June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Imaging Biomarkers of Diabetic Retinopathy Treatment and Progression Using Quantitative Ultra-widefield Fluorescein Angiography
Author Affiliations & Notes
  • Rahul Seshadri Iyengar
    Ophthalmology - Roski Eye Institute, University of Southern California, Los Angeles, California, United States
  • Michael Aaberg
    Emory University School of Medicine, Atlanta, Georgia, United States
  • Gina Yu
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Tapan Patel
    Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Corey Powell
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Annie Tran
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Caitlin Miranda
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Emma Young
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Katarina Demetriou
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Laxmi Devisetty
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Yannis M Paulus
    Ophthalmology - Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Rahul Iyengar, None; Michael Aaberg, None; Gina Yu, None; Tapan Patel, 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 grant 1K08EY027458
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2291. doi:
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      Rahul Seshadri Iyengar, Michael Aaberg, Gina Yu, Tapan Patel, Corey Powell, Annie Tran, Caitlin Miranda, Emma Young, Katarina Demetriou, Laxmi Devisetty, Yannis M Paulus; Imaging Biomarkers of Diabetic Retinopathy Treatment and Progression Using Quantitative Ultra-widefield Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2291.

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

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Abstract

Purpose : Ultra-widefield (UWF) fluorescein angiography (FA) is widely used in the evaluation of diabetic retinopathy (DR), but further study is necessary to explore how quantifiable biomarker areas on FA images may relate to DR treatments. This study seeks to determine if associations exist between areas of nonperfusion (NP) and neovascularization (NV) in eyes of patients with diabetes and treatment with panretinal photocoagulation (PRP) or intravitreal (IVT) injections, and if calculated areas and demographic factors are associated with DR progression.

Methods : In this retrospective, cross-sectional study, a total of 363 patients (651 eyes) who were treated at the University of Michigan Kellogg Eye Center between January 2009 and May 2018 were included. Eligible participants were 18 years or older with diagnoses of type 1 or 2 diabetes who received UWF FA. Patients with previous PRP or poor-quality images were excluded. Our main outcome measures included comparison analyses of measured surface areas (biomarkers) in millimeters squared (mm2), number of IVT injections and PRP treatments, and DR progression.

Results : Our cohort of 363 patients (651 eyes) received a total of 3,041 IVT injections and 878 PRP treatments with a mean follow-up time of 915 days (SD ±714). IVT injections were positively associated with posterior NP (difference, 1.15 mm2; 95% CI, 0.43 – 1.86; P = 0.0017). PRP treatments were positively associated with total NP (difference, 27.24 mm2; 95% CI, 14.68 – 39.79; P = 2.1x10-5), mid-periphery NP (difference, 10.34 mm2; 95% CI, 4.43 – 16.26; P = 6.1x10-4), far-periphery NP (difference, 18.67 mm2; 95% CI, 10.24 – 27.09; P = 1.4x10-5), total NV (difference, 1.75 mm2; 95% CI, 0.84 – 2.65; P = 1.6x10-4), mid-periphery NV (difference, 1.23 mm2; 95% CI, 0.51 – 1.96; P = 8.4x10-4), and far-periphery NV (difference, 0.37 mm2; 95% CI, 0.14 – 0.61; P = 0.0019). While DR progression was not associated with biomarker areas, it was positively associated with a pre-existing diagnosis of type 2 (147% increase; 95% CI, 7% – 473% increase; P = 0.03) as compared to type 1 diabetes.

Conclusions : Areas of NP and NV on UWF FA demonstrated associations with IVT injections and PRP treatments. Quantifiable biomarker areas in UWF FA may assist with patient prognostication and management.

This is a 2021 ARVO Annual Meeting abstract.

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