Is OCT-A Needed As An Investigative Tool During The Management Of Diabetic Macular Edema

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Brandon Armstrong
5 years ago
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MD, FRCS Professor of Ophthalmology Cairo University

(DME), a major cause of visual impairment in diabetic

1 Is OCT-A Needed As An Investigative Tool During The Management Of Diabetic Macular Edema Ayman M Khattab MD, FRCS Professor of Ophthalmology Cairo University Diabetic Macular Edema (DME) Diabetic macular edema (DME), a major cause of visual impairment in diabetic patients. Accounting for about three-fourths of cases of visual loss. 1

2 Slit Lamp Biomocroscopy Detects 80% of local areas of thickening. Failed to detect locations with average thickness 1.5 times the normal. 2

Detects vascular leakage in qualitative rather than quantitative manner.

3 Fluorescein Angiography FA is the gold standard in retinal imaging due to the capacity to visualize the retinal capillary bed and its changes, both in the macular area and in the periphery. FA is an invasive test. Detects vascular leakage in qualitative rather than quantitative manner. Not all the different layers of the retinal capillary network could be visualized ( only the superficial one). Fluorescein Angiography Early phase late phase 3

4 Focal Edema diffuse Edema cystoid Edema Wide field FA NV Ischaemic maculopathy Optical coherence tomography (OCT) Non-invasive imaging technique visualize structural features of DME including hard exudates, intraretinal or subretinal fluid accumulation. 4

5 OCT pattern of DME Optical coherence tomography (OCT) Visualize abnormalities of the vitreomacular interface. 5

6 Optical coherence tomography (OCT) Macular thickness may be automatically and reproducibly quantified which is useful in monitoring response to various therapies for DME Do we need more imaging tools for evaluation of DME? 6

Optical Coherence Tomography Angiography (OCT-A) A new method of non-invasive examination, which allows the visualization of the entire retinal and choroidal vasculature in a depth-resolved manner.

7 Optical Coherence Tomography Angiography (OCT-A) A new method of non-invasive examination, which allows the visualization of the entire retinal and choroidal vasculature in a depth-resolved manner. Easily repeatable technique that does not require dye injection. Can detect MAs, NVD, areas of retinal nonperfusion, an enlarged FAZ, vascular loops, intraretinal microvascular abnormalities, and some forms of intraretinal fluid, and it allows for observation of the capillary layers of the retina. Optical Coherence Tomography Angiography (OCT-A) 7

8 Diabetic Macular Edema Superficial capillary plexus Deep capillary plexus Diabetic Macular Edema Mild and Moderate NPDR with ME 8

alternative to traditional FA OCT angiograms from deep

9 Diabetic Macular Edema Severe NPDR with ME OCT-A enables visualization of MA and the FAZ emerging as an alternative to traditional FA OCT angiograms from deep plexus can better identify microaneurysms compared to FA. 9

10 Macular ischemia Moderate macular ischemia severe macular ischemia 10

Macular ischemia Severe ischemia To quantify foveal avascular zone (FAZ) area and macular vascular density objectively and to examine correlations with visual acuity Decreasing

11 Macular ischemia Severe ischemia To quantify foveal avascular zone (FAZ) area and macular vascular density objectively and to examine correlations with visual acuity Decreasing vascular density and enlargement of FAZ area of both SCP and DCP are associated with worse VA The DCP FAZ area correlation with VA was stronger when compared with superficial FAZ area 11

12 Can OCTA be a useful diagnostic tool for predicting the treatment response to anti-vegf agents? To investigate the structural integrity of the SCP and DCP using OCTA in patients with DME and its association with the response to antivegf treatment. Good responder to anti-vegf treatment (reduction of > 50 µm CMT) Poor responder to anti-vegf treatment (reduction of < 50 µm CMT) After 3 consecutive anti-vegf treatments 12

Poor responder DME eyes showed a significantly lower flow density,

DCP. The integrity of the DCP is important not only for the

agents The extent of DCP loss assessed by OCTA could be a useful

13 Poor responder DME eyes showed a significantly lower flow density, larger number of microaneurysms, and larger area of the FAZ in the DCP. The integrity of the DCP is important not only for the occurrence of DME but also for the treatment response to anti-vegf agents The extent of DCP loss assessed by OCTA could be a useful diagnostic tool for predicting the treatment response to anti-vegf agents 13

14 conclusion OCT-A imaging offers a new insight in DME pathogenesis It is a non invasive imaging tool and can be repeated. OCT-A imaging could quantify macular non perfusion objectively in the SCP and DCP. The integrity of the DCP detected by OCT-A imaging could be a predicting factor for the treatment response to anti VEGF. OCT-A imaging can be a useful tool to be added in the management of DME. Thank You 14

OCT Assessment of the Vitreoretinal Relationship in CSME

December 2007 Sonia Rani John et al. - IFIS 375 ORIGINAL ARTICLE OCT Assessment of the Vitreoretinal Relationship in CSME Dr. Manoj S. DNB FRCS, Dr. Unnikrishnan Nair MS DO FRCS, Dr. Gargi Sathish MS Introduction