Thottarath Sridevi, Tsai Wei-Shan, Gurudas Sarega, Pearce Elizabeth, Cheung Chui Ming Gemmy, Yamaguchi Taffeta Ching Ning, Sivaprasad Sobha
Moorfields Clinical Research Facility, NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Institute of Ophthalmology, University College London, London, United Kingdom.
JAMA Ophthalmol. 2025 Jan 1;143(1):45-52. doi: 10.1001/jamaophthalmol.2024.5105.
Some eyes with proliferative diabetic retinopathy (PDR) treated to stability with panretinal photocoagulation (PRP) continue to lose vision without diabetic macular edema. One presumed cause is macular capillary nonperfusion (CNP)-associated ischemia or infarction. Natural history data of macular CNP might guide treatment trials for it.
To assess visual function and optical coherence tomography angiography (OCTA) changes over 12 months in PRP-treated stable eyes with PDR and macular CNP.
DESIGN, SETTING, AND PARTICIPANTS: This prospective observational cohort study was conducted in a single center in the United Kingdom. Participants had stable laser-treated PDR in at least 1 eye with macular CNP and a best-corrected visual acuity (BCVA) letter score of at least 54 (Snellen equivalent ≥20/80) using Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recruitment was from December 2019 to August 2021 and follow-up for 12 months; data were analyzed from May to July 2024.
Changes in BCVA, low-luminance visual acuity (LLVA), and OCTA metrics over 12 months using linear mixed-effects models with unstructured variance accounting for within-participant correlation between the eligible study eye and repeated measures across time.
The cohort included 63 participants and 88 eyes. The mean (SD) age was 57.4 (11.9) years; 41 were male (65.1%) and 22 female (34.9%). Mean BCVA and LLVA ETDRS letter scores were 77.52 (SD, 8.0; approximate Snellen equivalent, 20/32) and 68.33 (SD, 8.9; Snellen, 20/40) at baseline and 78.76 (SD, 8.3; Snellen 20/25) and 70.20 (SD, 8.1; Snellen, 20/40) at 12 months. However, 7 participants (9.3%) lost at least 5 letters of visual acuity at 12 months. Linear mixed-effects analysis showed the foveal avascular zone (FAZ) area deteriorated over 12 months, with a mean increase of 1.80% (95% CI, 0.01%-3.63%; P = .05) at 6 months and 2.26% (95% CI, 0.29%-4.26%; P = .03) from baseline. Eyes that lost 5 or more letters had lower baseline superficial vascular density in both the 3 × 3-mm scan (mean [SD], 36.7 [4.8] vs 33.5 [2.0]; P = .006) and parafoveal area (38.7 [5.6] vs 34.7 [2.6]; P = .005). No association was found between a loss of 5 or more letters at 12 months and any baseline FAZ parameters.
This study found that FAZ area deteriorated over 12 months in eyes with stable laser-treated peripheral retina in eyes and macular CNP. Vision loss was uncommon and more prevalent in eyes with decreased SVD at baseline rather than FAZ parameters. Longer trials may be required to observe more events of change of 5 or more letters.
一些接受全视网膜光凝（PRP）治疗后病情稳定的增殖性糖尿病视网膜病变（PDR）患者，即便没有糖尿病性黄斑水肿，仍会继续丧失视力。一种推测的原因是黄斑区毛细血管无灌注（CNP）相关的缺血或梗死。黄斑CNP的自然病史数据可能会为其治疗试验提供指导。
评估接受PRP治疗且病情稳定的PDR合并黄斑CNP患者在12个月内的视觉功能和光学相干断层扫描血管造影（OCTA）变化。
设计、地点和参与者：这项前瞻性观察性队列研究在英国的一个中心进行。参与者至少有一只眼睛接受过激光治疗且病情稳定的PDR合并黄斑CNP，使用早期糖尿病视网膜病变研究（ETDRS）视力表，最佳矫正视力（BCVA）字母评分至少为54（Snellen视力相当于≥20/80）。招募时间为2019年12月至2021年8月，随访12个月；数据分析时间为2024年5月至7月。
使用线性混合效应模型，在考虑合格研究眼与不同时间重复测量之间的个体内相关性且采用非结构化方差的情况下，分析12个月内BCVA、低亮度视力（LLVA）和OCTA指标的变化。
该队列包括63名参与者和88只眼睛。平均（标准差）年龄为57.4（11.9）岁；男性41名（65.1%），女性22名（34.9%）。基线时BCVA和LLVA的ETDRS字母评分分别为77.52（标准差，8.0；近似Snellen视力相当于20/32）和68.33（标准差，8.9；Snellen视力，20/40），12个月时分别为78.76（标准差，8.3；Snellen视力20/25）和70.20（标准差，8.1；Snellen视力，20/40）。然而，7名参与者（9.3%）在12个月时至少丧失了5个字母的视力。线性混合效应分析显示，黄斑无血管区（FAZ）面积在12个月内有所恶化，6个月时平均增加1.80%（95%置信区间，0.01% - 3.63%；P = 0.05），与基线相比增加2.26%（95%置信区间，0.29% - 4.26%；P = 0.03）。在12个月时丧失5个或更多字母视力的眼睛，在3×3毫米扫描区域（平均[标准差]，36.7[4.8]对33.5[2.0]；P = 0.006）和黄斑旁区域（38.7[5.6]对34.7[2.6]；P = 0.005）的基线浅表血管密度较低。在12个月时丧失5个或更多字母视力与任何基线FAZ参数之间未发现关联。
本研究发现，在接受激光治疗且周边视网膜病情稳定、合并黄斑CNP的眼睛中，FAZ面积在12个月内有所恶化。视力丧失并不常见，在基线时浅表血管密度降低的眼睛中更为普遍，而非FAZ参数。可能需要更长时间的试验来观察更多丧失5个或更多字母视力变化的情况。
