role of optical coherence tomography angiography: Expert panel discussion. Indian J Ophthalmic. 2018; 66 (12): 1696–9.
[15] Tan ACS, Tan GS, Denniston AK, et al. An overview of the clinical applications of optical coherence tomography angiography. Eye (Lond). 2018; 32 (2): 262–86.
[16] Bresnick G H, Condit R, Syrjala S, et al. Abnormalities of the foveal avascular zone in diabetic retinopathy. Arch Ophthalmic 1984; 102 (9): 1286-1293.
[17] Hwang TS, Jia Y, Gao SS, et al. Optical coherence tomography angiography features of diabetic retinopathy. Retina 2015; 35 (11): 2371–2376.
[18] Gao W, Tátrai E, Ölvedy V, et al. Investigation of changes in thickness and reflectivity from layered retinal structures of healthy and diabetic eyes with optical coherence tomography. J Biomed SciEng 2011; 4: 657-665.
[19] Freiberg FJ, Pfau M, Wons J, et al. Optical coherence tomography angiography of the foveal avascular zone in diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol 2016; 254 (6): 1051-1058.
[20] Samara W A, Shahlaee A, Adam M K, et al. Quantification of diabetic macular ischemia using optical coherence tomography angiography and its relationship with visual acuity. Ophthalmology 2017; 124 (2): 235-244.
[21] Tang F Y, Ng D S, Lam A, et al. Determinants of quantitative optical coherence tomography angiography metrics in patients with diabetes. Sci Rep 2017; 7 (1): 2575.
[22] Vujosevic S, Midena E. Retinal layers changes in human preclinical and early clinical diabetic retinopathy support early retinal neuronal and Müller cells alterations. J Diabetes Res 2013; 2013: 905058.
[23] Pekel E, Altıncık SA, Pekel G. Evaluation of optic disc, retinal nerve fiber and macular ganglion cell layers in pediatric diabetes. Int Ophthalmol 2018; 38 (5): 1955-1961.
[24] DeBuc DC, Somfai, GM. Early detection of retinal thickness changes in diabetes using optical coherence tomography. Med SciMonit 2010; 16 (3): 15-21.
[25] Fernández DC, Somfai GM, Tátrai E, et al. Potentiality of intraretinal layer segmentation to locally detect early retinal changes in patients with diabetes mellitus using optical coherence tomography. Invest Ophthalmol Vis Sci 2008; 49 (13): 2751-2751.
[26] Wang X N, Li ST, Li W, et al. The thickness and volume of the choroid, outer retinal layers, and retinal pigment epithelium layer changes in patients with diabetic retinopathy. Int J Ophthalmol 2018; 11 (12): 1957–1962.
[27] Sohn E H, van Dijk H W, Jiao C, Kok P H, et al. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc Natl Acad Sci 2016; 113 (19): 2655-2664.
Cite This Article
  • APA Style

    Mohamed M. Halfawy, Abelrahman Gaber Salman, Azza M. A. Said, Tarek El Beltagi, Marwa A. Karim. (2022). Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema. International Journal of Ophthalmology & Visual Science, 7(1), 6-13. https://doi.org/10.11648/j.ijovs.20220701.12

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    ACS Style

    Mohamed M. Halfawy; Abelrahman Gaber Salman; Azza M. A. Said; Tarek El Beltagi; Marwa A. Karim. Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema. Int. J. Ophthalmol. Vis. Sci. 2022, 7(1), 6-13. doi: 10.11648/j.ijovs.20220701.12

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    AMA Style

    Mohamed M. Halfawy, Abelrahman Gaber Salman, Azza M. A. Said, Tarek El Beltagi, Marwa A. Karim. Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema. Int J Ophthalmol Vis Sci. 2022;7(1):6-13. doi: 10.11648/j.ijovs.20220701.12

