Abstract
Background
Retinal microaneurysms (MAs) are among the earliest signs of diabetic retinopathy (DR) and can be classified in several subtypes by non-invasive multimodal retinal imaging. The main aim of the present study is to characterize retinal MAs perfusion properties and their blood flow network connectivity by means of Dense Automatic-RealTime (DART) OCTA technology, checking the relationship with the multimodal retinal imaging classification and testing the clinical impact of DART.
Methods
A cross-sectional, observational study setting was chosen. Multimodal retinal imaging included confocal multicolour, OCT, OCTA and DART OCTA. We classified retinal MAs accordingly with the recently proposed multimodal retinal imaging classification and we tested the role of DART OCTA for detecting retinal MAs blood flow network connectivity. We also tested the relationship with clinical parameters.
Results
We included 206 retinal MAs of 36 DR eyes. We categorized retinal MAs as red (70; 34%), mixed (106; 51%) and green (30; 15%), corresponding to precise characteristics on structural OCT and both (regular) enface and DART OCTA images. The agreement between en-face and DART OCTA techniques for detecting MAs perfusion was very high (overall ICC 0.98; p < 0.01). However, DART OCTA provided clearer visualization than enface OCTA for detecting the blood flow network connectivity of retinal MAs, especially looking at the afferent and efferent MAs capillaries. Multimodal retinal imaging classification of retinal MAs provided significant correlations with DR duration, DR stage, and macular capillary non-perfusion.
Conclusions
DART OCTA provided several new insights on retinal MAs characteristics and their blood flow network connectivity.
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Data availability
Data are available after formal request to the corresponding author.
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Funding
Francesco Bandello consultant for: Alcon (Fort Worth, Texas, USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc (Irvine, California, USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch And Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), NovagaliPharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee, Belgium), Zeiss (Dublin, USA). Michel Teussink is employee of Heidelberg Engineering GmbH. All other authors have no disclosures to declare.
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Alessandro Arrigo and Emanuela Aragona: study design, data collection, data analysis, data interpretation, manuscript drafting. Michel Teussink and Maurizio Battaglia Parodi: data collection, data analysis, data interpretation, manuscript revision. Francesco Bandello: guarantee of the integrity of the research, data analysis, data interpretation, manuscript revision.
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Arrigo, A., Aragona, E., Teussink, M. et al. Digital histology of retinal microaneurysms as provided by dense B-scan (DART) OCTA: characteristics and clinical relevance in diabetic retinopathy. Eye 38, 3108–3112 (2024). https://doi.org/10.1038/s41433-024-03230-x
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DOI: https://doi.org/10.1038/s41433-024-03230-x
