Ding Xinyi, Xu Jia, Romano Francesco, Garg Itika, Gan Jenny, Overbey Katherine M, Garcia Mauricio D, Shan Mridula, Marrero-Alattar Ricardo, Vingopoulos Filippos, Cui Ying, Zhu Ying, Ploumi Ioanna, Stettler Isabella, Finn Matthew J, Vavvas Demetrios G, Husain Deeba, Wu David M, Patel Nimesh A, Kim Leo A, Miller John B
Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Ophthalmol Retina. 2025 Aug 19. doi: 10.1016/j.oret.2025.08.011.
To assess the severity and clinical significance of intraretinal microvascular abnormalities (IRMAs) using expanded field swept-source OCT angiography (SS-OCTA) in eyes with nonproliferative diabetic retinopathy (NPDR).
Cross-sectional, observational study.
One hundred thirty-nine eyes from 101 subjects with NPDR.
The montage of 12 × 12-mm angiography centered on the macula and optic nerve was evaluated by 2 masked graders for (1) the presence of IRMA in each 6 × 6-mm field, including center, superotemporal, inferotemporal, superonasal (SN), and inferonasal (IN) to the macula, and SN and IN to the optic nerve and (2) subtypes of IRMA (dilated trunk, net shape, loop, sea fan, and tufted IRMA). Nonperfusion areas (NPA) were quantified using FIJI. Nonproliferative diabetic retinopathy grading was initially collected from chart diagnoses and subsequently verified using ultra-widefield color fundus photos. Logistic and linear regression models were used to evaluate the relationships between IRMA features, diabetic retinopathy (DR) severity, and NPA.
Intraretinal microvascular abnormality features associated with severe NPDR.
Intraretinal microvascular abnormalities, observed with SS-OCTA, were present in 58.3% of all NPDR eyes and more prevalent in severe (96.6%) than mild (28.8%) to moderate (70.6%) NPDR. The number of affected fields and IRMA subtypes increased with DR severity (P < 0.01). The most common subtype of IRMA is the dilated trunk, comprising 58.3%, followed by the net shape subtype at 35.3%, loop at 11.5%, sea fan at 6.5%, and tufts at 5.8%. Significant predictors of severe NPDR included the presence of IRMA in the central field (odds ratio [OR]: 8.7; P = 0.01), more widely distributed IRMA (OR: 2.2; P < 0.01), a greater variety of IRMA subtypes (OR: 4.2, P < 0.01), and the presence of specific subtypes such as net shape (OR: 16.1; P = 0.02), sea fan (OR: 26.0; P < 0.01), and tufted IRMA (OR: 13.4; P = 0.03). Center-involving IRMA (β = 5.8; P = 0.046) and IRMA with loops (β = 7.0; P = 0.043) were found to be associated with increased NPA.
Our study demonstrates that IRMA lesions identified on OCT angiography, particularly their distribution and morphology, are associated with DR severity and provide complementary information that may facilitate the integration of SS-OCTA into clinical evaluation of DR.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
使用超广角扫频源光学相干断层扫描血管造影（SS-OCTA）评估非增殖性糖尿病视网膜病变（NPDR）患者视网膜内微血管异常（IRMA）的严重程度及临床意义。
横断面观察性研究。
101例NPDR患者的139只眼。
由2名盲法分级者评估以黄斑和视神经为中心的12×12 mm血管造影拼接图像，评估内容包括：（1）每个6×6 mm区域（包括黄斑中心、黄斑颞上、颞下、鼻上（SN）和鼻下（IN）以及视神经的SN和IN区域）中IRMA的存在情况；（2）IRMA的亚型（扩张主干型、网状型、环状型、海扇型和簇状IRMA）。使用FIJI软件对无灌注区（NPA）进行定量分析。非增殖性糖尿病视网膜病变分级最初从病历诊断中收集，随后使用超广角彩色眼底照片进行核实。采用逻辑回归和线性回归模型评估IRMA特征、糖尿病视网膜病变（DR）严重程度和NPA之间的关系。
与重度NPDR相关的视网膜内微血管异常特征。
在所有NPDR眼中，58.3%存在SS-OCTA观察到的视网膜内微血管异常，重度NPDR（96.6%）中的发生率高于轻度（28.8%）至中度（70.6%）NPDR。受累区域数量和IRMA亚型数量随DR严重程度增加而增加（P<0.01）。最常见的IRMA亚型是扩张主干型，占58.3%，其次是网状型，占35.3%，环状型占11.5%，海扇型占6.5%，簇状占5.8%。重度NPDR的显著预测因素包括中心区域存在IRMA（比值比[OR]：8.7；P = 0.01）、IRMA分布更广泛（OR：2.2；P<0.01）、IRMA亚型种类更多（OR：4.2，P<0.01）以及存在特定亚型，如网状型（OR：16.1；P = 0.02）、海扇型（OR：26.0；P<0.01）和簇状IRMA（OR：13.4；P = 0.03）。发现累及中心的IRMA（β = 5.8；P = 0.046）和环状IRMA（β = 7.0；P = 0.043）与NPA增加相关。
我们的研究表明，OCT血管造影识别出的IRMA病变，尤其是其分布和形态，与DR严重程度相关，并提供了补充信息，可能有助于将SS-OCTA纳入DR的临床评估。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
