3.9 Article

Retinal Vascular Caliber Association with Nonperfusion and Diabetic Retinopathy Severity Depends on Vascular Caliber Measurement Location

Journal

OPHTHALMOLOGY RETINA
Volume 5, Issue 6, Pages 571-579

Publisher

ELSEVIER INC
DOI: 10.1016/j.oret.2020.09.003

Keywords

diabetic retinopathy; retinal vascular caliber; retinal nonperfusion; ultrawide field imaging

Categories

Funding

  1. Massachusetts Lions Eye Research Fund, Belmont, MA
  2. National Academy of Science and Technology, Taguig City, Philippines
  3. Research to Prevent Blindness, Inc., New York, New York

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The study aimed to evaluate the association of retinal nonperfusion and diabetic retinopathy severity with the location of vascular caliber measurement using ultrawide field imaging. The results suggest that the association of vascular caliber with nonperfusion and DR severity differs based upon the retinal location at which vascular caliber is measured.
Purpose: To evaluate the association of retinal nonperfusion and diabetic retinopathy (DR) severity with location of vascular caliber measurement using ultrawide field (UWF) imaging. Design: Retrospective image review. Participants: Adults with diabetes mellitus. Methods: All images from subjects with same-day UWF fluorescein angiography (FA) and color imaging were evaluated. Predominantly peripheral lesions (PPL) and DR severity were graded from UWF color images. Non-perfusion was quantified using UWF-FA in defined retinal regions [posterior pole (PP), mid-periphery (MP), farperiphery (FP)]. Retinal vessel calibers were measured at an optic disc centered inner and outer zone. Main Outcome Measures: Nonperfusion index (NPI) in the PP, MP and FP. Mean arteriole and venule diameter in the inner and outer zones. Results: Two hundred eighty-five eyes of 193 patients (24.9% mild nonproliferative DR [NPDR], 22.8% moderate NPDR, 37.5% severe NPDR and 14.7% proliferative DR [PDR]) were reviewed. No significant associations between inner zone arteriolar diameter and retinal NPI overall or in any retinal region. In the outer zone, eyes with thinnest arteriolar calibers (quartile 1) were associated with a 1.7- to 2.4-fold nonperfusion increase across all retinal regions compared to the remaining eyes (P = 0.002 [PP] to 0.048 [FP]). In the outer zone, the percentage of eyes in the thinnest quartile of retinal arteriolar diameter increased with worsening DR severity (mild NPDR: 10% vs PDR: 31%, P = 0.007). This association was not observed when measured within the inner zone (P = 0.129). All venular caliber associations were not statistically significant when corrected for potentially confounding factors. Thinner outer zone retinal arteriolar caliber (quartile 1) was more common in eyes with PPL compared to eyes without PPL (34.1% vs 20.8%, P = 0.017) as were thicker outer venular calibers (quartile 4) (33% vs 21.3%, P = 0.036). Presence of PPL was associated with thinner outer zone arteriolar caliber (109.7 +/- 26.5 mu m vs 123.0 +/- 29.5 mu m, P = 0.001). Conclusions: The association of vascular caliber with nonperfusion and DR severity differs based upon the retinal location at which vascular caliber is measured. Peripheral arterial narrowing is associated with increasing nonperfusion, worsening DR severity and presence of PPL. In contrast, inner zone retinal arteriolar caliber is not associated with these findings. (C) 2020 by the American Academy of Ophthalmology

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