Santos Ana R, Lopes Marta, Santos Torcato, Reste-Ferreira Débora, Marques Inês P, Yamaguchi Taffeta C N, Miranda Telmo, Mendes Luís, Martinho António C V, Pearce Liz, Cunha-Vaz José
AIBILI - Association for Innovation and Biomedical Research On Light and Image, Coimbra, Portugal.
CORC - Coimbra Ophthalmology Reading Centre, Coimbra, Portugal.
Ophthalmol Ther. 2024 Dec;13(12):3161-3173. doi: 10.1007/s40123-024-01054-2. Epub 2024 Oct 26.
This study aimed to evaluate intraretinal microvascular abnormalities (IRMA) in eyes with advanced nonproliferative diabetic retinopathy (NPDR) using multimodal approach in co-located areas focusing on central retina (up to 50°) and to look at possible correlations between IRMA and other structural changes, like ischemia and presence of microaneurysms.
The RICHARD study (NCT05112445) included 60 eyes from 60 patients with type 2 diabetes with moderate-severe NPDR, diabetic retinopathy severity levels 43, 47, and 53 (DRSS). IRMA were defined as capillary tortuosity covering a minimum circular area of 300 µm (calculated to correspond to the Early Treatment Diabetic Retinopathy Study standard photo 8A) and were identified using multimodal imaging with distinct fields of view (FoV): color fundus photography (CFP) using a Topcon TRC-50DX camera (Topcon Medical Systems, Japan), Optos California ultra wide field fundus fluorescein angiography (UWF-FFA) (Optos plc, UK), and swept-source optical coherence tomography angiography (SS-OCTA) (PLEX® Elite 9000, ZEISS, USA). Different areas of the retina were examined: central macula (up to 20°) and posterior pole (between 20° and 50°).
Multimodal imaging was used to identify IRMA in co-located areas (FoV < 50°) including UWF-FFA, CFP, and SS-OCTA. In eyes with DRSS levels 47 and 53, IRMA were identified in both areas of the retina, while in eyes with DRSS level 43, IRMA were detected only outside of the central macula (FoV > 20°). Our results show that when evaluating the presence of IRMA (FoV < 50°), UWF-FFA detected 203 IRMA, SS-OCTA detected 133 IRMA, and CFP detected 104 IRMA. Our results also show that the presence of IRMA was positively associated with presence of microaneurysms.
Identification of IRMA in eyes with advanced NPDR is better achieved by UWF-FFA than CFP and SS-OCTA. A statistically significant correlation was found between the presence of IRMA and the increase in number of microaneurysms.
ClinicalTrials.gov, identifier NCT05112445.
本研究旨在采用多模态方法，在聚焦于中央视网膜（达50°）的同位置区域评估晚期非增殖性糖尿病视网膜病变（NPDR）患者眼中的视网膜内微血管异常（IRMA），并观察IRMA与其他结构变化（如缺血和微动脉瘤的存在）之间的可能相关性。
RICHARD研究（NCT05112445）纳入了60例2型糖尿病伴中度至重度NPDR患者的60只眼，糖尿病视网膜病变严重程度分级为43、47和53（DRSS）。IRMA被定义为覆盖最小圆形面积300 µm的毛细血管迂曲（经计算对应于糖尿病视网膜病变早期治疗研究标准照片8A），并使用具有不同视野（FoV）的多模态成像进行识别：使用Topcon TRC - 50DX相机（日本拓普康医疗系统公司）进行彩色眼底照相（CFP）、Optos California超广角眼底荧光血管造影（UWF - FFA）（英国Optos plc公司）以及扫频光学相干断层扫描血管造影（SS - OCTA）（美国蔡司公司的PLEX® Elite 9000）。检查视网膜的不同区域：中央黄斑（达20°）和后极部（20°至50°之间）。
采用多模态成像在同位置区域（FoV < 50°）识别IRMA，包括UWF - FFA、CFP和SS - OCTA。在DRSS分级为47和53的眼中，在视网膜的两个区域均识别出IRMA，而在DRSS分级为43的眼中，仅在中央黄斑以外（FoV > 20°）检测到IRMA。我们的结果显示，在评估IRMA（FoV < 50°）的存在时，UWF - FFA检测到203处IRMA，SS - OCTA检测到133处IRMA，CFP检测到104处IRMA。我们的结果还显示，IRMA的存在与微动脉瘤的存在呈正相关。
对于晚期NPDR患者眼中IRMA的识别，UWF - FFA比CFP和SS - OCTA效果更好。发现IRMA的存在与微动脉瘤数量的增加之间存在统计学上的显著相关性。
ClinicalTrials.gov，标识符NCT05112445。
