To characterize the two-year progression of neurodegeneration in different diabetic retinopathy (DR) risk phenotypes in type 2 diabetes.info:eu-repo/semantics/publishedVersio

Barreto, Patrícia

Coimbra, Rita

Cunha-Vaz, José

Lobo, Conceição

Madeira, Maria H.

Marques, Inês P.

Ribeiro, Luísa

Santos, Ana Rita

Santos, Torcato

European Journal of Ophthalmology

English

PubMed

To characterize the two-year progression of capillary closure in different diabetic retinopathy (DR) risk phenotypes in type 2 diabetes (T2D).info:eu-repo/semantics/publishedVersio

Marques, I.

Ribeiro, L.

Ferreira, S.

Santos, A.R.

Santos, T.

Cunha-Vaz, J.

Repositório Científico do Instituto Politécnico do Porto

1Diabetes Research Group, Swansea University Medical School, Swansea, UK2Moorfields Eye Hospital Foundation Trust, London, UK3School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK4Department of Ophthalmology, Aneurin Bevan University Health Board,Newport, UK5Department of Ophthalmology, Swansea Bay University Health Board,Swansea, UKDESIGN. Retrospective observational study.PURPOSE. The World Health Organisation (WHO) high-lighted the importance of reporting trends and progress inpreventing avoidable blindness in its 2009-2013, in orderto evaluate the impact of different strategies. This studyaims to understand the trends in the incidence of sight(SI) and severe sight impairment (SSI) certifications overa decade prior to the Covid-19 pandemic.METHODS. Certifications for SI and SSI in England andWales are received by the certification’s office atMoorfields Eye Hospital, London.RESULTS. Since 2010 there has been a gradual reductionin certifications for SI and SSI in England and Wales from72.8 to 41.3 per 100,000 people with diabetes in Englandand from 82.3 to 55.5 per 100,000 in Wales. However, inWales since 2016 there has been a gradual increase from43.5 to 55.5 per 100,000 people with diabetes, similar tothat recorded in 2013–2014 at 58.5 per 100,000. This coin-cides with an increase in the number of certifications for SIand SSI inWales of 15.7% in those aged 12–34 year and 8%in those 55–69 years respectively, as well as an overallincrease in all cause certifications in Wales since 2015from 40.1 to 51.8 per 100,000 people.CONCLUSIONS. Over the last decade there has been agradual decrease in certifications of SI and SSI due to diabeticretinopathy in both England andWales. However, in contrastto England there has been a slight reversal in this trend inWales since 2016 which requires further investigation.Characterization of Two-Year Progressionof Risk Phenotypes of Diabetic RetinopathyL. Ribeiro1,2, R. Coimbra1, T. Santos1, M.H. Madeira 1,2, A.R.Santos1,2,4, C. Lobo1,2,3 and J. Cunha-Vaz1,21AIBILI - Association for Innovation and Biomedical Research on Light andImage, Coimbra, Portugal2Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty ofMedicine, University of Coimbra, Coimbra, Portugal3Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra(CHUC), Coimbra, Portugal4Department of Orthoptics, School of Health, Polytechnic of Porto, Porto, PortugalDESIGN. Prospective observational 2-year study.PURPOSE. To characterize the two-years progression oftwo diabetic retinopathy (DR) risk phenotypes in type 2diabetes (T2D).METHODS. A prospective longitudinal cohort study(CORDIS, NCT03696810) was conducted with 4 visits(baseline, 6-months, one-year and two-year).Demographic and systemic data included age, sex, diabetesduration, lipidic profile and hemoglobin A1c (HbA1c).Ophthalmological examinations including visual acuity(BCVA), color fundus photography (CFP) and opticalcoherence tomography (OCT and OCTA), identified thepresence of nonproliferative diabetic retinopathy(NPDR). Phenotype classification was performed, at6-month visit, based on microaneurysm turnover (MAT,on CFP) and central retinal thickness (CRT, on OCT).Only risk phenotypes B (MAT< 6 and increased CRT)and C (MAT≥ 6 with or without increased CRT) wereincluded. ETDRS grading was performed at the baselineand last visits based on 7-fields CFP.RESULTS. 