Harvard Department of Ophthalmology, Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts.
Jaeb Center for Health Research, Tampa, Florida.
Retina. 2022 Jul 1;42(7):1302-1310. doi: 10.1097/IAE.0000000000003479.
Evaluate association of retinal nonperfusion (NP) on ultrawide field (UWF) fluorescein angiography (FA) with diabetic retinopathy (DR) severity and predominantly peripheral lesions (PPL).
Multicenter observational study, 652 eyes (361 participants) having nonproliferative DR (NPDR) without center-involved diabetic macular edema in at least one eye. Baseline 200° UWF-color and UWF-FA images were graded by a central reading center for color-PPL and FA-PPL, respectively. UWF-FA was graded for NP index within concentric zones: posterior pole (<10 mm from fovea), midperiphery (10-15 mm), and far periphery (>15 mm).
Baseline Early Treatment Diabetic Retinopathy Study DR severity was 31.7% no DR/mild NPDR, 24.1% moderate NPDR, 14.0% moderately severe NPDR, 25.6% severe/very severe NPDR, and 4.6% proliferative DR. Worse DR severity was associated with increased NP index overall (P = 0.002), in the posterior pole (P < 0.001), midperiphery (P < 0.001), and far periphery (P = 0.03). On average, 29.6% of imaged retinal NP was in the posterior pole, 33.7% in midperiphery, and 36.7% in far periphery. Increased NP index was associated with FA-PPL (P < 0.001) but not with color-PPL (P = 0.65).
Approximately, 70% of NP in diabetic eyes is located outside the posterior pole. Increased NP is associated with the presence of FA-PPL, suggesting UWF-FA may better predict future DR worsening than UWF-color alone.
评估超广角荧光素血管造影（FA）上视网膜无灌注（NP）与糖尿病视网膜病变（DR）严重程度和主要周边病变（PPL）的关联。
这是一项多中心观察性研究，共纳入 652 只眼（361 名参与者），这些眼至少有一只眼患有无黄斑中心受累的非增生性 DR（NPDR）。在中央阅读中心，对基线 200°超广角彩色和 FA 图像分别进行彩色 PPL 和 FA-PPL 的分级。在同心区域内，对 NP 指数进行 UWF-FA 分级：后极部（距黄斑中心凹<10mm）、中周边部（10-15mm）和远周边部（>15mm）。
基线时，早期糖尿病视网膜病变研究 DR 严重程度为 31.7%无 DR/轻度 NPDR、24.1%中度 NPDR、14.0%中度重度 NPDR、25.6%重度/非常重度 NPDR 和 4.6%增殖性 DR。更严重的 DR 严重程度与整体 NP 指数增加相关（P=0.002），在后极部（P<0.001）、中周边部（P<0.001）和远周边部（P=0.03）均如此。平均而言，29.6%的成像视网膜 NP 位于后极部，33.7%位于中周边部，36.7%位于远周边部。NP 指数增加与 FA-PPL 相关（P<0.001），但与彩色 PPL 无关（P=0.65）。
大约 70%的糖尿病患者 NP 位于后极部以外。NP 增加与 FA-PPL 有关，这表明 UWF-FA 可能比单独使用 UWF 彩色更好地预测未来的 DR 恶化。
