June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
The Relationship of Retinal Vessel Caliber to Diabetic Macular Ischemia
Author Affiliations & Notes
  • Gerald Liew
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    University of Sydney, Sydney, NSW, Australia
  • Dawn Sim
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    UCL Institute of Ophthalmology, London, United Kingdom
  • Pearse Keane
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    UCL Institute of Ophthalmology, London, United Kingdom
  • Ava Tan
    University of Sydney, Sydney, NSW, Australia
  • Paul Mitchell
    University of Sydney, Sydney, NSW, Australia
  • Jie Wang
    University of Sydney, Sydney, NSW, Australia
  • Tien Wong
    National University of Singapore, Singapore, Singapore
  • Marcus Fruttiger
    UCL Institute of Ophthalmology, London, United Kingdom
  • Adnan Tufail
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    UCL Institute of Ophthalmology, London, United Kingdom
  • Catherine Egan
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    UCL Institute of Ophthalmology, London, United Kingdom
  • Footnotes
    Commercial Relationships Gerald Liew, None; Dawn Sim, None; Pearse Keane, None; Ava Tan, None; Paul Mitchell, Novartis (R), Bayer (R); Jie Wang, None; Tien Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche (F); Marcus Fruttiger, AstraZeneca (F), Novartis (F), Novartis (C), Amakem (F); Adnan Tufail, Allergan (C), Bayer (C), GSK (C), Oculogics (C), Pfizer (C), Thrombogenics (C), Amakem (C), Heidelberg Engineering (R), Novarits/Alcon (C), Sanofi/Genzyme (C); Catherine Egan, Bayer (S), Oculogics (S), Novartis (S), Allergan (S), Novartis (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2435. doi:
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      Gerald Liew, Dawn Sim, Pearse Keane, Ava Tan, Paul Mitchell, Jie Wang, Tien Wong, Marcus Fruttiger, Adnan Tufail, Catherine Egan; The Relationship of Retinal Vessel Caliber to Diabetic Macular Ischemia. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2435.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Diabetic macular ischemia (DMI) is an important cause of visual loss. However the relationship of DMI to retinal vessel diameter has not been examined. We examined if retinal vessel caliber is related to the presence and severity of DMI to determine if retinal vessel diameter may be a marker of DMI.

 
Methods
 

Clinic based cross-sectional study of patients with type 2 diabetes presenting to a tertiary hospital over 6 months. Presence and severity of DMI was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols from fundus fluorescein images and classified as none/mild, moderate or severe according to foveal avascular zone (FAZ) size, capillary loss or dilatation, and perifoveal vascular abnormalities.. Custom software was used to quantify the greatest linear dimension and area of the FAZ. Retinal vessel caliber was measured using a validated semi-automated software on fundus fluorescein images.

 
Results
 

Of 53 patients examined, 18 (34%), 18 (34%) and 17 (32%) had none/mild, moderate and severe DMI respectively. Persons with moderate or severe DMI had narrower mean retinal arteriolar caliber than persons with no DMI (140.6 µm 95% Confidence Interval (CI) 134.7, 146.4 vs 150.7 µm, 95% CI 142.5, 158, p=0.04, Table) The association remained after multivariate adjustment for age, gender, previous panretinal photocoagulation and neovascularisation at the disc and elsewhere (adjusted mean retinal arteriolar caliber of 140.7 µm 95% CI 135.5, 146.0 vs 150.4 µm, 95% CI 142.9, 157.8, p=0.04) Increasing severity of DMI was also associated with narrower arterioles, with multivariate adjusted mean arteriolar calibers of 150.6, 142.1 and 139.1 µm in participants with none/mild, moderate and severe DMI respectively. Increased FAZ (greatest dimension and area of ischemia) were also associated with narrower arteriolar caliber; each standard deviation decrease in arteriolar caliber was associated with 0.21 mm (95% CI 0.05, 0.38) increase in diameter and 0.19 mm2 (95% CI 0.04, 0.33) increase in area.(p=0.01 for both, Figure 1) Retinal venular caliber and arteriole to venule ratio (AVR) were not associated with DMI.

 
Conclusions
 

Retinal arteriolar narrowing is associated with macular ischemia in eyes with diabetic retinopathy, suggesting it may be a marker for DMI.

 
 
Table. Retinal vessel calibers by severity of diabetic macular ischemia.
 
Table. Retinal vessel calibers by severity of diabetic macular ischemia.
   
Keywords: 499 diabetic retinopathy • 436 blood supply  
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