Purpose

To examine the relationships of retinal vessel geometric characteristics (RVGCs) to the incidence and progression of diabetic retinopathy (DR).

Design

Observational, prospective cohort study.

Participants

Nine hundred ninety-six persons with type 1 diabetes mellitus (T1DM) and 1370 persons with type 2 diabetes mellitus (T2DM) seen at a baseline examination who were eligible for follow-up examinations at subsequent 5-year intervals. A total of 3846 person-interval data from these follow-up examinations are the basis for the analyses.

Methods

Diabetic retinopathy and macular edema were assessed by grading of 30° stereoscopic color fundus photographs. Retinal vessel geometric characteristics were assessed using the Singapore I Vessel Assessment program from a digitized copy of 1 of the field 1 fundus photographs obtained at baseline and follow-up.

Main Outcome Measures

The 5-year incidence of any DR, progression of DR, and incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) in right eyes.

Results

Incident DR occurred in 45%, progression in 32%, PDR in 10%, and CSME in 5%. While adjusting for glycated hemoglobin, duration of diabetes, and other factors, retinal arteriolar simple tortuosity was associated significantly with the incidence of any DR (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.01–1.35). Retinal venular branching angle was associated significantly with progression of DR (OR, 1.18; 95% CI, 1.03–1.36), retinal venular curvature tortuosity was associated significantly with the incidence of PDR (OR, 1.15; 95% CI, 1.01–1.30), and retinal venular branching angle (OR, 1.41; 95% CI, 1.10–1.82) was associated significantly with the incidence of CSME. There were no significant associations of other RVGCs with any of the DR outcomes in the full multivariate model. Inclusion of all possible RVGCs did not improve the predictive value of the models that already included retinal vessel diameter and baseline DR severity level.

Conclusions

Retinal vessel geometric characteristics of the retinal venules were associated with progression of DR; however, most of the RVGCs measured from digitized fundus photographs added little to the assessment of risk of incidence and progression of DR when other risk factors were considered in T1DM and T2DM.

中文翻译：

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视网膜血管几何特征与糖尿病性视网膜病变发生和发展的关系

目的

要检查视网膜血管几何特征（RVGCs）与糖尿病性视网膜病变（DR）的发生和发展之间的关系。

设计

观察性，前瞻性队列研究。

参加者

在基线检查中发现有996例1型糖尿病（T1DM）和1370例2型糖尿病（T2DM）患者，他们有资格在随后的5年时间里进行随访检查。这些随访检查总共收集了3846人的时间间隔数据，作为分析的基础。

方法

通过对30°立体彩色眼底照片进行分级来评估糖尿病性视网膜病变和黄斑水肿。使用Singapore I血管评估程序，从基线和随访中获得的现场1眼底照片中的1张的数字化副本，评估视网膜血管的几何特征。

主要观察指标

右眼的任何DR的5年发病率，DR的进展以及增生性糖尿病性视网膜病变（PDR）和临床上显着的黄斑水肿（CSME）的发生率。

结果

突发事件DR发生率为45％，进展为32％，PDR为10％，CSME为5％。在调整糖化血红蛋白，糖尿病持续时间和其他因素后，视网膜小动脉单纯曲折度与任何DR的发生率均显着相关（比值比[OR]为1.17； 95％置信区间[CI]为1.01-1.35）。视网膜小静脉分支角与DR进展密切相关（OR，1.18； 95％CI，1.03-1.36），视网膜小静脉曲折弯曲与PDR的发生率显着相关（OR，1.15； 95％CI，1.01-1.30） ，视网膜静脉分支角（OR，1.41； 95％CI，1.10–1.82）与CSME的发生率显着相关。在完全多变量模型中，其他RVGC与任何DR结果均无显着相关性。

结论

视网膜小静脉的视网膜血管几何特征与DR的进展有关；但是，当在T1DM和T2DM中考虑其他危险因素时，大多数通过数字化眼底照片测量的RVGC对DR发生和发展的风险评估几乎没有增加。