非增生性糖尿病视网膜病变晚期毛细血管灌注不足的进展：RICHARD 研究的 6 个月分析

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2024-10-16 DOI:10.1016/j.xops.2024.100632

Inês Pereira Marques MD, PhD , Débora Reste-Ferreira MSc , Torcato Santos , Luís Mendes PhD , António Cunha-Vaz Martinho MD , Taffeta Ching Ning Yamaguchi PhD , Ana Rita Santos PhD , Elizabeth Pearce PhD , José Cunha-Vaz MD, PhD

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引用次数: 0

摘要

目的评估非增生性糖尿病视网膜病变（NPDR）晚期患者视网膜毛细血管灌注在 6 个月后的进展情况。方法对 60 名 2 型糖尿病患者中分别处于糖尿病视网膜病变严重程度量表（DRSS）43、47 和 53 级的 60 只眼睛进行为期 2 年的前瞻性纵向研究。方法通过 Optos California (Optos plc) 超宽场眼底荧光素血管造影术 (UWF-FFA)、扫描源 OCT 血管造影术 (SS-OCTA) (PLEX Elite 9000, 蔡司) 和光谱域 OCTA (SD-OCTA) (CIRRUS HD-OCT 5000 Angioplex, 蔡司) 对眼睛进行评估。主要结果测量缺血指数由 Optos 获得。通过 OCTA 获取浅层和深层毛细血管丛（SCP 和 DCP）的血管量化指标，即眼窝无血管区、骨骼化血管密度（SVD）和灌注密度（PD）指标。根据 CFP 图像，使用 RetmarkerDR（Retmarker SA，Meteda Group）自动进行微动脉瘤评估。结果扫源 OCTA 指标显示，NPDR 晚期之间存在显著的统计学差异。在内环（SVD、SCP：P = 0.005 和 DCP：P = 0.042；PD、SCP：P = 0.003）和外环（SVD、SCP：P = 0.007 和 DCP：P = 0.030；PD、SCP：P = 0.020 和 DCP：P = 0.025）基线时，发现 DRSS 47 级和 53 级之间存在差异。DRSS 43 级和 47 级在基线时未观察到明显差异。在 SD-OCTA 中，差异类似，但未达到统计学意义。总缺血指数随糖尿病视网膜病变（DR）严重程度的增加而增加，但 DRSS 级别之间的差异未达到统计学意义。微动脉瘤数量也随 DR 严重程度的增加而显著增加（P = 0.033）。在 DRSS 47 级和 53 级的眼球中，SS-OCTA 检测到 6 个月的病情进展具有统计学意义，但在 DRSS 43 级的眼球中没有发现。结论在 6 个月的时间内，通过进行 OCTA 检查和使用 CFP 进行微动脉瘤计数，可以发现 DRSS 等级为 47 和 53 的眼球存在明显的微血管疾病进展。

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Progression of Capillary Hypoperfusion in Advanced Stages of Nonproliferative Diabetic Retinopathy: 6-month Analysis of RICHARD Study

Purpose

To evaluate the 6-month progression of retinal capillary perfusion in eyes with advanced stages of nonproliferative diabetic retinopathy (NPDR).

Design

RICHARD (NCT05112445), 2-year prospective longitudinal study.

Participants

Sixty eyes with Diabetic Retinopathy Severity Scale (DRSS) levels 43, 47, and 53 from 60 patients with type 2 diabetes. Fifty-one patients completed the 6-month evaluation.

Methods

Eyes were evaluated on Optos California (Optos plc) ultrawidefield fundus fluorescein angiography (UWF-FFA), swept-source OCT angiography (SS-OCTA) (PLEX Elite 9000, ZEISS) and spectral-domain OCTA (SD-OCTA) (CIRRUS HD-OCT 5000 Angioplex, ZEISS). DRSS classification was performed based on 7-field color fundus photographs (CFPs) complemented with Optos California UWF-fundus imaging.

Main Outcome Measures

Ischemic index was obtained from Optos. Vascular quantification metrics, namely foveal avascular zone, skeletonized vessel density (SVD), and perfusion density (PD) metrics, were acquired on OCTA in the superficial and deep capillary plexuses (SCP and DCP). Microaneurysm assessment was automatically performed based on CFP images using the RetmarkerDR (Retmarker SA, Meteda Group).

Results

Swept-source-OCTA metrics showed statistically significant differences between the advanced stages of NPDR. Differences between DRSS levels 47 and 53 were found at baseline in the inner ring (SVD, SCP: P = 0.005 and DCP: P = 0.042 and PD, SCP: P = 0.003) and outer ring (SVD, SCP: P = 0.007 and DCP: P = 0.030 and PD, SCP: P = 0.020 and DCP: P = 0.025). No significant differences were observed at baseline between DRSS levels 43 and 47. In SD-OCTA, the differences were similar but did not reach statistical significance. The total ischemic index showed an increase in association with diabetic retinopathy (DR) severity, but the differences between DRSS levels did not reach statistical significance. The number of microaneurysms also increased significantly with DR severity (P = 0.033). Statistically significant 6-month progression was detected with SS-OCTA in eyes with DRSS levels 47 and 53 but not in DRSS level 43. In eyes with DRSS level 53, 6-month progression was identified using a combination of metrics of capillary nonperfusion and microaneurysm counts.

Conclusions

In a 6-month period, significant microvascular disease progression can be identified in eyes with DRSS levels 47 and 53 by performing OCTA examinations and microaneurysm counting using CFP.