Differential distribution of manifest lesions in diabetic retinopathy by fundus fluorescein angiography and fundus photography

Xiaoli Li,Jun Wang,Liang Zhang,Guanrong Zhang,Tian Huang,Ying Cui,Aiping Zhang,Jie Xie,Xiangting Chen,Qianli Meng

doi:10.1186/s12886-020-01740-2

Abstract

BackgroundTo analyze the distribution of manifest lesions of diabetic retinopathy (DR) by fundus fluorescein angiography (FFA) and color fundus photography (FP).MethodsA total of 566 eyes of 324 Chinese patients diagnosed with DR were included in this retrospective study. DR severity was graded by the international grading criterion. The distributions of microaneurysms (MA), intraretinal hemorrhages/exudates (He/Ex), intraretinal microvascular abnormality (IRMA), capillary nonperfusion areas (NPA), and neovascularization (NV) were estimated by multiple logistic regression analyse based on nine-field FFA and FP images.ResultsIn mild nonproliferative diabetic retinopathy (NPDR), the highest frequency of MA was found in the posterior pole (67.7%), followed by the inferior nasal (59.4%), and the nasal (55.4%) fields. In moderate NPDR, MA frequently distributed in the posterior pole (98.0%), nasal (97.0%), superior (96.0%), inferior nasal (94.9%), and inferior (92.9%) fields, whereas He/Ex were most prevalent in the posterior pole (69.7%). In severe NPDR and proliferative DR, IRMA, NPA, and NV were more frequent in the nasal field, particularly in the inferior nasal field (60.3, 38.7, and 76.0%, respectively). All lesions were more observed in the combined posterior pole, nasal, and inferior nasal fields than in the posterior pole or combined two fields in the early and severe stages of DR (P < 0.05).ConclusionsThe manifest lesions of DR were common in the nasal field besides the posterior pole in Chinese patients. A combined examination of the posterior pole, nasal, and inferior nasal mid-peripheral retina would help to detect different retinal lesions of DR.Trial registrationClinicalTrial. gov, NCT03528720. Registered 18 May 2018 - Retrospectively registered.

Highlights

To analyze the distribution of manifest lesions of diabetic retinopathy (DR) by fundus fluorescein angiography (FFA) and color fundus photography (FP)
In proliferative diabetic retinopathy (PDR), Feman et al found that neovascularization elsewhere in the retina (NVE) arose most frequently in the superotemporal quadrant at 6 mm from the optic disk [14], whereas Jansson et al showed that the majority of NVE lesions are located inferonasal to the optic disc and along the superior vascular arcades [1]
In order to show the retinal lesions from the posterior pole to the peripheral retina as clearly as possible, the mydriatic images of FFA and FP were divided into nine fields and were centered on the following areas: the macula, superior mid-peripheral retina, superior temporal mid-peripheral retina, temporal mid-peripheral retina, inferior temporal mid-peripheral retina, inferior mid-peripheral retina, inferior nasal mid-peripheral retina, nasal mid-peripheral retina, and superior nasal mid-peripheral retina (Fig. 1) [18, 19]

Summary

Introduction

To analyze the distribution of manifest lesions of diabetic retinopathy (DR) by fundus fluorescein angiography (FFA) and color fundus photography (FP). In proliferative diabetic retinopathy (PDR), Feman et al found that neovascularization elsewhere in the retina (NVE) arose most frequently in the superotemporal quadrant at 6 mm from the optic disk [14], whereas Jansson et al showed that the majority of NVE lesions are located inferonasal to the optic disc and along the superior vascular arcades [1] Considering these discordant findings, it is necessary to identify the distribution characteristics of the DR lesions in different populations of diabetic patients, which may help to clarify predisposition to or protection against certain areas of diabetes-induced retinal changes and improve strategies for screening and diagnosis of DR

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Conclusion