Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Doheny Eye Institute, Los Angeles, CA, USA.
Am J Ophthalmol. 2020 Oct;218:342-352. doi: 10.1016/j.ajo.2020.05.021. Epub 2020 May 22.
To determine whether a quantitative approach to assessment of the severity of diabetic retinopathy (DR) lesions on ultrawide field (UWF) images can provide new parameters to predict progression to proliferative diabetic retinopathy (PDR).
One hundred forty six eyes from 73 participants with DR and 4 years of follow-up data were included in this post hoc analysis, which was based on a cohort of 100 diabetic patients enrolled in a previously published prospective, comparative study of UWF imaging at the Joslin Diabetes Center. Diabetic Retinopathy Severity Score level was determined at baseline and 4-year follow-up visits using mydriatic 7-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs. All individual DR lesions (hemorrhage [H], microaneurysm [ma], cotton wool spot [CWS], intraretinal microvascular abnormality [IRMA]) were manually segmented on stereographic projected UWF. For each lesion type, the frequency/number, surface area, and distances from the optic nerve head (ONH) were computed. These quantitative parameters were compared between eyes that progressed to PDR in 4 years and eyes that did not progress. Univariable and multivariable logistic regression analyses were performed to identify parameters that were associated with an increased risk for progression to PDR.
A total of 146 eyes of 73 subjects were included in the final analysis. The mean age of the study cohort was 53.1 years, and 42 (56.8%) subjects were female. The number and surface area of H/ma's and CWSs were significantly (P ≤ .05) higher in eyes that progressed to PDR compared with eyes that did not progress by 4 years. Similarly, H/ma's and CWSs were located further away from the ONH (ie, more peripheral) in eyes that progressed (P < .05). DR lesion parameters that conferred a statistically significant increased risk for proliferative diabetic retinopathy in the multivariate model included hemorrhage area (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.25-5.53), and greater distance of hemorrhages from the ONH (OR, 1.24; 95% CI, 0.97-1.59).
Quantitative analysis of DR lesions on UWF images identifies new risk parameters for progression to PDR including the surface area of hemorrhages and the distance of hemorrhages from the ONH. Although these risk factors will need to be confirmed in larger, prospective studies, they highlight the potential for quantitative lesion analysis to inform the design of a more precise and complete staging system for diabetic retinopathy severity in the future. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
确定对超广角 (UWF) 图像上的糖尿病性视网膜病变 (DR) 病变严重程度进行定量评估是否可以提供新的参数来预测向增殖性糖尿病性视网膜病变 (PDR) 的进展。
本研究纳入了一项基于之前发表的前瞻性比较研究的队列中的 100 例糖尿病患者，该研究对 Joslin 糖尿病中心的 UWF 图像进行了评估，共纳入了 73 名患有 DR 且随访 4 年的参与者的 146 只眼，对这些参与者进行了回顾性分析。使用散瞳 7 标准场的早期糖尿病性视网膜病变研究 (ETDRS) 照片，在基线和 4 年随访时确定糖尿病视网膜病变严重程度评分。使用立体投影 UWF 手动对每个 DR 病变（出血 [H]、微动脉瘤 [ma]、棉絮斑 [CWS]、视网膜内微血管异常 [IRMA]）进行分段。对于每种病变类型，计算其频率/数量、表面积以及距视盘（ONH）的距离。比较了在 4 年内进展为 PDR 的眼睛和未进展的眼睛之间这些定量参数的差异。采用单变量和多变量逻辑回归分析来确定与进展为 PDR 风险增加相关的参数。
最终分析共纳入了 73 名参与者的 146 只眼。研究队列的平均年龄为 53.1 岁，42 名（56.8%）参与者为女性。与 4 年内未进展的眼睛相比，进展为 PDR 的眼睛中的 H/ma 和 CWS 的数量和面积明显更高（P≤0.05）。同样，进展眼的 H/ma 和 CWS 距 ONH 更远（即更偏侧）（P<0.05）。多变量模型中与增殖性糖尿病性视网膜病变风险显著增加相关的 DR 病变参数包括出血面积（比值比 [OR]，2.63；95%置信区间 [CI]，1.25-5.53）和出血距 ONH 的距离更大（OR，1.24；95% CI，0.97-1.59）。
对 UWF 图像上的 DR 病变进行定量分析可以确定新的进展为 PDR 的风险参数，包括出血面积和出血距 ONH 的距离。尽管这些危险因素需要在更大的前瞻性研究中得到证实，但它们强调了定量病变分析在未来为糖尿病视网膜病变严重程度制定更精确和完整的分期系统方面的潜力。
本文的发表得到了美国眼科学会的赞助。
