Macular capillary displacement in exudative and tractional macular oedema: a multimodal imaging study and pathophysiological hypothesis

Graefes Arch Clin Exp Ophthalmol. 2021 Dec;259(12):3675-3685. doi: 10.1007/s00417-021-05289-8. Epub 2021 Jul 8.

Abstract

Purpose: This study aims to describe vessel density differences in tractional versus exudative macular oedema with the aid of novel custom imaging analysis techniques.

Methods: In this retrospective study, patients with exudative and tractional macular oedema were imaged with optical coherence tomography (OCT), en-face OCT, OCT-angiography and fluorescein angiography. A novel image processing algorithm was developed to extrapolate data from the vessel density maps.

Results: Forty-one eyes of 36 patients were included. A total of 30 control eyes comprised the control group. At the deep capillary plexus (DCP), exudative eyes presented with a vessel density of 62.12 ± 5.7, significantly higher if compared to both tractional lamellar macular hole (57.6 ± 4.6, p = 0.004) and controls (52.07 ± 2.3, p < 0.001). At the superficial capillary plexus (SCP), there were no differences in vessel density between exudative eyes (51.9 ± 4.4) and both the tractional lamellar hole (54.9 ± 3.1, p = 0.083) and the control (51.72 ± 2.2, p = 0.083) groups. In the exudative subgroup, there was a direct correlation between areas of low flow and those of high flow at both the DCP and SCP (p = 0.001 and p = 0.042, respectively).

Conclusions: Intraretinal expansion of fluid may cause the displacement of the surrounding retinal parenchyma and capillaries.

Keywords: Cystoid macular oedema; Cystoid spaces; Optical coherence tomography angiography; Vessel density.

MeSH terms

  • Capillaries
  • Fluorescein Angiography
  • Humans
  • Macular Edema* / diagnosis
  • Macular Edema* / etiology
  • Multimodal Imaging
  • Retinal Vessels / diagnostic imaging
  • Retrospective Studies
  • Tomography, Optical Coherence