Macula vs periphery in diabetic retinopathy: OCT-angiography and ultrawide field fluorescein angiography imaging of retinal non perfusion

OBJECTIVES: To investigate the association between peripheral non-perfusion index (NPI) on ultrawide-field fluorescein angiography (UWF-FA) and quantitative OCT-Angiography (OCT-A) metrics in the macula. METHODS: In total, 48 eyes with UWF-colour fundus photos (CFP), UWF-FA (California, Optos) and OCT-A (Spectralis, Heidelberg) were included. OCT-A (3 x 3 mm) was used to determine foveal avascular zone (FAZ) parameters and vessel density (VD), perfusion density (PD), fractal dimension (FD) on superficial capillary plexus (SCP). NPI's extent and distribution was determined on UWF-FA within fovea centred concentric rings corresponding to posterior pole (<10 mm), mid-periphery (10-15 mm), and far-periphery (>15 mm) and within the total retinal area, the central macular field (6x6 mm), ETDRS fields and within each extended ETDRS field (P3-P7) .RESULTS: Macular PD was correlated to NPI in total area of retina (Spearman rho = 0.69, p < 0.05), posterior pole (rho = 0.48, p < 0.05), mid-periphery (rho = 0.65, p < 0.05), far-periphery (rho = 0.59, p < 0.05), P3-P7 (rho = 0,55 at least, p < 0.05 for each), central macula (rho = 0.47, p < 0.05), total area in ETDRS (rho = 0.55, p < 0.05). Macular VD and FD were correlated to NPI of total area of the retina (rho = 0.60 and 0.61, p < 0.05), the mid-periphery (rho = 0.56, p < 0.05) and far-periphery (rho = 0.60 and rho = 0.61, p < 0.05), and in P3-P7 (p < 0.05). FAZ perimeter was significantly corelated to NPI at posterior pole and central macular area (rho = 0.37 and 0.36, p < 0.05), and FAZ area to NPI in central macular area (rho = 0.36, p < 0.05). CONCLUSIONS: Perfusion macular metrics on OCT-A correlated with UWF-FA's non-perfusion (NP), particularly in the retina's mid and far periphery, suggesting that OCT-A might be a useful non-invasive method to estimate peripheral retinal NP.