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Observational Study
. 2022 Jul 1;42(7):1302-1310.
doi: 10.1097/IAE.0000000000003479.

ASSESSMENT OF FLUORESCEIN ANGIOGRAPHY NONPERFUSION IN EYES WITH DIABETIC RETINOPATHY USING ULTRAWIDE FIELD RETINAL IMAGING

Paolo S Silva  1 , Danni Liu  2 , Adam R Glassman  2 , Lloyd P Aiello  1 , Sandeep Grover  3 , Ronald M Kingsley  4 , Michele Melia  2 , Jennifer K Sun  1 ; DRCR Retina Network
Affiliations
Observational Study

ASSESSMENT OF FLUORESCEIN ANGIOGRAPHY NONPERFUSION IN EYES WITH DIABETIC RETINOPATHY USING ULTRAWIDE FIELD RETINAL IMAGING

Paolo S Silva et al. Retina. .

Abstract

Purpose: Evaluate association of retinal nonperfusion (NP) on ultrawide field (UWF) fluorescein angiography (FA) with diabetic retinopathy (DR) severity and predominantly peripheral lesions (PPL).

Methods: Multicenter observational study, 652 eyes (361 participants) having nonproliferative DR (NPDR) without center-involved diabetic macular edema in at least one eye. Baseline 200° UWF-color and UWF-FA images were graded by a central reading center for color-PPL and FA-PPL, respectively. UWF-FA was graded for NP index within concentric zones: posterior pole (<10 mm from fovea), midperiphery (10-15 mm), and far periphery (>15 mm).

Results: Baseline Early Treatment Diabetic Retinopathy Study DR severity was 31.7% no DR/mild NPDR, 24.1% moderate NPDR, 14.0% moderately severe NPDR, 25.6% severe/very severe NPDR, and 4.6% proliferative DR. Worse DR severity was associated with increased NP index overall (P = 0.002), in the posterior pole (P < 0.001), midperiphery (P < 0.001), and far periphery (P = 0.03). On average, 29.6% of imaged retinal NP was in the posterior pole, 33.7% in midperiphery, and 36.7% in far periphery. Increased NP index was associated with FA-PPL (P < 0.001) but not with color-PPL (P = 0.65).

Conclusion: Approximately, 70% of NP in diabetic eyes is located outside the posterior pole. Increased NP is associated with the presence of FA-PPL, suggesting UWF-FA may better predict future DR worsening than UWF-color alone.

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Figures

Figure 1.
Figure 1.. Early Treatment Diabetic Retinopathy Study (ETDRS) standard fluorescein angiographic fields 1 and 2 (shown for left eye).
Field 2F is centered one half disc diameter temporal to the center of the macula and field IF is positioned so that the temporal edge of the disc is located one fourth disc diameter from the temporal edge of the field. Background image is a 200-degree ultrawide field fluorescein angiogram. The two 30-degree fields extend along the horizontal meridian from about 15 degrees nasal to the disc to about 10 degrees temporal to the macula. The retinal periphery outside these two fields was not reported in the ETDRS. (Adapted and redrawn based on ETDRS Report 11.
Figure 2.
Figure 2.
Stereographically projected ultrawide field fluorescein angiogram with (A) grid overlay representing the Early Treatment Diabetic Retinopathy Study 7-standard fields (F) and the peripheral extended fields (EF). (B) concentric zones centered on the fovea for determination of retinal nonperfusion: Posterior (<10 mm), Mid-periphery (10–15 mm) and Far periphery (>15 mm). Adapted and redrawn based on Silva PS, et al.
Figure 2.
Figure 2.
Stereographically projected ultrawide field fluorescein angiogram with (A) grid overlay representing the Early Treatment Diabetic Retinopathy Study 7-standard fields (F) and the peripheral extended fields (EF). (B) concentric zones centered on the fovea for determination of retinal nonperfusion: Posterior (<10 mm), Mid-periphery (10–15 mm) and Far periphery (>15 mm). Adapted and redrawn based on Silva PS, et al.
Figure 3.
Figure 3.. Relationship of diabetic retinopathy severity with retinal nonperfused area and nonperfusion index.
Bars represent the average total retinal nonperfused area on UWF-FA in each DR severity group. Mean overall NPI for each DR severity group are shown as diamond symbols. NPI, nonperfusion index; DR, diabetic retinopathy; NPDR, non-proliferative DR; Mod Sev, moderately severe; Sev/V.Sev, severe or very severe; PDR, proliferative DR.
Figure 4.
Figure 4.. Nonperfusion heat map summarizing the distribution of nonperfusion in all eyes in this cohort.
The colors in the heat map represent the percentage of eyes in which nonperfusion was found for that specific retinal location.
See this image and copyright information in PMC

References

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