5, 6 All capillary beds disappear in typical nonperfused areas, and concomitantly reduced metabolism or hypoxia leads to degenerative or atrophic processes in the inner retinal layers, or vice versa, before neurodegeneration by diabetes decreases the expression of angiogenic factors and subsequently leads to capillary loss. In 45 eyes for which fluorescein angiography images were obtained, mild hypofluorescence was seen in 156 spots (84.8%) and focal nonperfused areas in 17 spots (9.2%).Įn face images of SS-OCT showed spots with inverted reflectivity in the NFL and GCL in DR.įour laminar plexuses in the retinal vasculature, which reside in the nerve fiber layer (NFL), ganglion cell layer (GCL), and the deep portions of the superficial nuclear layer (SINL) and those of the deep portions of the inner nuclear layer (DINL), respectively, perfuse and nourish neuroglial tissues in the inner retinal layers in healthy eyes. One-hundred sixty-nine spots (91.8%) were not visible on color fundus photographs, and 15 spots (8.2%) were accompanied by whitish-yellow lesions in the corresponding areas. In all 75 eyes, 153 of 184 spots (83.2%) were localized in the NFL and GCL, whereas 31 spots (16.8%) extended to retinal layers deeper than the GCL. These spots had various shapes in the NFL and GCL on en face OCT images the mean area was 0.126 ± 0.052 mm 2 at the NFL level. Thirty-seven of 45 eyes (82.2%) with moderate nonproliferative diabetic retinopathy (NPDR) or more severe grades were accompanied with well-defined spots with inverted reflectivity, whereas 30 eyes with no apparent retinopathy or mild NPDR had no such lesions. We investigated the morphologic characteristics of spots with inverted reflectivity, which had lower reflectivity than the surrounding areas in the nerve fiber layer (NFL) and higher reflectivity in the ganglion cell layer (GCL). We obtained three-dimensional images (6 × 6 mm) centered on the fovea, followed by the generation of en face images.
We retrospectively reviewed seventy-five eyes of 75 patients with DR (15 eyes with individual grades of DR severity). The purpose of this study was to characterize inner retinal spots with inverted reflectivity on en face images of swept-source optical coherence tomography (SS-OCT) in diabetic retinopathy (DR).
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