133 T2D individuals were included in thestudy, 81 (60%) eyes classified as phenotype B and 52(40%) eyes as phenotype C. Of these, 127 completed thetwo-year follow-up, 24 (19%) developed central-involvedmacular edema (CIME) and 2 clinically significantmacular edema (CSME) (1.6%). In the two-year period,two-step severity progression (ETDRS) occurred only inone eye with phenotype C.At baseline, eyes with phenotype C showed more capillaryclosure in the superficial capillary plexus (SCP), deepcapillary plexus (DCP) and full retina (FR, p < 0.001)and increased FAZ area (p < 0.001), indicating moreadvanced microvascular disease and confirming the ische-mia phenotype. During the two-year period both pheno-types, B and C, showed progression in GCL+ IPLthinning (p < 0.001) and decrease in vessel density in theDCP (<0.001). When analysing the two-year progressionof each phenotype, only phenotype C revealed significantdecrease in BCVA (p= 0.02) and enlargement of theFAZ (p= 0.03). CSME developed only in phenotype Cwhereas CIME occurred in both risk phenotypes.CONCLUSIONS. In the two-year period of follow-upboth phenotypes B and C showed progression in retinalneurodegeneration associated with progression in capillaryclosure identified by progressive decrease in vessel densityof the DCP. CIME developed in both phenotypes andCSME only in phenotype C.Characterization of Two-Year Progressionof Capillary Closure in NonproliferativeDiabetic RetinopathyI. Marques1,2, L. Ribeiro1,2, S. Ferreira1, A.R. Santos1,2,3,T. Santos1 and J. Cunha-Vaz 1,21AIBILI - Association for Innovation and Biomedical Research on Light andImage, Coimbra, Portugal2Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty ofMedicine, University of Coimbra, Coimbra, Portugal3Department of Orthoptics, School of Health, Polytechnic of Porto, Porto,PortugalDESIGN. Prospective observational 2-year study.14 European Journal of Ophthalmology 32(1S)PURPOSE. To characterize the two-year progression ofcapillary closure in different diabetic retinopathy (DR)risk phenotypes in type 2 diabetes (T2D).METHODS. A prospective longitudinal cohort study(CORDIS, NCT03696810) was conducted with 4 visits(baseline, 6-months, one-year and two-year). Demographicand systemic data included age, sex, diabetes duration,lipid profile and haemoglobin A1c (HbA1c).Ophthalmological examinations including visual acuity(BCVA), colour fundus photography (CFP) and opticalcoherence tomography (OCT and OCTA) identified nonpro-liferative diabetic retinopathy (NPDR). Phenotype classifica-tion was performed, at 6-month visit, based onmicroaneurysm turnover (MAT, on CFP) and centralretinal thickness (CRT, on OCT). Only risk phenotypes B(MAT<6 and increased CRT) and C (MAT≥ 6 with orwithout increased CRT) were included. ETDRS gradingwas performed at the baseline and last visit based on7-fields CFP.RESULTS. 