MultiColor imaging to detect different subtypes of retinal microaneurysms in diabetic retinopathy

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Abstract
Background Retinal microaneurysms (MAs) are among the earliest signs of diabetic retinopathy (DR) and are typically detected by fluorescein angiography (FA). Confocal MultiColor is a noninvasive-imaging technique able to analyze different retinal features by capturing three simultaneous reflectance images. The main aim of the present study was to characterize morphological features of MAs by means of MultiColor images and to compare these with spectral domain optical coherence tomography (SD-OCT) and FA findings. Methods A cross-sectional, observational study setting was chosen. Multimodal imaging included MultiColor, SD-OCT and FA images. We performed a qualitative analysis in order to assess the relationship between MultiColor and its green- and red-reflectance components, SD-OCT (hyperreflective, hyporeflective and mixed reflectivity) and FA findings. MAs detected on our MultiColor images were then categorized in accordance with a previously published histological classification. Results In our study FA images were used to detect 153 MAs in 30 eyes displaying DR. MultiColor was able to distinguish 122 MAs (80%). We identified green (16%), red (19%), and mixed (65%) MAs, corresponding to different reflectivity features detected by SD-OCT. MAs not visualized on MultiColor images corresponded to tiny hyperreflective lesions on SD-OCT. We compared our imaging findings with a histological MA classification reported in the literature. Our findings showed a strict relationship between MA subtypes and SD-OCT, suggesting that the composition of MAs (cells + endothelium + fibrosis) may influence the signal detected in MultiColor images. Conclusions MultiColor appears to be a useful technique for investigating MA features in patients with DR.