Search Results (146)

Background/Objectives: Diabetic macular edema (DME) is the primary cause of vision loss in people with diabetes, and if untreated, it can result in irreversible macular damage. Both fluorescein angiography (FA), the gold standard, and optical coherence tomography angiography (OCTA) are used for evaluation of this disease. The objective of this study was to compare the diagnostic value of both. Methods: We conducted a comparative analysis of 98 patients aged 18–80 years with significant DME and best-corrected visual acuity ≥0.1 according to the Snellen chart. Participants underwent glycated hemoglobin blood test (HbA1c) and ophthalmological examinations, including OCTA and FA. OCTA 3 × 3 mm scans of superficial (SCP) and deep capillary plexus (DCP) along with FA scans were exported to the Gimp computer program. Size of the foveal avascular zone (FAZ), the number of visible microaneurysms (MAs), and ETDRS report number 11 classification of the images were assessed. Results: FAZ size differed significantly in superficial plexus (0.41 mm²), deep plexus (0.43 mm²) OCTA, and FA (0.38 mm²) (p < 0.001). FAZ size in DCP OCTA closely correlated with that of FA (τ = 0.79, p < 0.001). The total number of MAs visualized in the OCTA was significantly lower than in FA (p < 0.001). ETDRS classification of scans revealed that the level of consistency between the examinations was moderate to very strong. Conclusions: OCTA may be useful in evaluating macular ischemia. It is less sensitive in detecting MAs in DME eyes. FAZ has sharper boundaries and is larger when measured in OCTA. Poor glycemic control results in higher incidence of MAs in macula. Full article

Background/Objectives: Discrepancies in diabetic retinopathy (DR) grading are well-documented, with retinal non-perfusion (RNP) quantification posing greater challenges. This study assessed intergrader agreement in DR evaluation, focusing on qualitative severity grading and quantitative RNP measurement. We aimed to improve agreement through structured consensus meetings. Methods: A retrospective analysis of 100 comparisons from 50 eyes (36 patients) was conducted. Two paired medical retina fellows graded ultra-widefield color fundus photographs (CFP) and fundus fluorescein angiography (FFA) images. CFP assessments included DR severity using the International Clinical Diabetic Retinopathy (ICDR) grading system, DR Severity Scale (DRSS), and predominantly peripheral lesions (PPL). FFA-based RNP was defined as capillary loss with grayscale matching the foveal avascular zone. Weekly adjudication by a senior specialist resolved discrepancies. Intergrader agreement was evaluated using Cohen’s kappa (qualitative DRSS) and intraclass correlation coefficients (ICC) (quantitative RNP). Bland–Altman analysis assessed bias and variability. Results: After eight consensus meetings, CFP grading agreement improved to excellent: kappa = 91% (ICDR DR severity), 89% (DRSS), and 89% (PPL). FFA-based PPL agreement reached 100%. For RNP, the non-perfusion index (NPI) showed moderate overall ICC (0.49), with regional ICCs ranging from 0.40 to 0.57 (highest in the nasal region, ICC = 0.57). Bland–Altman analysis revealed a mean NPI difference of 0.12 (limits: −0.11 to 0.35), indicating acceptable variability despite outliers. Conclusions: Structured consensus training achieved excellent intergrader agreement for DR severity and PPL grading, supporting the clinical reliability of ultra-widefield imaging. However, RNP measurement variability underscores the need for standardized protocols and automated tools to enhance reproducibility. This process is critical for developing robust AI-based screening systems. Full article

