June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Ultra-widefield Imaging shows significantly increased Retinal Non-perfusion area in Proliferative diabetic retinopathy compared to Diabetic macular edema phenotypes
Author Affiliations & Notes
  • Cody Moezzi
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Emma L Wolinsky
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Pachely B Mendivil
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Andrea Cabrera
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Muneeswar Gupta nittala
    University of California Los Angeles, Los Angeles, California, United States
    Doheny Eye Institute, Los Angeles, California, United States
  • Finny Monickaraj
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
    Veterans Health Administration, Albuquerque, New Mexico, United States
  • Arup Das
    Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
    Veterans Health Administration, Albuquerque, New Mexico, United States
  • Footnotes
    Commercial Relationships   Cody Moezzi None; Emma Wolinsky None; Pachely Mendivil None; Andrea Cabrera None; Muneeswar nittala None; Finny Monickaraj None; Arup Das None
  • Footnotes
    Support  NIH/NEI R01-EY028606
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2203 – F0266. doi:
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      Cody Moezzi, Emma L Wolinsky, Pachely B Mendivil, Andrea Cabrera, Muneeswar Gupta nittala, Finny Monickaraj, Arup Das; Ultra-widefield Imaging shows significantly increased Retinal Non-perfusion area in Proliferative diabetic retinopathy compared to Diabetic macular edema phenotypes. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2203 – F0266.

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

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Abstract

Purpose : Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) appear to be two distinctive diseases with unique characteristics, including the response to anti-VEGF treatment. Our previous cross-sectional studies showed that these two phenotypes are not always present concurrently. To determine if PDR and DME have distinctive microvasculature status, ultra-widefield fluorescein angiography (UWF-FA) images of patients with “PDR only” or with “DME only” diagnoses were analyzed.

Methods : A retrospective cohort study, of 18 patients, analyzing the UWF-FA images obtained using Optos California imaging system in patients with PDR only (10 eyes) and DME only (8 eyes). “PDR only” cases included those with preretinal or vitreous hemorrhage without any edema by OCT. The “DME only” cases included only center-involving edema with no concurrent neovascularization or vitreous hemorrhage. Three masked examiners graded the angiograms using the Optos Advance software free-hand tool to demarcate the extent of capillary nonperfusion (areas of hypofluorescence). The outcomes included gradable area, area of capillary nonperfusion, and non-perfusion index (NPI; nonperfused/total gradable area). Statistical analyses were performed with a two-sample t-test for unpaired variables.

Results : Quantification of UWF-FA images revealed that patients with a “PDR only” diagnosis had an average area of nonperfusion measuring 329.6 mm2 (SD±92.9 mm2) and those with “DME only” diagnosis had an average area of nonperfusion measuring 193.0 mm2 (SD±27.8 mm2). Our analysis revealed that the areas of retinal capillary nonperfusion was significantly higher (1.7 fold) for patients with “PDR only” compared to patients with “DME only” (p<0.005). The NPI in “PDR only” cases was significantly higher than that observed in “DME only” cases, 0.43 and 0.26, respectively (p =0.002).

Conclusions : Ultra-widefield fluorescein angiography demonstrates significantly increased areas of capillary nonperfusion in cases with a “PDR only” diagnosis compared to “DME only” diagnosed cases. The increased severity of nonperfusion in PDR cases may be related to increased production of VEGF and consequent angiogenesis. These preliminary findings show that PDR and DME may be driven by distinct pathological processes and molecular mediators.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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