Diabetic retinopathy with extensively large area of capillary non-perfusion: characteristics and treatment outcomes

Abstract

Background Capillary non-perfusion is an important characteristic for diabetic retinopathy (DR) indicating microvascular damage and ischemia. Data on the description and treatment outcomes of DR with large area of non-perfusion are lacking to date. We aim to describe the characteristics and treatment outcomes in a series of patients with DR who presented extensively large area of capillary non-perfusion (LACNP). Methods Fundus fluorescein angiograms from medical charts in patients diagnosed with DR between Jan 2017 and Dec 2019 were retrospectively reviewed. Clinical data in eyes with LACNP including imaging and laboratory findings at the first presentation were analyzed. The LACNP was defined as over 70% area of capillary non-perfusion throughout the whole image retina. The mean follow-up duration was 12.4 ± 16.7 months. Follow-up data including extensive pan-retinal photocoagulation and surgical intervention and treatment outcomes were evaluated. Results A total of 43 eyes in 24 patients with LACNP were included, accounting for 3.3% of DR populations in the same period. The overall percentage of non-perfusion area was 79.1 ± 8.1%. All patients received proper control of diabetes and hypertension, and extensive pan-retinal laser photocoagulation. During the follow-up periods, 20 eyes (46.5%) developed severe neovascular complications, of which 15 eyes (34.9%) underwent vitrectomy and/or anti-glaucoma surgeries. Conservative therapies including glycemic control and supplemental laser photocoagulation were conducted in 23 eyes (53.5%) without neovascular complications. In the final follow-up, best corrected visual acuity improved or maintained stable in 19 eyes (44.2%) while deteriorated in 24 eyes (55.8%). Conclusions The presence of LACNP is the hallmark of advanced DR and often indicates a poor visual outcome, although aggressive treatments may slow DR progression and maintain central vision for some time.

Retinal non-perfusion: recognizing and defining what is important

“…fundamental component of diabetic retinopathy (DR), retinal venous occlusive disease, and possibly even age-related macular degeneration if underlying choroidal ischemia is included. Specifically within the context of DR, RNP may be a very early marker of disease progression [1] and increased RNP area has been correlated with increased DR severity [2,3].…”

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

“…FA retains fundamental importance in DME evaluation because it is the only imaging method able to detect vascular leakage and identify non-perfused areas and neovascularization in the retinal periphery [ 28 ], whose identification is mandatory to classify the DR severity and guide the treatment [ 4 ]. Non-perfused peripheral areas may indeed release inflammatory mediators that can sustain and explain a persistent DME, and the laser ablation of these ischemic areas may improve the central retinal morphology and function [ 29 ].…”

Retinal Ischaemia in Diabetic Retinopathy: Understanding and Overcoming a Therapeutic Challenge

“…A retrospective longitudinal study of 24 patients (43 eyes) with large areas of capillary nonperfusion, defined as more than 70% of the retinal area imaged, found that 75% of eyes had increased levels of creatinine and urea nitrogen and 37.5% of eyes had hypertension. Multivariable regression analysis, however, was not conducted to account for the influence of other potential risk factors [ 63 ].…”