Yoshida Miyo, Murakami Tomoaki, Nishikawa Keiichi, Ishihara Kenji, Mori Yuki, Tsujikawa Akitaka
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Ophthalmol Sci. 2025 Mar 12;5(4):100761. doi: 10.1016/j.xops.2025.100761. eCollection 2025 Jul-Aug.
To elucidate the progression pathways of diabetic macular ischemia (DMI) using OCT angiography (OCTA) images and to assess changes in visual acuity (VA) associated with each pathway.
A single-center, prospective case series study.
One hundred fifty-one eyes from 151 patients with a 3-year follow-up period.
We obtained 3 × 3 mm swept-source OCTA images and conducted analyses of en face images within a central 2.5 mm diameter circle. Nonperfusion squares (NPSs) were defined as 15 × 15-pixel squares without retinal vessels. Each eye at baseline and after 3 years was embedded into a 2-dimensional uniform manifold approximation and projection space and assigned to 1 of 5 severity grades-, , , , and -using the k-nearest neighbors method. We assessed major transitions (involving ≥4 cases) during 3 years. Subsequent probabilistic analyses enabled the construction of a graphical model, wherein directed arrows represented inferred pathways of DMI progression. From this cohort, 103 eyes of 103 patients who did not receive any ocular treatments during the follow-up period were subsequently evaluated for VA changes.
Inference of DMI progression pathways.
In most cases, NPS counts increased in both the superficial and deep layers. The major transitions between these severity groups at 3 years displayed a unique distribution, and probabilistic analyses suggested a directed graphical model comprising 7 inferred pathways of DMI progression: to , to , to , to , to , to , and to Eyes of the and cial groups had greater increases in superficial NPS within the central sector than those of the group. Additionally, deep NPS counts within the central sector decreased more in the eyes of the group than in those of the and groups. Notably, the eyes of the and groups exhibited greater VA deterioration at 3 years compared with those in the group.
A directed graphical model of DMI progression may serve as a useful tool for inferring progression pathways and predicting VA deterioration.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
使用光学相干断层扫描血管造影（OCTA）图像阐明糖尿病性黄斑缺血（DMI）的进展途径，并评估与每种途径相关的视力（VA）变化。
单中心前瞻性病例系列研究。
151例患者的151只眼，随访期为3年。
我们获取了3×3mm的扫频源OCTA图像，并对直径2.5mm的中心圆内的正面图像进行分析。无灌注方块（NPS）定义为15×15像素且无视网膜血管的方块。将每只眼在基线时和3年后的数据嵌入二维均匀流形近似和投影空间，并使用k近邻法将其分为5个严重程度等级之一：1级、2级、3级、4级和5级。我们评估了3年内的主要转变（涉及≥4例）。随后的概率分析构建了一个图形模型，其中有向箭头表示DMI进展的推断途径。在这个队列中，对随访期间未接受任何眼部治疗的103例患者的103只眼进行了VA变化评估。
DMI进展途径的推断。
在大多数情况下，浅层和深层的NPS计数均增加。3年时这些严重程度组之间的主要转变呈现出独特的分布，概率分析提示了一个包含7条DMI进展推断途径的有向图形模型：1级到2级、2级到3级、3级到4级、4级到5级、1级到3级、2级到4级以及3级到5级。1级和2级组眼中中央区域浅层NPS的增加幅度大于3级组。此外，3级组眼中中央区域深层NPS计数的减少幅度大于1级和2级组。值得注意的是，与3级组相比，1级和2级组的眼在3年时视力恶化更明显。
DMI进展的有向图形模型可作为推断进展途径和预测视力恶化的有用工具。
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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