Factors predicting final visual outcome in quiescent proliferative diabetic retinopathy

Park, In Won; Kwon, Soonil

doi:10.1038/s41598-020-74184-9

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…However, in the case of severe retinal ischemia, diffusion of oxygen needed by macular may remain insufficient and even lead to macular edema in spite of PRP, causing lower vision [ 15 , 30 ]. This finding is also in line with the study that lower vision is associated with the larger avascular zone area of foveal in DR patients [ 31 ]. Therefore, prevention of DR-worsening may be an important strategy to reduce DR-related vision loss, even blindness.…”

Section: Discussionsupporting

confidence: 93%

A prediction model for worsening diabetic retinopathy after panretinal photocoagulation

Lei

et al. 2022

Diabetol Metab Syndr

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Background As one of the severe complications of diabetes mellitus, diabetic retinopathy (DR) is the leading cause of blindness in the working age worldwide. Although panretinal photocoagulation (PRP) was standard treatment, PRP-treated DR still has a high risk of progression. Hence, this study aimed to assess the risk factors and establish a model for predicting worsening diabetic retinopathy (DR-worsening) within five years after PRP. Methods Patients who were diagnosed with severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy and treated with PRP were included, and those patients were randomly assigned to either a training or validation cohort. The multivariate logistic regression analysis was used to screen potential risk factors for DR-worsening in the training cohort. Then the model was established after including significant independent risk factors and further validated using discrimination and calibration. Results A total of 271 patients were included, and 56.46% of patients had an outcome of DR-worsening. In the training cohort (n = 135), age (odds ratio [OR] = 0.94, 95% confidence interval [CI] 0.90–0.98), baseline best corrected visual acuity (logMAR) (OR = 10.74, 95% CI 1.84–62.52), diabetic nephropathy (OR = 9.32, 95% CI 1.49–58.46), and hyperlipidemia (OR = 3.34, 95% CI 1.05–10.66) were screened out as the independent risk factors, which were incorporated into the predictive model. The area under the receiver operating characteristic curve and calibration slope in the training and validation cohort were 0.79, 0.96 (95% CI 0.60–1.31), and 0.79, 1.00 (95% CI 0.66–1.34), respectively. Two risk groups were developed depending on the best cut-off value of the predicted probability, and the actual probability was 34.90% and 82.79% in the low-risk and high-risk groups, respectively (P < 0.001). Conclusions This study developed and internally validated a new model to predict the probability of DR-worsening after PRP treatment within five years. The model can be used as a rapid risk assessment system for clinical prediction of DR-worsening and identify individuals at a high risk of DR-worsening at an early stage and prescribe additional treatment.

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Section: Discussionsupporting

confidence: 93%

A prediction model for worsening diabetic retinopathy after panretinal photocoagulation

Lei

et al. 2022

Diabetol Metab Syndr

View full text Add to dashboard Cite

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“…However, in cases where the macular ischemic condition presenting as low visual acuity is severe, diffusion of oxygen may remain insufficient despite PRP, and DR could actually worsen. In particular, this finding in line with the result of a study that reported that low visual acuity is associated with larger foveal avascular zone size in patients with DR 10 . Poor visual acuity can imply macular ischemia, which is likely to be associated with a progression of DR.…”

Section: Discussionsupporting

confidence: 90%

Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Baek

Park

Cho

et al. 2021

Sci Rep

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Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

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“…Among the systemic parameters VD was significantly correlated with HbA1c, which is in agreement with previous studies. [ 33 34 ]…”

Section: Discussionmentioning

confidence: 99%

Quantitative analysis of retinal microvascular changes in prediabetic and diabetic patients

Ratra

Dalan²,

Prakash³

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To evaluate and correlate retinal microvascular changes in prediabetic and diabetic patients with functional and systemic parameters. Methods: Optical coherence tomography angiography (OCTA) was performed on all subjects after medical evaluation and laboratory investigations for blood sugar, glycosylated hemoglobin, and others. Automated quantification of vascular indices of the superficial plexus were analyzed. Results: Hundred and eleven persons (222 eyes) were grouped into prediabetic (PDM) (60 eyes), diabetic without retinopathy (NDR) (56 eyes), diabetic with retinopathy (DR) (66 eyes), and healthy controls (CTR) (40 eyes). The superficial retinal capillary plexus showed no significant changes in the prediabetic and NDR groups; however, central foveal thickness (CFT) was significantly reduced in PDM ( P = 0.04). The circularity of the foveal avascular zone (FAZ) ( P = 0.03) and the vessel density (VD) ( P = 0.01) showed significant reduction from PDM to NDR. All vascular parameters were significantly reduced in DR and correlated with disease severity. The CFT correlated significantly with FAZ area. The VD and perfusion density were seen to correlate significantly with HbA1c and contrast sensitivity. The visual acuity was significantly correlated with the FAZ. Logistic regression revealed VD [OR 20.42 (7.9–53)] and FAZ perimeter [OR 9.8 (4.2–23.2)] as the strongest predictors of DR. Conclusion: The changes in OCTA can help predict onset of DR. FAZ changes are seen in early stages and are correlated well with systemic parameters, making it an easy target to monitor and screen for severity of DR. Significant reduction in the CFT in PDM suggests that neuronal damage precedes vascular changes.

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Factors predicting final visual outcome in quiescent proliferative diabetic retinopathy

Cited by 9 publications

References 39 publications

A prediction model for worsening diabetic retinopathy after panretinal photocoagulation

A prediction model for worsening diabetic retinopathy after panretinal photocoagulation

Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Quantitative analysis of retinal microvascular changes in prediabetic and diabetic patients

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