Optical Coherence Tomography Angiography Changes in Diabetic Macular Ischemia after Systemic Normobaric Oxygen Therapy

TL;DR

This study found that short-term oxygen therapy can improve blood vessel density in the eyes of patients with diabetic macular ischemia.

Contribution

The study is the first to show OCTA changes in DMI patients after normobaric oxygen therapy.

Findings

Foveal avascular zone decreased significantly after oxygen therapy.

Deep capillary plexus vessel density at the fovea increased significantly.

Retinal thickness changes varied by gender after treatment.

Abstract

To evaluate vascular changes on optical coherence tomography angiography (OCTA) in patients with diabetic macular ischemia (DMI) after systemic normobaric oxygen (NBO) therapy.

This before–after interventional studyincluded 26 eyes of 26 patients with DMI.Macular OCTA was performed before and after 1 hour of 100% NBO therapy at a flow of 10 L/min delivered by face mask. As primary outcomes, changes in OCTA metrics were evaluated using the paired t-test. Subgroup analyses were performed based on gender. The secondary outcomes included identifying parameters correlated with best-corrected visual acuity (BCVA) and factors associated with improvement in OCTA parameters.

The patients included 15 males and 11 females aged 59.48
±
9.67 years. Overall, no significant change was observed in retinal thickness; however, there was a significant decrease in retinal thickness among females and a significant increase among males (P

<
0.001). The foveal avascular zone (FAZ) decreased significantly from 0.38
±
0.14 to 0.34
±
0.12 mm2 (P = 0.035). Superficial capillary plexus vessel density (SCP-VD) and deep capillary plexus vessel density (DCP-VD) at fovea increased from 13.5
±
6.37 to 14.98
±
6.33% (P = 0.059) and from 24.61
±
6.75 to 26.59
±
6.16% (P = 0.022), respectively. In males, BCVA correlated significantly with baseline DCP parameters but corresponded with none of the SCP parameters. In females, BCVA significantly correlated with pre-O2 DCP-VD of the perifoveal inferior quadrant. Finally, regression analysis did not show any parameter that could predict a favorable response.

Using OCTA, we observed a decrease in FAZ and an increase in DCP-VD at fovea after short-term NBO therapy for patients with DMI.