OSLI Retina

August 2019

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474 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Widefield Swept-Source Optical Coherence Tomography Angiography of Proliferative Diabetic Retinopathy Elie H. Motulsky, MD, PhD; Guanghui Liu, MD, PhD; Yingying Shi, MD; Fang Zheng, MD; Harry W. Flynn Jr., MD; Giovanni Gregori, PhD; Philip J. Rosenfeld, MD, PhD BACKGROUND AND OBJECTIVE: To demonstrate the utility of widefield swept-source optical coherence tomography angiography (SS-OCTA) for the di- agnosis and management of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Consecutive patients with vision-threatening diabetic retinopathy were im- aged with widefield SS-OCTA using the 12 mm × 12 mm scan pattern. RESULTS: Twenty-four eyes of 12 patients under- went SS-OCTA imaging. In all 24 eyes, the en face total retinal flow images detected areas of decreased retinal perfusion, and the en face vitreoretinal in- terface (VRI) slabs detected foci of retinal neovas- cularization (NV). NV was treated and followed us- ing the VRI images. CONCLUSIONS: Widefield SS-OCTA is a useful, noninvasive technology for the detection and mon- itoring of NV in PDR. Features of interest, such as areas of decreased retinal perfusion, increased reti- nal thickness, and NV, can be identified from dif- ferent en face slabs extracted from a single 12 mm × 12 mm scan. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:474-484.] INTRODUCTION Diabetic retinopathy (DR) is a major cause of pre- ventable blindness among working-age adults around the world. 1 About a third of diabetic patients have vision-threatening DR, which is defined as severe, nonproliferative DR or proliferative DR (PDR) or the presence of diabetic macular edema (DME). 2 PDR is characterized by the growth of retinal neovascular- ization (NV). 3 Retinal NV of the optic disc (NVD) or elsewhere (NVE) can dramatically impact vision by causing vitreous hemorrhages or tractional retinal de- tachments. 4 Both NVDs and NVEs appear on fundus biomicroscopy as irregular vascular networks either along the retinal surface or protruding into the vitre- ous cavity. Although the clinical examination remains an im- portant component for the staging of DR, fluorescein angiography (FA) is the gold standard for the diag- nosis and monitoring of PDR. 5 Some might advocate that FA is expensive, time-consuming, requires a trained photographer, involves uncomfortable bright lights, and requires the intravenous injection of a flu- orescent dye that can be associated with nausea and vomiting, along with the much rarer complications of anaphylaxis and even death. 6 Due to all these disad- vantages, FA is not usually repeated at all clinical vis- its. Moreover, FA is not a suitable screening tool for the growing diabetic population worldwide, which likely results in an under-reporting of PDR. 7 From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami (EHM, GL, YS, FZ, HWFJ, GG, PJR); and the Department of Ophthalmology, Affiliated People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, P.R. China (GL). Originally submitted July 12, 2018. Revision received October 14, 2018. Accepted for publication January 17, 2019. Supported by grants from Carl Zeiss Meditec (Dublin, CA), the Salah Foundation, the National Eye Institute Center Core Grant (P30EY014801), and a Research to Prevent Blindness Unrestricted Grant to the Department of Ophthalmology, University of Miami Miller School of Medicine. Dr. Liu was supported by the Scholarship of Fujian Province for Studying Abroad in 2015. Drs. Gregori and Rosenfeld received research support from Carl Zeiss Meditec. Dr. Gregori and the University of Miami co-own a patent that is licensed to Carl Zeiss Meditec. Dr. Rosenfeld has also received additional research support from Genentech and Tyrogenex. He is a consultant for Achillion Pharmaceuticals, Acucela, Boehringer-Ingelheim, Carl Zeiss Meditec, Chengdu Kanghong Biotech, Ocunexus Therapeutics, Genentech, Healios K.K, Hemera Biosciences, F. Hoffmann-La Roche Ltd., Isarna Pharmaceuticals, Lin Bioscience, MacRegen, NGM Biopharmaceuticals, Ocunexus, Ocudyne, Tyrogenex, and Unity Biotechnology, and has equity interest in Apellis, Digisight, and Ocudyne. Dr. Flynn is a DRCR Network Data and Safety Monitoring Committee member; opinions expressed are his own and are not representative of DRCR-Net. The remaining authors report no relevant financial disclosures. Address correspondence to Philip J. Rosenfeld, MD, PhD, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136; email: prosenfeld@miami.edu. doi: 10.3928/23258160-20190806-01

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