June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Quantification of Nonperfusion and Neovascularization on Ultrawide-Field Fluorescein Angiography in Patients with Diabetes and Association with Vitreous Hemorrhage, Macular Edema, and Vitrectomy
Author Affiliations & Notes
  • Gina Yu
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Michael Aaberg
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
    Emory University School of Medicine, Atlanta, Georgia, United States
  • Tapan Patel
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Rahul Iyengar
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
    Ophthalmology, Keck School of Medicine of University of Southern California, California, United States
  • Corey Powell
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Annie Tran
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Caitlin Miranda
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Emma Young
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Katarina Demetriou
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Laxmi Devisetty
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Yannis Mantas Paulus
    Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Gina Yu, None; Michael Aaberg, None; Tapan Patel, None; Rahul Iyengar, None; Corey Powell, None; Annie Tran, None; Caitlin Miranda, None; Emma Young, None; Katarina Demetriou, None; Laxmi Devisetty, None; Yannis Paulus, None
  • Footnotes
    Support  National Eye Institute 1K08EY027458; unrestricted departmental support from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5264. doi:
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      Gina Yu, Michael Aaberg, Tapan Patel, Rahul Iyengar, Corey Powell, Annie Tran, Caitlin Miranda, Emma Young, Katarina Demetriou, Laxmi Devisetty, Yannis Mantas Paulus; Quantification of Nonperfusion and Neovascularization on Ultrawide-Field Fluorescein Angiography in Patients with Diabetes and Association with Vitreous Hemorrhage, Macular Edema, and Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5264.

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

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Abstract

Purpose : To quantify the surface areas of nonperfusion (NP) and neovascularization (NV) in patients with diabetes using ultrawide-field (UWF) fluorescein angiography (FA) and evaluate associations with diabetic retinopathy risk factors, and to calculate a threshold NP area associated with increased risk for proliferative disease

Methods : We evaluated nine years of clinical data via retrospective chart review of adult patients diagnosed with diabetes that received a UWF FA obtained from Optos 200Tx or California machines at the University of Michigan Kellogg Eye Center (January 2009 and May 2018) after approval from the Institutional Review Board. Trained, masked graders segmented NP and NV regions for analysis. Eyes with severe media opacities, indistinguishable areas of NP or NV, or prior panretinal photocoagulation were excluded. Surface area was calculated with Optos research software and ITK-SNAP for a nominal eye diameter of 24mm. Multiple linear regression analysis was completed to determine significant associations

Results : A total of 651 eyes were included: 76 eyes with no diabetic retinopathy (DR), 92 with mild non-proliferative diabetic retinopathy (NPDR), 144 with moderate NPDR, 101 with severe NPDR, 220 with proliferative diabetic retinopathy (PDR), and 18 with DR of unknown severity. Of 363 patients, 299 had type 2 diabetes (82.3%), 61 (16.8%) had type 1, and 3 had unknown type (0.8%). Vitreous hemorrhage (VH) was found in 18 eyes (2.8%) and had a significant positive association with total NP area (difference = 30.00, 95% CI: 5.26-54.75, p=0.02). Presence of diabetic macular edema (374 eyes, 57.4%) and history of pars plana vitrectomy (35 eyes, 5.4%) had no significant associations with NP or NV. We identified a threshold total area of NP of 77.48 mm2, above which patients have an increased risk of developing PDR (sensitivity of 59.5% and specificity of 73.6%).

Conclusions : Our results indicate that the surface areas of NP and NV can be quantified on UWF FA. VH is significantly associated with a greater total area of NP in patients with diabetes. Eyes with at least 77.48 mm2 of total NP are at increased risk of developing PDR.

This is a 2020 ARVO Annual Meeting abstract.

 

Example segmentation of patient with PDR. Green indicates focal avascular zone, red indicates nonperfusion, and purple indicates neovascularization.

Example segmentation of patient with PDR. Green indicates focal avascular zone, red indicates nonperfusion, and purple indicates neovascularization.

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