133 T2D individuals were included in thestudy, 81 (60%) eyes classified as phenotype B and 52(40%) eyes as phenotype C. Of these, 127 completed thetwo-year follow-up with 24 (19%) developingcentral-involved macular edema (CIME) and 2 (1.6%)clinically significant macular edema (CSME).At baseline, eyes with phenotype C showed more capillaryclosure in the superficial capillary plexus (SCP), deepcapillary plexus (DCP) and full retina (FR), p < 0.001)and increased FAZ area (p < 0.001), indicating moreadvanced ischemic disease. During the two-year follow-upperiod, the decrease in skeletonized vessel density indicat-ing capillary closure, occurred mainly in the DCP in bothphenotypes. Positive associations with the increased capil-lary closure were identified with GCL+IPL thinning(representing neurodegeneration) and decreased BCVA.Using a combination of parameters such as FAZ metrics,vessel density and degree of neurodegeneration it was pos-sible to identify different risk profiles in eyes with the sameETDRS levels.CONCLUSIONS. Significant progression in capillaryclosure was identified by a decrease in vessel density inthe deep capillary plexus and increase in the FAZ areacombined with progression in neurodegeneration (identify-ing different risk profiles in eyes with the same ETDRSgrade). Eyes developing CIME had less decrease invessel density of the SCP at baseline.Addressing Technical Failures in a DiabeticRetinopathy Screening ProgrammeE. McBride1, D. Garrahy1, R.W.A. Acheson1, D. Keegan2,C. Murphy2, S. McMahon1 and L. O’Toole11NEC Care, Cork City, Co Cork, Ireland2Diabetic RetinaScreen, National Screening Service, Health Service Executive,Dublin, IrelandDESIGN. A retrospective review of the technical failure(TF) rate over a 24-month period.PURPOSE. The consequence of a TF at diabetic retinop-athy screening, is that the patient must be reassessed at asecond slit-lamp examination. This is inconvenient forthe patient as well as costly to the screening programme.We looked to identify why TFs occur and if by modifyingour protocol they could be avoided.METHODS. The TF rate was determined at monthlyintervals over a 24 month period from February 2019 toFebruary 2021. An analysis for the specific reasons forTF was performed at six monthly intervals. Interventionsintroduced during the 24 months included the use of GPhenylephrine 2.5%, the capture of 3 instead of 2 fundalimages, regular camera servicing, and multidisciplinaryteaching (MDT) sessions.RESULTS. In Feb 2019 the TF rate was 14% (529/3357),in Feb 2021 it had reduced to 5% (199/4410). The mostcommon cause of TF at each 6 monthly analysis was cata-ract 48% (range 40–60). The number of artefact-related TFfell from 30% to 5% over 24 months. Non-modifiablecauses for TF included asteroid hyalosis, corneal scarring,and patients not being able to appropriately position at thecamera.Following the introduction of MDT and conversion tothree rather than two image acquisition, the TF ratereduced from 14% in Feb 2019 to 6% a month later. Theintroduction of G Phenylephrine 2.5% combined withMDT resulted in a decrease in the TF rate from 7% inJuly 2020 to 5% two months later.CONCLUSIONS. MDT sessions alone or combined withother interventions, resulted in a significant reduction inthe TF rate. This underlines the need for ongoing educa-tional sessions for screeners. Cataracts account for themajority of TFs in our catchment area, and despite full dila-tion and multiple image acquisition, most patients with cat-aracts still require referral to our optometric services.Teleophthalmology Diabetic RetinopathyScreening Program in Castilla y LeónI.O.B.A. Laurencio1, M.I. Lopez1, J.C. Pastor1, L. Mena1 andP. Arlanzon11Reading Centre of the Eye Institute of University of Valladolid, Valladolid, SpainDESIGN. A prospective cohort study was conducted inthe Tele-ophthalmology Diabetic Retinopathy ScreeningProgram in Castilla y León; between January 1 toDecember 30 of 2021, with 45 health centers recruitingin Valladolid and Palencia and a centralized readingcenter grading the images.PURPOSE. Diabetic retinopathy (DR) is a leading causeof blindness worldwide. Tele-ophthalmology based dia-betic retinopathy screening programs are an important32st Meeting of the European Association 15