Background: This study aimed to evaluate retinal arteriole parameters using adaptive optics (AO) rtx1™ (Imagine Eyes, Orsay, France) and peripapillary and macular vessel densities with optical coherence tomography angiography (OCTA) in eyes with different stages of primary open-angle glaucoma (POAG) compared to healthy eyes. It also investigated the associations between vascular parameters and glaucoma severity, as defined by structural (OCT) and functional (visual field) changes. Methods: Fifty-seven eyes from 31 POAG patients and fifty from 25 healthy volunteers were examined. Retinal arteriole morphology was assessed using the AO rtx1™-fundus camera, which measured lumen diameter, wall thickness, total diameter, wall-to-lumen ratio (WLR), and wall cross-sectional area. OCTA was used to measure vessel densities in superficial (SCP) and deep (DCP) capillary plexuses of the macula and radial peripapillary capillary plexus (RPCP) and FAZ area. Structural OCT parameters (RNFL, GCC, rim area) and visual field tests (MD, PSD) were also performed. Results: Glaucoma eyes showed significantly thicker arteriole walls (12.8 ± 1.4 vs. 12.2 ± 1.3 µm; p = 0.030), narrower lumens (85.5 ± 10.4 vs. 100.6 ± 11.1 µm; p < 0.001), smaller total diameters (111.0 ± 10.4 vs. 124.1 ± 12.4 µm; p < 0.001), and higher WLRs (0.301 ± 0.04 vs. 0.238 ± 0.002; p < 0.001) than healthy eyes. In glaucoma patients, OCTA revealed significantly reduced vessel densities in SCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), DCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), and RPCP plexuses (35.42 ± 4.97 vs. 39.27 ± 1.48; p < 0.001). The FAZ area was enlarged in eyes with glaucoma (0.546 ± 0.299 vs. 0.295 ± 0.125 mm²); p < 0.001). Positive correlations were found between vessel densities and OCT parameters (RNFL, r = 0.621; GCC, r = 0.536; rim area, r = 0.489), while negative correlations were observed with visual field deficits (r = −0.517). Conclusions: Vascular deterioration, assessed by AO rtx1™ and OCTA, correlates closely with structural and functional damage in glaucoma. Retinal microcirculation changes may precede structural abnormalities in the optic nerve head. Both imaging methods enable the earlier detection, staging, and monitoring of glaucoma compared to conventional tests. Full article

Background/Objectives: To investigate the role of multimodal imaging, specifically optical coherence tomography angiography (OCTA) and adaptive optics (AO), in the diagnosis and monitoring of diabetic retinopathy. Methods: Our study represents an observational, cross-sectional analysis including sixty-nine patients from four distinct groups: a control group (17 patients), diabetic patients without diabetic retinopathy (no DR) (14 patients), diabetic patients with non-proliferative diabetic retinopathy (NPDR) (18 patients), and diabetic patients with proliferative diabetic retinopathy (PDR patients). A comprehensive ophthalmological evaluation, along with high-resolution imaging using OCTA and AO, was performed. OCTA images of the superficial capillary plexus, acquired with the OCT Angio Topcon, were analyzed using a custom-developed MATLAB algorithm, while AO retinal vascular images were evaluated with the manufacturer’s software of the Adaptive Optics Retinal Camera rtx1™. Results: Our findings demonstrated statistically significant reductions in foveal avascular zone circularity, superficial capillary plexus density, vessel length density, and fractal dimension, correlating with the severity of diabetic retinopathy, particularly in the PDR. Additionally, mean wall thickness and wall-to-lumen ratio were significantly increased in patients with diabetic retinopathy, notably in PDR. Conclusions: In conclusion, our findings demonstrate that the combined use of OCTA and AO imaging offers complementary insights into the microvascular alterations associated with diabetic retinopathy progression and severity. These high-resolution modalities together reveal both perfusion deficits and structural vascular changes, underscoring their utility as essential tools for early detection, staging, monitoring, and informed management of DR. Full article

Background/Objectives: This study investigates the macular microvasculature in a large cohort of primary Sjögren’s disease (SjD) patients using optical coherence tomography angiography (OCTA), focusing on how disease duration, activity, and hydroxychloroquine (HCQ) treatment influence retinal microcirculation. Methods: A total of 106 eyes (53 SjD patients) and 70 eyes (35 age- and gender-matched healthy controls (HCs)) were examined. The vessel area density (VAD, %) and foveal avascular zone (FAZ, mm2) were measured in three retinal layers: Superficial Vascular Plexus (SVP), Intermediate Capillary Plexus (ICP), and Deep Capillary Plexus (DCP), respectively, in three peri-macular circular sectors (c1, c2, c3) each. Results: The VAD was significantly lower in c1 of the DCP in SjD compared to HCs (29.14 ± 7.07 vs. 31.78 ± 9.55, p = 0.038). The FAZ was significantly larger in SjD in both SVP (0.41 ± 0.13 vs. 0.34, 0.11, p < 0.001; Cohen’s |d| = 0.55) and DCP (0.45 ± 0.15 vs. 0.4 ± 0.14, p = 0.014; Cohen’s |d| ± 0.38). Significant correlations were observed between the FAZ size and reductions in the VAD in the SVP and DCP (p = 0.010, Cohen’s |d| = 0.2; p < 0.001, Cohen’s |d| ± 0.26) and across all layers combined (p = 0.019, Cohen’s |d| = −0.18). Conclusions: There was a negative correlation between the VAD in the DCP and disease duration (ρ = −0.28, p = 0.040). No significant correlation was identified between the duration of HCQ intake and the VAD or FAZ. Our findings indicate microvascular alterations in the DCP of SjD, characterized by a reduced VAD and an enlarged FAZ, which may be attributable to inflammatory or arteriosclerotic factors. OCTA may prove to be a valuable tool for the stratification of vascular risk in SjD. Full article

