Quantitative detection of macular microvascular abnormalities identified by optical coherence tomography angiography in different hematological diseases

Abstract

It is now understood that hematological diseases can have detrimental effects on the retina, reducing retinal capillaries, compromising visual function, and potentially causing irreversible visual impairment. Over the years, there has been limited research on macular microvascular abnormalities, such as changes in vessel density and the foveal avascular zone (FAZ) and variations in the severity of these effects across different types of blood disorders. This study aims to quantitatively assess the impact of various hematological disorders on the retina using optical coherence tomography angiography (OCTA). Compared with healthy eyes, patients with different blood diseases exhibited reductions in linear vessel density (LVD), perfusion vessel density (PVD), FAZ area, and FAZ perimeter. Notably, patients with erythrocyte diseases showed more significant abnormalities in LVD and PVD, while patients with lymphocytic diseases demonstrated more pronounced abnormalities in the FAZ area and perimeter. OCTA imaging could potentially reflect changes of the retinal microvascular of patients with hematological diseases and may serve as a valuable tool for distinguishing abnormalities affecting different blood cell lines. This approach offers a novel avenue for assessing, treating, and monitoring blood disorders.

Keywords: Erythrocyte diseases; Lymphocyte diseases; Myelocyte diseases; Optical coherence tomography angiography; Pancytopenia diseases.

Fig. 1

Overview of the study. (A) Subject Enrollment: The diagnosis of blood diseases was based on the patients’ clinical manifestations and confirmed through blood and bone marrow data. (B) Data Collection: Subjects were categorized into different groups based on their diagnoses and laboratory disease indicators. Each patient and healthy control underwent a comprehensive ophthalmic examination using slit-lamp and Optical Coherence Tomography Angiography (OCTA). Parameters including Linear Vessel Density (LVD), Perfusion Vessel Density (PVD), and Foveal Avascular Zone (FAZ) were recorded for subsequent analysis. (C) Diagram of blood cell composition, a, normal erythrocyte; b, sickle-shaped erythrocyte; c, Normal leukocyte; d, Normal lymphocyte; e, abnormal lymphocytes. The cell body is larger than normal lymphocytes, the chromatin may be darker, and sometimes vacuoles may appear; f, normal platelets; g, deformation of platelets. OCTA, optical coherence tomography angiography; LVD, linear vessel density; PVD, perfusion vessel density. FAZ, foveal avascular zone.

Fig. 2

Comparison of optical coherence tomographical parameters in patients with different hematological diseases and the normal control group. (A-d), (I-L), examples of linear vessel density, perfusion vessel density, FAZ, and B-scan acquired by OCTA in 3 × 3 and 6 × 6 scanning patterns; (E-H) Vessel density and FAZ comparisons of patients with different blood diseases and normal control group in 3 × 3 scanning pattern; (M-P), Vessel density and FAZ comparisons of patients with different blood diseases and normal control group in 6 × 6 scanning pattern. OCTA, optical coherence tomographic angiography; FAZ, foveal avascular zone. * indicates a statistically significant difference (*, p < 0.05; **, p < 0.01; ***, p < 0.001).