Characterization of two-year progression of capillary closure in nonproliferative diabetic retinopathy

We characterized the progression of different diabetic retinopathy (DR) phenotypes in type 2 diabetes (T2D). A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with three visits (baseline, 6 months, and 1 year). Demographic and systemic data included age, sex, diabetes duration, lipid profile, and hemoglobin A1c (HbA1c). Ophthalmological examinations included best-corrected visual acuity (BCVA), color fundus photography (CFP), and optical coherence tomography (OCT and OCTA). Phenotype classification was performed at the 6-month visit based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Only risk phenotypes B (MAT < 6 and increased CRT) and C (MAT ≥ 6 with or without increased CRT) were included. ETDRS grading was performed at the baseline visit based on seven-field CFP.A total of 133 T2D individuals were included in the study; 81 (60%) eyes were classified as phenotype B and 52 (40%) eyes as phenotype C. Of these, 128 completed the 1-year follow-up. At baseline, eyes with phenotype C showed greater capillary closure (superior capillary plexus, deep capillary plexus, and full retina, p < 0.001) and increased foveal avascular zone (FAZ) area (p < 0.001), indicating more advanced microvascular disease. Neurodegeneration represented by thinning of the ganglion cell layer + inner plexiform layer (GCL + IPL) was present in both phenotypes. When analyzing the 1-year progression of each phenotype, only phenotype C revealed a significant decrease in BCVA (p = 0.02) and enlargement of the FAZ (p = 0.03). A significant progressive decrease in the vessel density of the deep capillary layer and in MAT occurred in both phenotypes, but these changes were particularly relevant in phenotype C and ETDRS grades 43–47. During the 1-year period, both phenotypes B and C showed progression in GCL + IPL thinning (p < 0.001). In the 1-year period of follow-up, both phenotypes B and C showed progression in retinal neurodegeneration, whereas phenotype C showed more marked disease progression at the microvascular level.info:eu-repo/semantics/publishedVersio

Ophthalmology and Therapy

Characterization of one-year progression of risk phenotypes of diabetic retinopathy 

Lobo, C.

Marques, I.P.

