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Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study
  1. Da Wei Yang1,
  2. Zi Qi Tang1,
  3. Fang Yao Tang1,
  4. Simon KH Szeto1,2,
  5. Jason Chan1,2,
  6. Fanny Yip1,2,
  7. Cherie YK Wong1,2,
  8. An Ran Ran1,
  9. Timothy YY Lai1,2,
  10. Carol Y. Cheung1
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  2. 2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
  1. Correspondence to Dr Carol Y. Cheung, Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong; carolcheung{at}cuhk.edu.hk

Abstract

Aims We investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion at the level of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in a cohort of patients with diabetes mellitus (DM).

Materials and methods 617 patients with DM were recruited from July 2015 to December 2020 at the Chinese University of Hong Kong Eye Centre. Image quality assessment (gradable or ungradable for assessing DMI) and DMI evaluation (presence or absence of DMI) were assessed at the level of the SCP and DCP by OCTA.

Results 1107 eyes from 593 subjects were included in the final analysis. 560 (50.59%) eyes had DMI at the level of SCP, and 647 (58.45%) eyes had DMI at the level of DCP. Among eyes without diabetic retinopathy (DR), DMI was observed in 19.40% and 24.13% of eyes at SCP and DCP, respectively. In the multivariable logistic regression models, older age, poorer visual acuity, thinner ganglion cell–inner plexiform layer thickness, worsened DR severity, higher haemoglobin A1c level, lower estimated glomerular filtration rate and higher low-density lipoprotein cholesterol level were associated with SCP-DMI. In addition to the aforementioned factors, presence of diabetic macular oedema and shorter axial length were associated with DCP-DMI.

Conclusion We reported a series of associated factors of SCP-DMI and DCP-DMI. The binary outcome of DMI might promote a simplified OCTA-based DMI evaluation before subsequent quantitative analysis for assessing DMI extent and fulfil the urge for an updating diabetic retinal disease staging to be implemented with OCTA.

  • imaging
  • retina
  • vision
  • macula

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Conception and design: CYC, DWY and TYYL. Data collection: DWY, ZQT, FYT, ARR, SKHS, JC, FY and CYKW. Analysis and interpretation: DWY, FYT, SKHS, JC, FY and CYKW. Drafting the article: DWY and ZQT. Critical revision of the article. CYC, DWY, TYYL and ARR. Final approval of the version to be published, obtainment of funding and overall responsibility: CYC. Guarantor: CYC

  • Funding CUHK Direct Grant (Project Code: 4054419 & 4054487).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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