Abstract
PurposeTo determine whether venous beading (VB) in two or more quadrants is an appropriate grading criterion for severe nonproliferative diabetic retinopathy (NPDR).MethodsA hospital-based, retrospective, cross-sectional study. A total of 806 patients admitted with diabetic retinopathy (DR) from January 2014 to April 2017 were included in this study. DR severity was graded by the international grading criterion. The status of VB, intraretinal microvascular abnormalities (IRMA), capillary nonperfusion, arteriovenous nicking, and diabetic macular edema was evaluated based on fundus fluorescein angiography.ResultsThe prevalence of VB in eyes with proliferative diabetic retinopathy (PDR), severe NPDR, and moderate NPDR was 41.3% (327/791), 5.9% (31/526), and 0% (0/295), respectively (p < 0.001). Moreover, the proportion of VB in two or more quadrants was even lower (27.1% for PDR and 2.1% for severe NPDR, p < 0.001), and among the total of 225 eyes with VB in two or more quadrants, 214 eyes (95.1%) were graded as PDR. Furthermore, VB formation was significantly correlated with capillary nonperfusion, duration of diabetes (both p < 0.001), and smoking (p < 0.05). After adjusting for age, sex, and other possible factors, VB (OR = 7.479, p < 0.001) and IRMA (OR = 2.433, p < 0.001) were determined as independent risk factors for developing PDR.ConclusionsOur study suggested that VB in two or more quadrants might not be a sensitive grading criterion for severe NPDR among a Chinese population with type 2 diabetes. Nevertheless, VB has a great specificity to define an advanced form of DR.
Highlights
Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM); worldwide, DR has become the leading cause of blindness in working-age adults, especially in Asian countries due to the sharply increasing prevalence of type 2 diabetes [1,2,3]
The duration of diabetes obtained by calculation was 9.3 ± 3.2, 4.6 ± 2.1, and 4.0 ± 2.4 for proliferative diabetic retinopathy (PDR), severe nonproliferative DR (NPDR), and moderate NPDR, respectively
The present study determined the prevalence of retinal vascular lesions, including venous beading (VB), intraretinal microvascular abnormalities (IRMA), capillary nonperfusion, arteriovenous nicking, and diabetic macular edema (DME), among different DR severity levels based on a combination of dilated ophthalmoscopy and fundus fluorescein angiography (FFA)
Summary
Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM); worldwide, DR has become the leading cause of blindness in working-age adults, especially in Asian countries due to the sharply increasing prevalence of type 2 diabetes [1,2,3]. The International Diabetic Retinopathy Severity Scales (IDRSS) were proposed as a simplified grading version [10] and approved as the international DR grading criterion by the Diabetic Retinopathy Preferred Practice Pattern (DR PPP) [11]. This criterion divided DR into the following levels with increasing risks of retinopathy: (1) no apparent retinopathy, (2) mild nonproliferative DR (NPDR), Graefes Arch Clin Exp Ophthalmol (2018) 256:1059–1065. The determination of severe NPDR, which is currently based on the international 4-2-1 rule (intraretinal hemorrhage (IRH), venous beading (VB), and intraretinal microvascular abnormalities (IRMA)), is quite critical due to its high probability of progressing to PDR [9]. The prevalence of retinal vascular lesions in different DR severity levels has not been reported
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