Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity

Peripheral Lesions Identified by Mydriatic Ultrawide Field Imaging: Distribution and Potential Impact on Diabetic Retinopathy Severity
复制标题

DOI：
10.1016/j.ophtha.2013.05.004
复制
发表时间：
2013-12-01
期刊：
OPHTHALMOLOGY
影响因子：
13.7
通讯作者：
Aiello, Lloyd Paul
Aiello, Lloyd Paul
中科院分区：
医学1区
文献类型：
--
作者：
Silva, Paolo S.;Cavallerano, Jerry D.;Aiello, Lloyd Paul

文献摘要

被引文献

相似文献

目的：与早期治疗糖尿病视网膜病变研究(ETDRS)7标准视野摄影相比较，评价散瞳超宽视野成像(DiSLO200；Optos plc，英国苏格兰)所确定的糖尿病视网膜病变(DR)。设计：DiSLO200、ETDRS 7标准视野照片和扩张性眼底检查(DFE)的前瞻性对比研究。参与者：选择103例(206只眼)糖尿病患者206只眼，分别代表所有水平的DR。根据DR病变的严重程度和分布对图像进行分级。主要观察指标：出血和/或微动脉瘤的分布(H/mA)、静脉串珠(Vb)、视网膜内微血管异常(IRMA)和其他部位的新生血管(NVE)。结果：ETDRS 7标准视野片的DR严重程度分布为无DR 12.5%，非增殖型DR 22.5%，中度DR 22.5%，中度DR 30%，重度/极重度DR 8%，增殖性DR 27%。DiSLO200和ETDRS胶片照片之间的糖尿病视网膜病变严重程度在80%的眼睛匹配(加权kappa=0.74，kappa=0.84)，94.5%的眼睛在1级以内。58.8%的眼DiSLO200和DFE匹配(加权kappa=0.69，kappa=0.47)，91.2%的眼在1级以内。40只眼(20%)在DiSLO200和ETDRS胶片照片之间存在DR严重程度差异。引起差异的视网膜病变分别为H/mA 52%，IRMA 26%，NVE 17%，VB 4%。大约三分之一的H/Ma、IRMA和NVE主要位于ETDRS区域之外。在DiSLO200上发现的病变，而不是ETDRS胶片照片显示，10%的眼睛DR水平更严重。H/mA分别为77%、72%、61%、65%和59%(P&lt；0.0001)；VB分别为22%、24%、21%、28%和22%(P=0.009)；IRMA分别为52%、40%、29%、47%和36%(P&t；0.0001)；结论：DiSLO200图像在判断DR严重程度方面与ETDRS胶片及DFE基本一致。在DiSLO200图像的基础上，DR病变在整个视网膜上的分布明显不均匀。在这个队列中，DiSLO200发现的其他外周病变表明，10%的眼睛比ETDRS视野内的病变更严重地评估了DR。然而，外周病变对特定ETDRS严重程度内随时间推移的DR进展的影响尚不清楚，需要进行前瞻性评估。(C)2013年由美国眼科学会颁发。
Objective: To assess diabetic retinopathy (DR) as determined by lesions identified using mydriatic ultrawide field imaging (DiSLO200; Optos plc, Scotland, UK) compared with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-standard field film photography.Design: Prospective comparative study of DiSLO200, ETDRS 7-standard field film photographs, and dilated fundus examination (DFE).Participants: A total of 206 eyes of 103 diabetic patients selected to represent all levels of DR.Methods: Subjects had DiSLO200, ETDRS 7-standard field film photographs, and DFE. Images were graded for severity and distribution of DR lesions. Discrepancies were adjudicated, and images were compared side by side.Main Outcome Measures: Distribution of hemorrhage and/or microaneurysm (H/Ma), venous beading (VB), intraretinal microvascular abnormality (IRMA), and new vessels elsewhere (NVE). Kappa (kappa) and weighted kappa statistics for agreement.Results: The distribution of DR severity by ETDRS 7-standard field film photographs was no DR 12.5%; nonproliferative DR mild 22.5%, moderate 30%, and severe/very severe 8%; and proliferative DR 27%. Diabetic retinopathy severity between DiSLO200 and ETDRS film photographs matched in 80% of eyes (weighted kappa = 0.74, kappa = 0.84) and was within 1 level in 94.5% of eyes. DiSLO200 and DFE matched in 58.8% of eyes (weighted kappa = 0.69, kappa = 0.47) and were within 1 level in 91.2% of eyes. Forty eyes (20%) had DR severity discrepancies between DiSLO200 and ETDRS film photographs. The retinal lesions causing discrepancies were H/Ma 52%, IRMA 26%, NVE 17%, and VB 4%. Approximately one-third of H/Ma, IRMA, and NVE were predominantly outside ETDRS fields. Lesions identified on DiSLO200 but not ETDRS film photographs suggested a more severe DR level in 10% of eyes. Distribution in the temporal, superotemporal, inferotemporal, superonasal, and inferonasal fields was 77%, 72%, 61%, 65%, and 59% for H/Ma, respectively (P < 0.0001); 22%, 24%, 21%, 28%, and 22% for VB, respectively (P = 0.009); 52%, 40%, 29%, 47%, and 36% for IRMA, respectively (P< 0.0001), and 8%, 4%, 4%, 8%, and 5% for NVE, respectively (P = 0.03). All lesions were more frequent in the temporal fields compared with the nasal fields (P< 0.0001).Conclusions: DiSLO200 images had substantial agreement with ETDRS film photographs and DFE in determining DR severity. On the basis of DiSLO200 images, significant nonuniform distribution of DR lesions was evident across the retina. The additional peripheral lesions identified by DiSLO200 in this cohort suggested a more severe assessment of DR in 10% of eyes than was suggested by the lesions within the ETDRS fields. However, the implications of peripheral lesions on DR progression within a specific ETDRS severity level over time are unknown and need to be evaluated prospectively. (C) 2013 by the American Academy of Ophthalmology.