Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema
Diabetic retinopathy is a form of diabetic microangiopathy, and vascular hyperpermeability in the macula leads to retinal thickening and concomitant reduction of visual acuity in diabetic macular edema (DME). In this review, we discuss multimodal fundus imaging, comparing the pathogenesis and interv...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-05-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/5/896 |
| _version_ | 1797599161706610688 |
|---|---|
| author | Tomoaki Murakami Kenji Ishihara Noriko Terada Keiichi Nishikawa Kentaro Kawai Akitaka Tsujikawa |
| author_facet | Tomoaki Murakami Kenji Ishihara Noriko Terada Keiichi Nishikawa Kentaro Kawai Akitaka Tsujikawa |
| author_sort | Tomoaki Murakami |
| collection | DOAJ |
| description | Diabetic retinopathy is a form of diabetic microangiopathy, and vascular hyperpermeability in the macula leads to retinal thickening and concomitant reduction of visual acuity in diabetic macular edema (DME). In this review, we discuss multimodal fundus imaging, comparing the pathogenesis and interventions. Clinicians diagnose DME using two major criteria, clinically significant macular edema by fundus examination and center-involving diabetic macular edema using optical coherence tomography (OCT), to determine the appropriate treatment. In addition to fundus photography, fluorescein angiography (FA) is a classical modality to evaluate morphological and functional changes in retinal capillaries, e.g., microaneurysms, capillary nonperfusion, and fluorescein leakage. Recently, optical coherence tomography angiography (OCTA) has allowed us to evaluate the three-dimensional structure of the retinal vasculature and newly demonstrated that lamellar capillary nonperfusion in the deep layer is associated with retinal edema. The clinical application of OCT has accelerated our understanding of various neuronal damages in DME. Retinal thickness measured by OCT enables us to quantitatively assess therapeutic effects. Sectional OCT images depict the deformation of neural tissues, e.g., cystoid macular edema, serous retinal detachment, and sponge-like retinal swelling. The disorganization of retinal inner layers (DRIL) and foveal photoreceptor damage, biomarkers of neurodegeneration, are associated with visual impairment. Fundus autofluorescence derives from the retinal pigment epithelium (RPE) and its qualitative and quantitative changes suggest that the RPE damage contributes to the neuronal changes in DME. These clinical findings on multimodal imaging help to elucidate the pathology in the neurovascular units and lead to the next generation of clinical and translational research in DME. |
| first_indexed | 2024-03-11T03:31:47Z |
| format | Article |
| id | doaj.art-ea298952cc3b47e9ab87c7d899894b4a |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T03:31:47Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-ea298952cc3b47e9ab87c7d899894b4a2023-11-18T02:21:52ZengMDPI AGMedicina1010-660X1648-91442023-05-0159589610.3390/medicina59050896Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular EdemaTomoaki Murakami0Kenji Ishihara1Noriko Terada2Keiichi Nishikawa3Kentaro Kawai4Akitaka Tsujikawa5Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDepartment of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, JapanDiabetic retinopathy is a form of diabetic microangiopathy, and vascular hyperpermeability in the macula leads to retinal thickening and concomitant reduction of visual acuity in diabetic macular edema (DME). In this review, we discuss multimodal fundus imaging, comparing the pathogenesis and interventions. Clinicians diagnose DME using two major criteria, clinically significant macular edema by fundus examination and center-involving diabetic macular edema using optical coherence tomography (OCT), to determine the appropriate treatment. In addition to fundus photography, fluorescein angiography (FA) is a classical modality to evaluate morphological and functional changes in retinal capillaries, e.g., microaneurysms, capillary nonperfusion, and fluorescein leakage. Recently, optical coherence tomography angiography (OCTA) has allowed us to evaluate the three-dimensional structure of the retinal vasculature and newly demonstrated that lamellar capillary nonperfusion in the deep layer is associated with retinal edema. The clinical application of OCT has accelerated our understanding of various neuronal damages in DME. Retinal thickness measured by OCT enables us to quantitatively assess therapeutic effects. Sectional OCT images depict the deformation of neural tissues, e.g., cystoid macular edema, serous retinal detachment, and sponge-like retinal swelling. The disorganization of retinal inner layers (DRIL) and foveal photoreceptor damage, biomarkers of neurodegeneration, are associated with visual impairment. Fundus autofluorescence derives from the retinal pigment epithelium (RPE) and its qualitative and quantitative changes suggest that the RPE damage contributes to the neuronal changes in DME. These clinical findings on multimodal imaging help to elucidate the pathology in the neurovascular units and lead to the next generation of clinical and translational research in DME.https://www.mdpi.com/1648-9144/59/5/896center-involving diabetic macular edemaclinically significant macular edemadiabetic macular edemadiabetic retinopathydisorganization of retinal inner layersfluorescein angiography |
| spellingShingle | Tomoaki Murakami Kenji Ishihara Noriko Terada Keiichi Nishikawa Kentaro Kawai Akitaka Tsujikawa Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema Medicina center-involving diabetic macular edema clinically significant macular edema diabetic macular edema diabetic retinopathy disorganization of retinal inner layers fluorescein angiography |
| title | Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema |
| title_full | Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema |
| title_fullStr | Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema |
| title_full_unstemmed | Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema |
| title_short | Pathological Neurovascular Unit Mapping onto Multimodal Imaging in Diabetic Macular Edema |
| title_sort | pathological neurovascular unit mapping onto multimodal imaging in diabetic macular edema |
| topic | center-involving diabetic macular edema clinically significant macular edema diabetic macular edema diabetic retinopathy disorganization of retinal inner layers fluorescein angiography |
| url | https://www.mdpi.com/1648-9144/59/5/896 |
| work_keys_str_mv | AT tomoakimurakami pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema AT kenjiishihara pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema AT norikoterada pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema AT keiichinishikawa pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema AT kentarokawai pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema AT akitakatsujikawa pathologicalneurovascularunitmappingontomultimodalimagingindiabeticmacularedema |