视网膜血氧测定与超广角血管造影显示的外周糖尿病视网膜病变病变及无灌注的相关性
Association of Retinal Oximetry with Peripheral Diabetic Retinopathy Lesions and Nonperfusion on Ultra-widefield Angiography.
作者信息
Sampani Konstantina, Ashraf Mohamed, Pitoc Cloyd M, Rhee Jae, Tolson Ann M, Cavallerano Jerry D, Sun Jennifer K, Aiello Lloyd Paul, Silva Paolo S
机构信息
Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
出版信息
Ophthalmol Sci. 2024 Dec 24;5(3):100686. doi: 10.1016/j.xops.2024.100686. eCollection 2025 May-Jun.
PURPOSE
To evaluate the association of retinal ischemia measured using retinal oximetry with retinal nonperfusion and predominantly peripheral lesions on ultra-widefield (UWF) fluorescein angiography (FA PPL).
DESIGN
Prospective single-center, image evaluation study.
PARTICIPANTS
Images from 42 eyes from 21 participants with diabetes.
METHODS
Ultra-widefield images were evaluated to determine diabetic retinopathy (DR) severity. Ultra-widefield FA images were used to measure nonperfusion area (NPA, mm) and nonperfusion index (NPI) and FA PPL presence. Retinal oximetry was performed to measure venous oxygen saturation (VO, %) and arteriovenous difference (A-V, %) within a 2-disc diameter ring centered on the optic disc.
MAIN OUTCOME MEASURES
Nonperfusion area, NPI, and presence of FA PPL.
RESULTS
Mean age was 40.7 ± 10.4 years, diabetes duration 21.4 ± 10.0 years, hemoglobin A1c (HbA1c) 7.7 ± 1.0, 33.3% (14) were female, and 76.2% (32) had type 1. Distribution of DR on UWF color imaging was no-DR 9.5% (4); mild 45.2% (19), moderate 21.4% (9), and severe 9.5% (4) nonproliferative DR; and proliferative DR 14.3 (6) with FA PPL present in 25 (59.5%). Mean NPA/NPI was associated with increasing DR severity ( = 0.0014/0.0018), even after correction for diabetes duration and HbA1c ( = 0.0029/0.0025). In multivariate analysis adjusting for diabetes duration, HbA1c, and DR severity, the presence of FA PPL was associated with increasing VO and decreasing A-V (VO; = 0.03, A-V; = 0.009).
CONCLUSIONS
Past studies have established an increased risk of DR progression with the presence of FA PPL. These data show that FA PPL presence is associated with retinal oximetry measures consistent with the presence of venous shunting or reduced retinal oxygen consumption, possibly indicative of greater areas of retinal ischemia. These findings highlight the value of retinal oximetry as a noninvasive measure of retinal ischemia and as a potential marker for increased risk of DR worsening.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
评估使用视网膜血氧测定法测量的视网膜缺血与超广角（UWF）荧光素血管造影（FA PPL）上的视网膜无灌注及主要为周边病变之间的关联。
设计
前瞻性单中心图像评估研究。
参与者
来自21名糖尿病患者的42只眼睛的图像。
方法
评估超广角图像以确定糖尿病视网膜病变（DR）的严重程度。使用超广角FA图像测量无灌注面积（NPA，mm）、无灌注指数（NPI）以及FA PPL的存在情况。进行视网膜血氧测定以测量以视盘为中心的2个视盘直径环内的静脉血氧饱和度（VO，%）和动静脉差值（A-V，%）。
主要观察指标
无灌注面积、NPI以及FA PPL的存在情况。
结果
平均年龄为40.7±10.4岁，糖尿病病程为21.4±10.0年，血红蛋白A1c（HbA1c）为7.7±1.0，33.3%（14例）为女性，76.2%（32例）为1型糖尿病。UWF彩色成像上DR的分布情况为：无DR 9.5%（4只眼睛）；轻度非增殖性DR 45.2%（19只眼睛），中度21.4%（9只眼睛），重度9.5%（4只眼睛）；增殖性DR 14.3%（6只眼睛），其中25只眼睛（59.5%）存在FA PPL。平均NPA/NPI与DR严重程度增加相关（P = 0.0014/0.0018），即使在对糖尿病病程和HbA1c进行校正后（P = 0.0029/0.0025）。在对糖尿病病程、HbA1c和DR严重程度进行校正的多变量分析中，FA PPL的存在与VO增加和A-V降低相关（VO：P = 0.03，A-V：P = 0.009）。
结论
过去的研究已证实存在FA PPL会增加DR进展的风险。这些数据表明，FA PPL的存在与视网膜血氧测定结果相关，这些结果与静脉分流或视网膜氧消耗减少一致，可能表明视网膜缺血面积更大。这些发现突出了视网膜血氧测定作为视网膜缺血的无创测量方法以及DR恶化风险增加的潜在标志物的价值。
财务披露
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
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