title: Deep Retinal Capillary Nonperfusion Is Associated With Photoreceptor Disruption in Diabetic Macular Ischemia.
abstract: OBJECTIVE
  To report outer retinal structural changes associated with macular capillary nonperfusion at the level of deep capillary plexus (DCP) in diabetic patients.
  
  
  METHODS
  Prospective observational cross-sectional study.
  
  
  METHODS
  The study included 14 eyes of 10 patients who were diagnosed as having diabetic retinopathy. To study the outer retina and localize areas of capillary nonperfusion at the superficial (SCP) or DCP, we used the spectral-domain optical coherence tomography (SDOCT) device (RTVue-XR Avanti; Optovue Inc, Fremont, California, USA) with split-spectrum amplitude-decorrelation angiography (SSADA) software for optical coherence tomography angiography (OCTA). Two independent masked graders (F.S. and A.A.F.) qualitatively evaluated SDOCT scans as either normal or having outer retina disruption. The angiographic images were examined to define the presence and location of capillary nonperfusion.
  
  
  RESULTS
  Eight eyes showed outer retinal disruption on SDOCT that co-localized to areas of enlarged foveal avascular zone, areas of no flow between capillaries, and capillary nonperfusion of the DCP. Six eyes without outer retinal changes on SDOCT showed robust perfusion of the DCP.
  
  
  CONCLUSIONS
  Using OCTA, this study shows that macular photoreceptor disruption on SDOCT in patients with diabetic retinopathy corresponds to areas of capillary nonperfusion at the level of the DCP. This is important in highlighting the contribution of the DCP to the oxygen requirements of the photoreceptors as well as the outer retina in diabetic macular ischemia.
authors.affiliation: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; G.B. Bietti Eye Foundation-IRCCS, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Scarinci
authors.affiliation: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Nesper
authors.affiliation: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: afawzimd@gmail.com.
authors.forename: Amani A
authors.initials: AA
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D002196:Capillaries / Q000503:physiopathology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D008266:Macula Lutea / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012164:Retinal Diseases / Q000503:physiopathology*; D012171:Retinal Vessels / Q000503:physiopathology*; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity / Q000502:physiology