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Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography
  1. Felipe F Conti1,2,3,
  2. Vivian L Qin4,
  3. Eduardo B Rodrigues2,
  4. Sumit Sharma1,
  5. Aleksandra V Rachitskaya1,
  6. Justis P Ehlers1,
  7. Rishi P Singh1,3,4
  1. 1 Cole Eye Institute, Cleveland Clinic, Cleveland, USA
  2. 2 Federal University of São Paulo, São Paulo, Brazil
  3. 3 Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, USA
  4. 4 Case Western Reserve University School of Medicine, Cleveland, USA
  1. Correspondence to Dr Rishi P SinghCole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; drrishisingh{at}


Background/aims Split-spectrum amplitude decorrelation angiography for spectral-domain optical coherence tomography has enabled detailed, non-invasive assessment of vascular flow. This study evaluates choriocapillaris and retinal capillary perfusion density (CPD) in diabetic eyes using optical coherence tomography angiography (OCTA).

Methods Records of 136 eyes that underwent OCTA imaging at a single institution were reviewed. Eyes were grouped as non-diabetic controls (37 eyes), patients with diabetes mellitus (DM) without diabetic retinopathy (DM without DR, 31 eyes), non-proliferative diabetic retinopathy (NPDR, 41 eyes) and proliferative diabetic retinopathy (PDR, 27 eyes). Quantitative CPD analyses were performed on OCTA images for assessing perfusion density of the choriocapillaris and retinal plexus for all patients and compared between groups.

Results Eyes with NPDR and PDR showed significantly decreased choriocapillaris CPD compared with controls, while DM eyes without DR did not show significant change. Choriocapillaris whole-image CPD was decreased by 8.3% in eyes with NPDR (p<0.01) and decreased by 7.1% in eyes with PDR (p<0.01). Choriocapillaris parafoveal CPD was decreased by 8.9% in eyes with NPDR (p<0.01) and decreased by 8.2% in eyes with PDR (p<0.01). Compared with controls, only eyes with PDR showed significantly decreased retinal CPD, as well as significantly increased foveal avascular zone (FAZ) area. In those patients, retinal whole-image CPD was decreased by 9.7% (p<0.01), retinal foveal CPD was decreased by 20.5% (p<0.01) and retinal parafoveal CPD was decreased by 11.4% (p<0.01). FAZ area was increased by 50.9% (p<0.01).

Conclusions Choriocapillaris and retinal CPD are reduced in diabetic retinopathy, while FAZ area is increased in eyes with PDR. Vascular changes captured by new imaging modalities can further characterise diabetic choroidopathy.

  • diabetic
  • retinopathy
  • choroidopathy
  • optical coherence tomography
  • angiography

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  • Contributors All authors made substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data. They also drafted the work or revised it critically for important intellectual content. Finally, they all gave final approval for the version submitted. All the authors have contributed to the planning, conduct and reporting of the work described in the article. 

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RPS received grants and personal fees from Regeneron, Genentech/Roche, Apellis, Optos, Zeiss, Biogen and Alcon/Novartis outside the submitted work. JPE received grants and personal fees from Regeneron, Thrombogenics and Alcon/Novartis; royalties from Leica/Bioptigen outside the submitted work. AVR received personal fees from Allergan, Zeiss and Alcon/Novartis outside the submitted work. SS received grants and personal fees from Allergan and Mallingcrofdt outside the submitted work.

  • Patient consent Not required.

  • Ethics approval This retrospective study was performed at Cole Eye Institute, Cleveland, Ohio, after receiving approval from the Cleveland Clinic Investigational Review Board (IRB study number 15-080).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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