Association of predominant peripheral lesions with retinal microvasculature and risk of vitreous hemorrhage in proliferative diabetic retinopathy.

PURPOSE

This study examines the association between predominant peripheral lesions (PPL) and retinal microvasculature with the short-term risk of vitreous hemorrhage (VH) in eyes with proliferative diabetic retinopathy (PDR).

METHODS

A total of 111 PDR eyes from 84 patients with the same day Ultra-widefield Color Fundus Photography (Optos) and Swept-source Optical Coherence Tomography Angiograms (PLEX Elite 9000). UWF images were graded by 2 independent graders for PPL, defined as over 50% of diabetic lesions localized in the extended field compared to its respective ETDRS field. Only one field with PPL was required for the eye to be graded as having PPL. Ischemia index (ISI) and other OCTA metrics were calculated on FIJI and ARI network software. Retinal microvasculature alterations in 6 × 6-mm and 12 × 12-mm angiograms were compared between eyes with and without PPL using Generalized Estimating Eq. 101 eyes from 75 patients followed for at least 3 months were included in the prospective part of this study. Additionally, patient history of complications and treatments were reviewed, and a multilevel Cox mixed-effect regression was applied to analyze PPL as predictors for the development of VH.

RESULTS

PPL were identified in 36 out of 111 eyes (32.4%). OCTA parameters didn't show significant differences in groups with or without PPL. Over a period of 16.4 ± 11.0 months, VH occurred in 23 eyes, 14 with a history of VH and 9 without. A significant association was found between PPL presence and new VH occurrence (p = 0.028) but not for recurrent VH (P > 0.05). The extent of PPL was a significant predictor for the new VH, after adjustments for age, DM duration and prior anti-vascular endothelial growth factor (anti-VEGF) and panretinal photocoagulation (PRP) treatment (HR = 1.92, p = 0.03, 95% CI [1.06-3.50]).

CONCLUSION

Center and posterior OCTA metrics are comparable in eyes with or without PPL, but PPL is associated with VH development. Advancements in UWF imaging technologies may lead to the development of a new DR grading scheme to predict VH risk in patients with PDR.