32nd Meeting of the European Associationfor Diabetic Eye Complications (EAsDEC)Belfast, Northern Ireland, UnitedKingdom, 26th – 28th May 2022Free Paper SessionsAssociation of Predominantly PeripheralLesions on Ultrawide Field Imaging andthe Risk of Diabetic RetinopathyWorsening Over Time: Results from theDRCR Retina Network Protocol AAP.S. Silva1 on behalf of the DRCR Retina Network1Joslin Diabetes Centre, Department of Ophthalmology, Harvard MedicalSchool, Boston, MA, USADESIGN OF STUDY. Prospective multicenter longitu-dinal observational studyPURPOSE. To determine whether predominantly periph-eral lesions (PPL) identified on UWF imaging and angio-graphic risk factors are associated with increased diseaseworsening beyond the risk associated with baselineETDRS DR severity score (DRSS).METHODS. A total 544 study eyes with nonproliferativeDR (NPDR) from 367 adult participants with diabetes.200° UWF-colour images were collected at each annualvisit through 4 years. UWF-fluorescein angiography (FA)images imaging was performed at baseline, 1 and 4years. A centralized reading center graded DR severityand PPL on UWF-colour (colour-PPL) and UWF-FA(FA-PPL). PPL were defined as DR lesions with agreater extent outside versus inside the standard ETDRSfields. Initiation of treatment for DR and/or DME was atinvestigator discretion. The primary outcome was diseaseworsening over 4 years, defined as 2 or more stepsDRSS worsening within ETDRS fields on UWF-colourimages or receipt of DR treatment.RESULTS. The 4-year disease worsening rates were 45%for eyes with mild NPDR at baseline, 40% for moderateNPDR, 26% for moderately-severe NPDR, and 43% forsevere NPDR. At baseline, 41% of eyes had colour-PPLand 46% had FA-PPL. Disease worsening was not asso-ciated with baseline colour-PPL (present vs absent: 38%vs 43%; HR, 0.78; 95% CI, 0.57–1.08; p= 0.13) but wasassociated with baseline FA-PPL (present vs absent: 50%vs 31%; HR, 1.72; 95% CI, 1.25–2.36; p< 0.001).CONCLUSIONS. Although no relationship was identi-fied with colour-PPL, presence of FA-PPL was associatedwith greater risk of disease worsening over 4 years, inde-pendent of baseline DR severity level. These resultssuggest that evaluation of the retinal far periphery isimportant in understanding which eyes with NPDR are athigher risk for future disease worsening. Peripheral find-ings on UWF-FA should be considered for incorporationin future DR staging systems.Characterization of Two-Year Progressionof Neurodegeneration in Different RiskPhenotypes of Diabetic RetinopathyA.R. Santos1,2,4, C. Lobo1,2,3, L. Ribeiro1,2, I.P. Marques1,2,S. Ferreira1, T. Santos1 and J. Cunha-Vaz1,21AIBILI - Association for Innovation and Biomedical Research on Light andImage, Coimbra, Portugal2Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty ofMedicine, University of Coimbra, Coimbra, Portugal3Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra(CHUC), Coimbra, Portugal4Department of Orthoptics, School of Health, Polytechnic of Porto, Porto,PortugalDESIGN. Prospective observational 2-year study.PURPOSE. To characterize the two-year progression ofneurodegeneration in different diabetic retinopathy (DR)risk phenotypes in type 2 diabetes.METHODS. A prospective longitudinal cohort study(CORDIS, NCT03696810) was conducted with 3 visits(baseline, 6-months and one-year). Demographic and sys-temic data included age, sex, diabetes duration, lipid profileand haemoglobin A1c (HbA1c). Ophthalmological exami-nations included visual acuity (BCVA), colour fundus pho-tography (CFP) and optical coherence tomography (OCTand OCTA). Phenotype classification was performed, at6-month visit, based on microaneurysm turnover (MATon CFP) and central retinal thickness (CRT, on OCT).Only risk phenotypes B (MAT< 6 and increased CRT)and C (MAT≥ 6 with or without increased CRT) wereAbstractsEuropean Journal of Ophthalmology2022, Vol. 32(1S) 1–24© The Author(s) 2022Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/11206721221092575journals.sagepub.com/home/ejoincluded. ETDRS grading was performed at the baselineand last visit based on 7-fields CFP.RESULTS. Of the 133 T2D individuals included in thestudy, 81 (60%) eyes were classified as phenotype B and52 (40%) eyes as phenotype C. Of these, 127 completedthe two-year follow-up, with 24 (19%) developing centreinvolving macular edema (CIME) and 2 (1.6%) clinicallysignificant macular edema (CSME).Neurodegeneration represented by thinning of the GCL+IPL was present in both phenotypes showing no statistic-ally significant differences between these phenotypes.Furthermore, GCL+IPL thickness decreased with time(average of −0.605 