Wu Yi, He Mingguang, Huang Wenyong, Wang Wei
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.
Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong, China.
Acta Diabetol. 2024 Feb;61(2):195-204. doi: 10.1007/s00592-023-02194-w. Epub 2023 Oct 11.
To determine the association between retinal blood vessel flow and geometric parameters and the risk of diabetic retinopathy (DR) progression through a 2-year prospective cohort study.
Patients with type 2 diabetes mellitus (T2DM) were recruited from a diabetic registry between November 2017 and March 2019. All participants underwent standardized examinations at the baseline and 2-year follow-up visit, and the presence and severity of DR were assessed based on standard seven-field color fundus photographs. They also underwent swept-source optical coherence tomography angiography (OCTA) imaging to obtain measurements of foveal avascular zone area, blood vessel density (VD), fractal dimension (FD), blood vessel tortuosity (BVT) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP).
A total of 233 eyes of 125 patients were included, and 40 eyes (17.17%) experienced DR progression within 2 years. DR progression was significantly associated with lower baseline VD (odds ratio [OR] 2.323 per SD decrease; 95% confidence interval [CI] 1.456-3.708; P < 0.001), lower FD (OR, 2.484 per SD decrease; 95% CI 1.268-4.867; P = 0.008), and higher BVT (OR, 2.076 per SD increase; 95% CI 1.382-3.121; P < 0.001) of the DCP after adjusting for confounding factors. The addition of OCTA metrics improved the predictive ability of the original model for DR progression (area under the curve [AUC] from 0.725 to 0.805; P = 0.022).
OCTA-derived VD, FD and BVT in the DCP were independent predictors of DR progression and showed additive value when added to established risk models predicting DR progression.
通过一项为期2年的前瞻性队列研究，确定视网膜血管血流与几何参数之间的关联以及糖尿病视网膜病变（DR）进展的风险。
2017年11月至2019年3月期间，从糖尿病登记处招募2型糖尿病（T2DM）患者。所有参与者在基线和2年随访时均接受了标准化检查，并根据标准的七视野彩色眼底照片评估DR的存在和严重程度。他们还接受了扫频光学相干断层扫描血管造影（OCTA）成像，以获取黄斑无血管区面积、血管密度（VD）、分形维数（FD）、浅表毛细血管丛（SCP）和深层毛细血管丛（DCP）中血管迂曲度（BVT）的测量值。
共纳入125例患者的233只眼，其中40只眼（17.17%）在2年内出现DR进展。在调整混杂因素后，DR进展与DCP的基线VD较低（每标准差降低的比值比[OR]为2.323；95%置信区间[CI]为1.456 - 3.708；P < 0.001）、FD较低（OR为每标准差降低2.484；95% CI为1.268 - 4.867；P = 0.008）以及BVT较高（OR为每标准差增加2.076；95% CI为1.382 - 3.121；P < 0.001）显著相关。OCTA指标的加入提高了原始模型对DR进展的预测能力（曲线下面积[AUC]从0.725提高到0.805；P = 0.022）。
OCTA得出的DCP中的VD、FD和BVT是DR进展的独立预测因素，并且在添加到预测DR进展的既定风险模型中时显示出附加价值。
