PURPOSE To investigate the relationship between the diabetic retinopathy (DR) severity and quantitative ultra-widefield angiographic metrics, including leakage index, ischemic index, and microaneurysm count. DESIGN Retrospective image analysis study. METHODS Eyes with DR that had undergone ultra-widefield fluorescein angiography (UWFA) with associated color photography were identified. All eyes were laser-naive and had not received any intravitreal pharmacotherapy within 6 months of UWFA. Each eye was graded for DR severity. Quantitative angiographic parameters were evaluated with a semiautomated analysis platform with expert reader correction, as needed. Angiographic parameters included panretinal leakage index, ischemic index, and microaneurysm count. Clinical characteristics analyzed included age, gender, race, hemoglobin A1C level, hypertension, systolic blood pressure, diastolic blood pressure, and smoking history. MAIN OUTCOME MEASURES Association of DR severity with panretinal leakage index, ischemic index, and microaneurysm count. RESULTS Three hundred thirty-nine eyes were included with mean age of 62±13 years. Forty-two percent of eyes were from women and 57.5% were from men. Distribution of DR severity was as follows: mild NPDR in 11.2%, moderate NPDR in 23.9%, severe NPDR in 40.1%, and PDR with 24.8%. Panretinal leakage index [mild NPDR (mean = 0.51%), moderate NPDR mean = 1.20%, severe NPDR (mean = 2.75%), and PDR (mean = 5.84%); P<2×10-16], panretinal ischemic index [mild NPDR (mean = 0.95%, moderate NPDR (mean = 1.37%), severe NPDR (mean = 2.80%), and PDR (mean = 9.53%); P<2×10-16], and panretinal microaneurysm count [mild NPDR (mean = 36), moderate NPDR (mean = 129), severe NPDR (mean = 203), and PDR (mean = 254); P<5×10-7] were strongly associated with DR severity. Multivariate analysis demonstrated that ischemic index and leakage index were the parameters associated most strongly with level of DR severity. CONCLUSIONS Panretinal leakage index, panretinal ischemic index, and panretinal microaneurysm count are associated with DR severity. Additional research is needed to understand the clinical implications of these parameters related to progression risk, prognosis, and implications for therapeutic response.

中文翻译：

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定量超广角血管造影和糖尿病视网膜病变严重程度：全视网膜渗漏指数、缺血指数和微动脉瘤计数的评估。

目的 探讨糖尿病视网膜病变 (DR) 严重程度与定量超宽视野血管造影指标（包括渗漏指数、缺血指数和微动脉瘤计数）之间的关系。设计回顾性图像分析研究。方法 对经过超宽视场荧光素血管造影 (UWFA) 和相关彩色摄影的患有 DR 的眼睛进行鉴定。所有眼睛均未接受过激光治疗，且在 UWFA 治疗后 6 个月内未接受过任何玻璃体内药物治疗。每只眼睛都根据 DR 严重程度进行分级。使用半自动分析平台评估定量血管造影参数，并根据需要进行专家读数校正。血管造影参数包括全视网膜渗漏指数、缺血指数和微动脉瘤计数。分析的临床特征包括年龄、性别、种族、糖化血红蛋白水平、高血压、收缩压、舒张压和吸烟史。主要观察指标 DR 严重程度与全视网膜渗漏指数、缺血指数和微动脉瘤计数的关联。结果 纳入339只眼，平均年龄62±13岁。42% 的眼睛来自女性，57.5% 来自男性。DR严重程度分布如下：轻度NPDR占11.2%，中度NPDR占23.9%，重度NPDR占40.1%，PDR占24.8%。全视网膜渗漏指数[轻度 NPDR（平均值 = 0.51%）、中度 NPDR 平均值 = 1.20%、重度 NPDR（平均值 = 2.75%）和 PDR（平均值 = 5.84%）；P<2×10-16]，全视网膜缺血指数[轻度 NPDR（平均值 = 0.95%，中度 NPDR（平均值 = 1.37%），重度 NPDR（平均值 = 2.80%）和 PDR（平均值 = 9.53%）；P< 2×10-16]和全视网膜微动脉瘤计数[轻度 NPDR（平均值 = 36）、中度 NPDR（平均值 = 129）、重度 NPDR（平均值 = 203）和 PDR（平均值 = 254）；P<5×10- 7] 与 DR 严重程度密切相关。多变量分析表明，缺血指数和渗漏指数是与 DR 严重程度关联性最强的参数。结论 全视网膜渗漏指数、全视网膜缺血指数和全视网膜微动脉瘤计数与 DR 严重程度相关。需要进行研究来了解这些与进展风险、预后相关的参数的临床意义以及对治疗反应的影响。