Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.
Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Transl Vis Sci Technol. 2023 Feb 1;12(2):7. doi: 10.1167/tvst.12.2.7.
To evaluate the ability of ultrawide field (UWF)-directed optical coherence tomography (OCT) to detect retinal neovascularization in eyes thought to have severe nonproliferative diabetic retinopathy (NPDR).
Retrospective study of 20 consecutive patients diagnosed with severe NPDR by clinical examination. All patients underwent UWF color imaging (UWF-CI) and UWF-directed OCT following a prespecified imaging protocol to assess the mid periphery, 15/32 (46.9%) eyes underwent UWF-fluorescein angiography (FA). On OCT, new vessels elsewhere (NVE) were defined when vessels breached the internal limiting membrane.
A total of 32 eyes of 20 patients were evaluated. Of the 45 suspected areas of intraretinal microvascular abnormalities (IRMA) on UWF-CI, 38 (84.4%) were imaged by UWF-directed OCT, and 9/38 IRMA (23.7%) were NVE by OCT. Furthermore, UWF-directed OCT identified seven additional NVE in three eyes not seen on UWF-CI. This resulted in a change in diabetic retinopathy (DR) severity from severe NPDR to PDR in 8/32 eyes (25.0%). Among the 46.9% of eyes with UWF-FA, UWF-directed OCT agreed with the UWF-FA findings in 80% (12/15 eyes), missing only one peripheral NVE outside the UWF-OCT scanning area. Two eyes had subtle NVD that were not evident on UWF-directed OCT.
This pilot study suggests that UWF-directed OCT may help differentiate IRMA from NVE and detect unrecognized NVE in eyes with advanced DR in a clinical practice setting. Future prospective studies in larger cohorts could determine whether this rapid and noninvasive method is clinically relevant in determining NVE presence or retinopathy progression and complication risk.
UWF-directed OCT may offer a noninvasive alternative to detect NVE in eyes with DR.
评估超广角（UWF）定向光相干断层扫描（OCT）检测疑似严重非增生性糖尿病视网膜病变（NPDR）患者视网膜新生血管的能力。
回顾性研究 20 例连续临床诊断为严重 NPDR 的患者。所有患者均按预定的成像方案进行超广角彩色成像（UWF-CI）和超广角定向 OCT 检查，以评估中周部。15/32（46.9%）只眼进行超广角荧光血管造影（FA）检查。在 OCT 上，当血管突破内界膜时，将其他部位的新生血管（NVE）定义为新血管。
共评估 20 例患者的 32 只眼。在 UWF-CI 上怀疑有 45 处视网膜内微血管异常（IRMA）区域，其中 38 只（84.4%）用超广角定向 OCT 成像，9/38 只（23.7%）用 OCT 发现 NVE。此外，超广角定向 OCT 还在 3 只未在 UWF-CI 上发现的眼中发现了另外 7 处 NVE。这导致 32 只眼中的 8 只（25.0%）从严重 NPDR 转变为 PDR。在 46.9%的超广角 FA 眼中，超广角定向 OCT 与超广角 FA 结果一致，仅漏诊 1 只超广角 OCT 扫描区域以外的周边 NVE。2 只眼有细微的 NVD，但超广角定向 OCT 上没有明显显示。
这项初步研究表明，超广角定向 OCT 可能有助于区分 IRMA 和 NVE，并在临床实践中检测到晚期 DR 眼中未被识别的 NVE。未来更大队列的前瞻性研究可以确定这种快速、无创的方法在确定 NVE 存在或视网膜病变进展和并发症风险方面是否具有临床意义。
叶方伟