Introduction: Recent technological progress in optical imaging—such as adaptive optics, interferometry and tomography—has greatly improved the resolution of retinal imaging. The ability to capture sequential images over time is particularly valuable for continuous monitoring and assessment of retinal diseases. Methods: This cross-sectional study involved patients with type 2 diabetes mellitus and age-matched controls from the Diabetes and Ophthalmology Department of the Emergency Military Clinical Hospital “Dr. Constantin Papilian” Cluj-Napoca between October 2023 and October 2024. These patients were assessed for inclusion and exclusion criteria and then categorized into two groups: the diabetes group and control group. Each participant underwent a comprehensive ophthalmological examination and retinal evaluation using SS-OCT (Spectralis Heidelberg Engineering, Heidelberg, Germany). The parameters measured included the superficial and deep foveal avascular zones (FAZ) in only one eye for each patient, selected based on image quality. Additionally, each patient underwent quantitative analysis of serum C-reactive protein (CRP) levels. Results: A total of 33 patients (33 eyes) featured, 13 men and 20 women. The DM group showed statistically significant higher results for CRP value compared to healthy subjects (p < 0.001). Also, both superficial and deep FAZ areas were statistically significantly higher for diabetes patients compared to the healthy controls (p < 0.05). The correlation analysis revealed that there was no significant correlation between CRP and either superficial FAZ (p = 0.809) or deep FAZ (p = 0.659). However, a significant positive moderate correlation was found between superficial FAZ and deep FAZ (r = 0.577, p = 0.015). Conclusions: Our findings showed a significantly enlarged FAZ in diabetic patients compared to healthy individuals, highlighting its potential as an early indicator of microvascular alterations in diabetes. While CRP levels were notably elevated in the diabetic group, no significant association was found between CRP and FAZ measurements, suggesting that FAZ changes may occur independently of systemic inflammatory status. Full article

Our study aimed to assess the anatomical changes in the retina, including the assessment of the reduction of diabetic macular edema (DME) on optical coherence tomography (OCT) and the improvement of retinal microvascular parameters, defined by the reduction of nonperfusion areas on OCT angiography (OCTA) after intravitreal injections of 6 mg faricimab, an anti-VEGF drug used in the treatment of DME. The study included twenty-two patients aged between 61 and 74 years, each of whom received four loading doses of 6 mg faricimab at 1-month intervals, as described in the summary of product characteristics. Hemodynamic parameters were analyzed by OCT angiography before the first intravitreal injection of faricimab and one month after each subsequent injection. The following parameters were analyzed: non-perfusion area (NPA), superficial capillary plexus (SCP) and deep capillary plexus (DCP), outer retinal flow area (ORFA), choriocapillaris flow area (CCFA) and foveal avascular zone (FAZ). Despite differences in the magnitude of improvement and time to improvement from the start of treatment with intravitreal injections of 6 mg faricimab, reductions in DME and improvements in OCTA parameters resulted in increased retinal blood flow and better visual acuity. Full article

