Predictors of Peripheral Retinal Non-Perfusion in Clinically Significant Diabetic Macular Edema

Area of Science:

• Ophthalmology
• Retinal Imaging
• Diabetic Retinopathy Research

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss.
• Peripheral non-perfusion (PNP) may influence DME's progression and treatment.
• Understanding predictors of PNP in DME is essential for patient management.

Purpose of the Study:

• To investigate the predictive value of central macular features and clinico-demographic factors for PNP in patients with DME.
• To determine if macular vascular metrics can predict the presence of PNP.
• To highlight the importance of peripheral imaging for PNP detection in DME.

Main Methods:

• Prospective study involving 48 eyes with DME using multi-modal retinal imaging.
• Acquired data included demographics, clinical history, ultrawide field photography, fluorescein angiography, OCT, and OCT angiography.
• Statistical analyses included linear mixed models and logistic regression to identify predictive features for PNP.

Main Results:

• Insulin use, PRP treatment, and diffuse fluorescein leakage were significantly different between eyes with and without PNP.
• Macular vascular metrics (vessel density, FAZ area, capillary tortuosity) did not significantly differ.
• Predictive features for PNP included subretinal fluid, FAZ eccentricity, ellipsoid zone disruption, prior anti-VEGF therapy, insulin use, and absence of ischemic heart disease.

Conclusions:

• Central macular vascular changes do not predict peripheral non-perfusion in diabetic macular edema.
• Peripheral retinal vascular imaging is vital for identifying PNP in DME patients.
• The study underscores the need for comprehensive peripheral assessment in DME management.