Quantitative ultra-widefield fluorescein angiography biomarkers in diabetic retinopathy and association with treatment and progression

Rahul S Iyengar; Salma Fleifil; Michael T Aaberg; Gina Yu; Tapan P Patel; Corey Powell; Annie K Tran; Yannis M Paulus

doi:10.2147/OPTH.S472071

Quantitative ultra-widefield fluorescein angiography biomarkers in diabetic retinopathy and association with treatment and progression

Clin Ophthalmol. 2024 Dec 27:18:4019-4028. doi: 10.2147/OPTH.S472071. eCollection 2024.

Authors

Rahul S Iyengar^{1

2}, Salma Fleifil¹, Michael T Aaberg^{1

3}, Gina Yu^{1

4}, Tapan P Patel^{1

5}, Corey Powell⁶, Annie K Tran¹, Yannis M Paulus^{1

5

7}

Affiliations

¹ Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA.
² Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine at USC, Los Angeles, CA, USA.
³ Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Department of Ophthalmology, Byers Eye Institute, Stanford Health Care, Palo Alto, CA, USA.
⁵ Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, USA.
⁷ Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Purpose: To determine if demographic factors and calculated areas of nonperfusion (NP) and neovascularization (NV) on ultra-widefield (UWF) fluorescein angiography (FA) in the eyes of patients with diabetes are associated with treatment with intravitreal injections (IVIs), panretinal photocoagulation (PRP), and diabetic retinopathy (DR) progression.

Patients and methods: This retrospective, cross-sectional study included 363 patients (651 eyes) treated at the University of Michigan Kellogg Eye Center between January 2009 and May 2018. Eligible participants were 18 years or older diagnosed with diabetes who received UWF FA. Patients with previous PRP or poor-quality images were excluded. Main outcome measures included comparison analyses of measured surface areas in millimeters squared (mm²) of total and regional retinal nonperfusion and neovascularization, number of IVIs and PRP treatments, and DR progression.

Results: Our cohort received 3,041 IVIs and 878 PRP treatments with a mean follow-up of 915 days (SD ±714). IVIs were positively associated with posterior NP (difference, 1.15 mm²; 0.43-1.86; P=0.0017). PRP treatments were positively associated with total NP (difference, 27.24 mm²; 14.68-39.79; P<0.001) and total NV (difference, 1.75 mm²; 0.84-2.65; P<0.001), as well as regional areas. While progression was not associated with NP/NV area, it was positively associated with a pre-existing diagnosis of type 2 as compared to type 1 diabetes (147% increase; 7-373% increase; p=0.03).

Conclusion: Areas of NP and NV on UWF FA demonstrated associations with PRP and IVIs in DR patients.

Keywords: diabetic retinopathy; intravitreal injections; panretinal photocoagulation; ultra-widefield fluorescein angiography.

Grants and funding

This work was supported by the National Eye Institute grant 1R01EY033000 (YMP), 1R01EY034325 (YMP), Alcon Research Institute Young Investigator Grant, and unrestricted departmental support from Research to Prevent Blindness. Though these organizations were not specifically involved with the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication; they helped fund researchers involved with this study that did complete these responsibilities.