NOVEL THREE TYPES OF NEOVASCULARIZATION ELSEWHERE DETERMINE THE DIFFERENTIAL CLINICAL FEATURES OF PROLIFERATIVE DIABETIC RETINOPATHY

VASCULAR CHANGES AND IRREVERSIBLE COMPLICATIONS IN 120° FUNDUS USING WIDEFIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN VOGT-KOYANAGI-HARADA DISEASE

PURPOSE

To characterize the changes in fundus corresponding to 120° field of view in chronic Vogt-Koyanagi-Harada disease in the quiescent phase and explore the associations with irreversible complications in the fundus using widefield swept-source optical coherence tomography angiography.

METHODS

Prospective cross-sectional study. Sixty-nine patients with chronic Vogt-Koyanagi-Harada disease (115 eyes) and 55 healthy control subjects (110 eyes) were included and underwent widefield swept-source optical coherence tomography angiography. Univariate analyses of variations in retinal and choroidal vessel density (VD), choroidal volume, and choroidal vascularity index in patients with Vogt-Koyanagi-Harada with different disease durations and the control subjects were conducted. Logistic regression analysis was used to identify the associations with irreversible complications, including choroidal neovascularization, vasoproliferative tumor of the retina, and chorioretinal atrophy.

RESULTS

The Welch analysis of variance showed lower VD of superficial retina, deep retina, choriocapillaris, and large-sized and medium-sized vessels of the choroid, and choroidal volume and choroidal vascularity index in the patients with disease duration of >24 months compared with those with disease duration of ≤24 months (all P ≤ 0.011). The regression analysis revealed that the disease duration ( P = 0.008; OR = 1.02, 95% CI, 1.005-1.035) and VD of large-sized and medium-sized vessels of the choroid ( P = 0.001; OR = 0.707, 95% CI, 0.575-0.87) were significantly correlated with the irreversible complications.

CONCLUSION

Patients with chronic Vogt-Koyanagi-Harada in the quiescent phase with disease duration of >24 months exhibit more severe decreased VD in each layer of the retina and choroid, reduced choroidal volume, and sparse choroidal vascularity compared with those with disease duration ≤24 months. Prolonged duration and decreased VD of large-sized and medium-sized vessels of the choroid were associated with irreversible complications in the fundus.

Early Sign of Retinal Neovascularization Evolution in Diabetic Retinopathy: A Longitudinal OCT Angiography Study

Purpose

To assess whether the combination of en face OCT and OCT angiography (OCTA) can capture observable, but subtle, structural changes that precede clinically evident retinal neovascularization (RNV) in eyes with diabetic retinopathy (DR).

Design

Retrospective, longitudinal study.

Participants

Patients with DR that had at least 2 visits.

Methods

We obtained wide-field OCTA scans of 1 eye from each participant and generated en face OCT, en face OCTA, and cross-sectional OCTA. We identified eyes with RNV sprouts, defined as epiretinal hyperreflective materials on en face OCT with flow signals breaching the internal limiting membrane on the cross-sectional OCTA without recognizable RNV on en face OCTA and RNV fronds, defined as recognizable abnormal vascular structures on the en face OCTA. We examined the corresponding location from follow-up or previous visits for the presence or progression of the RNV.

Main Outcome Measures

The characteristics and longitudinal observation of early signs of RNV.

Results

From 71 eyes, we identified RNV in 20 eyes with the combination of OCT and OCTA, of which 13 (65%) were photographically graded as proliferative DR, 6 (30%) severe nonproliferative DR, and 1 (5%) moderate nonproliferative diabetic retinopathy. From these eyes, we identified 38 RNV sprouts and 26 RNV fronds at the baseline. Thirty-four RNVs (53%) originated from veins, 24 (38%) were from intraretinal microabnormalities, and 6 (9%) were from a nondilated capillary bed. At the final visit, 53 RNV sprouts and 30 RNV fronds were detected. Ten eyes (50%) showed progression, defined as having a new RNV lesion or the development of an RNV frond from an RNV sprout. Four (11%) RNV sprouts developed into RNV fronds with a mean interval of 7.0 months. Nineteen new RNV sprouts developed during the follow-up, whereas no new RNV frond was observed outside an identified RNV sprout. The eyes with progression were of younger age (P = 0.014) and tended to be treatment naive (P = 0.07) compared with eyes without progression.

Conclusions

Longitudinal observation demonstrated that a combination of en face OCT and cross-sectional OCTA can identify an earlier form of RNV before it can be recognized on en face OCTA.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.