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Choriocapillaris perfusion assessed using swept source optical coherence tomographic angiography and the severity of diabetic retinopathy
  1. Wei Wang1,2,3,
  2. Xiao Guo1,2,3,
  3. Yifan Chen4,
  4. Kun Xiong1,
  5. Xia Gong1,
  6. Meng Yuan1,
  7. Xiaoling Liang1,2,3,
  8. Wenyong Huang1,2,3
  1. 1 Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  2. 2 Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  3. 3 Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  4. 4 University of Oxford, Oxford, UK
  1. Correspondence to Dr Wenyong Huang, Sun Yat-Sen University, Guangzhou 516000, China; huangwenyong{at}


Aims To investigate the relationship between choriocapillaris (CC) blood perfusion and the severity of diabetic retinopathy (DR) using swept-source optical coherence tomography angiography (SS-OCTA).

Methods Type 2 diabetes mellitus in the Guangzhou was recruited. DR was graded according to the standardised seven-field colour retinal images adhering to the ETDRS scale. CC perfusion was quantified by evaluating the flow deficit (FD) density, FD number and FD size using SS-OCTA. Multivariable linear regressions were used to evaluate the correlation between CC FD metrics and DR severity.

Results A total of 1692 patients (eyes) were included in the final analysis. Participants with DR had a significantly higher FD density than the NDR group, with the differences of 1.61% (95% CI 1.04 to 2.18; p<0.001) among mild non-proliferative DR (NPDR) patients, 2.23% (95% CI 1.76 to 2.70; p<0.001) among moderate NPDR patients and 3.31% (95% CI 2.27 to 4.36; p<0.001) among severe DR than NDR patients after adjusting for confounding factors. Similarly, the higher FD number and size were also correlated with severer degree of DR (all p<0.05). Furthermore, the addition of FD density to conventional risk factors significantly improved the performance for discriminating DR from NDR patients (AUC 0. 829, 95% CI 0. 804 to 0. 855; p<0.001).

Conclusion Quantitative FD density, number and size assessed by using SS-OCTA were independently correlated with the severity of DR. The assessment of the CC perfusion metrics in the macula may be a sensitive biomarker of DR changes.

  • diagnostic tests/investigation
  • choroid
  • epidemiology
  • imaging
  • public health

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • WW and XG are joint first authors.

  • Contributors WW and WH had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: WW, XL, YC and WH. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: WW and XG. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: WW and MY. Obtained funding: WH and WW. Administrative, technical or material support: WH, WW. Study supervision: WH. WW and WH are the guarantors.

  • Funding This study was supported by the the National Natural Science Foundation of China (82171084; 82000901; 81900866), the Guangzhou Science and Technology Plan of Guangdong Pearl River Talents Program (202102010162), the Fundamental Research Funds of the State Key Laboratory of Ophthalmology (303060202400362).

  • Disclaimer The funding organisations had no role in the design or conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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