Impact of Predominant Peripheral Lesions on Retinal Microvasculature and Risk of Vitreous Hemorrhage in Proliferative Diabetic Retinopathy

Abstract

Purpose : To investigate the association of predominant peripheral lesions (PPLs) with retinal microvasculature on WF SS-OCTA and the risk of VH in eyes with PDR.

Methods : The cross-sectional part of this study included 111 PDR eyes of 84 patients with same-day UWF-FP (California; Optos plc., Dunfermline, UK) and WF SS-OCTA (PLEX® Elite 9000; Carl Zeiss Meditec, Dublin, CA). A subset of 101 eyes from 75 patients followed for at least 3 months were included in the prospective part of this study, where the history of complications and treatments was reviewed. UWF-FP were graded by 2 independent graders for the presence of and the number of fields with PPLs – defined as more than 50% of diabetic lesions subjectively residing in the extended field compared to the respective ETDRS field. Only 1 field with PPLs was required for the eye to be graded as having PPLs. Ischemic index (ISI) and common SS-OCTA vascular metrics were calculated on FIJI and ARI network, respectively. 6×6- and 12×12-mm retinal microvasculature alterations were compared between eyes with and without PPLs utilizing the Mann-Whitney U test. The association between the presence and extent of PPLs and the development of VH was evaluated using generalized estimating equations and multilevel Cox mixed-effects regressions

Results : PPLs were present in 36 out of 111 eyes (32.4%). OCTA parameters, including ISI, vessel density and vessel skeletonized density did not show significant differences in groups with or without PPLs. Over a period of 18.1±10.2 months, 34 VH events occurred in 23 eyes – 14 having a history of VH (recurrent VH) and 9 having no VH history (new VH). There was an association between the presence of PPLs and the development of new VH (p=0.04), but not for recurrent VH. The number of peripheral fields with PPLs was a significant predictor for the new development of VH, after adjusting for age, DM duration and prior anti-VEGF as well as PRP (HR= 1.92, p=0.03).

Conclusions : While 6x6- and 12x12-mm OCTA metrics in eyes with or without PPLs are comparable, the presence and extent of PPLs are associated with the new development of VH. Given the advancement of UWF imaging technologies, the development of a new DR grading scheme to account for PPLs may enhance our ability to predict the risk of VH in patients with PDR.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

(A) Eye with PPLs (B) Eye without PPLs. Blue arrows indicate DBH