Predictive Factors for the Progression of Diabetic Macular Ischemia

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• 作者：Dawn A. Sim ; Pearse A. Keane ; Javier Zarranz-Ventura ; Catey V. Bunce ; Marcus Fruttiger ; Praveen J. Patel ; Adnan Tufail ; Catherine A. Egan
• 刊名：American Journal of Ophthalmology
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：156
• 期：4
• 页码：684-692.e1
• 全文大小：1666 K

文摘

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Purpose

To investigate the predictive factors for diabetic macular ischemia progression through the analysis of fluorescein angiography (FA) parameters.

Design

Retrospective, longitudinal study.

Methods

Data were collected from 79 eyes of 79 patients with type 2 diabetes mellitus. Macular ischemia severity was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and custom software used to quantify the foveal avascular zone (FAZ) area. Patients with ischemia grades ¡°mild,¡± ¡°moderate,¡± or ¡°severe¡± and at least 2 macula-centered FA images over a minimum of 6?months were included. Main outcome measures were change in macular ischemia grades and FAZ enlargement rate (mm²/year).

Results

The median FAZ areas in mild, moderate, and severe ischemia grades at baseline were 0.28, 0.37, and 0.73?mm², and significantly increased at the final FA (0.31, 0.41, and 1.23?mm²) (P?= .001). The median duration of follow-up was 27.5, 31.0, and 24.0?months, and was not significantly different between groups. FAZ enlargement rates were higher in the more advanced ischemia grades¡ª¡°severe¡± (0.073?mm² [10.4 % ]/year) compared to ¡°mild¡± (0.021?mm² [7.50 % ]/year) (P?=?.02) or ¡°moderate¡± (0.019 [5.13 % ] mm²/year) (P?= .03). A greater ischemia severity grade was predictive for progression (odds ratio [OR]?= 2.47, confidence interval [CI]?= 1.21-5.05, P?= .02). Macular ischemia progression itself was an independent predictive factor for visual acuity loss (OR?= 4.60, CI?= 1.54-13.7, P?= .03).

Conclusions

The rate of FAZ enlargement ranges from 5 % -10 % of baseline FAZ area per year in eyes with established ischemia. A greater macular ischemia grade was independently predictive for progression, and diabetic macular ischemia progression itself was predictive of the loss of visual function.