Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt.
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Ophthalmol Retina. 2021 Jun;5(6):571-579. doi: 10.1016/j.oret.2020.09.003. Epub 2020 Sep 11.
To evaluate the association of retinal nonperfusion and diabetic retinopathy (DR) severity with location of vascular caliber measurement using ultrawide field (UWF) imaging.
Retrospective image review.
Adults with diabetes mellitus.
All images from subjects with same-day UWF fluorescein angiography (FA) and color imaging were evaluated. Predominantly peripheral lesions (PPL) and DR severity were graded from UWF color images. Nonperfusion was quantified using UWF-FA in defined retinal regions [posterior pole (PP), mid-periphery (MP), far-periphery (FP)]. Retinal vessel calibers were measured at an optic disc centered inner and outer zone.
Nonperfusion index (NPI) in the PP, MP and FP. Mean arteriole and venule diameter in the inner and outer zones.
Two hundred eighty-five eyes of 193 patients (24.9% mild nonproliferative DR [NPDR], 22.8% moderate NPDR, 37.5% severe NPDR and 14.7% proliferative DR [PDR]) were reviewed. No significant associations between inner zone arteriolar diameter and retinal NPI overall or in any retinal region. In the outer zone, eyes with thinnest arteriolar calibers (quartile 1) were associated with a 1.7- to 2.4-fold nonperfusion increase across all retinal regions compared to the remaining eyes (P = 0.002 [PP] to 0.048 [FP]). In the outer zone, the percentage of eyes in the thinnest quartile of retinal arteriolar diameter increased with worsening DR severity (mild NPDR: 10% vs PDR: 31%, P = 0.007). This association was not observed when measured within the inner zone (P = 0.129). All venular caliber associations were not statistically significant when corrected for potentially confounding factors. Thinner outer zone retinal arteriolar caliber (quartile 1) was more common in eyes with PPL compared to eyes without PPL (34.1% vs 20.8%, P = 0.017) as were thicker outer venular calibers (quartile 4) (33% vs 21.3%, P = 0.036). Presence of PPL was associated with thinner outer zone arteriolar caliber (109.7 ± 26.5μm vs 123.0 ± 29.5μm, P = 0.001).
The association of vascular caliber with nonperfusion and DR severity differs based upon the retinal location at which vascular caliber is measured. Peripheral arterial narrowing is associated with increasing nonperfusion, worsening DR severity and presence of PPL. In contrast, inner zone retinal arteriolar caliber is not associated with these findings.
利用超广角（UWF）成像评估视网膜无灌注与糖尿病视网膜病变（DR）严重程度与血管口径测量位置的相关性。
回顾性图像分析。
患有糖尿病的成年人。
评估了同一天接受 UWF 荧光素血管造影（FA）和彩色成像的所有受试者的图像。从 UWF 彩色图像中评估主要周边病变（PPL）和 DR 严重程度。使用 UWF-FA 在特定的视网膜区域（后极（PP）、中周（MP）、远周（FP））定量非灌注。在以视盘为中心的内区和外区测量视网膜血管口径。
PP、MP 和 FP 中的无灌注指数（NPI）。内区和外区的动脉和小静脉直径的平均值。
共回顾了 193 名患者的 285 只眼（24.9%轻度非增生性 DR[NPDR]、22.8%中度 NPDR、37.5%重度 NPDR 和 14.7%增生性 DR[PDR]）。在整个视网膜区域或任何视网膜区域，内区动脉直径与视网膜 NPI 之间均无显著相关性。在外区，与其余眼相比，最细的小动脉口径（第 1 四分位数）的眼在所有视网膜区域的无灌注增加了 1.7 到 2.4 倍（P = 0.002[PP]至 0.048[FP]）。在外区，随着 DR 严重程度的恶化，最细视网膜小动脉直径的眼所占比例增加（轻度 NPDR：10% vs PDR：31%，P = 0.007）。当在内部区域测量时，这种相关性并不显著（P = 0.129）。当校正潜在混杂因素时，所有静脉口径的关联均无统计学意义。与无 PPL 的眼相比，有 PPL 的眼的外区视网膜小动脉更细（第 1 四分位数）（34.1% vs 20.8%，P = 0.017），外区静脉更厚（第 4 四分位数）（33% vs 21.3%，P = 0.036）。PPL 的存在与外区小动脉口径较细（109.7 ± 26.5μm 与 123.0 ± 29.5μm，P = 0.001）相关。
血管口径与无灌注和 DR 严重程度的相关性取决于测量血管口径的视网膜位置。外周动脉狭窄与无灌注增加、DR 严重程度恶化和 PPL 存在相关。相比之下，内区视网膜小动脉口径与这些发现无关。
