Advances in the diagnosis, management and pathophysiology of capillary nonperfusion

Abstract

‘Capillary dropout’ or ‘nonperfusion’ describes both an anatomic condition and an angiographic appearance in many retinal diseases. In this review, we will discuss several illustrative pediatric and adult retinal vascular diseases including retinopathy of prematurity, familial exudative vitreoretinopathy, diabetic retinopathy and retinal vein occlusions with capillary nonperfusion. Enhanced retinal imaging techniques have demonstrated that capillary nonperfusion is more common in vascular diseases than previously assumed. A large body of experimental evidence in animal models has started to elucidate the underlying pathophysiology of this process. In addition, it has become clear in hereditary and congenital diseases that genetic mutations involving Wnt signaling are integral to retinal vascular development and disease. Defects in the Wnt signaling pathway seem to be related to abnormalities in retinal vascular formation and/or angiomaintenance. Abnormalities in either of these processes may lead to capillary nonperfusion. We review clinical features of capillary nonperfusion and discuss the evolving management of this entity based on novel imaging modalities and molecular mediators.

Keywords::

• capillary
• diabetic retinopathy
• fluorescein angiography
• ischemia
• nonperfusion

Financial & competing interests disclosure

MT Trese is a consultant for the following companies: Nu-Vue Technologies, Synergetics, Thrombogenics, Genentech, FocusROP and Retinal Solutions LLC. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.