Foveal neovascularisation (NV) in proliferative diabetic retinopathy (PDR) is uncommon. The study aim is to analyse a series of cases of foveal NV in PDR and ascertain the factors leading to its development.
Methods
In this retrospective case-control study, optical coherence tomography (OCT) and OCT-angiography (OCTA) images of PDR cases with/without foveal NV diagnosed on fluorescein angiography were analysed.
Results
From 124 consecutive PDR eyes, foveal NV was identified in 12 (10%) eyes. Eyes with foveal NV showed thin choroid (p = 0.001), increased FAZ area and reduced vessel density at the macula compared to control group on OCT and OCTA. After regression analysis, an increased FAZ in the superficial capillary plexus slab (p = 0.002) was associated with foveal NV development.
Conclusion
Our case series suggest that foveal NV is an uncommon finding, occurring due to reduced choroidal and inner retinal perfusion at the macula. Further studies are required to assess the treatment outcomes in such eyes.
ArcherDB. Neovascularization of the retina. Trans Ophthalmol Soc U K1976; 96: 471–493.
2.
WangSZuoYWangN, et al.Fundus fluorescence angiography in diagnosing diabetic retinopathy. Pak J Med Sci2017; 33: 1328–1332.
3.
Vaz-PereiraSMorais-SarmentoTEsteves MarquesR. Optical coherence tomography features of neovascularization in proliferative diabetic retinopathy: a systematic review. Int J Retina Vitr2020; 6: 26.
4.
IshibazawaANagaokaTYokotaH, et al.Characteristics of retinal neovascularization in proliferative diabetic retinopathy imaged by optical coherence tomography angiography. Investig Opthalmology Vis Sci2016; 57: 6247.
5.
Writing Committee for the Diabetic Retinopathy Clinical Research Network, GrossJGGlassmanAR, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA2015; 314: 2137–2146.
6.
JanssonRWFrøysteinTKrohnJ. Topographical distribution of retinal and optic disc neovascularization in early stages of proliferative diabetic retinopathy. Investig Opthalmology Vis Sci2012; 53: 8246.
7.
SchocketLSBruckerAJNiknamRM, et al.Foveolar choroidal hemodynamics in proliferative diabetic retinopathy. Int Ophthalmol2004; 25: 89–94.
8.
FinkelsteinDPatzAFineSL, et al.Abortive foveal retinal neovascularization in diabetic retinopathy. Retina Phila Pa1981; 1: 62–66.
KurzPANguyanHCooneyMJ. Bilateral foveal neovascularization in a patient with insulin-dependent diabetes mellitus. Arch Ophthalmol Chic Ill 19602003; 121: 1656–1657.
11.
AndreanosKRotsosTKymionisG, et al.Optical coherence tomography angiography of foveal neovascularization in diabetic retinopathy. Case Rep Ophthalmol2018; 9: 93–97.
12.
RajagopalJKamathAGKamathGG, et al.Foveal neovascularisation in diabetic retinopathy: case report and review of literature. Int Ophthalmol2010; 30: 311–314.
13.
SethAGhoshBBhambhwaniV, et al.Foveal neovascularization in a patient with type 2 diabetes mellitus. Oman J Ophthalmol2017; 10: 255–256.
14.
DhurandharDRaniPK. Optical coherence tomography angiography of foveal neovascularisation in proliferative diabetic retinopathy. BMJ Case Rep2019 Aug 20; 12(8): e230382. DOI: 10.1136/bcr-2019-230382.
15.
MurakawaSHasegawaTKoizumiH, et al.Foveal retinal neovascularization in proliferative diabetic retinopathy: assessment by optical coherence tomography angiography. Retina Phila Pa2017; 37: e135–e137.
16.
Vaz-PereiraSProençaH. Foveal neovascularization in type 2 diabetes. Ophthalmol Retina2019; 3: 566.
17.
BansalAShankarMMultaniP, et al.Multimodal imaging of foveal neovascularisation in diabetic retinopathy. Clin Exp Optom2019; 102: 440–441.
18.
JaoKNortheyLCEssexRW. Treatment of foveal neovascularization in a patient With type 1 diabetes. JAMA Ophthalmol2018; 136: e182584.
19.
GrossJGGlassmanARLiuD, et al.Five-Year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol2018; 136: 1138.
20.
SalzDAWitkinAJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol2015; 22: 145–150.
21.
Early treatment diabetic retinopathy study design and baseline patient characteristics. ETDRS report number 7. Ophthalmology1991; 98: 741–756.
22.
AshtonN. Retinal vascularization in health and disease: proctor award lecture of the association for research in ophthalmology. Am J Ophthalmol1957; 44: 7–17.
23.
CaiJBoultonM. The pathogenesis of diabetic retinopathy: old concepts and new questions. Eye2002; 16: 242–260.
24.
ProvisJ. The Macula, the fovea and blood supply: what do we know and how does it help?Clin Experiment Ophthalmol2013; 41: 28–43.
25.
CoughlinBAFeenstraDJMohrS. Müller cells and diabetic retinopathy. Vision Res2017; 139: 93–100.
26.
PownerMBGilliesMCZhuM, et al.Loss of Müller's Cells and photoreceptors in macular telangiectasia type 2. Ophthalmology2013; 120: 2344–2352.
27.
ToutSChan-LingTHolländerH, et al.The role of müller cells in the formation of the blood-retinal barrier. Neuroscience1993; 55: 291–301.
28.
AyachitAGReddyLUJoshiS, et al.Epiretinal neovascularization: a novel OCT angiography finding in macular telangiectasia type 2. Ophthalmol Retina2019; 3: 516–522.
