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  • Widefield swept-source OCTA can predict vitreous hemorrhage in PDR

    Retina/Vitreous

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    Review of: Widefield swept-source OCT angiography metrics associated with the development of diabetic vitreous hemorrhage: A prospective study

    Cui Y, Zhu Y, Lu E, et al. Ophthalmology, September 2021

    This prospective observational study was conducted to assess the utility of widefield optical coherence tomography angiography (OCTA) in identifying predictive factors for vitreous hemorrhage (VH) occurrence in patients with proliferative diabetic retinopathy (PDR).

    Study design

    A total of 45 adults in the United States (55 eyes) with PDR and no history of VH were followed up for ≥3 months. All patients underwent widefield swept-source (SS) OCTA, and the images were analyzed by independent operators. Systemic and ocular parameters, including duration of diabetes, glycated hemoglobin level, best-corrected visual acuity, IOP, and widefield SS OCTA metrics were screened as well. The primary endpoint was duration of time between the baseline visit and the first VH occurrence.

    Outcomes

    The median follow-up period was 363 days, and during that time 24% of the PDR eyes showed evidence of VH. The occurrence of VH was associated with the presence of extensive neovascularizations, defined as those with a total area of >4 disc diameters, and forward neovascularizations which traversed the posterior hyaloid face into the vitreous. These were also significantly associated with time to VH development, as was duration of diabetes. Conversely, a lower risk of VH occurrence was linked to the presence of flat neovascularizations.

    Limitations

    The main limitations of the study were the small sample size with a limited number of events and the limited field of view of the images (50° to 60°).

    Clinical significance

    Widefield SS OCTA was shown to be useful for evaluating neovascularizations as well as recognizing which biomarkers and other factors are linked to the development of VH in patients with PDR. Future studies containing larger patient populations and longer follow-up times are needed to verify these risk factors and imaging biomarkers.