Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy
Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy
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DOI：
10.1007/s00417-020-04607-w
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发表时间：
2020-01-27
影响因子：
2.7
通讯作者：
Raman, Rajiv
中科院分区：
文献类型：
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作者：
Verma, Aditya;Alagorie, Ahmed Roshdy;Raman, Rajiv
目的利用超宽视野眼底成像分析印度人群糖尿病视网膜病变（DR）的分布。方法715例（1406只眼）印度糖尿病视网膜病变患者入组本多中心、前瞻性、观察性研究，使用Optos Daytona Plus（Optos plc，Dunfermline，Scotland，UK）进行UWF伪彩色成像。将图像传输至Doheny Image阅读中心（洛杉矶，CA）进行分级。将ETDRS网格覆盖在UWF图像的立体投影上，并由2名蒙面分级员对图像进行独立分级。根据先前的标准，考虑病变数量和面积，将病变分布分级为以中心为主（PCL）或以外周为主（PPL）。如果与相应的ETDRS视野相比，在至少一个周边视野中观察到> 50%的病变面积，则将图像分级为PPL。还根据糖尿病视网膜病变国际分类（ICDR）分级量表评估了糖尿病视网膜病变的严重程度。主要观察指标为病变分布（PPL与PCL）：不同DR级别的眼的总体和特定视野内的病变分布。结果病变分布为PPL的眼占37%，PCL的眼占63%（P < 0.003）。在所有ICDR严重程度水平中，PPL分布的频率显著不同，轻度非增殖性DR（NPDR）（30.9%）、中度NPDR（40.3%）、重度NPDR（38.5%）和PDR（34.9%）的频率，P = 0.005。当评估哪些单个射野被评定为显示PPL分布时，射野4的频率最高，射野7的频率最低。对于任何级别的DR，颞区的PPL频率最高，其次是上级、下区和鼻区（P < 0.001）。只有3.5%的眼在所有五个周边视野中显示PPL分布。结论1/3的UWF图像显示PPL分布，颞象限PPL分布最广，不同级别DR的PPL分布差异显著，UWF成像对筛查转诊视网膜病变有重要意义。
Purpose To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging. Methods Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR. Results Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P < 0.003). The frequency of a PPL distribution varied significantly across all ICDR severity levels, with frequencies of mild non-proliferative DR (NPDR) (30.9%), moderate NPDR (40.3%), severe NPDR (38.5%) and PDR (34.9%), P = 0.005. When assessing which individual fields were rated to show a PPL distribution, the frequency was greatest in field 4 and least in field 7. For any grade of DR, temporal fields showed the greatest PPL frequency, followed in order by the superior, inferior, and nasal fields (P < 0.001). Only 3.5% of eyes showed PPL distribution in all five peripheral fields. Conclusions One-third of the UWF images showed a PPL distribution in this cohort with the temporal quadrant having the widest distribution of PPL. As the PPL distribution varied significantly between various grades of DR, UWF imaging may prove to be important for screening of referral warranted retinopathy.