Aggarwal Akshita, Prabha Dibya, Takkar Brijesh, Sivaprasad Sobha, Rani Padmaja Kumari
Srimati. Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
Standard Chartered-LVPEI Academy for Eye Care Education, Hyderabad, Telangana, India.
Ophthalmol Ther. 2025 Jul 24. doi: 10.1007/s40123-025-01213-z.
Retinal neovascularization in proliferative diabetic retinopathy (PDR) presents with varying morphology and clinical implications. This study aims to classify retinal neovascularization into subtypes and assess their correlation with ischemic index using widefield optical coherence tomography (OCT) angiography.
This retrospective observational study included 50 treatment-naïve patients (84 eyes) with PDR who underwent baseline widefield fundus photography (CLARUS 500™) and widefield optical coherence tomography angiography (WF-OCTA; Plex Elite 9000) between January 2022 and June 2024. Quantitative analysis of WF-OCTA images assessed capillary nonperfusion (CNP), ischemic index (ISI), and three neovascularization (NV) subtypes: type 1 NV (flat, intraretinal or subinternal limiting membrane growth), type 2 NV (preretinal proliferation extending into the vitreous), and type 3 NV (a combination of types 1 and 2 features, showing both flat and protruding components). Two clinicians manually delineated capillary nonperfusion (CNP) using ImageJ software. Neovascularization (NV) was classified by subtype and location (posterior versus mid-periphery). Ischemic index (ISI), nonperfusion area, best corrected visual acuity (BCVA), and the need for adjunctive interventions (additional laser or vitreoretinal surgery) were correlated with treatment response to panretinal photocoagulation (PRP).
Type 1 neovascularization was most frequent (42.1%), with a mean ischemic index (ISI) of 0.19 ± 0.17. Type 3 neovascularization showed the highest ISI (0.27 ± 0.07) and largest nonperfusion area (36.66 mm ± 10.24). Best corrected visual acuity (BCVA) improved in 58% of patients after panretinal photocoagulation, with type 3 showing the greatest improvement. Adjunct laser therapy was required more frequently for type 2 (13 cases) following standard panretinal photocoagulation. However, type 3 required the least supplemental laser.
WF-OCTA proves valuable in the assessment of disease severity and its extent, along with possible implications on planning the intervention for PDR.
增殖性糖尿病视网膜病变（PDR）中的视网膜新生血管具有不同的形态和临床意义。本研究旨在利用广角光学相干断层扫描血管造影（OCTA）将视网膜新生血管分为不同亚型，并评估它们与缺血指数的相关性。
这项回顾性观察研究纳入了50例未经治疗的PDR患者（84只眼），这些患者在2022年1月至2024年6月期间接受了基线广角眼底照相（CLARUS 500™）和广角光学相干断层扫描血管造影（WF-OCTA；Plex Elite 9000）检查。对WF-OCTA图像进行定量分析，评估毛细血管无灌注（CNP）、缺血指数（ISI）以及三种新生血管（NV）亚型：1型NV（扁平状，视网膜内或内界膜下生长）、2型NV（视网膜前增殖并延伸至玻璃体）和3型NV（1型和2型特征的组合，兼具扁平状和突出成分）。两名临床医生使用ImageJ软件手动勾勒出毛细血管无灌注（CNP）区域。新生血管（NV）根据亚型和位置（后部与中周部）进行分类。缺血指数（ISI）、无灌注面积、最佳矫正视力（BCVA）以及辅助干预措施（额外激光治疗或玻璃体视网膜手术）的需求与全视网膜光凝（PRP）的治疗反应相关。
1型新生血管最为常见（42.1%），平均缺血指数（ISI）为0.19±0.17。3型新生血管的ISI最高（0.27±0.07），无灌注面积最大（36.66 mm±10.24）。全视网膜光凝后，58%的患者最佳矫正视力（BCVA）得到改善，其中3型改善最为明显。在标准全视网膜光凝后，2型患者更频繁地需要辅助激光治疗（13例）。然而，3型所需的补充激光最少。
WF-OCTA在评估疾病严重程度及其范围以及对PDR干预计划的可能影响方面具有重要价值。