µm/year; p= 0.010). This decreaseremained statistically significant (ß= 0.624, p= 0.006)when controlling for age, sex, diabetes duration andHbA1c. Changes in time for GCL+IPL thickness are alsonegatively associated with longitudinal changes in FAZarea (β=−1.469), FAZ perimeter and deep capillaryplexus vessel density in phenotype C and in contrast withPhenotype B. No correlation was found between the pres-ence of increased neurodegeneration and the developmentof CIME.CONCLUSIONS. In the two-year period of follow-upboth phenotypes B and C showed progression in retinalneurodegenerative changes in phenotype C. The neurode-generation is associated with microvascular related vari-ables indicative of capillary closure. There is noassociation between the progression in neurodegenerationand development of CIME.Transcriptomic Analysis Reveals thatRetinal Neuromodulation is the MainUnderlying Mechanisms of theNeuroprotective Effect of Sitagliptin inDiabetic RetinaH. Ramos1, P. Bogdanov1,2, J. Huerta1, D. Sabater1, A. Deàs-Just1,C. Hernández1,2,3 and R. Simó1,2,31Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute,Barcelona, Spain2Centro de Investigación Biomédica en Red de Diabetes y EnfermedadesMetabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ICSIII),Madrid, Spain3Department of Medicine, Universitat Autònoma de Barcelona, Barcelona,SpainDESIGN. Neurovascular unit (NVU) impairment is anearly event in the pathogenesis of diabetic retinopathy(DR), which participates in the neurodegeneration andthe early microvascular impairment of the diabetic retina.Consequently, NVU becomes an emergent therapeutictarget of DR. The diminishment of synaptic protein expres-sion, the impairment of neurotransmission and alterationsin neuronal morphology have been described as underlyingmechanisms of NVU impairment. Topical administration(eye drops) of sitagliptin, dipeptidyl peptidase-4 inhibitor(DPP-4i), prevented retinal neurodegeneration inducedby diabetes in db/db mice.PURPOSE. To further explore the mechanisms involvedin the beneficial effects of DPP-4i on diabetes-inducedretinal neurodegeneration, we have compared the retinalexpression patterns of vehicle-treated db/db mice (anexperimental model of DR) with db/db mice treated withsitagliptin.METHODS. Ten db/db mice, aged 10 weeks, were topic-ally treated with sitagliptin eye drops (5 μL/eye; concentra-tion: 10 mg/mL) for 2 weeks twice per day, while other tendb/db were received a topical administration of vehicle(5 μL/eye). Ten db/+ mice (non-diabetic mice) wereassigned as control group. At 12 weeks, after euthanasia,one eye was used for a transcriptomic analysis and theother for its validation through RT-PCR and for proteinassays through Western Blotting (WB) andImmunohistochemistry (IHC). Full-field electroretinogramrecordings were used to address retinal functionality.RESULTS. Diabetic mice topically treated with sitagliptinpresented different expression patterns in the retina in com-parison to those treated with vehicle. In the analysis of bio-logical significance, neurotransmission was the mostenriched biological process. Additionally, we observedthat both mRNA and WB/IHC of presynaptic proteinsinvolved in vesicle biogenesis, mobilization, docking,fusion and recycling, were down-regulated in db/db miceretinas in comparison with non-diabetic controls. Topicaladministration of sitagliptin inhibits this down-regulationcaused by diabetes and improves the functionality of dia-betic retinas. This effect was unrelated to blood glucoseimprovement.CONCLUSIONS. Sitagliptin exerts neuroprotective effectsin db/db mice retinas by inhibiting the diabetes-induceddown-regulation of key presynaptic proteins. This findingopen up a new strategy for treating not only DR but alsoother retinal diseases in which synaptic abnormalities/neuro-degeneration play a crucial role.Inflammation is Underlying in RetinalDegenerations: Similarities and DifferencesBetween Diabetic Retinopathy and RetinalDegeneration in Huntington’s DiseaseF. Cano-Cano1, L.M.V. Valor2, I.H.C. Hervás-Corpión3, A.G.O.Gallardo-Orihuela1, L.G.J. Gómez-Jaramillo1, M.C.G.M.González-Montelongo1 and A.I.A. Arroba11Diabetes Laboratory, Research Unit, Biomedicine Research and InnovationInstitute of Cadiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain2Research Support Laboratory, Alicante University Hospital, Institute ofSanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain3The Advanced Therapies for Pediatric Solid Tumors Research Group, ClínicaUniversidad de Navarra - Centro de Investigación Médica Aplicada (CIMA),Navarra, Spain2 European Journal of Ophthalmology 32(1S)

