A Custom-Made Semiautomatic Analysis of Retinal Nonperfusion Areas After Dexamethasone for Diabetic Macular Edema

Lisa Toto; Rossella D'Aloisio; Antonio Maria Chiarelli; Luca Di Antonio; Federica Evangelista; Giada D'Onofrio; Arcangelo Merla; Mariacristina Parravano; Guido Di Marzio; Rodolfo Mastropasqua

doi:10.1167/tvst.9.7.13

A Custom-Made Semiautomatic Analysis of Retinal Nonperfusion Areas After Dexamethasone for Diabetic Macular Edema

Transl Vis Sci Technol. 2020 Jun 11;9(7):13. doi: 10.1167/tvst.9.7.13. eCollection 2020 Jun.

Affiliations

¹ Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, via dei Vestini 31, 66100, Italy.
² Department of Neuroscience, Imaging, and Clinical Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, via dei Vestini 31, 66100, Italy.
³ IRCCS - Fondazione Bietti, Rome, via Livenza 3, 00198, Italy.
⁴ Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Via del Pozzo 71, 41125, Italy.

Abstract

Purpose: To evaluate the changes of retinal capillary nonperfusion areas and retinal capillary vessel density of the superficial capillary plexus (SCP) and deep capillary plexus in patients with diabetes with diabetic macular edema treated with an intravitreal dexamethasone implant (IDI).

Methods: We enrolled 28 patients with diabetic retinopathy and diabetic macular edema candidates to IDI. All patients underwent widefield optical coherence tomography angiography with PLEX Elite 9000 device with 15 × 9 mm scans centered on the foveal center at baseline, 1 month, 2 months, and 4 months after IDI. In all the patients, the variation of the retinal capillary nonperfusion areas and of the retinal vessel density of the SCP and deep capillary plexus were calculated using an automatic software written in Matlab (MathWorks, Natick, MA).

Results: During follow-up, SCP showed a statistically significant reduction of ischemic areas at 1 month after IDI (P = 0.04) and slightly increased not significantly thereafter (P = 0.15). The percentage of nonperfusion areas changed from 11.4% at baseline, to 6.3% at 1 month, 8.1%, at 2 months, and 10.2% at 4 months. The whole vessel density of SCP slightly increased (not significantly) from 35.30% at baseline to 38.00% at 1 month, and then decreased to 37.85% at 2 months and 36.04% at 4 months (P = 0.29). Retinal capillary nonperfusion areas and retinal vessel density at the deep capillary plexus did not change significantly (P = 0.31 and P = 0.73, respectively).

Conclusions: Widefield optical coherence tomography angiography showed a decrease in retinal capillary nonperfusion areas after dexamethasone implant suggesting a possible drug-related reperfusion of retinal capillaries particularly evident in the early period.

Translational relevance: A custom-made automatic analysis of retinal nonperfusion areas may allow a better and precise evaluation of ischemic changes after intravitreal therapy.

Keywords: diabetic macular edema; intravitreal dexamethasone implant; retinal nonperfusion areas; widefield OCT angiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Dexamethasone / therapeutic use
Diabetes Mellitus*
Diabetic Retinopathy* / diagnostic imaging
Humans
Macular Edema* / drug therapy
Retinal Vessels / diagnostic imaging
Tomography, Optical Coherence

Substances

Dexamethasone