Optical coherence tomography (OCT) and OCT Angiography in Stages 3 and 4 proliferative sickle cell retinopathy

JFO Open Ophthalmology Pub Date : 2024-10-20 DOI:10.1016/j.jfop.2024.100144

Ogugua Ndubuisi Okonkwo , Adekunle Olubola Hassan , Oyekunle Idris , Arinze Anthony Onwuegbuna , Toyin Akanbi , Chineze Agweye , Utam Ashibel

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Abstract

Purpose

To investigate macular findings in Goldberg stages 3 and 4 proliferative sickle cell retinopathy (PSCR) using optical coherence tomography (OCT) and OCT Angiography.

Methods

A case-control study using retrospective OCT and OCTA data from PSCR eyes (cases) and prospective data from age and sex-matched normal (controls). OCTA data included vessel density (VD) in the superficial capillary vascular plexus (SCP) and deep capillary vascular plexus (DCP), foveal avascular zone (FAZ) characterization, including the shape (in the SCP & DCP), size (area covered), and perimeter. OCT data were whole, superior, and inferior hemi-retina thickness for the superficial and deep retina.

Results

There were 38 OCT / OCTA scans of PSCR eyes of 21 SCD patients; ten eyes were excluded for not meeting inclusion criteria. We analyzed nineteen (19) patients (ten unilateral and 9 bilateral), 28 eyes, nine SS eyes (32%), and nineteen SC eyes (68%). The controls consisted of 29 eyes of 16 normal subjects (three unilateral and 13 bilateral). The commonest FAZ shape in PSCR was “irregular” in 14 eyes (50%), followed by “round” in 11 eyes (39.3%) versus controls, the commonest shape “round” in 18 eyes (62%), followed by “irregular” 9 eyes (31%) (p = 0.165). FAZ area and perimeter were larger in PSCR (p > 0.05). The deep and superficial VD was reduced in PSCR. The mean whole deep VD for cases was 48.9 ± 6.1 versus 52.9 ± 6.4 for controls (p = 0.019). Mean whole superficial VD for cases was 47.4 ± 5.5 versus 49.8 ± 3.4 for controls (p = 0.058).

Retina thickness in the whole, superior and inferior hemi-retina, for superficial and deep retina, was higher in PSCR compared to controls (p < 0.05). Superficial whole thickness for cases and controls were 287.0 μm [IQR 35.3 μm] versus 273.0 μm [IQR 18 μm] respectively (p = 0.008). Deep whole thickness for cases and controls was 287.0 μm [IQR 35.25 μm] versus 273.0 μm [IQR 18 μm] (p = 0.008).

VD was reduced in SS compared to SC eyes (deep whole VD: 50.28 ± 6.01 vs 46.78 ± 5.80) (p = 0.139). Retina thickness in SS was reduced relative to SC. Peripheral retinal laser photocoagulation did not affect VD, though it was associated with a thinner macula.

Conclusion

OCT/OCTA of stage 3 and 4 PSCR revealed reduced VD in the DCP and SCP. Despite the thin temporal retina in SCD, there is a thicker whole, superior, and inferior hemiretina in both the superficial and deep retina. An irregularly shaped FAZ is common, a reflection of abnormal microcapillary loss in the perifoveal area.

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第 3 期和第 4 期增殖性镰状细胞视网膜病变的光学相干断层扫描 (OCT) 和 OCT 血管造影术

方法利用PSCR眼（病例）的回顾性OCT和OCTA数据以及年龄和性别匹配的正常眼（对照组）的前瞻性数据进行病例对照研究。OCTA 数据包括浅层毛细血管丛（SCP）和深层毛细血管丛（DCP）的血管密度（VD）、眼窝无血管区（FAZ）的特征，包括形状（SCP & DCP）、大小（覆盖面积）和周长。OCT数据包括浅层和深层视网膜的整体、上部和下部半视网膜厚度。结果21名SCD患者的38个PSCR眼的OCT/OCTA扫描结果；10只眼因不符合纳入标准而被排除。我们分析了 19 名患者（10 名单侧患者和 9 名双侧患者）的 28 只眼睛，其中 9 只为 SS 眼睛（32%），19 只为 SC 眼睛（68%）。对照组包括 16 名正常人的 29 只眼睛（3 只单眼和 13 只双眼）。PSCR患者最常见的FAZ形状是 "不规则 "的有14只眼睛（50%），其次是 "圆形 "的有11只眼睛（39.3%），而对照组最常见的形状是 "圆形 "的有18只眼睛（62%），其次是 "不规则 "的有9只眼睛（31%）（P = 0.165）。PSCR患者的FAZ面积和周长更大（p >0.05）。PSCR患者的深层和浅层VD均缩小。病例的平均整个深层 VD 为 48.9 ± 6.1，而对照组为 52.9 ± 6.4（p = 0.019）。病例的平均整个浅层 VD 为 47.4 ± 5.5，而对照组为 49.8 ± 3.4（p = 0.058）。与对照组相比，PSCR 的整个视网膜、上半视网膜和下半视网膜以及浅层和深层视网膜的厚度都更高（p <0.05）。病例和对照组的表层整体厚度分别为 287.0 μm [IQR 35.3 μm] 和 273.0 μm [IQR 18 μm]（P = 0.008）。病例和对照组的深层整体厚度分别为 287.0 μm [IQR 35.25 μm] 与 273.0 μm [IQR 18 μm] （p = 0.008）。与 SC 眼相比，SS 眼的 VD 有所减少（深层整体 VD：50.28 ± 6.01 vs 46.78 ± 5.80）（p = 0.139）。与 SC 眼相比，SS 眼的视网膜厚度减少。尽管外周视网膜激光光凝与黄斑变薄有关，但并不影响 VD。尽管 SCD 的颞侧视网膜较薄，但在浅层和深层视网膜中，整个半视网膜、上半视网膜和下半视网膜都较厚。不规则形状的FAZ很常见，反映了眼底周围区域微毛细血管的异常缺失。

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JFO Open Ophthalmology

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