Diabetic Retinopathy Severity and Peripheral Lesions Are Associated with Nonperfusion on Ultrawide Field Angiography
Diabetic Retinopathy Severity and Peripheral Lesions Are Associated with Nonperfusion on Ultrawide Field Angiography
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DOI：
10.1016/j.ophtha.2015.07.034
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发表时间：
2015-12-01
期刊：
影响因子：
13.7
通讯作者：
Aiello, Lloyd Paul
中科院分区：
文献类型：
--
作者：
Silva, Paolo S.;Dela Cruz, Amanda J.;Aiello, Lloyd Paul
目的：评估超宽视野荧光素血管造影（UWF）外周无灌注的存在是否与糖尿病视网膜病变（DR）的严重程度和主要外周病变（PPLs）的存在相关。设计：单部位、横断面、回顾性研究。参与者：37名糖尿病受试者的68只眼，有或无DR，既往无全视网膜激光光凝病史。200度UWF图像和UWF FA图像均在同一次访视时采集。早期治疗糖尿病视网膜病变研究（ETDRS）模板基于椎间盘和黄斑位置数字叠加到立体投影UWF图像上。评价图像是否存在PPL，PPL定义为5个扩展视野中超过50%的分级病变位于ETDRS视野之外。由2名盲法独立评分员对UWF-FA图像进行视网膜无灌注区（NPA）范围和无灌注指数（NPA）评估结果：DR的严重程度分布为：无DR（8.8%），轻度非增殖性DR（NPDR）（17.6%），轻度非增殖性DR（17.6%），轻度非增殖性DR（17.6%），轻度非增殖性DR（17.6%），轻度非增殖性DR（17.6%）。中度NPDR，32.4%;重度NPDR，17.6%;增殖性DR（PDR），19.1%;高危PDR，4.4%; PPL存在于61.8%。有很强的级内（r = 0.95）和级间（r = 0.86）协议的NPA。PPL的存在与NPA（191.8 mm（2）vs. 306.1 mm（2）; P = 0.0019）和NPI（0.25 vs. 0.43; P = 0.0003）增加相关。在调整DR严重程度和糖尿病持续时间后，这些关系仍然显着。在无PDR的眼中（n = 52），NPA和NPI增加与DR恶化相关（NPA，P = 0.001; NPI，P = 0.0003）。NPA和NPI与临床上显著的黄斑水肿无关（NPA，P = 0.99; NPI，P = 0.67），也与视力无关（NPA，r = 0.14，P = 0.23; NPI，r = 0.24，P = 0.05）。这两个参数与PPL的存在和DR严重程度高度相关。鉴于PPL的存在和程度与DR进展风险增加相关，PPL的临床识别可能密切反映了无灌注和缺血的程度，从而解释了进展风险增加。(C)2015年，美国眼科学会。
Purpose: To assess whether the presence of peripheral nonperfusion on ultrawide field (UWF) fluorescein angiography (FA) is associated with diabetic retinopathy (DR) severity and the presence of predominantly peripheral lesions (PPLs).Design: Single-site, cross-sectional, retrospective study.Participants: Sixty-eight eyes of 37 diabetic subjects with or without DR and no history of prior panretinal laser photocoagulation.Methods: Both 200 degrees UWF images and UWF FA images were acquired at the same visit. Early Treatment Diabetic Retinopathy Study (ETDRS) templates were overlaid digitally based on disc and macula location onto stereographically projected UWF images. Images were evaluated for the presence of PPLs, defined as more than 50% of the graded lesion located outside the ETDRS field in each of the 5 extended fields. The UWF-FA images were evaluated by 2 masked, independent graders for extent of retinal nonperfusion area (NPA) and nonperfusion index (NPI; nonperfused/total gradable area).Main Outcome Measures: Association of NPA and NPI with DR severity and presence of PPLs.Results: Distribution of DR severity was as follows: no DR, 8.8% eyes; mild nonproliferative DR (NPDR), 17.6%; moderate NPDR, 32.4%; severe NPDR, 17.6%; proliferative DR (PDR), 19.1%; and high-risk PDR, 4.4%; with PPL present in 61.8%. There was strong intragrader (r = 0.95) and intergrader (r = 0.86) agreement for NPA. Presence of PPLs was associated with increased NPA (191.8 mm(2) vs. 306.1 mm(2); P = 0.0019) and NPI (0.25 vs. 0.43; P = 0.0003). These relationships remained significant after adjusting for DR severity and diabetes duration. In eyes without PDR (n = 52), increasing NPA and NPI was associated with worsening DR (NPA, P = 0.001; NPI, P = 0.0003). NPA and NPI were not associated with clinically significant macular edema (NPA, P = 0.99; NPI, P = 0.67), nor correlated with visual acuity (NPA, r = 0.14, P = 0.23; NPI, r = 0.24, P = 0.05).Conclusions: Following a standardized protocol, the evaluation of UWF FA for NPA and NPI is reproducible. Both parameters are correlated highly with the presence of PPLs and DR severity. Given that the presence and extent of PPLs have been associated with increased risks of DR progression, the clinical identification of PPLs may reflect closely the extent of nonperfusion and ischemia, thus accounting for the increased risk of progression. (C) 2015 by the American Academy of Ophthalmology.