Characterization of two-year progression of neurodegeneration in different risk phenotypes of diabetic retinopathy

To characterize the two-years progression of two diabetic retinopathy (DR) risk phenotypes in type 2 diabetes (T2D).info:eu-repo/semantics/publishedVersio

Coimbra, R.

Madeira, M.H.

1Diabetes Research Group, Swansea University Medical School, Swansea, UK2Moorfields Eye Hospital Foundation Trust, London, UK3School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK4Department of Ophthalmology, Aneurin Bevan University Health Board,Newport, UK5Department of Ophthalmology, Swansea Bay University Health Board,Swansea, UKDESIGN. Retrospective observational study.PURPOSE. The World Health Organisation (WHO) high-lighted the importance of reporting trends and progress inpreventing avoidable blindness in its 2009-2013, in orderto evaluate the impact of different strategies. This studyaims to understand the trends in the incidence of sight(SI) and severe sight impairment (SSI) certifications overa decade prior to the Covid-19 pandemic.METHODS. Certifications for SI and SSI in England andWales are received by the certification’s office atMoorfields Eye Hospital, London.RESULTS. Since 2010 there has been a gradual reductionin certifications for SI and SSI in England and Wales from72.8 to 41.3 per 100,000 people with diabetes in Englandand from 82.3 to 55.5 per 100,000 in Wales. However, inWales since 2016 there has been a gradual increase from43.5 to 55.5 per 100,000 people with diabetes, similar tothat recorded in 2013–2014 at 58.5 per 100,000. This coin-cides with an increase in the number of certifications for SIand SSI inWales of 15.7% in those aged 12–34 year and 8%in those 55–69 years respectively, as well as an overallincrease in all cause certifications in Wales since 2015from 40.1 to 51.8 per 100,000 people.CONCLUSIONS. Over the last decade there has been agradual decrease in certifications of SI and SSI due to diabeticretinopathy in both England andWales. However, in contrastto England there has been a slight reversal in this trend inWales since 2016 which requires further investigation.Characterization of Two-Year Progressionof Risk Phenotypes of Diabetic RetinopathyL. Ribeiro1,2, R. Coimbra1, T. Santos1, M.H. Madeira 1,2, A.R.Santos1,2,4, C. Lobo1,2,3 and J. Cunha-Vaz1,21AIBILI - Association for Innovation and Biomedical Research on Light andImage, Coimbra, Portugal2Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty ofMedicine, University of Coimbra, Coimbra, Portugal3Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra(CHUC), Coimbra, Portugal4Department of Orthoptics, School of Health, Polytechnic of Porto, Porto, PortugalDESIGN. Prospective observational 2-year study.PURPOSE. To characterize the two-years progression oftwo diabetic retinopathy (DR) risk phenotypes in type 2diabetes (T2D).METHODS. A prospective longitudinal cohort study(CORDIS, NCT03696810) was conducted with 4 visits(baseline, 6-months, one-year and two-year).Demographic and systemic data included age, sex, diabetesduration, lipidic profile and hemoglobin A1c (HbA1c).Ophthalmological examinations including visual acuity(BCVA), color fundus photography (CFP) and opticalcoherence tomography (OCT and OCTA), identified thepresence of nonproliferative diabetic retinopathy(NPDR). Phenotype classification was performed, at6-month visit, based on microaneurysm turnover (MAT,on CFP) and central retinal thickness (CRT, on OCT).Only risk phenotypes B (MAT< 6 and increased CRT)and C (MAT≥ 6 with or without increased CRT) wereincluded. ETDRS grading was performed at the baselineand last visits based on 7-fields CFP.RESULTS. 133 T2D individuals were included in thestudy, 81 (60%) eyes classified as phenotype B and 52(40%) eyes as phenotype C. Of these, 127 completed thetwo-year follow-up, 24 (19%) developed central-involvedmacular edema (CIME) and 2 clinically significantmacular edema (CSME) (1.6%). In the two-year period,two-step severity progression (ETDRS) occurred only inone eye with phenotype C.At baseline, eyes with phenotype C showed more capillaryclosure in the superficial capillary plexus (SCP), deepcapillary plexus (DCP) and full retina (FR, p < 0.001)and increased FAZ area (p < 0.001), indicating moreadvanced microvascular disease and confirming the ische-mia phenotype. During the two-year period both pheno-types, B and C, showed progression in GCL+ IPLthinning (p < 0.001) and decrease in vessel density in theDCP (<0.001). When analysing the two-year progressionof each phenotype, only phenotype C revealed significantdecrease in BCVA (p= 0.02) and enlargement of theFAZ (p= 0.03). CSME developed only in phenotype Cwhereas CIME occurred in both risk phenotypes.CONCLUSIONS. In the two-year period of follow-upboth phenotypes B and C showed progression in retinalneurodegeneration associated with progression in capillaryclosure identified by progressive decrease in vessel densityof the DCP. CIME developed in both phenotypes andCSME only in phenotype C.Characterization of Two-Year Progressionof Capillary Closure in NonproliferativeDiabetic RetinopathyI. Marques1,2, L. Ribeiro1,2, S. Ferreira1, A.R. Santos1,2,3,T. Santos1 and J. Cunha-Vaz 1,21AIBILI - Association for Innovation and Biomedical Research on Light andImage, Coimbra, Portugal2Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty ofMedicine, University of Coimbra, Coimbra, Portugal3Department of Orthoptics, School of Health, Polytechnic of Porto, Porto,PortugalDESIGN. Prospective observational 2-year study.14 European Journal of Ophthalmology 32(1S)