Background/Objectives: The aim of this study was to investigate quantitative differences in optical coherence tomography angiography (OCTA) between diabetic patients and healthy controls and to identify the early OCTA biomarkers for diabetic macular changes. Methods: Ophthalmological examination and OCTA were performed on two groups of diabetic patients (with and without mild diabetic retinopathy) and healthy controls. Macular, foveal, perifoveal, and parafoveal vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), and flow area in the choriocapillaris were calculated. Results: A total of 431 eyes of 233 participants were analyzed. The VD in the SCP in the whole macula was the lowest in the DM + DR group and lower than in the DMnoDR group; however, in the fovea, it was the highest in the DM + DR group and higher than in the DMnoDR group. The VD in the SCP in the parafovea was lower in the DM + DR group than in the DMnoDR group, and in the perifovea, it was lower in the DMnoDR group than in the control group. The VD in the DCP in the macula, parafovea, and perifovea was lower in the DM + DR group than in the DMnoDR and control groups. The FAZ and flow areas in the choriocapillaris were smaller in the DM + DR group than in both the DMnoDR and control groups. Conclusions: VD reduction in the SCP and the DCP of the macular and parafoveal regions, as well as in the DCP of the perifoveal region, may indicate progression of diabetic retinopathy from subclinical to clinical stages; however, an increase in the foveal region in the SCP can be a compensatory mechanism. VD reduction in the perifovea and whole macula in the SCP can be a screening factor for subclinical macular changes. FAZ reduction before clinical signs of retinopathy may be an early compensatory vascular mechanism. Full article

Background/Objectives: The retinal microvasculature may reflect systemic vascular health and can be non-invasively imaged using optical coherence tomography angiography (OCTA). Investigation of the capillary plexuses in the macula and the peripapillary area could potentially provide insights into the pathophysiology of ocular manifestations in preeclampsia. We aimed to review the literature on OCTA metrics in preeclampsia to evaluate its use in this condition. Methods: A literature search was performed using the PubMed database, and studies published up to December 2024 were included. Results: We summarized the current evidence on chorioretinal microvascular changes in pregnancy and the ocular manifestations of preeclampsia. We reported findings from seven published studies characterizing the chorioretinal capillary plexuses in preeclampsia using OCTA. These revealed changes in microvasculature characteristics, such as foveal avascular zone size and vessel density in the macula and the peripapillary area; however, there was variability in reported parameters. Conclusions: Microvascular changes in the chorioretinal capillary plexus in preeclampsia were reported by several studies; however, results were inconsistent and may have been affected by multiple factors. Nevertheless, OCTA may have diagnostic and prognostic value, by providing evidence of microcirculation sequalae and aiding our understanding of ocular manifestations in this condition. Further studies are warranted to establish appropriate OCTA acquisition protocols and metrics, and whether these could guide clinical practice in preeclampsia. Full article

Background: Our study evaluated the correlation between internal carotid artery stenosis (ICAS) and retinal microvascular changes in patients with hypertensive retinopathy, dyslipidemia and ICAS. We analyzed vascular measurements provided by optical coherence tomography angiography (OCTA) and carotid Doppler ultrasonography (US) and linked OCTA parameters with carotid artery US measurements on the same side. Statistical differences in OCTA analysis among three groups (no stenosis, mild stenosis and moderate stenosis) were evaluated and correlated with carotid Doppler parameters. Our study aimed to evaluate whether OCTA can be proposed as a screening method in patients diagnosed with mild and moderate ICAS in order to improve the early detection of carotid changes, thus potentially reducing the rate of cardiovascular and cerebral complications of ICAS. Methods: We conducted a study on hypertensive patients with ICAS using six OCTA parameters in the analysis of the retinal vasculature and carotid Doppler US velocities of three carotid arteries and the vertebral artery (VA). Kruskal–Wallis and Dunn’s post hoc tests were used to determine whether there were statistically significant differences between the normal, mild and moderate stenosis groups. Spearman and Pearson correlation were used to obtain correlations among OCTA parameters such as the foveal avascular zone (FAZ), non-flow area (NFA), vascular flow area (VFA) and blood flow velocity on carotid Doppler US. Results: In the final analysis, 49 patients were included and 3 groups of stenosis were obtained, comprising 21 subjects with no stenosis, 19 with mild stenosis and 9 with moderate stenosis. Right eye and left eye groups were formed. In the right eye group with right ICAS, we found statistically significant results for FAZ circularity when comparing the normal stenosis group to the mild stenosis group (p = 0.025) and the mild stenosis group to the moderate stenosis group (p = 0.006). Statistically significant results were also observed for NFA when comparing the normal stenosis group to the moderate stenosis group (p = 0.004) and the mild stenosis group to the moderate stenosis group (p = 0.011). When comparing the FAZ area (p = 0.016) and VFA (p = 0.037) for the normal and moderate groups, statistically significant values were obtained. When comparing the normal and moderate stenosis groups with regard to the left eye, we found statistically significant results for VFA (p = 0.041), NFA (p = 0.045) and VFA (p = 0.029). When comparing the mild and moderate carotid artery stenosis groups, we obtained statistically significant results for NFA (p = 0.001), FAZ area (p = 0.007) and VFA (p = 0.013). In the right eye group, correlations between internal carotid artery (ICA) peak systolic velocity (PSV) and VFA (rho = −0.286), ICA end-diastolic velocity (EDV) and NFA (r = 0.365), external carotid artery (ECA) PSV and VFA (r = −0.288; rho = −0.317), common carotid artery (CCA) PSV and NFA (rho = −0.345), CCA EDV and NFA (rho = −0.292) and VA PSV and VFA (r = −0.327; rho = −0.379) were found. When analyzing OCTA parameters, we found statistically significant results for NFA and VFA (r = −0.374; rho = −0.288). Correlations were also found in the left eye group between ICA PSV and NFA (r = −0.351; rho = −0.313), ICA EDV and VFA (r = −0.421; rho = −0.314), ECA PSV and NFA (r = −0.412; rho = −0.457), CCA PSV and NFA (p = −0.288; rho = −0.339), and CCA EDV and NFA (r = −0.404; rho = −0.417). Conclusions: Our study found correlations between carotid Doppler velocities and OCTA vascular flow parameters; thus, OCTA may be used as a tool for monitoring the microvascular changes associated with carotid stenosis. OCTA can provide insights concerning the overall vascular condition of the patient, since it provides subjective data on vessel density and flow; therefore, by monitoring hypertensive patients with both OCTA and carotid Doppler US, we may be able to increase efficiency in screening and diagnosing patients with IACS. Full article

