PURPOSE To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging. METHODS Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR. RESULTS Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P < 0.003). The frequency of a PPL distribution varied significantly across all ICDR severity levels, with frequencies of mild non-proliferative DR (NPDR) (30.9%), moderate NPDR (40.3%), severe NPDR (38.5%) and PDR (34.9%), P = 0.005. When assessing which individual fields were rated to show a PPL distribution, the frequency was greatest in field 4 and least in field 7. For any grade of DR, temporal fields showed the greatest PPL frequency, followed in order by the superior, inferior, and nasal fields (P < 0.001). Only 3.5% of eyes showed PPL distribution in all five peripheral fields. CONCLUSIONS One-third of the UWF images showed a PPL distribution in this cohort with the temporal quadrant having the widest distribution of PPL. As the PPL distribution varied significantly between various grades of DR, UWF imaging may prove to be important for screening of referral warranted retinopathy.

中文翻译：

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通过散瞳超宽视野眼底成像在糖尿病性视网膜病变中识别的周围病变分布。

目的使用超宽视野（UWF）眼底成像分析印度人群中糖尿病性视网膜病变（DR）的分布。方法在印度多发性糖尿病性视网膜病变的115位受试者（1406眼）中，采用UWF伪彩色成像和Optos Daytona Plus（Optos plc，Dunfermline，苏格兰，英国）进行了这项多中心，前瞻性，观察性研究。图像被传送到加利福尼亚洛杉矶的Doheny图像阅读中心进行分级。ETDRS网格覆盖在UWF图像的立体投影上，并且由2位蒙版的定级者对图像进行独立定级。根据先前的标准，考虑到病灶的数目和面积，病灶的分布主要分为中央（PCL）或主要是外围（PPL）。如果>，则图像被评为PPL。与相应的ETDRS视野相比，在至少一个周边视野中看到50％的病变区域。糖尿病视网膜病变的严重程度也根据国际糖尿病视网膜病变分类（ICDR）等级量表进行评估。主要结局指标是病变分布（PPL与PCL）：各种级别的DR的整体和特定视野内。结果病变分布在37％的眼中为PPL，在63％的眼中为PCL（P <0.003）。在所有ICDR严重程度级别中，PPL分布的频率均发生显着变化，其中轻度非增殖性DR（NPDR）（30.9％），中度NPDR（40.3％），重度NPDR（38.5％）和PDR（34.9％）的频率， P ＝ 0.005。当评估哪些单个字段被评定为显示PPL分布时，频率在字段4中最大，而在字段7中最小。对于任何级别的DR，颞野均显示出最大的PPL频率，其后依次是上，下和鼻腔（P <0.001）。在所有五个周边视野中，只有3.5％的眼睛显示PPL分布。结论在这一队列中，有三分之一的UWF图像显示了PPL分布，颞象限具有最宽的PPL分布。由于不同级别的DR之间的PPL分布差异很大，因此UWF成像对于筛查推荐的有保证的视网膜病变可能很重要。结论在这一队列中，有三分之一的UWF图像显示了PPL分布，颞象限具有最宽的PPL分布。由于不同级别的DR之间的PPL分布差异很大，因此UWF成像对于筛查推荐的有保证的视网膜病变可能很重要。结论在这一队列中，有三分之一的UWF图像显示了PPL分布，颞象限具有最宽的PPL分布。由于不同级别的DR之间的PPL分布差异很大，因此UWF成像对于筛查推荐的有保证的视网膜病变可能很重要。