PURPOSE

To examine the associations of peripapillary microvascular metrics with diabetic retinopathy (DR) incidence and development using swept-source optical coherence tomography angiography (SS-OCTA).

DESIGN

Prospective cohort study.

METHODS

A total of 1033 eyes from 1033 patients with type 2 diabetes mellitus (T2DM) were included, with 2-year follow-up. The peripapillary microvascular metrics at the superficial capillary plexus (SCP) were measured by SS-OCTA at the baseline, including peripapillary vascular density (pVD) and peripapillary vascular length density (pVLD). The DR incidence and progression were evaluated with 7 standard fields of stereoscopic color fundus photographs. The associations were tested with logistic regression models after adjusting for established risk factors and confounding factors. The prediction value of OCTA metrics was examined with the elevation of area under the receiver operating characteristic curve (AUROC).

RESULTS

The 2-year incidence of diabetic retinopathy (DR) was 25.1% (n = 222) in non-DR (NDR) eyes, 7.4% DR progression (n = 11) in DR eyes, and 4.17% RDR eyes (n = 43) in all eyes. After adjusting for established factors, lower whole-image pVD (wi-pVD) (relative risk [RR] = 0.81; 95% CI = 0.68-0.96; P = .015), circular pVD (circ-pVD) (RR = 0.79; 95% CI = 0.66-0.95; P = .013), whole-image pVLD (wi-pVLD) (RR = 0.79; 95% CI = 0.67-0.94; P = .008), and circular pVLD (circ-pVLD) (RR = 0.76; 95% CI = 0.63-0.91; P = .003) were significantly associated with increased risk of DR incidence; wi-pVD (RR = 0.48; 95% CI = 0.35-0.67; P < .001), circ-pVD (RR = 0.65; 95% CI = 0.45-0.94; P = .023), and wi-pVLD (RR = 0.46; 95% CI = 0.33-0.66; P < .001) were associated with incident risk of RDR. Both pVD and pVLD of SCP were not significantly associated with DR progression. The AUROC for the DR incidence risk prediction model increased from 0.631 to 0.658 (4.28%; P = .041) by circ-pVLD; the AUC of the RDR incidence risk prediction model increased from 0.631 to 0.752 by wi-pVD (19.18%; P = .009), to 0.752 by circ-pVD (19.18%; P=.009), and to 0.752 by wi-pVLD (19.18%; P = .009).

CONCLUSION

Lower pVD and pVLD of SCP are associated with 2-year incident DR and RDR among the T2DM population. The peripapillary metrics imaged by SS-OCTA can provide additional value to the prediction of DR incidence and development.

中文翻译：

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周围毛细血管微血管系统预测糖尿病视网膜病变的发生和发展：一项 SS-OCTA 研究

目的

使用扫描源光学相干断层扫描血管造影术 (SS-OCTA) 检查视乳头周围微血管指标与糖尿病视网膜病变 (DR) 发病率和发展的关联。

设计

前瞻性队列研究。

方法

共纳入 1033 名 2 型糖尿病 (T2DM) 患者的 1033 只眼，随访 2 年。在基线时通过 SS-OCTA 测量浅表毛细血管丛 (SCP) 周围毛细血管微血管指标，包括毛细血管周围血管密度 (pVD) 和毛细血管周围血管长度密度 (pVLD)。用立体彩色眼底照片的 7 个标准视野评估 DR 的发生率和进展。在调整已确定的风险因素和混杂因素后，使用逻辑回归模型测试这些关联。OCTA 指标的预测值通过接受者操作特征曲线 (AUROC) 下面积的升高来检验。

结果

糖尿病视网膜病变 (DR) 的 2 年发病率在非 DR (NDR) 眼中为 25.1% (n = 222)，在 DR 眼中 DR 进展率为 7.4% (n = 11)，在 RDR 眼中为 4.17% (n = 43) ）在所有人的眼中。调整既定因素后，降低全图 pVD (wi-pVD)（相对风险 [RR] = 0.81；95% CI = 0.68-0.96；P  = .015），圆形 pVD (circ-pVD) (RR = 0.79 ；95% CI = 0.66-0.95；P  = .013）、全图像 pVLD (wi-pVLD)（RR = 0.79；95% CI = 0.67-0.94；P  = .008）和圆形 pVLD（circ-pVLD )（RR = 0.76；95% CI = 0.63-0.91；P  = .003）与 DR 发病风险增加显着相关；wi-pVD（RR = 0.48；95% CI = 0.35-0.67；P < .001），circ-pVD（RR = 0.65；95% CI = 0.45-0.94；P = .023）和 wi-pVLD（RR = 0.46；95% CI = 0.33-0.66；P < .001）与 RDR 的事件风险相关。SCP 的 pVD 和 pVLD 均与 DR 进展无显着相关性。通过 circ-pVLD ，DR 发病风险预测模型的 AUROC 从 0.631 增加到 0.658 (4.28%；P  = .041)；RDR 发病风险预测模型的 AUC 通过 wi-pVD 从 0.631 增加到 0.752 (19.18%; P  = .009)，通过 circ-pVD 增加到 0.752 (19.18%; P=.009)，通过 wi-增加到 0.752 pVLD (19.18%; P  = .009)。

结论

SCP 的较低 pVD 和 pVLD 与 T2DM 人群中的 2 年事件 DR 和 RDR 相关。SS-OCTA 成像的毛细血管周围指标可以为 DR 发病率和发展的预测提供额外的价值。