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Choroidal-Derived Intraretinal Neovascularization Compensates for Diabetic Retinopathy Ischemia via Dual-Pathway
Liuxing He1, Xiaoyu Guo1, Ziyi Yong1
1From the School of Ophthalmology & Optometry, Biomedical Engineering and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (all authors).
American Journal of Ophthalmology
|November 11, 2025
Summary
Pan-retinal photocoagulation (PRP) causes direct damage and adaptive changes in diabetic retinopathy (DR) vasculature. Ultrawide-field OCTA shows compensatory neovascularization may preserve retinal perfusion after PRP treatment.
Area of Science:
- Ophthalmology
- Medical Imaging
- Vascular Biology
Background:
- Diabetic retinopathy (DR) is a leading cause of vision loss.
- Pan-retinal photocoagulation (PRP) is a standard treatment for DR to reduce retinal hypoxia.
- Understanding PRP's microvascular effects is crucial for optimizing treatment.
Purpose of the Study:
- To characterize hemodynamic changes induced by PRP in diabetic retinopathy.
- To compare alterations in photocoagulated (PRP) and non-photocoagulated (NPRP) areas.
- To analyze changes across retinal and choroidal layers using ultrawide-field swept-source OCT angiography.
Main Methods:
- Prospective longitudinal interventional study of 37 patients (44 eyes) with severe DR.
- Ultrawide-field swept-source OCT angiography (UWF-SS OCTA) performed at baseline and 3 months post-PRP.
- Quantification of vessel density (VD) in superficial (SCP), deep (DCP), and choroidal capillary plexuses (CCP), and choroidal vascularity index (CVI).
Main Results:
- Non-photocoagulated areas showed reduced VD in DCP and CCP.
- Photocoagulated areas exhibited decreased SCP VD and CVI.
- Choroidal-derived intraretinal neovascularization (CDIRN) was observed at laser scars.
Conclusions:
- PRP induces both direct thermodamage (reduced CVI) and adaptive autoregulation (VD changes).
- CDIRN formation at laser scars may compensate for perfusion loss in PRP areas.
- A dual pathway model of thermodamage and CDIRN-mediated compensation explains PRP's efficacy in preventing ischemic injury.