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  • @article{10.11648/j.ijovs.20220701.12,
      author = {Mohamed M. Halfawy and Abelrahman Gaber Salman and Azza M. A. Said and Tarek El Beltagi and Marwa A. Karim},
      title = {Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {7},
      number = {1},
      pages = {6-13},
      doi = {10.11648/j.ijovs.20220701.12},
      url = {https://doi.org/10.11648/j.ijovs.20220701.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20220701.12},
      abstract = {Background: Evaluating Foveal avascular zone by OCTA (Optical Coherence Tomography angiography) in diabetic patients, has a crucial role in early detection of pathophhsiological changes affecting the macular area, and has a pedective value for early retinal neuro degenerative changes. Materials and experiments: Aim: To evaluate dimensions of Foveal Avascular Zone (FAZ) at level of superficial and deep capillary plexuses (SCP/DCP) in patients with different grades of non proliferative diabetic retinopathy without Diabetic Macular Edema (DME) using OCTA. Eighty type II diabetes mellitus patients and 20 healthy control, ecxluding proliferative diabetic retinopathy and DME. Divided to four groups according to ETDRS Classification. All undewent: measurement of glycosylated hemoglobin level, standard Structural OCT for the macula and optic nerve head with OCTA for evaluation of FAZ in both SCP and DCP networks of all eyes using (Heidelberg engineering, OCT spectralis, Germany) (SD-OCT). Results: Mean FAZ in SCP in control group (0.32 ± 0.12) mm2 versus (0.44 ± 0.17) mm2 in patients` group, while FAZ IN DCP (0.23) mm2 ± 0.12 in controls versus (0.34 ± 0.16) mm2 in patients. There was a statistically significant wider FAZ in DR patients (P-value 0.003). Conclusion: Enlargement of FAZ in SCP and DCP in patients with moderate to severe NPDR without DME was detected using OCTA, Preceeded by reduction in thickness of ORL and GCC layer. This can be used to monitor the progression of the disease and to evaluate the response to treatment.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema
    AU  - Mohamed M. Halfawy
    AU  - Abelrahman Gaber Salman
    AU  - Azza M. A. Said
    AU  - Tarek El Beltagi
    AU  - Marwa A. Karim
    Y1  - 2022/01/25
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ijovs.20220701.12
    DO  - 10.11648/j.ijovs.20220701.12
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 6
    EP  - 13
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20220701.12
    AB  - Background: Evaluating Foveal avascular zone by OCTA (Optical Coherence Tomography angiography) in diabetic patients, has a crucial role in early detection of pathophhsiological changes affecting the macular area, and has a pedective value for early retinal neuro degenerative changes. Materials and experiments: Aim: To evaluate dimensions of Foveal Avascular Zone (FAZ) at level of superficial and deep capillary plexuses (SCP/DCP) in patients with different grades of non proliferative diabetic retinopathy without Diabetic Macular Edema (DME) using OCTA. Eighty type II diabetes mellitus patients and 20 healthy control, ecxluding proliferative diabetic retinopathy and DME. Divided to four groups according to ETDRS Classification. All undewent: measurement of glycosylated hemoglobin level, standard Structural OCT for the macula and optic nerve head with OCTA for evaluation of FAZ in both SCP and DCP networks of all eyes using (Heidelberg engineering, OCT spectralis, Germany) (SD-OCT). Results: Mean FAZ in SCP in control group (0.32 ± 0.12) mm2 versus (0.44 ± 0.17) mm2 in patients` group, while FAZ IN DCP (0.23) mm2 ± 0.12 in controls versus (0.34 ± 0.16) mm2 in patients. There was a statistically significant wider FAZ in DR patients (P-value 0.003). Conclusion: Enlargement of FAZ in SCP and DCP in patients with moderate to severe NPDR without DME was detected using OCTA, Preceeded by reduction in thickness of ORL and GCC layer. This can be used to monitor the progression of the disease and to evaluate the response to treatment.
    VL  - 7
    IS  - 1
    ER  - 

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Author Information
  • Faculty of Medicine, Ain Shams University, Cairo, Egypt

  • Faculty of Medicine, Ain Shams University, Cairo, Egypt

  • Faculty of Medicine, Ain Shams University, Cairo, Egypt

  • Research Institute of Ophthalmology, Giza, Egypt

  • Faculty of Medicine, Ain Shams University, Cairo, Egypt

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