| Chapter 1:Analysis for the distribution characteristic of retinal peripheral lesions in diabetic retinopathy by using ultrawide field imaging systemObjective:To investigate the distribution characteristic of retinal peripheral lesions in Chinese diabetic retinopathy(DR)population by using non-mydriatic and noninvasive ultrawide imaging system.Methods:A cross-sectional study.388 eyes of 265 DR patients were included in this study.Ultrawide field fundus examination were performed by Optos Daytona.Photoshop software was used to simulate Early Treatment Diabetic Retinopathy Study Research Group(ETDRS)7-standard fields,which was also defined as central retinal area 1-7.Peripheral areas adjacent to central retinal area 1-7 were divided into peripheral retinal area 3-7 respectively.Eyes were designated as predominantly peripheral lesions(PPL)when at least 1 retinal peripheral area 3-7 had more lesions than its respective adjacent central area 3-7.Otherwise were designated as predominantly central lesions(PCL).The χ2 test was used to compare the constituent ratio differences of PPL in each retinal region of eyes with different DR stages.Results:Of these 388 eyes enrolled in this study,200 eyes had PPL(200/388,51.5%),including 32 eyes(36.8%,32/87)in mild non-proliferative DR(NPDR),89 eyes(55.3%,89/161)in moderate NPDR,42 eyes(51.9%,42/81)in severe NPDR and 37 eyes(62.6%,37/59)in PDR.The difference was statistically significant(χ2=11.440,P<0.05),Beisdes,there are 87,101,78,67,38 PPL regions located in peripheral retinal area 3-7 respectively.The regional distribution of PPL was significantly different(χ2=37.640,P<0.001).Conclusion:In the Chinese population included in this study,PPL accounted for 51.5%of DR patients,and the proportion of PPL was positively correlated with DR severity.In addition,peripheral retinal lesions were most common in the temporal retina.Chapter 2:Multimodal imaging analysis for the impact of retinal peripheral lesions on central neurovascular structure and retinal function in diabetic retinopathyObjective:To explore the impact of peripheral retinal lesions on central retinal neurovascular structure and retinal function in diabetic retinopathy(DR)by applying novel multimodal imaging techniques.Methods:Ninety-seven diabetic patients were included in this cross-sectional study.DR was classified into mild non-proliferative DR(NPDR),moderate NPDR,severe NPDR,and proliferative DR(PDR)according to the international clinical diabetic retinopathy and diabetic macular oedema disease severity scales.Ultrawide field(UWF)pseudocolor images were collected by Optos Daytona and graded as with predominantly peripheral lesions(PPL)and without PPL.Macular neurovascular alterations and retinal function were measured by optical coherence tomography angiography(OCTA)and handheld,mydriasis-free,full-field flicker electroretinogram(ERG)recording device RETeval,respectively.Central microcirculation and retinal function were compared between eyes with and without PPL.Results:The study evaluated 186 eyes,including 92 eyes without PPL and 94 eyes with PPL.DR severity,central retinal vessel density,GCC and RNFL thickness were comparable between eyes with and without PPL(P>0.05).Delayed implicit time and decreased pupil area ratio were found in the PPL group compared with eyes without PPL,and this difference remained unchanged after adjusting for systemic factors(all P<0.01).Conclusion:According to the existing DR staging criteria,there was no significant difference in DR severity between the PPL and without PPL groups,but the implicit time in ERG examination was significantly delayed in PPL group,suggesting that additional peripheral lesions may participate in deterioration of retinal function.Therefore,DR risk assessment based on classical ETDRS protocols may ignore the potential role of peripheral retinal lesions in DR progression.Besides,ultrawide filed imaging system and retinal function examination may provide a multidimensional supplement for DR management. |
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