Baseline Nonperfusion and Deep Capillary Plexus Ischemia Predict Two-Year Retinal Nonperfusion Progression in...

Area of Science:

• Ophthalmology
• Medical Imaging
• Diabetic Retinopathy Research

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss.
• Predicting the progression of retinal nonperfusion in DR is crucial for timely intervention.
• Ultra-widefield fluorescein angiography (UWF-FA) and macular optical coherence tomography angiography (OCTA) are key imaging modalities in DR assessment.

Purpose of the Study:

• To identify baseline factors, including UWF-FA nonperfusion and macular OCTA metrics, that predict 2-year progression of retinal nonperfusion in DR.
• To evaluate the predictive performance of these factors in a prospective cohort.

Main Methods:

• A prospective observational study included 73 patients (110 eyes) with DR.
• Retinal nonperfusion was quantified using the ischemic index from UWF-FA.
• Macular OCTA metrics, including deep capillary plexus (DCP) geometric perfusion deficit and vessel density, were analyzed.
• Linear mixed-effects models and receiver operating characteristic (ROC) analyses were used to assess predictors of nonperfusion progression over 2 years.

Main Results:

• Mean 2-year ischemic index progression was 0.45 ± 0.90%, with higher progression in moderate to severe nonproliferative DR.
• Greater baseline UWF-FA ischemic index, higher DCP geometric perfusion deficit, and lower DCP vessel density independently predicted nonperfusion progression.
• The area under the curve (AUC) for predicting binary nonperfusion progression was 0.84 for baseline ischemic index, 0.77 for DCP geometric perfusion deficit, and 0.70 for DCP vessel density.

Conclusions:

• Baseline UWF-FA nonperfusion is the strongest predictor of retinal nonperfusion progression in DR.
• Macular DCP OCTA metrics provide independent, noninvasive prognostic information.
• Macular DCP OCTA parameters can serve as adjunctive biomarkers to refine DR risk stratification, especially when UWF-FA is not available.