视乳头旁脉络膜微血管可预测糖尿病视网膜病变进展及糖尿病性黄斑水肿的发生：一项为期三年的前瞻性研究。
Parapapillary Choroidal Microvasculature Predicts Diabetic Retinopathy Progression and Diabetic Macular Edema Development: A Three-Year Prospective Study.
作者信息
Guo Xiao, Chen Yanping, Bulloch Gabriella, Xiong Kun, Chen Yifan, Li Yuting, Liao Huan, Huang Wenyong, Zhu Zhuoting, Wang Wei
机构信息
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Centre for Eye Research Australia (G.B., Z.Z.), Melbourne, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
出版信息
Am J Ophthalmol. 2023 Jan;245:164-173. doi: 10.1016/j.ajo.2022.07.008. Epub 2022 Jul 19.
PURPOSE
To determine the predictive value of the microcirculation of the optic nerve head by swept-source optical coherence tomography angiography for identifying individuals with high risk of diabetic retinopathy (DR) progression and diabetic macular edema (DME) development.
DESIGN
Prospective observational cohort study.
METHODS
A total of 946 patients (1879 eyes) with type 2 diabetes mellitus were recruited who had no DR or mild nonproliferative DR at baseline, and no DME. All subjects underwent 3 × 3 mm swept-source optical coherence tomography angiography centered on the optic nerve head to generate angiograms in 4 layers: radial peripapillary plexus, superficial retinal capillary plexus (SCP), deep retinal capillary plexus, and choriocapillaris (CC). The CC flow deficit percentage (CC FD%), vessel density (VD), and perfusion density (PD) were quantified.
RESULTS
During the 3 consecutive years of follow-up, 312 eyes (16.60%) experienced DR progression and 115 eyes (6.12%) developed DME. The DR progression was related to a lower VD of the SCP (relative risk per standard deviation decrease, 95% confidence interval): 1.30, 1.14-1.48; P < .001), a lower PD of the SCP (1.41, 1.24-1.60; P < .001), a lower VD of the radial peripapillary plexus (1.23, 1.08-1.40; P = .002), and an elevated CC FD% (1.62, 1.40-1.88; P < .001). The DME occurrence was associated with a lower VD of SCP (1.35, 1.09-1.66; P = .005), a lower PD of SCP (1.29, 1.05-1.59; P = .016), and a higher CC FD% (1.29, 1.03-1.61; P < .001). The CC FD% significantly improved the predictive power, with the increase of the C-statistic for DR progression and DME occurrence by 3.83% (P = .002) and 5.24% (P < .001), respectively.
CONCLUSIONS
This study provides the first longitudinal evidence suggesting that peripapillary CC FD% can improve the prediction of DR progression and DME development beyond traditional risk factors.
目的
通过扫频光学相干断层扫描血管造影术确定视神经乳头微循环对识别糖尿病视网膜病变（DR）进展和糖尿病性黄斑水肿（DME）发生高风险个体的预测价值。
设计
前瞻性观察队列研究。
方法
共招募了946例2型糖尿病患者（1879只眼），这些患者在基线时无DR或轻度非增殖性DR，且无DME。所有受试者均接受以视神经乳头为中心的3×3 mm扫频光学相干断层扫描血管造影术，以生成4层血管造影图：放射状视乳头周围丛、视网膜浅毛细血管丛（SCP）、视网膜深毛细血管丛和脉络膜毛细血管（CC）。对CC血流缺损百分比（CC FD%）、血管密度（VD）和灌注密度（PD）进行量化。
结果
在连续3年的随访期间，312只眼（16.60%）发生DR进展，115只眼（6.12%）发生DME。DR进展与SCP的较低VD（每标准差降低的相对风险，95%置信区间）：1.30，1.14 - 1.48；P <.001）、SCP的较低PD（1.41，1.24 - 1.60；P <.001）、放射状视乳头周围丛的较低VD（1.23，1.08 - 1.40；P =.002）以及升高的CC FD%（1.62，1.40 - 1.88；P <.001）相关。DME的发生与SCP的较低VD（1.35，1.09 - 1.66；P =.005）、SCP的较低PD（1.29，1.05 - 1.59；P =.016）以及较高的CC FD%（1.29，1.03 - 1.61；P <.001）相关。CC FD%显著提高了预测能力，DR进展和DME发生的C统计量分别增加了3.83%（P =.002）和5.24%（P <.001）。
结论
本研究提供了首个纵向证据，表明视乳头周围CC FD%可改善对DR进展和DME发生的预测，超越传统风险因素。
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