Yuan Melissa, Romano Francesco, Ding Xinyi, Garcia Mauricio, Garg Itika, Overbey Katherine Millner, Bennett Cade, Ploumi Ioanna, Stettler Isabella, Lains Ines, Vingopoulos Filippos, Rodriguez Jocelyn, Patel Nimesh A, Kim Leo A, Vavvas Demetrios G, Husain Deeba, Miller Joan W, Miller John B
Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar;263(3):679-687. doi: 10.1007/s00417-024-06660-1. Epub 2024 Nov 15.
To assess the prevalence of foveal neovascularization (FNV) and its associated clinical features in proliferative diabetic retinopathy (PDR) eyes.
Cross-sectional observational study. Participants underwent ultra-widefield photography, optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA). FNV was defined as a hyperreflective lesion breaching the internal limiting membrane and displaying flow signal on OCTA, within 1-mm of foveal avascular zone. Vascular metrics were obtained from the ARI Network portal. Ischemic index (ISI) and inner choroid flow deficit percentage were calculated using FIJI from 12 × 12 and 6 × 6-mm scans, respectively. Logistic regression models were used to compare eyes with and without FNV.
We included 249 eyes of 164 patients (age: 58 [50-65] years). FNV was identified in 20 eyes (8%). Univariate logistic regression revealed significant associations between FNV and younger age (p = 0.03), higher maximal HbA1c (p = 0.04), worse visual acuity (VA) (p = 0.01), presence of disorganization of retinal inner layers (DRIL) (p = 0.01), no macular posterior vitreous detachment (PVD) (p = 0.03), neovascularization elsewhere (NVE) and at the disc (NVD) (p = 0.01 and p = 0.001), and greater ISI (p = 0.04). In multivariable analysis, a significant association remained between FNV and worse VA (p = 0.04), NVD (p < 0.001), DRIL (p < 0.001), and absence of macular PVD (p = 0.01). No associations were found with SS-OCTA vascular metrics.
This study provides a comprehensive characterization of FNV in PDR. FNV was identified in 8% of our cohort, being more prevalent in younger patients with severe PDR, as evidenced by NVD and DRIL presence. The absence of macular PVD may explain its association with younger age.
What is known • Neovascularization at the fovea occurs rarely in proliferative diabetic retinopathy. • OCT and OCT-angiography can be used to evaluate foveal neovascularization, which may be associated with choroidal vascular abnormalities. What is new • Foveal neovascularization was seen in 8% of eyes with proliferative diabetic retinopathy in this cohort. • Risk factors for foveal neovascularization included younger age, absence of macular posterior vitreous detachment, presence of neovascularization of the disc, and presence of disorganization of retinal inner layers. • We did not identify an association between foveal neovascularization and choroidal perfusion abnormalities in this study.
评估增生性糖尿病视网膜病变（PDR）患者眼中黄斑区新生血管（FNV）的患病率及其相关临床特征。
横断面观察性研究。参与者接受超广角摄影、光学相干断层扫描（OCT）和扫频源OCT血管造影（SS-OCTA）检查。FNV定义为在黄斑无血管区1毫米范围内，突破内界膜的高反射性病变，并在OCTA上显示血流信号。从ARI网络门户获取血管指标。分别使用FIJI软件从12×12毫米和6×6毫米扫描图像计算缺血指数（ISI）和脉络膜内层血流缺失百分比。采用逻辑回归模型比较有和无FNV的眼睛。
我们纳入了164例患者的249只眼（年龄：58[50 - 65]岁）。20只眼（8%）发现有FNV。单因素逻辑回归显示，FNV与较年轻的年龄（p = 0.03）、较高的最大糖化血红蛋白（p = 0.04）、较差的视力（VA）（p = 0.01）、视网膜内层紊乱（DRIL）的存在（p = 0.01）、无黄斑后玻璃体脱离（PVD）（p = 0.03）、其他部位新生血管（NVE）和视盘新生血管（NVD）（p = 0.01和p = 0.001）以及较高的ISI（p = 0.04）之间存在显著关联。多变量分析显示，FNV与较差的VA（p = 0.04）、NVD（p < 0.001）、DRIL（p < 0.001）和无黄斑PVD（p = 0.01）之间仍存在显著关联。未发现与SS-OCTA血管指标有关联。
本研究全面描述了PDR中FNV的特征。我们队列中8%的患者发现有FNV，在伴有NVD和DRIL的重度PDR年轻患者中更为常见。无黄斑PVD可能解释了其与较年轻年龄的关联。
已知内容 • 黄斑区新生血管在增生性糖尿病视网膜病变中很少见。 • OCT和OCT血管造影可用于评估黄斑区新生血管，其可能与脉络膜血管异常有关。新发现 • 本队列中8%的增生性糖尿病视网膜病变患者眼中可见黄斑区新生血管。 • 黄斑区新生血管的危险因素包括较年轻的年龄、无黄斑后玻璃体脱离、视盘新生血管的存在以及视网膜内层紊乱的存在。 • 本研究未发现黄斑区新生血管与脉络膜灌注异常之间的关联。
