Korean J Ophthalmol.  2016 Oct;30(5):344-351. 10.3341/kjo.2016.30.5.344.

Anterior Diabetic Retinopathy Studied by Ultra-widefield Angiography

• Bae K
• Lee JY
• Kim TH
• Cho GE
• Ahn J
• Kim SJ
• Kim JH
• Kang SW

• KMID: 2353827
• DOI: http://doi.org/10.3341/kjo.2016.30.5.344

Abstract

PURPOSE
To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence.
METHODS
A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated.
RESULTS
Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients (p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis (p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients (p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients (p = 0.010).
CONCLUSIONS
Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles.

Keyword

Diabetic retinopathy; Fluorescein angiography

MeSH Terms

Angiography*
Blood Glucose
Diabetic Retinopathy*
Fluorescein Angiography
Humans
Incidence
Lipoproteins
Logistic Models
Prevalence
Retinaldehyde
Retrospective Studies
Blood Glucose
Lipoproteins
Retinaldehyde

Figure

• 

  Fig. 1 The overlaying circle used for classification of the diabetic retinopathy locational type. The circle is presented as a dotted line, encompassing the conventional seven-standard Early Treatment Diabetic Retinopathy Study fields. This case represents moderate non-proliferative diabetic retinopathy with diffuse involvement.

• 

  Fig. 2 The three types of non-proliferative diabetic retinopathy (DR): the anterior type of DR (A), the posterior type of DR (B), and the diffuse type of DR (C). If retinal changes were located only outside the overlaying circle, anterior type DR (A) was noted. Conversely, when microvascular changes were limited within the overlaying circle, posterior type DR (B) was assigned. If diabetic retinal changes were noted in both sides of the overlaying circle, diffuse type DR (C) was assigned. Imaginary boundary line (dotted line), which was encompassing the conventional seven-standard Early Treatment Diabetic Retinopathy Study fields (solid line), was used for the classification of anterior or posterior type of diabetic retinopathy.

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  Fig. 3 Anterior diabetic retinopathy (DR) stages: mild non-proliferative anterior DR (A), moderate non-proliferative anterior DR (B), severe non-proliferative anterior DR (C), and proliferative DR with anterior type DR (D). Proliferative DR (D) patients were not enrolled in this study.

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  Fig. 4 The proportion of the diabetic retinopathy types according to stage of non-proliferative diabetic retinopathy (NPDR).

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