The impact of prematurity has been reported to affect ocular development during infancy and childhood. Research into long-term ocular outcomes in adults born preterm is highly relevant due to a possible impact on the development of age-related ocular diseases such as macular degeneration. The aim was to review the currently available literature regarding outcomes of prematurity on ocular morphology in adults to provide a summary of the long-term effects of prematurity and associated factors such as low birth weight (BW) and retinopathy of prematurity (ROP) and its treatment. Adults formerly born preterm have a higher prevalence of refractive error, lower visual acuity, a higher prevalence of strabismus, shorter axial length, a steeper corneal radius, increased macular thickness, and a thinner peripapillary retinal nerve fiber layer thickness (RNFL), as well as changes in vessel anatomy and the foveal avascular zone. Adults who suffered from ROP have a high risk of myopic refractive error, amblyopia, shallower anterior chambers and thicker crystalline lenses, higher corneal aberrations, thinner RNFL thickness, and foveal hypoplasia. Individuals with advanced ROP requiring treatment also have higher rates of astigmatism, an increased temporal RNFL thickness, altered macular curvature, and reduced visual acuity. Prematurity leads to lifelong ocular morphological and functional changes, suggesting that fetal origins may contribute to age-related ocular diseases. This could have implications for ophthalmologic monitoring and the frequency of check-ups in adulthood. Full article

Background/Objectives: The aim of the current investigation was to assess the short-term changes in retinal-choroidal vasculature and the morphological complexity of non-exudative macular neovascularization (NE-MNV) using optical coherence tomography angiography (OCTA) and spectral-domain optical coherence tomography (SD-OCT). Methods: Sixteen eyes of 12 patients with NE-MNV underwent baseline and six-month follow-up examinations, including comprehensive ophthalmological assessment and imaging. Central macular thickness, foveal avascular zone, vessel density, flow area, and choroidal vascularity index were analyzed. NE-MNV morphology was quantitatively assessed for area, vessel characteristics, and fractal dimensions. Results: Significant changes in NE-MNV morphology were noted over six months, especially in fractal dimensions, vessel junctions, and vessel length (p-values: 0.01, 0.037, and 0.036, respectively). While there was an increase in the NE-MNV area, it did not reach statistical significance. No significant changes were shown regarding the standard SD-OCT and OCTA output parameters or choroidal measurements. Conclusions: The increase in NE-MNV fractal dimensions suggests rising complexity in the neovascular network and may indicate possible implications for clinical management. The correlation between baseline and follow-up measures underscores a trend toward complexity, pointing to the necessity for closer monitoring of patients with higher NE-MNV fractal dimensions. Full article

