Gan Jenny, Ding Xinyi, Ploumi Ioanna, Romano Francesco, Overbey Katherine M, Garcia Mauricio D, Garg Itika, Vingopoulos Filippos, Stettler Isabella, Finn Matthew J, Razavi Peyman, Rodriguez Jocelyn M, Bennett Cade F, Patel Nimesh A, Kim Leo A, Husain Deeba, Vavvas Demetrios G, Miller John B
Harvard Retinal Imaging Lab, Boston, MA, USA.
Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
Graefes Arch Clin Exp Ophthalmol. 2025 Aug 19. doi: 10.1007/s00417-025-06864-z.
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).
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.
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]).
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.
本研究探讨增殖性糖尿病视网膜病变（PDR）患者中主要周边病变（PPL）与视网膜微血管系统与玻璃体出血（VH）短期风险之间的关联。
对84例患者的111只PDR眼进行同一天的超广角彩色眼底照相（Optos）和扫频光学相干断层扫描血管造影（PLEX Elite 9000）。UWF图像由2名独立分级人员对PPL进行分级，PPL定义为糖尿病病变在扩展视野中所占比例超过其各自ETDRS视野的50%。一只眼只要有一个视野存在PPL就被分级为有PPL。在FIJI和ARI网络软件上计算缺血指数（ISI）和其他OCTA指标。使用广义估计方程比较有和没有PPL的眼睛在6×6mm和12×12mm血管造影中的视网膜微血管改变。本研究的前瞻性部分纳入了75例患者的101只眼，随访至少3个月。此外，回顾了患者的并发症和治疗史，并应用多级Cox混合效应回归分析PPL作为VH发生的预测因素。
111只眼中有36只（32.4%）发现有PPL。OCTA参数在有或没有PPL的组中没有显示出显著差异。在16.4±11.0个月的时间里，23只眼发生了VH，14只眼有VH病史，9只眼没有。发现PPL的存在与新的VH发生之间存在显著关联（p = 0.028），但与复发性VH无关（P>0.05）。在调整年龄、糖尿病病程以及既往抗血管内皮生长因子（抗VEGF）和全视网膜光凝（PRP）治疗后，PPL的程度是新VH的显著预测因素（HR = 1.92，p = 0.03，95%CI [1.06 - 3.50]）。
有或没有PPL的眼睛中，中央和后部OCTA指标具有可比性，但PPL与VH的发生有关。UWF成像技术的进步可能会导致开发一种新的DR分级方案，以预测PDR患者的VH风险。
