Widefield swept-source optical coherence tomography angiography metrics associated with neovascular glaucoma in patients with proliferative diabetic retinopathy.
Lu Edward S, Cui Ying, Le Rongrong, Zhu Ying, Wang Jay C, Laíns Inês, Katz Raviv, Lu Yifan, Zeng Rebecca, Garg Itika
AI Summary
This study found that extensive retinal nonperfusion, not neovascularization itself, was strongly associated with neovascular glaucoma in PDR patients, highlighting ischemia as a key clinical indicator.
Abstract
Purpose
To explore the association between widefield swept-source optical coherence tomography angiography (WF SS-OCTA) metrics, including nonperfusion area (NPA) and neovascularization (NV), and presence of neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR).
Methods
A prospective, cross-sectional study was conducted from November 2018 to February 2020. A total of 85 eyes of 60 PDR patients without NVG and 9 eyes of 8 PDR patients with NVG were included. Retinal ischemic parameters (NPA; ischemia index [NPA/total retinal area]) and NV features (NV number; NV area; NV vessel density) were evaluated. Foveal avascular zone (FAZ), macular thickness/volume, and choroidal thickness/volume were obtained using the Zeiss ARI Network. WF SS-OCTA retinal and choroidal metrics, systemic, and ocular parameters were screened using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression for variable selection. Firth's bias-reduced logistic regression (outcome: presence of NVG) was subsequently used to identify parameters associated with NVG.
Results
After LASSO variable selection, 8 variables were significantly associated with the presence of NVG: DM duration (years), insulin (yes/no), best-corrected visual acuity (BCVA) (logMAR), IOP, ischemia index, skeletonized vessel density, macular thickness (inner inferior, outer temporal regions). Firth's bias-reduced logistic regression showed ischemia index (odds ratio [OR]=13.2, 95% confidence interval [CI]:5.3-30.7, P<0.001) and BCVA (OR=5.8, 95%CI:1.2-28.8, P<0.05) were associated with the presence of NVG. NV metrics, FAZ, and choroidal parameters were not related to NVG.
Conclusions
Retinal ischemia but not NV was associated with the presence of NVG in patients with PDR using WF SS-OCTA. Larger, longitudinal studies are needed to validate imaging biomarkers associated with diabetic NVG.
MeSH Terms
Shields Classification
Key Concepts4
In patients with proliferative diabetic retinopathy (PDR), retinal ischemia, as measured by widefield swept-source optical coherence tomography angiography (WF SS-OCTA) ischemia index, was associated with the presence of neovascular glaucoma (NVG) (odds ratio [OR]=13.2, 95% confidence interval [CI]:5.3-30.7, P<0.001).
In patients with proliferative diabetic retinopathy (PDR), best-corrected visual acuity (BCVA) was associated with the presence of neovascular glaucoma (NVG) (OR=5.8, 95%CI:1.2-28.8, P<0.05).
In patients with proliferative diabetic retinopathy (PDR), neovascularization (NV) metrics (NV number, NV area, NV vessel density), foveal avascular zone (FAZ), and choroidal parameters were not related to the presence of neovascular glaucoma (NVG) when assessed using widefield swept-source optical coherence tomography angiography (WF SS-OCTA).
After LASSO variable selection, 8 variables were significantly associated with the presence of neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR): DM duration (years), insulin (yes/no), best-corrected visual acuity (BCVA) (logMAR), IOP, ischemia index, skeletonized vessel density, macular thickness (inner inferior, outer temporal regions).
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