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Diabetic foveal neovascularization is associated with diminished subfoveal choroidal flow on optical coherence tomography angiography

Eye volume 39, pages 2169–2175 (2025)Cite this article

Subjects

Abstract

Objective

To evaluate the role of retinal and choriocapillaris blood flow in the development of diabetic foveal neovascularization (DFN) using optical coherence tomography angiography (OCTA).

Methods

Eyes with proliferative diabetic retinopathy (PDR) and DFN underwent OCTA imaging; defined as surface retinal neovascularization within the central foveal 1 mm diameter circle. 3 × 3 and 6 × 6 mm2 choriocapillaris and superficial and deep retinal capillary plexus (SCP and DCP) slabs were extracted to evaluate adjusted flow index (AFI) as a surrogate for blood flow. For choriocapillaris flow; total, subfoveal and extrafoveal AFI were assessed, while only total AFI was calculated for SCP and DCP. These findings were compared to healthy controls and eyes with PDR with no DFN.

Results

18 eyes of 18 patients were included in each of the 3 groups: healthy controls, PDR with and without DFN. Choriocapillaris AFI was significantly lower in PDR with DFN than healthy controls in all but the 6 × 6 mm2 extrafoveal AFI (p < 0.01). PDR with DFN also showed a lower AFI compared to eyes without DFN, but only in the 3 × 3 mm2 total and subfoveal AFI (p = 0.01). SCP and DCP AFI were not statistically significant.

Conclusions

Our findings suggest that choroidal hypoperfusion may be a potential driving factor for the development of DFN. The detection of these changes in the smaller scans of the total and subfoveal areas suggests a rather exaggerated and localized subfoveal distribution of ischaemia. Larger longitudinal studies are needed to explore the use of subfoveal choroidal AFI as a prognostic sign for DFN.

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Fig. 1: Multimodal imaging of proliferative diabetic retinopathy with diabetic foveal neovascularization.
Fig. 2: Choriocapillaris adjusted flow index calculation.

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Available on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo university, Giza, Egypt

    Alaa E. Fayed & Ramy R. Fikry

  2. Oxford Eye Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK

    Alaa E. Fayed

  3. Watany Research and Development Center, Watany Eye Hospital, Cairo, Egypt

    Alaa E. Fayed, Mira A. Gabra, Ramy R. Fikry & Rania Estawro

  4. Deparment of Ophthalmology, School of Medicine, New Giza University, Giza, Egypt

    Mira A. Gabra

  5. General Organization of Teaching Hospitals and Institutes, Cairo, Egypt

    Mira A. Gabra

Authors
  1. Alaa E. Fayed
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  2. Mira A. Gabra
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  3. Ramy R. Fikry
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  4. Rania Estawro
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Contributions

RE and AEF formulated the study hypothesis and methodology. MAG, RE and RRF recruited the patients and obtained the imaging. AEF and MAG calculated the measurements. AEF, RRF and RE analysed the data. AEF drafted the manuscript. RE, MAG and RRF revised the manuscript.

Corresponding author

Correspondence to Alaa E. Fayed.

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Competing interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Watany Eye Hospital research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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An abstract for this manuscript has been presented at the 2024 ARVO annual meeting.

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Fayed, A.E., Gabra, M.A., Fikry, R.R. et al. Diabetic foveal neovascularization is associated with diminished subfoveal choroidal flow on optical coherence tomography angiography. Eye 39, 2169–2175 (2025). https://doi.org/10.1038/s41433-025-03806-1

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