Photodiagnosis and photodynamic therapy · 2025
Inadequacies and inaccuracies in grading non proliferative diabetic retinopathy without fluorescein fundus angiography in Chinese patients.
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Peng Hongjuan, Zhu Haoyang, Peng Suyin, Dai Tongtong
Аннотация
PURPOSE: This study aims to evaluate the adequacy and accuracy of grading non-proliferative diabetic retinopathy (NPDR) in Chinese patients without the use of fluorescein fundus angiography (FFA). Additionally, it investigates how often more severe lesions detected via FFA might affect NPDR grading based on the International Clinical Diabetic Retinopathy Severity Scale (ICDRS).
METHODS: A hospital-based prospective study was conducted. Patients with NPDR graded using multicolor scanning laser imaging fundus photography (MCIFP) according to ICDRS were included. Microaneurysms (MAs), intraretinal hemorrhages (IHs), venous beading (VB), and intraretinal microvascular abnormalities (IRMAs) were analyzed using both MCIFP and FFA. Neovascularizations (NVs) identified by FFA were also assessed.
RESULTS: A total of 667 eyes from 388 NPDR patients were included. FFA revealed IRMAs in 35/144 (24.3 %), 126/317 (39.7 %), and 109/206 (52.9 %) eyes classified as mild, moderate, and severe NPDR, respectively, based on MCIFP with ICDRS. NVs were detected on FFA in 25/144 (17.3 %), 65/317 (20.5 %), and 63/206 (30.5 %) eyes in the mild, moderate, and severe NPDR categories, respectively. Among severe NPDR eyes, VB was identified in only 13/206 (6.31 %) eyes and ≥2 quadrants of VB in 9/206 (4.36 %) eyes using MCIFP. The agreement between FFA and MCIFP diagnoses was 0.585 for mild NPDR, 0.341 for moderate NPDR, and 0.304 for severe NPDR.
CONCLUSION: The grading of NPDR in Chinese patients without FFA appears inadequate and inaccurate. Routine use of FFA is recommended for NPDR grading, screening, treatment guidance, and follow-up in China.
METHODS: A hospital-based prospective study was conducted. Patients with NPDR graded using multicolor scanning laser imaging fundus photography (MCIFP) according to ICDRS were included. Microaneurysms (MAs), intraretinal hemorrhages (IHs), venous beading (VB), and intraretinal microvascular abnormalities (IRMAs) were analyzed using both MCIFP and FFA. Neovascularizations (NVs) identified by FFA were also assessed.
RESULTS: A total of 667 eyes from 388 NPDR patients were included. FFA revealed IRMAs in 35/144 (24.3 %), 126/317 (39.7 %), and 109/206 (52.9 %) eyes classified as mild, moderate, and severe NPDR, respectively, based on MCIFP with ICDRS. NVs were detected on FFA in 25/144 (17.3 %), 65/317 (20.5 %), and 63/206 (30.5 %) eyes in the mild, moderate, and severe NPDR categories, respectively. Among severe NPDR eyes, VB was identified in only 13/206 (6.31 %) eyes and ≥2 quadrants of VB in 9/206 (4.36 %) eyes using MCIFP. The agreement between FFA and MCIFP diagnoses was 0.585 for mild NPDR, 0.341 for moderate NPDR, and 0.304 for severe NPDR.
CONCLUSION: The grading of NPDR in Chinese patients without FFA appears inadequate and inaccurate. Routine use of FFA is recommended for NPDR grading, screening, treatment guidance, and follow-up in China.