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Morphological and topographical appearance of microaneurysms on optical coherence tomography angiography
  1. Vivian Schreur1,
  2. Artin Domanian1,
  3. Bart Liefers1,2,
  4. Freerk G Venhuizen1,2,
  5. B Jeroen Klevering1,
  6. Carel B Hoyng1,
  7. Eiko K de Jong1,
  8. Thomas Theelen1
  1. 1 Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2 Diagnostic Image Analysis Group, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Thomas Theelen, Department of Ophthalmology, Radboud University Medical Center, Nijmegen 6525 EX, The Netherlands; Thomas.Theelen{at}


Aims To investigate retinal microaneurysms in patients with diabetic macular oedema (DME) by optical coherence tomography angiography (OCTA) according to their location and morphology in relationship to their clinical properties, leakage on fundus fluorescein angiography (FFA) and retinal thickening on structural OCT.

Methods OCTA and FFA images of 31 eyes of 24 subjects were graded for the presence of microaneurysms. The topographical and morphological appearance of microaneurysms on OCTA was evaluated and classified. For each microaneurysm, the presence of focal leakage on FFA and associated retinal thickening on OCT was determined.

Results Of all microaneurysms flagged on FFA, 295 out of 513 (58%) were also visible on OCTA. Microaneurysms with focal leakage and located in a thickened retinal area were more likely to be detected on OCTA than not leaking microaneurysms in non-thickened retinal areas (p=0.001). Most microaneurysms on OCTA were seen in the intermediate (23%) and deep capillary plexus (22%). Of all microaneurysms visualised on OCTA, saccular microaneurysms were detected most often (31%), as opposed to pedunculated microaneurysms (9%). Irregular, fusiform and mixed fusiform/saccular-shaped microaneurysms had the highest likeliness to leak and to be located in thickened retinal areas (p<0.001, p<0.001 and p=0.001).

Conclusions Retinal microaneurysms in DME could be classified topographically and morphologically by OCTA. OCTA detected less microaneurysms than FFA, and this appeared to be dependent on leakage activity and retinal thickening. Morphological appearance of microaneurysms (irregular, fusiform and mixed saccular/fusiform) was associated with increased leakage activity and retinal thickening.

  • diabetic macularoedema
  • optical coherence tomography angiography
  • fluorescein angiography
  • microaneurysms
  • image analysis

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  • Contributors VS and TT designed the study, VS and AD carried out the experiments, BL and FGV developed custom image analysis software, BJK, CBH, EKJ and TT contributed to the interpretation of the results. VS took the lead in writing the manuscript with input from all authors.

  • 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 None declared.

  • Patient consent Not required.

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

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