Purpose: To analyze the retinal and choriocapillaris changes in diabetic patients with no or with early signs of diabetic retinopathy using high-definition (HD) angio optical coherence tomography angiography (OCTA) software and spectral-domain (SD) OCT. Methods: A total of 112 eyes (54 eyes from 27 diabetic patients and 58 eyes from 29 control subjects) were included in this retrospective cross-sectional study of healthy and diabetic adults. Retinal microvascular changes were assessed by using HD-OCTA software to calculate vascular density (VD) and foveal avascular zone (FAZ). SD-OCT was used to assess retinal thickness and volume in parafovea as well as ganglion cell complex (GCC) parameters. Results: The VD-whole image was significantly higher in the healthy control group (MW z = 1109.5, p = 0.012; t = 2.611, p = 0.010). Also, VD-parafovea was significantly higher in the healthy subjects (MW z = 1053.5, p = 0.004; t = 3.207, p = 0.002). GCC focal loss volume (FLV) was significantly decreased in diabetic patients (p = 0.051). Non-flow FAZ did not show a statistically significant difference between groups, although the FAZ was larger in the diabetic patients. Conclusions: Diabetic patients with no or early signs of diabetic retinopathy have decreased VD compared to healthy individuals. They also present retinal changes at the GCC that are correlated with initial neurodegeneration. HD-OCTA and SD-OCT can detect vascular changes and structural signs of retinal neurodegeneration before clinically apparent diabetic retinopathy. Potentially, these methods may offer new biomarkers for monitoring disease progression and visual prognosis. Full article

Objectives: To evaluate the short- and long-term effects of subthreshold micropulse laser (SMPL) treatment on the microvascular network in diabetic macular edema (DME). Methods: This 12-month prospective study included 67 eyes (67 patients) with mild DME and good best-corrected visual acuity (BCVA), randomized into SMPL (33 eyes) or sham (34 eyes) groups. Assessments were performed at baseline (T1), 3 months (T2), and 12 months (T3). Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to measure central retinal thickness (CRT), macular thickness (MT), macular volume (MV), foveal avascular zone (FAZ) area, microaneurysm (MA) count, and vessel parameters in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: The SMPL group showed a greater relative reduction in FAZ area in the SCP at 3 months (3.21 ± 13.03% vs. −5.73 ± 13.3%; p = 0.032) with a trend toward significance at 12 months (2.37 ± 12.47% vs. −3.3 ± 7.92%; p = 0.086) compared to the sham group. No changes in FAZ size, MA count, and other microvascular parameters were observed in either group. In the SMPL group, BCVA improved at 3 months (T2 > T1, p = 0.003); CRT decreased at 12 months (T2 > T3, p = 0.023); MT decreased at 12 months (T2 > T3, p = 0.006) and MV decreased at 12 months (T2 > T3, p = 0.007). No changes were detected in the sham group. No treatment-related complications occurred. Conclusions: SMPL may improve the macular microvasculature in mild DME by reducing FAZ size in the SCP. It provides visual and functional benefits while maintaining a favorable safety profile. Full article

Background/Objectives: The aim of this study was to investigate the potential contribution of microaneurysms (MAs) and retinal cysts to the pathogenesis of macular non-perfusion in patients with diabetic macular edema (DME) using multimodal imaging. Methods: In this cross-sectional study, 42 eyes with DME were analyzed using color fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT). Macular non-perfusion within the central 3000 µm was categorized by location and extent into foveal avascular zone enlargement (FAZE), focal non-perfusion (FNP) and diffuse non-perfusion (DNP). A custom-developed software was used to assess the colocalization of retinal cysts on OCT with areas of non-perfusion on the corresponding FA images. Also, the presence of leaky MAs adjacent to retinal cysts on FA was verified. Results: Colocalization between retinal cysts and non-perfusion was observed in 32 of 42 (76%) eyes: 19 of 23 (83%) eyes with FAZE and 13 of 16 (81%) eyes with FAZE+FNP. No cysts colocalization was found in all three eyes (100%) presenting with DNP. None of the eyes presented with FNP alone. In the remaining seven eyes (four eyes with FAZE and three eyes with FAZE+FNP), no colocalization was noticed. At least one leaky MA adjacent to retinal cysts was identified in all eyes presented with colocalization. Conclusions: Retinal cysts may contribute to the development of limited non-perfusion in DME. Leaky MAs appear to be the primary source of cyst formation, which may lead to localized capillary occlusion in the macula. Full article