Lin Benjamin R, Carletti Piero, Yi Jonathan, Rosenfeld Philip J, Russell Jonathan F
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA.
Department of Ophthalmology and Visual Sciences, University of Iowa, 200 Hawkins Dr, PFP 11196-J, Iowa City, USA.
Graefes Arch Clin Exp Ophthalmol. 2025 Feb;263(2):361-368. doi: 10.1007/s00417-024-06650-3. Epub 2024 Oct 8.
The purpose of this study was to assess whether diabetic NV is perfused by the arterial or the venous circulation.
This is a retrospective, consecutive case series evaluating patients with proliferative diabetic retinopathy (PDR) imaged with ultrawide-field (UWF) fluorescein angiography (FA). Areas of neovascularization elsewhere (NVE) and neovascularization of the disc (NVD) were assessed. Perfusion was defined as arterial, arteriovenous, or venous if the area of diabetic neovascularization (NV) began to hyperfluoresce either prior, during, or after laminar venous flow, respectively.
A total of 180 eyes from 176 patients with 928 NV were identified (830 NVE, 98 NVD). Of those, 5.1% of NVE were classified as arterial and 58.2% of NVD were classified as arterial. The remaining NV were classified as arteriovenous except for a small subset (6.1%) which were indeterminate. None of the NV were classified as venous. Noteworthy examples demonstrated NV that nearly fully perfused prior to any detectable fluorescence within nearby veins as well as clear shunting of blood from a feeding artery to a draining vein.
UWF FA images suggest that some NV is perfused by retinal arteries. This may be useful in devising strategies for early detection and treatment of NV precursors.
What is known • Diabetic retinal neovascularization has long been thought to be perfused by the retinal venous circulation. • Vascular endothelial growth factor has been shown to play key roles in both angiogenesis and arteriogenesis. What is new • Ultrawide-field fluorescein angiography demonstrates that at least some diabetic neovascularization is perfused by the retinal arterial circulation. • This supports the hypothesis that diabetic neovascularization may arise from arterially-perfused intraretinal microvascular abnormalities in the capillary bed.
本研究旨在评估糖尿病性新生血管是由动脉循环还是静脉循环灌注。
这是一项回顾性连续病例系列研究，评估接受超广角（UWF）荧光素血管造影（FA）成像的增殖性糖尿病视网膜病变（PDR）患者。评估其他部位新生血管（NVE）和视盘新生血管（NVD）的区域。如果糖尿病性新生血管（NV）区域分别在层流静脉血流之前、期间或之后开始出现高荧光，则灌注定义为动脉灌注、动静脉灌注或静脉灌注。
共纳入176例患者的180只眼，有928处NV（830处NVE，98处NVD）。其中，5.1%的NVE被分类为动脉灌注，58.2%的NVD被分类为动脉灌注。其余的NV被分类为动静脉灌注，除了一小部分（6.1%）不确定。没有NV被分类为静脉灌注。值得注意的例子显示，NV在附近静脉出现任何可检测到的荧光之前几乎完全灌注，以及血液从供血动脉明显分流到引流静脉。
UWF FA图像表明，一些NV由视网膜动脉灌注。这可能有助于制定早期检测和治疗NV前驱病变的策略。
已知内容 • 长期以来，人们一直认为糖尿病视网膜新生血管是由视网膜静脉循环灌注的。 • 血管内皮生长因子已被证明在血管生成和动脉生成中都起关键作用。新内容 • 超广角荧光素血管造影表明，至少一些糖尿病性新生血管是由视网膜动脉循环灌注的。 • 这支持了糖尿病性新生血管可能源于毛细血管床中动脉灌注的视网膜内微血管异常的假说。
