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

Baek, Sung Uk; Park, Min Seon; Cho, Bum-Joo; Park, In Won; Kwon, Soonil

doi:10.1038/s41598-021-93384-5

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Increased visual loss is associated with increased DR severity [ 24 ], and thus once DR progressed, active treatment such as PRP or intravitreal anti-VEGF injection was one of the best ways to reduce DR-related blindness [ 29 ]. 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 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, several risk factors have been proposed to be associated with DR-worsening, including age, uncontrolled diabetes, renal dysfunction, lipid metabolic abnormalities, anemia, etc. [14][15][16][17][18]. Although these factors can provide guidance in clinical management, they cannot accurately predict the specific risk of DR-worsening.…”

Section: Introductionmentioning

confidence: 99%

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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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