Analysis of peripheral pathological features of diabetic retinopathy based on ultra-wide-angle fundus imaging_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhuang Xuenan ^1,2 , Cao Dan ¹ , Yao Jie ^1,2 , Chen Ruoyu ^1,3 , Chen Yesheng ¹ , Wang Zicheng ^1,4 ,  Zhang Liang ^1,2,3,4

1. Guangdong Provincial People’s Hospital, Guangdong Institute of Eye Disease Control, Guangdong Academy of Medical Sciences, Guangdong 515000, China;
2. Medical College of Shantou University, Shantou 515041, China;
3. The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510000, China;
4. Medical College, South China University of Technology, Guangzhou 510000, China;

Corresponding author：

Zhang Liang, Email: zhangliang5413@163.com

Keywords：

Diabetic retinopathy; Predominantly peripheral lesions; Ultra-wide field imaging

DOI：

10.3760/cma.j.cn511434-20200928-00475

Video：

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Objective To analyze the distribution characteristics of peripheral retinopathy in Chinese patients with diabetic retinopathy (DR).Methods A cross-sectional study. From January to December 2019, 265 cases of 388 eyes of DR patients diagnosed in the eye examination of Guangdong Provincial People's Hospital were included in the study. Among them, there were 211 eyes in 148 males and 177 eyes in 117 females; the average age was 58.4±12.3 years. Ultra-wide-angle fundus imaging (UWF) examination was performed by Daytona in Aalborg, UK. Use Photoshop to simulate the standard 7-azimuth (S7F) area, which was used as the central retinal area 1-7. The peripheral retinal areas 3-7 (P3-P7) were the adjacent peripheral retinal areas of the central retinal area 3-7, respectively. Divided DR into peripheral lesion predominant type (PPL) and central lesion predominant type (PCL). PPL was defined as at least one peripheral retinal area with more severe disease than its adjacent central area. χ² test was performed on the difference of PPL composition ratio in each retinal area of eyes with different DR stages.Results Among 388 eyes, 200 eyes were PPL (51.5%, 200/388). Compared of PPL composition ratios of eyes with different stages of DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR were 32 (36.8%, 32/87), 89 (55.3%, 89/161)), 42 (51.9%, 42/81), 37 (62.6%, 37/59), the difference was statistically significant (χ²=11.440, P=0.010). Comparison of the distribution of PPL in each retinal area in DR eyes: in 200 PPL eyes, areas 3, 4, 5, 6, and 7 have 87, 101, 78, 67, and 38 eyes, respectively. The distribution of PPL in each retinal area in DR eyes was compared, and the difference was statistically significant (χ²=37.640, P＜0.001).Conclusions PPL accounts for 51.5% of the eyes with DR. The DR stage are more severe, the proportion of PPL is higher. The temporal retinal peripheral lesions are the most common.

Citation： Zhuang Xuenan, Cao Dan, Yao Jie, Chen Ruoyu, Chen Yesheng, Wang Zicheng, Zhang Liang. Analysis of peripheral pathological features of diabetic retinopathy based on ultra-wide-angle fundus imaging. Chinese Journal of Ocular Fundus Diseases, 2021, 37(7): 523-527. doi: 10.3760/cma.j.cn511434-20200928-00475 Copy

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2.	Zhang G, Chen H, Chen W, et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.
3.	Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified airlie house classification. ETDRS report number 10[J]. Ophthalmology, 1991, 98(5 Suppl): S786-806.
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6.	Romero-Aroca P, Baget-Bernaldiz M, Navarro-Gil R, et al. Glomerular filtration rate and/or ratio of urine albumin to creatinine as markers for diabetic retinopathy: a ten-year follow-up study[J/OL]. J Diabetes Res, 2018, 2018: 5637130[2018-02-26]. https://pubmed.ncbi.nlm.nih.gov/29682579/. DOI: 10.1155/2018/5637130.
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9.	Sears CM, Nittala MG, Jayadev C, et al. Comparison of subjective assessment and precise quantitative assessment of lesion distribution in diabetic retinopathy[J]. JAMA Ophthalmol, 2018, 136(4): 365-371. DOI: 10.1001/jamaophthalmol.2018.0070.
10.	Aiello LP, Odia I, Glassman AR, et al. Comparison of early treatment diabetic retinopathy study standard 7-field imaging with ultrawide-field imaging for determining severity of diabetic retinopathy[J]. JAMA Ophthalmol, 2019, 137(1): 65-73. DOI: 10.1001/jamaophthalmol.2018.4982.
11.	Silva PS, Cavallerano JD, Haddad NM, et al. Peripheral lesions identified on ultrawide field imaging predict increased risk of diabetic retinopathy progression over 4 years[J]. Ophthalmology, 2015, 122(5): 949-956. DOI: 10.1016/j.ophtha.2015.01.008.
12.	Hafner J, Pollreisz A, Egner B, et al. Presence of peripheral lesions and correlation to macular perfusion, oxygenation and macular neurodegeneration in early tye Ⅱ diabetic retinal desease[J]. Retina, 2020, 40(10): 1964-1971. DOI: 10.1097/iae.0000000000002704.
13.	Silva PS, Horton MB, Clary D, et al. Identification of diabetic retinopathy and ungradable image rate with ultrawide field imaging in a national teleophthalmology program[J]. Ophthalmology, 2016, 123(6): 1360-1367. DOI: 10.1016/j.ophtha.2016.01.043.
14.	Silva PS, El-Rami H, Barham R, et al. Hemorrhage and/or microaneurysm severity and count in ultrawide field images and early treatment diabetic retinopathy study photography[J]. Ophthalmology, 2017, 124(7): 970-976. DOI: 10.1016/j.ophtha.2017.02.012.
15.	Silva PS, Cavallerano JD, Sun JK, et al. Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity[J]. Ophthalmology, 2013, 120(12): 2587-2595. DOI: 10.1016/j.ophtha.2013.05.004.
16.	Hafner J, Ginner L, Karst S, et al. Regional patterns of retinal oxygen saturation and microvascular hemodynamic parameters preceding retinopathy in patients with type Ⅱ diabetes[J]. Invest Ophthalmol Vis Sci, 2017, 58(12): 5541-5547. DOI: 10.1167/iovs.17-22523.

1. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515-2523. DOI: 10.1001/jama.2017.7596.
2. Zhang G, Chen H, Chen W, et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.
3. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified airlie house classification. ETDRS report number 10[J]. Ophthalmology, 1991, 98(5 Suppl): S786-806.
4. Nagiel A, Lalane RA, Sadda SR, et al. Ulrea-widefield fundus imaging: a review of clinical applications and future trends[J]. Retina, 2016, 36(4): 660-678. DOI: 10.1097/iae.0000000000000937.
5. Cicinelli MV, Cavalleri M, Brambati M, et al. New imaging systems in diabetic retinopathy[J]. Acta Diabetol, 2019, 56(9): 981-994. DOI: 10.1007/s00592-019-01373-y.
6. Romero-Aroca P, Baget-Bernaldiz M, Navarro-Gil R, et al. Glomerular filtration rate and/or ratio of urine albumin to creatinine as markers for diabetic retinopathy: a ten-year follow-up study[J/OL]. J Diabetes Res, 2018, 2018: 5637130[2018-02-26]. https://pubmed.ncbi.nlm.nih.gov/29682579/. DOI: 10.1155/2018/5637130.
7. Verma A, Alagorie AR, Ramasamy K, et al. Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(4): 725-733. DOI: 10.1007/s00417-020-04607-w.
8. Wilkinson CP, Ferris FL 3rd, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/s0161-6420(03)00475-5.
9. Sears CM, Nittala MG, Jayadev C, et al. Comparison of subjective assessment and precise quantitative assessment of lesion distribution in diabetic retinopathy[J]. JAMA Ophthalmol, 2018, 136(4): 365-371. DOI: 10.1001/jamaophthalmol.2018.0070.
10. Aiello LP, Odia I, Glassman AR, et al. Comparison of early treatment diabetic retinopathy study standard 7-field imaging with ultrawide-field imaging for determining severity of diabetic retinopathy[J]. JAMA Ophthalmol, 2019, 137(1): 65-73. DOI: 10.1001/jamaophthalmol.2018.4982.
11. Silva PS, Cavallerano JD, Haddad NM, et al. Peripheral lesions identified on ultrawide field imaging predict increased risk of diabetic retinopathy progression over 4 years[J]. Ophthalmology, 2015, 122(5): 949-956. DOI: 10.1016/j.ophtha.2015.01.008.
12. Hafner J, Pollreisz A, Egner B, et al. Presence of peripheral lesions and correlation to macular perfusion, oxygenation and macular neurodegeneration in early tye Ⅱ diabetic retinal desease[J]. Retina, 2020, 40(10): 1964-1971. DOI: 10.1097/iae.0000000000002704.
13. Silva PS, Horton MB, Clary D, et al. Identification of diabetic retinopathy and ungradable image rate with ultrawide field imaging in a national teleophthalmology program[J]. Ophthalmology, 2016, 123(6): 1360-1367. DOI: 10.1016/j.ophtha.2016.01.043.
14. Silva PS, El-Rami H, Barham R, et al. Hemorrhage and/or microaneurysm severity and count in ultrawide field images and early treatment diabetic retinopathy study photography[J]. Ophthalmology, 2017, 124(7): 970-976. DOI: 10.1016/j.ophtha.2017.02.012.
15. Silva PS, Cavallerano JD, Sun JK, et al. Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity[J]. Ophthalmology, 2013, 120(12): 2587-2595. DOI: 10.1016/j.ophtha.2013.05.004.
16. Hafner J, Ginner L, Karst S, et al. Regional patterns of retinal oxygen saturation and microvascular hemodynamic parameters preceding retinopathy in patients with type Ⅱ diabetes[J]. Invest Ophthalmol Vis Sci, 2017, 58(12): 5541-5547. DOI: 10.1167/iovs.17-22523.

Chinese Journal of Ocular Fundus Diseases

Analysis of peripheral pathological features of diabetic retinopathy based on ultra-wide-angle fundus imaging

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