Characterization of two-year progression of risk phenotypes of diabetic retinopathy

Introduction: We characterized the progression
of different diabetic retinopathy (DR) phenotypes
in type 2 diabetes (T2D).
Methods: A prospective longitudinal cohort
study (CORDIS, NCT03696810) was conducted
with three visits (baseline, 6 months, and 1
year). Demographic and systemic data included
age, sex, diabetes duration, lipid profile, and
hemoglobin A1c (HbA1c). Ophthalmological
examinations included best-corrected visual
acuity (BCVA), color fundus photography
(CFP), and optical coherence tomography (OCT
and OCTA). Phenotype classification was performed
at the 6-month visit based on microaneurysm
turnover (MAT, on CFP) and central
retinal thickness (CRT, on OCT). Only risk
phenotypes B (MAT\6 and increased CRT) and
C (MAT C 6 with or without increased CRT)
were included. ETDRS grading was performed at
the baseline visit based on seven-field CFP.
Results: A total of 133 T2D individuals were
included in the study; 81 (60%) eyes were classified
as phenotype B and 52 (40%) eyes as phenotype
C. Of these, 128 completed the 1-year
follow-up. At baseline, eyes with phenotype C
showed greater capillary closure (superior capillary
plexus, deep capillary plexus, and full retina,
p\0.001) and increased foveal avascular zone
(FAZ) area (p\0.001), indicating more advanced
microvascular disease. Neurodegeneration represented
by thinning of the ganglion cell
layer ? inner plexiform layer (GCL ? IPL) was
present in both phenotypes. Whenanalyzing the
1-year progression of each phenotype, only
phenotype C revealed a significant decrease in
BCVA (p = 0.02) and enlargement of the FAZ
(p = 0.03). A significant progressive decrease in
the vessel density of the deep capillary layer and
in MAT occurred in both phenotypes, but these changes were particularly relevant in phenotype
C and ETDRS grades 43–47. During the 1-year
period, both phenotypes B and C showed progression
in GCL ? IPL thinning (p\0.001).
Conclusions: In the 1-year period of follow-up,
both phenotypes B and C showed progression
in retinal neurodegeneration, whereas phenotype
C showed more marked disease progression
at the microvascular level

Barreto, Patrícia Susana Correia Lopes

Vaz, José Guilherme Fernandes da Cunha

Estudo Geral

Characterization of One-Year Progression of Risk Phenotypes of Diabetic Retinopathy

https://recipp.ipp.pt/bitstream/10400.22/22039/1/ART_Ana%20Rita%20Santos%201.pdf

Characterization of two-year progression of neurodegeneration in different risk phenotypes of diabetic retinopathy

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Repositório Científico do Instituto Politécnico do Porto

Repositório Científico do Instituto Politécnico do Porto

Repositório Científico do Instituto Politécnico do Porto

Repositório Científico do Instituto Politécnico do Porto

Estudo Geral