Predictive Factors for the Progression of Diabetic Macular Ischemia

PurposeTo investigate the predictive factors for diabetic macular ischemia progression through the analysis of fluorescein angiography (FA) parameters.DesignRetrospective, longitudinal study.MethodsData were collected from 79 eyes of 79 patients with type 2 diabetes mellitus. Macular ischemia severity was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and custom software used to quantify the foveal avascular zone (FAZ) area. Patients with ischemia grades “mild,” “moderate,” or “severe” and at least 2 macula-centered FA images over a minimum of 6 months were included. Main outcome measures were change in macular ischemia grades and FAZ enlargement rate (mm2/year).ResultsThe median FAZ areas in mild, moderate, and severe ischemia grades at baseline were 0.28, 0.37, and 0.73 mm2, and significantly increased at the final FA (0.31, 0.41, and 1.23 mm2) (P = .001). The median duration of follow-up was 27.5, 31.0, and 24.0 months, and was not significantly different between groups. FAZ enlargement rates were higher in the more advanced ischemia grades-“severe” (0.073 mm2 [10.4%]/year) compared to “mild” (0.021 mm2 [7.50%]/year) (P = .02) or “moderate” (0.019 [5.13%] mm2/year) (P = .03). A greater ischemia severity grade was predictive for progression (odds ratio [OR] = 2.47, confidence interval [CI] = 1.21-5.05, P = .02). Macular ischemia progression itself was an independent predictive factor for visual acuity loss (OR = 4.60, CI = 1.54-13.7, P = .03).ConclusionsThe rate of FAZ enlargement ranges from 5%-10% of baseline FAZ area per year in eyes with established ischemia. A greater macular ischemia grade was independently predictive for progression, and diabetic macular ischemia progression itself was predictive of the loss of visual function.