Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
Eye Clinic, Ospedale Oftalmico, Turin, Italy.
Ophthalmol Retina. 2024 Sep;8(9):880-888. doi: 10.1016/j.oret.2024.04.005. Epub 2024 Apr 10.
To evaluate best-corrected visual acuity (BCVA), retina sensitivity (RS), and fixation impairment by microperimetry (MP) due to the presence and severity of disorganization of retinal inner and outer layers (DRIL/DROL) and ischemia in OCT/OCT angiography (OCTA) in diabetic retinopathy (DR).
Retrospective case-control study.
Seventy-six eyes (65 patients) with DR were analyzed. Major exclusion criteria were: center-involving diabetic macular edema (DME), significant media opacity, nondiabetic macular pathology, and active proliferative DR. Patients with DRIL and DROL within central 3 mm were enrolled as cases. Patients with DR and no retina disorganization were considered as controls.
A detailed grading of MP and OCT/OCTA images using Image J software, and specific Image Manipulation Program was applied to colocalize the presence of retina disorganization and RS. Best-corrected visual acuity and RS were correlated with the disorganization of retina layers' characteristics and grading (grade 1-DRIL; grade 2-DROL; grade 3-DROL plus, with involvement of the ellipsoid zone). The same procedure of colocalization was applied to the vascular layers on OCTA using MATLAB.
Correlation between BCVA and MP parameters with disorganization of retina layers grading and OCTA parameters.
Best-corrected visual acuity, mean RS within 1 mm and central 3 mm (overall RS [oRS]), perfusion density, vessel density, and geometric perfusion deficit in intermediate and deep capillary plexuses were lower in cases versus controls (P < 0.001). Mean RS within 1 mm (21.4 decibels [dB] ± 2.4 vs. 13.8 dB ± 5.4, P = 0.002), oRS (22.0 dB ± 2.1 vs. 14.4 dB ± 4.6, P < 0.001), and BCVA (76.1 ± 7.4 vs. 61.2 ± 20.4 ETDRS letters; P = 0.02), had a significant decrease from grade 1 to grade 3 retina disorganization. Choriocapillaris flow voids (CC-FVs) increased from grade 1 to grade 3 (DROL plus) (P = 0.004). Overall retina sensitivity and CC-FV were identified as significant predictors of retina disorganization grade with an adjusted coefficient of determination, R = 0.45. Cases had more dense scotomas (P = 0.03) than controls with a positive correlation between the worsening of fixation stability and the severity of DRIL/DROL (P = 0.04).
Microperimetry and BCVA documented a reduction in visual function in patients with DR and disorganization of retina layers at different grades, with greater functional impairment when outer retina layers and photoreceptors are involved. The severity of retina disorganization and the presence of ischemia could serve as a potential biomarker of functional impairment.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估最佳矫正视力（BCVA）、视网膜敏感度（RS）和微视野计（MP）的固视障碍，原因是糖尿病视网膜病变（DR）中存在和严重程度的视网膜内层和外层（DRIL/DROL）紊乱和缺血，以及 OCT/OCT 血管造影（OCTA）。
回顾性病例对照研究。
76 只眼（65 例）患有 DR。主要排除标准为：中心性糖尿病黄斑水肿（DME）、显著的媒介不透明度、非糖尿病性黄斑病变和活跃性增生性 DR。在中央 3 毫米内有 DRIL 和 DROL 的患者被纳入病例组。没有视网膜组织紊乱的 DR 患者被认为是对照组。
使用 Image J 软件对 MP 和 OCT/OCTA 图像进行详细分级，并应用特定的图像操作程序对视网膜组织紊乱和 RS 的存在进行共定位。最佳矫正视力和 RS 与视网膜层特征和分级（1 级-DRIL；2 级-DROL；3 级-DROL 加，累及椭圆体带）的紊乱相关。在 OCTA 上使用 MATLAB 对血管层进行相同的共定位程序。
BCVA 与 MP 参数与视网膜层分级和 OCTA 参数的相关性。
与对照组相比，病例组的最佳矫正视力、1 毫米内和中央 3 毫米内（整体 RS [oRS]）的平均 RS、灌注密度、血管密度以及中间和深层毛细血管丛的几何灌注缺损均较低（P < 0.001）。1 毫米内的平均 RS（21.4 分贝[dB] ± 2.4 与 13.8 dB ± 5.4，P = 0.002）、oRS（22.0 dB ± 2.1 与 14.4 dB ± 4.6，P < 0.001）和 BCVA（76.1 ± 7.4 与 61.2 ± 20.4 ETDRS 字母；P = 0.02）从 1 级到 3 级视网膜组织紊乱显著下降。脉络膜毛细血管血流空洞（CC-FVs）从 1 级到 3 级（DROL 加）增加（P = 0.004）。整体视网膜敏感度和 CC-FV 被确定为视网膜组织紊乱分级的显著预测因子，调整后的决定系数，R = 0.45。与对照组相比，病例组有更多密集的暗点（P = 0.03），并且随着 DRIL/DROL 严重程度的加重，固视稳定性的恶化呈正相关（P = 0.04）。
微视野计和 BCVA 记录了不同分级 DR 患者的视力功能下降，当外层视网膜和光感受器受累时，功能障碍更严重。视网膜组织紊乱的严重程度和缺血的存在可能是功能障碍的潜在生物标志物。
本文末尾的注释和披露中可能包含专有或商业披露信息。
