Multimodal characteristics of iris neovascularization in patients with proliferative diabetic retinopathy

doi:10.3877/cma.j.issn.2095-2007.2021.01.002

Abstract

Abstract:

Objective

To investigate the characteristics of iris angiography in patients with proliferative diabetic retinopathy (PDR) and iris neovascularization.

Methods

32 patients (64 eyes) diagnosed as PDR in the Ophthalmology Center of Beijing Tongren Hospital and Beijing Shijingshan Hospital, affiliated to Capital Medical University from September 2017 to December 2018 were collected. The age, course of diabetes, intraocular pressure and visual acuity of patients were examined and recorded. All patients were underwent both iris fluorescein angiography (IFA) and indocyanine green angiography (IICGA). Two experienced ophthalmologists analyszed the imaging of IFA and IICGA for iris neovascularization (NVI), recorded the vascular morphology and distribution of NVI, and summarized the characteristics of two kinds of iris angiography images. The iris region was extracted by the Snake algorithm, then angiography region was segmented by Otsu algorithm, and the proportion of NVI in the total iris area was calculated. The age, course of diabetes, intraocular pressure, visual acuity and the proportion of NVI area were described by mean±standard deviation. Spearman correlation analysis was used to analyze the correlation between NVI area, diabetes duration, intraocular pressure and visual acuity.

Results

In IFA images, NVI manifested as leaking vascular plexus. The morphology of NVI in IFA for some severe cases was invisible because of rapid leak fluorescence and deep iris pigmentation. While for IICGA images, these were not found. The detection rate of two kinds of NVI angiography was about 100% in accordance with the clinician′s interpretation. Among of 22 patients (38 eyes) diagnosed with NVI by IFA and IICGA, 6 cases (10 eyes) had iris synechia, accounting for 26.3%; 7 cases (12 eyes) had irregular iris morphology, accounting for 31.6% and 9 cases (17 eyes) had neovascularization near the pupil margin, accounting for 45%. IICGA showed the distribution of NVI in 22 patients (38 eyes): 10 cases (17 eyes) with pupil margin involvement, 4 cases (5 eyes) with 1 quadrant, 2 cases (2 eyes) with 2 quadrants, 1 case (1 eye) with 3 quadrants and 8 cases (13 eyes) with 4 quadrants. The proportion of NVI area in NVI patients was positively correlated with intraocular pressure, and there was statistically significant differences between them (r=0.567, P<0.05), but non-significant difference with the course of diabetes mellitus (r=-0.167, P>0.05) and visual acuity (r=0.115, P>0.05).

Conclusions

NVI could be found in both IICGA and IFA in patients with PDR, and there was non-significant difference between two angiographic methods in detecting NVI. IICGA could clearly show the morphology and distribution of NVI, which has more advantages in the early diagnosis of NVI, and is suggested to be used for quantitative analysis for neovascularization. In addition, proportion of NVI area was positively correlated with intraocular pressure significantly.

Key words: Proliferative diabetic retinopathy, Iris neovascularization, Iris Indocyanine green angiography, Iris fluorescein sodium angiography

Yunhe Ding, Shenshen Yan, Lu Wang, Yanyun Chen, Tingting Song, Lu Zhang, Zheqing Li, Zhi Yang, Pei Tian. Multimodal characteristics of iris neovascularization in patients with proliferative diabetic retinopathy[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(01): 8-13.

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