Khan Abdullah Zafar, Ribeiro Reis Ana Paula, Olvera-Barrios Abraham, Zhou Yukun, Williamson Dominic J, Struyyen Robbert R, Khalid Hagar, Egan Catherine, Denniston Alastair K, Keane Pearse A, Wagner Siegfried K
University College London, London, UK.
University College Dublin School of Medicine, Dublin, Ireland.
BMJ Open. 2025 Sep 9;15(9):e105231. doi: 10.1136/bmjopen-2025-105231.
To investigate whether quantitative retinal markers, derived from multimodal retinal imaging, are associated with increased risk of mortality among individuals with proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy.
Longitudinal retrospective cohort analysis.
This study was nested within the AlzEye cohort, which links longitudinal multimodal retinal imaging data routinely collected from a large tertiary ophthalmic institution in London, UK, with nationally held hospital admissions data across England.
A total of 675 individuals (1129 eyes) with PDR were included from the AlzEye cohort. Participants were aged ≥40 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male.
The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.
After adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95% CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95% CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95% CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95% CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95% CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95% CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95% CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95% CI: 1.03 to 2.38) remained significantly associated with mortality.
Several quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.
探讨源自多模态视网膜成像的定量视网膜标志物是否与增殖性糖尿病视网膜病变（PDR，糖尿病视网膜病变最严重的形式）患者的死亡风险增加相关。
纵向回顾性队列分析。
本研究嵌套于AlzEye队列中，该队列将从英国伦敦一家大型三级眼科机构常规收集的纵向多模态视网膜成像数据与全英格兰全国范围内的医院入院数据相联系。
从AlzEye队列中纳入了675例患有PDR的个体（1129只眼）。参与者年龄≥40岁（平均年龄57.3岁，标准差10.3），410例（60.7%）为男性。
主要结局为全因死亡率。定量视网膜标志物分别通过使用AutoMorph和拓普康高级边界分割技术从眼底照片和光学相干断层扫描中得出。我们使用未调整和调整后的Cox比例风险模型来估计视网膜特征与死亡时间之间关联的风险比（HR）。
在对社会人口学因素进行调整后，动脉分形维数每降低1个标准差（HR：1.54，95%置信区间：1.18至2.04）、动脉血管密度（HR：1.59，95%置信区间：1.15至2.17）、动脉平均宽度（HR：1.35，95%置信区间：1.02至1.79）、视网膜中央小动脉等效直径（HR：1.39，95%置信区间：1.05至1.82）和神经节细胞 - 内丛状层（GC - IPL）厚度（HR：1.61，95%置信区间：1.03至2.50）均与死亡风险增加相关。在进一步对高血压进行调整后，动脉分形维数（HR：1.45，95%置信区间：1.08至1.92）、动脉血管密度（HR：1.47，95%置信区间：1.05至2.08）和GC - IPL厚度（HR：1.56，95%置信区间：1.03至2.38）仍与死亡率显著相关。
与微血管形态和视网膜神经厚度相关的几种定量视网膜标志物与PDR患者的死亡率增加相关。视网膜成像在识别那些有即将发生危及生命后遗症最高风险的PDR个体中的作用值得进一步研究。
