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. 2020 May 12;9(5):1433.
doi: 10.3390/jcm9051433.

Retinopathy Phenotypes in Type 2 Diabetes with Different Risks for Macular Edema and Proliferative Retinopathy

Ines P Marques  1 , Maria H Madeira  1 , Ana L Messias  2 , Torcato Santos  1 , António C-V Martinho  1 , João Figueira  1   3 , José Cunha-Vaz  1
Affiliations

Retinopathy Phenotypes in Type 2 Diabetes with Different Risks for Macular Edema and Proliferative Retinopathy

Ines P Marques et al. J Clin Med. .

Abstract

Our group reported that three diabetic retinopathy (DR) phenotypes: A, characterized by low microaneurysm turnover (MAT < 6) and normal central retinal thickness (CRT); B, low MAT (<6) and increased CRT, and C, high MAT (≥6), present different risks for development of macular edema (DME) and proliferative retinopathy (PDR). To test these findings, 212 persons with type 2 diabetes (T2D) and mild nonproliferative retinopathy (NPDR), one eye per person, were followed for five years with annual visits. Of these, 172 completed the follow-up or developed an outcome: PDR or DME (considering both clinically significant macular edema (CSME) and center-involved macular edema (CIME)). Twenty-seven eyes (16%) developed either CSME (14), CIME (10), or PDR (4), with one eye developing both CSME and PDR. Phenotype A showed no association with development of vision-threatening complications. Seven eyes with phenotype B and three with phenotype C developed CIME. Phenotype C showed higher risk for CSME development, with 17.41 odds ratio (p = 0.010), compared with phenotypes A + B. All eyes that developed PDR were classified as phenotype C. Levels of HbA1c and triglycerides were increased in phenotype C (p < 0.001 and p = 0.018, respectively). In conclusion, phenotype C identifies eyes at higher risk for development of CSME and PDR, whereas phenotype A identifies eyes at very low risk for vision-threatening complications.

Keywords: diabetes; macular edema; proliferative retinopathy; retinopathy.

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Conflict of interest statement

I.P.M., M.H.M., A.L.M., T.S. and A.C.–V.M. do not have financial disclosures. J.F.: member of Advisory board for Alimera, Allergan, Bayer, Bhoeringer, and Novartis; J.C.–V. reports grants from Carl Zeiss Meditec outside the submitted work and is consultant for Alimera Sciences, Allergan, Bayer, Gene Signal, Novartis, Pfizer, Precision Ocular Ltd., Roche, Sanofi–Aventis, Vifor Pharma, and Carl Zeiss Meditec.

Figures

Figure 1
Figure 1
Composition of the patients included in the study over the study period: CONSORT flowchart. CIME: center-involved macular edema; CSME: clinically significant macular edema; PDR: proliferative retinopathy.
Figure 2
Figure 2
Analysis of the time to event of the development of outcomes. (A) Number of people with type 2 diabetes (T2D) developing different outcomes; (B) Number of people with T2D developing outcomes per phenotype.
See this image and copyright information in PMC

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