The impact of macular edema on microvascular and metabolic alterations in retinitis pigmentosa
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RETINAL DISORDERS
The impact of macular edema on microvascular and metabolic alterations in retinitis pigmentosa Margarita G. Todorova 1,2 & Hendrik P. N. Scholl 1,3 & Maria della Volpe-Waizell 1 Received: 5 May 2020 / Revised: 15 July 2020 / Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The primary aim of our study was to evaluate retinal microvascular anomalies recorded with optical coherence tomography angiography (OCTA) and the retinal metabolic function measured with retinal oximetry (RO) in patients with retinitis pigmentosa (RP). The secondary aim of the study was to link the presence of macular edema to microvascular and metabolic parameters in RP. Methods OCTA and RO were performed on 94 eyes: 64 eyes diagnosed with RP with (ME-RP) and without (no-ME-RP) macular edema were compared with 30 control eyes. Study end points were as follows: mean superficial (FAZ-S) and deep foveal avascular zone (FAZ-D) determined by OCTA. In addition, we evaluated the mean arterial (A-SO2; %), venular (V-SO2; %) oxygen saturation, their difference (A-V SO2; %), as well as the corresponding mean diameter of the retinal arterioles (D-A; μm) and venules (D-V; μm). Results RP patients differed from controls by enlarged FAZ-S and FAZ-D (p ≤ 0.001), attenuated retinal vessels (p ≤ 0.001), and increased retinal vessel oxygen saturation (p ≤ 0.010). Subgroup analyses within RP patients revealed more pronounced alterations of microvascular parameters and metabolic function in the presence of macular edema. In the no-ME-RP subgroup, significant interactions were present between FAZ-S, A-SO2, and V-SO2, whereas in the ME-RP subgroup, we found significant correlations between FAZ-D and D-A. Conclusion A combined microvascular structure–metabolic function approach enhances our understanding of inherited retinal diseases. The presence of macular edema in RP seems to be a result of more altered microvascular–metabolic function. Macular edema should thus be taken into consideration when evaluating microvascular and/or metabolic changes in RP. Keywords Optical coherence tomography angiography . Inherited retinal diseases . Retinitis pigmentosa . Foveal avascular zone . Retinal oximetry . Retinal vessel diameter . Metabolic function . Macular edema
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00417-020-04913-3) contains supplementary material, which is available to authorized users. * Margarita G. Todorova [email protected] 1
Department of Ophthalmology, University of Basel, Basel, Switzerland
2
Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
3
Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
Retinitis pigmentosa (RP) represents a heterogeneous group of inherited retinal diseases marked by progressive photoreceptor cell degeneration [1–3]. Apart from pigmentary changes with a perivascular “bone spicule” configuration and the pale, prominent
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