用于预测非增生性糖尿病视网膜病变临床重要结果的扩大视野 OCT 血管造影生物标记物。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-28 DOI:10.1016/j.ajo.2024.10.016

Xinyi Ding , Francesco Romano , Itika Garg , Jenny Gan , Filippos Vingopoulos , Mauricio D. Garcia , Katherine M. Overbey , Ying Cui , Ying Zhu , Cade F. Bennett , Isabella Stettler , Mridula Shan , Matthew J. Finn , Demetrios G. Vavvas , Deeba Husain , Nimesh A. Patel , Leo A. Kim , John B. Miller

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引用次数: 0

摘要

目的：评估扩展视野扫源光学相干断层扫描血管造影（SS-OCTA）成像生物标志物在预测非增生性糖尿病视网膜病变（NPDR）患者临床重要结果发生方面的实用性：方法：单中心临床研究：方法：单中心临床研究。研究纳入了 57 名参与者（中位年龄：64.0 岁；平均糖尿病病程：15.8 年）的 88 只非增生性糖尿病视网膜病变眼，这些参与者至少连续两次接受 SS-OCTA 扫描，随访时间至少 6 个月。评估基线时是否存在视网膜内微血管异常（IRMA），以及随访期间 12 × 12 毫米血管造影上 IRMA 的稳定性。根据 FIJI 和 ARI 网络计算基线非灌注缺血指数（ISI）和其他 SS-OCTA 指标。重要临床结果的定义是在最后一次临床就诊时发生以下一个或多个事件：1.明显的DR进展（2阶DR进展或进展为增殖性DR (PDR)）；2.出现新的中心累及性糖尿病黄斑水肿（CI-DME）；3.在随访期间开始接受PRP或抗血管内皮生长因子注射治疗。研究人员采用混合效应 Cox 回归模型来探讨这些结果：经过 25.1 ± 10.8 个月的临床随访，我们在 17 只眼睛（19.3%）中观察到了显著的临床结果。其中，7 只眼睛（8.0%）的病情明显恶化，4 只眼睛（4.5%）发展为 CI-DME。15只眼睛（17.0%）开始注射抗血管内皮生长因子，2只眼睛（2.3%）开始注射PRP。在对年龄、DM持续时间和之前的抗血管内皮生长因子治疗进行调整后，我们的分析显示，随访期间不稳定的IRMA和基线时较高的缺血指数与重大临床结果的发生显著相关，HRs分别为3.88（95% CI：1.56-9.64；p=0.004）和1.05（95% CI：1.02-1.09；p=0.004）：总之，IRMA长期不稳定且基线缺血较多的NPDR眼发生重大临床后果的风险较高。我们的研究结果表明，扩大视野的 SS-OCTA 可为临床 DR 分期和预测高风险患者提供额外的预后益处。

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Expanded Field OCT Angiography Biomarkers for Predicting Clinically Significant Outcomes in Non-Proliferative Diabetic Retinopathy

Purpose

To evaluate the utility of extended field swept-source Optical Coherence Tomography Angiography (SS-OCTA) imaging biomarkers in predicting the occurrence of clinically significant outcomes in eyes with Non-Proliferative Diabetic Retinopathy (NPDR).

Design

Retrospective clinical case-control study.

Methods

Single-center clinical study. Eighty-eight eyes with NPDR from 57 participants (median age: 64.0 years; mean duration of diabetes: 15.8 years) with at least 2 consecutive SS-OCTA scans over a follow-up period of at least 6 months were included. The presence of intraretinal microvascular abnormalities (IRMAs) at baseline and the stability of IRMAs during follow-up period on 12 × 12-mm angiograms were evaluated. Baseline nonperfusion ischemia index (ISI) and other SS-OCTA metrics were calculated on FIJI and ARI Network. Significant clinical outcomes were defined as occurrence of one or more of the following events at the last available clinical visit:1. significant DR progression (2-step DR progression or progression to proliferative DR (PDR)); 2) development of new center-involving diabetic macular edema (CI-DME); and 3) initiation of treatment with PRP or anti-VEGF injections during the follow-up period. Mixed-effects Cox regression models was used to explore these outcomes.

Results

Following a clinical follow-up period lasting 25.1 ± 10.8 months, we observed significant clinical outcomes in 17 eyes (19.3%). Among these, 7 eyes (8.0%) experienced significant progression and 4 eyes (4.5%) developed CI-DME. Anti-VEGF injections were initiated in 15 eyes (17.0%), while PRP was initiated in 2 eyes (2.3%). Upon adjusting for age, the duration of DM, and prior Anti-VEGF treatments, our analysis revealed that non-stable IRMAs during the follow-up periods and a higher ischemia index at baseline were significantly associated with the occurrence of significant clinical outcomes with HRs of 3.88 (95% CI: 1.56-9.64; p = .004) and 1.05 (95% CI: 1.02-1.09; p = .004), respectively.

Conclusions

In conclusion, NPDR eyes with non-stable IRMAs over time and more ischemia at baseline are in higher risk of developing significant clinical outcomes. Our findings suggest that expanded field SS-OCTA may offer additional prognostic benefits for clinical DR staging and predicting high-risk patients.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.