Clinical and imaging characteristics associated with foveal neovascularization in proliferative diabetic retinopathy.

IF 2.4 3区 医学 Q2 OPHTHALMOLOGY
Melissa Yuan, Francesco Romano, Xinyi Ding, Mauricio Garcia, Itika Garg, Katherine Millner Overbey, Cade Bennett, Ioanna Ploumi, Isabella Stettler, Ines Lains, Filippos Vingopoulos, Jocelyn Rodriguez, Nimesh A Patel, Leo A Kim, Demetrios G Vavvas, Deeba Husain, Joan W Miller, John B Miller
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引用次数: 0

Abstract

Purpose: To assess the prevalence of foveal neovascularization (FNV) and its associated clinical features in proliferative diabetic retinopathy (PDR) eyes.

Methods: Cross-sectional observational study. Participants underwent ultra-widefield photography, optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA). FNV was defined as a hyperreflective lesion breaching the internal limiting membrane and displaying flow signal on OCTA, within 1-mm of foveal avascular zone. Vascular metrics were obtained from the ARI Network portal. Ischemic index (ISI) and inner choroid flow deficit percentage were calculated using FIJI from 12 × 12 and 6 × 6-mm scans, respectively. Logistic regression models were used to compare eyes with and without FNV.

Results: We included 249 eyes of 164 patients (age: 58 [50-65] years). FNV was identified in 20 eyes (8%). Univariate logistic regression revealed significant associations between FNV and younger age (p = 0.03), higher maximal HbA1c (p = 0.04), worse visual acuity (VA) (p = 0.01), presence of disorganization of retinal inner layers (DRIL) (p = 0.01), no macular posterior vitreous detachment (PVD) (p = 0.03), neovascularization elsewhere (NVE) and at the disc (NVD) (p = 0.01 and p = 0.001), and greater ISI (p = 0.04). In multivariable analysis, a significant association remained between FNV and worse VA (p = 0.04), NVD (p < 0.001), DRIL (p < 0.001), and absence of macular PVD (p = 0.01). No associations were found with SS-OCTA vascular metrics.

Conclusions: This study provides a comprehensive characterization of FNV in PDR. FNV was identified in 8% of our cohort, being more prevalent in younger patients with severe PDR, as evidenced by NVD and DRIL presence. The absence of macular PVD may explain its association with younger age.

Key messages: What is known • Neovascularization at the fovea occurs rarely in proliferative diabetic retinopathy. • OCT and OCT-angiography can be used to evaluate foveal neovascularization, which may be associated with choroidal vascular abnormalities. What is new • Foveal neovascularization was seen in 8% of eyes with proliferative diabetic retinopathy in this cohort. • Risk factors for foveal neovascularization included younger age, absence of macular posterior vitreous detachment, presence of neovascularization of the disc, and presence of disorganization of retinal inner layers. • We did not identify an association between foveal neovascularization and choroidal perfusion abnormalities in this study.

与增殖性糖尿病视网膜病变眼窝新生血管相关的临床和成像特征。
目的:评估增殖性糖尿病视网膜病变(PDR)眼窝新生血管(FNV)的发生率及其相关临床特征:横断面观察研究。参与者接受了超宽视场摄影、光学相干断层扫描(OCT)和扫描源 OCT 血管造影(SS-OCTA)检查。FNV 被定义为在眼窝无血管区 1 毫米范围内,突破内缘膜并在 OCTA 上显示血流信号的高反射病变。血管指标来自 ARI 网络门户。缺血指数(ISI)和脉络膜内血流缺失百分比分别通过 12 × 12 和 6 × 6 毫米扫描的 FIJI 计算得出。使用逻辑回归模型对有无 FNV 的眼球进行比较:我们共纳入了 164 名患者的 249 只眼睛(年龄:58 [50-65] 岁)。在 20 只眼睛(8%)中发现了 FNV。单变量逻辑回归显示,FNV 与年龄较小(p = 0.03)、最大 HbA1c 较高(p = 0.04)、视力较差(VA)(p = 0.01)、视网膜内层紊乱(DRIL)(p = 0.01)、无黄斑后玻璃体脱离(PVD)(p = 0.03)、其他部位(NVE)和视盘处(NVD)新生血管(p = 0.01 和 p = 0.001)以及更大的 ISI(p = 0.04)。在多变量分析中,FNV 与 VA 恶化(p = 0.04)、NVD(p 结论)之间仍存在显著关联:本研究全面描述了 PDR 中 FNV 的特征。在我们的队列中,有 8% 的患者发现了 FNV,从 NVD 和 DRIL 的存在可以看出,FNV 在年轻的重度 PDR 患者中更为普遍。没有黄斑部血管内皮沉积可能是其与年轻有关的原因:已知信息 - 增殖性糖尿病视网膜病变很少发生眼窝处的新生血管。- OCT和OCT-血管造影可用于评估眼窝新生血管,这可能与脉络膜血管异常有关。新发现 - 在本组研究中,8%的增殖性糖尿病视网膜病变患者出现了眼窝新生血管。- 出现眼窝新生血管的风险因素包括年龄较小、无黄斑后玻璃体脱离、视盘出现新生血管以及视网膜内层紊乱。- 在这项研究中,我们没有发现眼窝新生血管与脉络膜灌注异常之间存在关联。
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来源期刊
CiteScore
5.40
自引率
7.40%
发文量
398
审稿时长
3 months
期刊介绍: Graefe''s Archive for Clinical and Experimental Ophthalmology is a distinguished international journal that presents original clinical reports and clini-cally relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, Graefe''s Archive provides rapid dissemination of clinical and clinically related experimental information.
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