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Retinal vasculature of different diameters and plexuses exhibit distinct vulnerability in varying severity of diabetic retinopathy

Eye (2024)Cite this article

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Abstract

Objectives

To study the changes in vessel densities (VD) stratified by vessel diameter in the retinal superficial and deep vascular complexes (SVC/DVC) using optical coherence tomography angiography (OCTA) images obtained from people with diabetes and age-matched healthy controls.

Methods

We quantified the VD based on vessel diameter categorized as <10, 10–20 and >20 μm in the SVC/DVC obtained on 3 × 3 mm2 OCTA scans using a deep learning-based segmentation and vascular graph extraction tool in people with diabetes and age-matched healthy controls.

Results

OCTA images obtained from 854 eyes of 854 subjects were divided into 5 groups: healthy controls (n = 555); people with diabetes with no diabetic retinopathy (DR, n = 90), mild and moderate non-proliferative DR (NPDR) (n = 96), severe NPDR (n = 42) and proliferative DR (PDR) (n = 71). Both SVC and DVC showed significant decrease in VD with increasing DR severity (p < 0.001). The largest difference was observed in the <10 μm vessels of the SVC between healthy controls and no DR (13.9% lower in no DR, p < 0.001). Progressive decrease in <10 μm vessels of the SVC and DVC was seen with increasing DR severity (p < 0.001). However, 10–20 μm vessels only showed decline in the DVC, but not the SVC (p < 0.001) and there was no change observed in the >20 μm vessels in either plexus.

Conclusions

Our findings suggest that OCTA is able to demonstrate a distinct vulnerability of the smallest retinal vessels in both plexuses that worsens with increasing severity of DR.

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Fig. 1: Workflow to facilitate deep-learning-based segmentation of real OCTA images without the need for human annotations. Initially, we modelled synthetic retinal vessel networks using a physiological simulation.
Fig. 2: Optical coherence tomography angiograms (first and third columns) and extracted vascular graphs (second and fourth columns) of the superficial and deep vascular complexes of the retina in healthy subjects and patients with diabetes mellitus (DM).

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Data availability

The data that support the findings of this study are available from the corresponding author upon 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. Watany Eye Hospital, Cairo, Egypt

    Alaa E. Fayed, Sherry M. Bassily & Ramy R. Fikry

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

    Alaa E. Fayed

  4. Lab for AI in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Martin J. Menten, Linus Kreitner, Johannes C. Paetzold & Daniel Rueckert

  5. BioMedIA, Imperial College London, London, UK

    Martin J. Menten, Johannes C. Paetzold & Daniel Rueckert

  6. NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Ahmed M. Hagag & Sobha Sivaprasad

  7. Boehringer Ingelheim Limited, London, UK

    Ahmed M. Hagag

  8. University College London, London, UK

    Sobha Sivaprasad

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Contributions

AEF, MM AMH and SS conceptualized the project. AEF, SB and RRF collected the imaging and patient information. MM, LK, JCP and DR performed the data analysis. AMH performed the statistical analysis. AEF wrote the manuscript. All authors contributed to reviewing the manuscript.

Corresponding author

Correspondence to Alaa E. Fayed.

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Competing interests

AF: None, MM: None, LK: None, JCP: None, DR: None, SB: None, AH: Boehringer Ingelheim Ltd (E), SS: Bayer (F), Novartis (F), Abbvie (F), Roche (F), Boehringer Ingelheim (F), Optos (F), EyeBiotech (F), Biogen (F)Apellis (F), Janssen Pharmaceuticals (F), Ocular Therapeutix (F), OcuTerra (F). SS is a member of the Eye Editorial Board.

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Fayed, A.E., Menten, M.J., Kreitner, L. et al. Retinal vasculature of different diameters and plexuses exhibit distinct vulnerability in varying severity of diabetic retinopathy. Eye (2024). https://doi.org/10.1038/s41433-024-03021-4

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  • DOI: https://doi.org/10.1038/s41433-024-03021-4

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