Quantifying Microvascular Abnormalities With Increasing Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography.
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"Quantifying Microvascular Abnormali..." refers methods in this paper
...Monocular best-corrected visual acuity (BCVA) was determined for all subjects using Snellen eye charts and converted to the logMAR as described previously.(18) Patients were graded as having hypertension based on review of their electronic medical records....
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"Quantifying Microvascular Abnormali..." refers background in this paper
...Histopathology has shown that degeneration of the retinal capillary pericytes and endothelial cells are early and seemingly invariable features of DR.1,2 The loss of these cells leads to acellular capillaries with impaired or absent perfusion.3 The resulting ischemia causes an upregulation of angiogenic signaling molecules, including VEGF and erythropoietin,4 which increase vascular permeability and ultimately promote proliferative diabetic retinopathy (PDR).5 A clinical understanding of the changes at the microvascular level could provide important information regarding the perfusion status of the retina during the different stages of DR and the likelihood of developing more severe retinopathy....
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...Retinal and choriocapillaris vascular nonperfusion in OCTA is correlated significantly with disease severity in eyes with DR. Higher flow in the SCP may be an early marker of diabetic microvascular changes before clinical signs of DR....
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...This decreased flow in the DCP may be an important topic for future studies exploring visual function in DR, as we have demonstrated recently a significant impact of DCP nonperfusion on the integrity of the photoreceptors.36,37 We introduced PAN as a new OCTA parameter, which, in its essence, is an inverse approach to vessel density and serves as a quantitative marker for the nonflow area in OCTA.21 Quantification of nonperfused areas (i.e., nonflow area) has been shown to be sensitive to early capillary closure in DR.15,38 Furthermore, since there was no vessel density algorithm for the choriocapillaris in the AngioVue software, calculating PAN allowed us to quantify choriocapillaris nonperfusion....
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...The ability of OCTA to visualize the three-dimensional capillary layers with high resolution has allowed investigators to explore the capillary layers that are most affected in DR.6–8 Previous qualitative studies in DR have demonstrated that OCTA is capable of delineating retinal capillary nonperfusion with better resolution than conventional fluorescein angiography.9–11 Other studies have found decreased capillary density in patients with DR compared to healthy controls, as well as an association between reduced capillary density and worsening DR.12,13 Furthermore, the ability of OCTA to distinguish healthy eyes from eyes with varying levels of DR severity was demonstrated through the use of an automated algorithm for measuring avascular areas in the macula.14,15 While the studies described provide important information regarding the use of OCTA and have furthered our understanding of the vascular changes associated with DR, they have been limited to small cohorts and comparisons between only two study groups....
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...In this study, we evaluated the correlation between retinal and choriocapillaris microvascular changes on OCTA and disease severity in eyes with DR....
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