Severe retinal non-perfusion is associated with fewer retinal lesions on ultra-wide field fundus photography in proliferative diabetic retinopathy.

Abstract

To explore the relationship between the number of retinal lesions observed on ultra-wide field fundus photography (UWF-FP) and the non-perfusion index (NPI) quantified on UWF fluorescein angiography (UWF-FA) in patients with proliferative diabetic retinopathy (PDR). The NPI was measured on early-phase UWF-FA in 100 eyes from 100 patients with PDR, including both type 1 and type 2 diabetes. Eyes were divided into quartiles based on NPI values. Red dots (microaneurysms, retinal hemorrhages, and intraretinal microvascular abnormalities), venous beading, cotton-wool spots (CWS), and white thread-like arterioles were counted on UWF-FP. Mean NPI values for quartiles 1 to 4 were 2.8 ± 1.1%, 8.5 ± 2.1%, 17.3 ± 4.5%, and 42.8 ± 12.2%, respectively. Eyes in the highest NPI quartile (quartile 4) had significantly fewer retinal lesions on UWF-FP (76.1 ± 50.6) and fewer CWS compared with those in the lowest NPI quartile, which showed 253.0 ± 165.5 retinal lesions (p < 0.001). White thread-like arterioles were present in 80.0% of eyes in quartile 4 and none in quartile 1. Patients in quartile 4 were predominantly type 2 diabetics with higher rates of end-stage kidney disease, peripheral neuropathy, lower-extremity peripheral artery disease, and prior limb amputation or revascularization. In patients with poorly controlled, long-standing type 2 diabetes complicated by renal failure, peripheral neuropathy, peripheral arterial disease, or lower-limb amputation, fluorescein angiography should be considered when highly ischemic PDR is suspected, particularly in the presence of white thread-like arterioles, as it may otherwise appear milder on color fundus photography.