Comparative study between fundus fluorescein angiography and optical coherence tomography angiography in evaluation of diabetic maculopathy

• Published in: Delta Journal of Ophthalmology Vol. 24; no. 4; pp. 221 - 226
• Main Authors: Zaky, Marwa, Hamed, Walaa, Marey, Hatem, Ghoubashy, Esraa El
• Format: Journal Article
• Language: English
• Published: Medknow Publications and Media Pvt. Ltd 01.10.2023; Wolters Kluwer Medknow Publications
• Subjects: Angiography; diabetic maculopathy; Diabetic retinopathy; Diabetics; Fluorescein; fluorescein angiography; fundus; optical coherence tomography angiography; Tomography
• ISSN: 1110-9173; 2090-4835
• DOI: 10.4103/djo.djo_20_23

Background Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients. Purpose The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy. Patients and methods This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared. Results The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference ( P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA ( P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P < 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P < 0.001, and U = 35.955, P < 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema. Conclusion OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation.