ImportanceSome eyes with proliferative diabetic retinopathy (PDR) treated to stability with panretinal photocoagulation (PRP) continue to lose vision without diabetic macular edema. One presumed cause is macular capillary nonperfusion (CNP)–associated ischemia or infarction. Natural history data of macular CNP might guide treatment trials for it.ObjectiveTo assess visual function and optical coherence tomography angiography (OCTA) changes over 12 months in PRP-treated stable eyes with PDR and macular CNP.Design, Setting, and ParticipantsThis prospective observational cohort study was conducted in a single center in the United Kingdom. Participants had stable laser-treated PDR in at least 1 eye with macular CNP and a best-corrected visual acuity (BCVA) letter score of at least 54 (Snellen equivalent ≥20/80) using Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recruitment was from December 2019 to August 2021 and follow-up for 12 months; data were analyzed from May to July 2024.Main Outcomes and MeasuresChanges in BCVA, low-luminance visual acuity (LLVA), and OCTA metrics over 12 months using linear mixed-effects models with unstructured variance accounting for within-participant correlation between the eligible study eye and repeated measures across time.ResultsThe cohort included 63 participants and 88 eyes. The mean (SD) age was 57.4 (11.9) years; 41 were male (65.1%) and 22 female (34.9%). Mean BCVA and LLVA ETDRS letter scores were 77.52 (SD, 8.0; approximate Snellen equivalent, 20/32) and 68.33 (SD, 8.9; Snellen, 20/40) at baseline and 78.76 (SD, 8.3; Snellen 20/25) and 70.20 (SD, 8.1; Snellen, 20/40) at 12 months. However, 7 participants (9.3%) lost at least 5 letters of visual acuity at 12 months. Linear mixed-effects analysis showed the foveal avascular zone (FAZ) area deteriorated over 12 months, with a mean increase of 1.80% (95% CI, 0.01%-3.63%; P = .05) at 6 months and 2.26% (95% CI, 0.29%-4.26%; P = .03) from baseline. Eyes that lost 5 or more letters had lower baseline superficial vascular density in both the 3 × 3–mm scan (mean [SD], 36.7 [4.8] vs 33.5 [2.0]; P = .006) and parafoveal area (38.7 [5.6] vs 34.7 [2.6]; P = .005). No association was found between a loss of 5 or more letters at 12 months and any baseline FAZ parameters.Conclusions and RelevanceThis study found that FAZ area deteriorated over 12 months in eyes with stable laser-treated peripheral retina in eyes and macular CNP. Vision loss was uncommon and more prevalent in eyes with decreased SVD at baseline rather than FAZ parameters. Longer trials may be required to observe more events of change of 5 or more letters.

中文翻译：

---

稳定的激光治疗增殖性糖尿病视网膜病变眼中的黄斑毛细血管无灌注


重要性一些增殖性糖尿病视网膜病变 （PDR） 的眼睛在接受全视网膜光凝术 （PRP） 治疗至稳定后继续失去视力，而没有糖尿病性黄斑水肿。一个推测的原因是黄斑毛细血管灌注不灌注 （CNP） 相关的缺血或梗死。黄斑 CNP 的自然历史数据可能指导其治疗试验。目的评估 PRP 治疗的 PDR 和黄斑 CNP.Design 稳定眼的视觉功能和光学相干断层扫描血管造影 （OCTA） 在 12 个月内的变化，环境和参与者这项前瞻性观察队列研究在英国的一个中心进行。参与者至少有 1 只患有黄斑 CNP 的眼睛接受了稳定的激光治疗 PDR，并且使用早期治疗糖尿病视网膜病变研究 （ETDRS） 图表的最佳矫正视力 （BCVA） 字母评分至少为 54（Snellen 等效 ≥20/80）。招募时间为 2019 年 12 月至 2021 年 8 月，随访 12 个月;主要结局和措施使用线性混合效应模型在 12 个月内 BCVA、低亮度视力 （LLVA） 和 OCTA 指标的变化，非结构化方差考虑了符合条件的研究眼与重复测量之间的参与者内部相关性随时间的变化。结果该队列包括 63 名参与者和 88 只眼睛。平均 （SD） 年龄为 57.4 （11.9） 岁;男性 41 例 （65.1%） 和女性 22 例 （34.9%）。平均 BCVA 和 LLVA ETDRS 字母评分为 77.52（SD，8.0;近似 Snellen 等效值，20/32）和 68.33（SD，8.9;Snellen，20/40）和 78.76 （SD，8.3;Snellen 20/25） 和 70.20 （SD， 8.1;Snellen，20/40），12 个月大。然而，7 名参与者 （9.3%） 在 12 个月时至少失去了 5 个字母的视力。 线性混合效应分析显示，中心凹无血管区 （FAZ） 面积在 12 个月内恶化，平均增加 1.80% （95% CI，0.01%-3.63%;P = .05） 和 2.26% （95% CI，0.29%-4.26%;P = .03） 从基线。丢失 5 个或更多字母的眼睛在 3 × 3 mm 扫描中基线浅表血管密度较低（平均值 [SD]，36.7 [4.8] vs 33.5 [2.0];P = .006） 和中心凹旁面积 （38.7 [5.6] vs 34.7 [2.6];P = .005）。未发现 12 个月时丢失 5 个或更多字母与任何基线 FAZ 参数之间存在关联。结论和相关性本研究发现，在接受稳定激光治疗的眼周视网膜和黄斑 CNP 的眼睛中，FAZ 面积在 12 个月内恶化。视力丧失并不常见，并且在基线时 SVD 降低而不是 FAZ 参数降低的眼睛中更为普遍。可能需要更长的试验来观察更多 5 个或更多字母的变化事件。