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Optical coherence tomography angiography in proliferative diabetic retinopathy
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Introdução: A retinopatia diabética (RD) é a principal causa de cegueira em indivíduos em idade ativa. As principais técnicas utilizadas para avaliar a RD e a retinopatia diabética proliferativa (RDP) são a angiografia fluoresceínica (AF) e a tomografia de coerência ótica (OCT). A OCT é uma técnica não invasiva usada clinicamente para diagnosticar e monitorizar alterações estruturais na RD. Recentemente foi desenvolvida uma nova técnica de OCT, a tomografia de coerência ótica angiográfica (OCT-A), que permite a avaliação do fluxo dos complexos neovasculares (NVC) e a criação de um mapa vascular ao nível da microcirculação. Este estudo tem como objetivo a descrição das características da RDP utilizando OCT-A. Métodos: Estudo retrospetivo de 23 olhos de 21 doentes com RDP que foram submetidos a OCT-A para avaliação de NVCs. As imagens foram adquiridas durante a observação clínica de rotina com o OCT-A DRI Triton Swept-Source, Avanti RTVue XR e Cirrus HD-OCT 5000. A segmentação foi ajustada para incluir a vascularização entre a cavidade vítrea e a membrana limitante interna (MLI). A presença de NVC foi confirmada por observação clínica, retinografia e/ou por AF. Resultados: Foram identificados 35 NVCs, correspondentes em 34.3% dos casos a neovascularização do disco (NVD) e em 65.7% a neovascularização elsewhere (NVE). Os NVE foram identificados no OCT estrutural como tecido de média ou alta refletividade que penetrava a MLI e os NVD como tecido sobre ao disco ou fazendo protusão do disco com configuração em “sea fan”. A OCT-A mostrou fluxo em todos os NVE e em 66.7% dos NVD, de acordo com atividade neovascular. Áreas sem fluxo ou com escassos capilares, interpretadas como não perfusão capilar, foram identificadas adjacentes a 87.0% dos NVE. Anomalias microvasculares intrarretinianas (IRMAs) foram encontradas próximo de 69.6% dos NVE. Verificou-se ausência de fluxo em 4 NVD, todos eles com cone de sombra posterior associado e considerados inativos. Conclusões: A OCT-A é uma técnica de imagem recente que é útil na RDP para avaliar NVCs, IRMAs e áreas de não perfusão. Como tal, tem um papel promissor no diagnóstico, monitorização e orientação terapêutica da RDP.
Introduction: Diabetic retinopathy (DR) is the leading cause of blindness in the working population. The most relevant imaging techniques used to evaluate DR and proliferative diabetic retinopathy (PDR) are fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). OCT is a non-invasive technique that has been used clinically to diagnose and monitor structural changes in DR. Recently, a new OCT technique was developed, optical coherence tomography angiography (OCT-A), which allows to evaluate the flow of the new vessels complexes (NVC) and to create a vascular mapping at the microcirculation level. This study aims to describe features of neovascularization in PDR using OCT-A. Methods: Retrospective case series of 23 eyes from 21 patients who underwent OCT-A of NVCs due to PDR. Eye were imaged with DRI Triton Swept-Source OCT-A, Avanti RTVue XR and Cirrus HD-OCT 5000 as part of routine clinical examination. Segmentation was adjusted to include vasculature between the vitreous cavity and the inner limiting membrane. The presence of NVC was confirmed by clinical examination, color or red-free fundus photograph and/or FFA. Results: Thirty-five NVCs were imaged, of which, 34.3% were neovascularization of the disc (NVD) and 65.7% were neovascularization elsewhere. NVC were identified in the structural OCT as medium to highly reflective tissue that breached the ILM in all cases of NVE and as tissue sitting above or protruding from the disc in a sea fan configuration in NVD. OCT-A showed flow in all NVE and in 66.7% of NVD, in agreement with neovascular activity. Areas with absent flow or sparse of capillaries, interpreted as capillary non-perfusion, were identified adjacent to 87.0% of NVE and intrarretinal microvascular abnormalities were noted next to 69.6% of NVE. Flow was absent in 4 NVD, all with posterior shadowing and considered inactive. Conclusions: OCT-A is a recent image technique useful to evaluate NVCs, IRMAs and non-perfusion areas. It showed a promising role in the screening, monitoring and treatment management of PDR.
Introduction: Diabetic retinopathy (DR) is the leading cause of blindness in the working population. The most relevant imaging techniques used to evaluate DR and proliferative diabetic retinopathy (PDR) are fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). OCT is a non-invasive technique that has been used clinically to diagnose and monitor structural changes in DR. Recently, a new OCT technique was developed, optical coherence tomography angiography (OCT-A), which allows to evaluate the flow of the new vessels complexes (NVC) and to create a vascular mapping at the microcirculation level. This study aims to describe features of neovascularization in PDR using OCT-A. Methods: Retrospective case series of 23 eyes from 21 patients who underwent OCT-A of NVCs due to PDR. Eye were imaged with DRI Triton Swept-Source OCT-A, Avanti RTVue XR and Cirrus HD-OCT 5000 as part of routine clinical examination. Segmentation was adjusted to include vasculature between the vitreous cavity and the inner limiting membrane. The presence of NVC was confirmed by clinical examination, color or red-free fundus photograph and/or FFA. Results: Thirty-five NVCs were imaged, of which, 34.3% were neovascularization of the disc (NVD) and 65.7% were neovascularization elsewhere. NVC were identified in the structural OCT as medium to highly reflective tissue that breached the ILM in all cases of NVE and as tissue sitting above or protruding from the disc in a sea fan configuration in NVD. OCT-A showed flow in all NVE and in 66.7% of NVD, in agreement with neovascular activity. Areas with absent flow or sparse of capillaries, interpreted as capillary non-perfusion, were identified adjacent to 87.0% of NVE and intrarretinal microvascular abnormalities were noted next to 69.6% of NVE. Flow was absent in 4 NVD, all with posterior shadowing and considered inactive. Conclusions: OCT-A is a recent image technique useful to evaluate NVCs, IRMAs and non-perfusion areas. It showed a promising role in the screening, monitoring and treatment management of PDR.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Diabetes mellitus Retinopatia diabética proliferativa Neovascularização Tomografia de coerência ótica angiográfica Oftalmologia