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Maria Luísa Ribeiro, Inês Marques, Sónia Ferreira, Ana Rita Santos, Torcato Santos, Jose G Cunha-Vaz; Characterization of two-year progression of risk phenotypes of diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2504 – F0230.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize the two-years progression of two diabetic retinopathy (DR) risk phenotypes in type 2 diabetes (T2D).
A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with 4 visits (baseline, 6-months, one-year and two-year). Demographic and systemic data included age, sex, diabetes duration, lipidic profile and hemoglobin A1c (HbA1c). Ophthalmological examinations including visual acuity (BCVA), color fundus photography (CFP) and optical coherence tomography (OCT and OCTA), identified the presence of nonproliferative diabetic retinopathy (NPDR). Phenotype classification was performed, at 6-month visit, based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Only risk phenotypes B (MAT<6 and increased CRT) and C (MAT≥6 with or without increased CRT) were included. ETDRS grading was performed at the baseline and last visits based on 7-fields CFP.
133 T2D individuals were included in the study, 81 (60%) eyes classified as phenotype B and 52 (40%) eyes as phenotype C. Of these, 127 completed the two-year follow-up, 24 (19%) developed central-involved macular edema (CIME) and 2 clinically significant macular edema (CSME) (1.6%). In the two-year period, two-step severity progression (ETDRS) occurred only in one eye with phenotype C.At baseline, eyes with phenotype C showed more capillary closure in the superficial capillary plexus (SCP), deep capillary plexus (DCP) and full retina (FR, p<0,001) and increased FAZ area (p<0,001), indicating more advanced microvascular disease and confirming the ischemia phenotype. During the two-year period both phenotypes, B and C, showed progression in GCL+IPL thinning (p<0,001) and decrease in vessel density in the DCP (<0,001). When analyzing the two-year progression of each phenotype, only phenotype C revealed significant decrease in BCVA (p=0,02) and enlargement of the FAZ (p=0,03). CSME developed only in phenotype C whereas CIME occurred in both risk phenotypes.
In the two-year period of follow-up both phenotypes B and C showed progression in retinal neurodegeneration associated with progression in capillary closure identified by progressive decrease in vessel density of the DCP. CIME developed in both phenotypes and CSME only in phenotype C.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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