title: Predictive factors for the progression of diabetic macular ischemia.
abstract: OBJECTIVE
  To investigate the predictive factors for diabetic macular ischemia progression through the analysis of fluorescein angiography (FA) parameters.
  
  
  METHODS
  Retrospective, longitudinal study.
  
  
  METHODS
  Data 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 (mm(2)/year).
  
  
  RESULTS
  The median FAZ areas in mild, moderate, and severe ischemia grades at baseline were 0.28, 0.37, and 0.73 mm(2), and significantly increased at the final FA (0.31, 0.41, and 1.23 mm(2)) (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 mm(2) [10.4%]/year) compared to "mild" (0.021 mm(2) [7.50%]/year) (P = .02) or "moderate" (0.019 [5.13%] mm(2)/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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: National Institute for Health Research, Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom. Electronic address: dawn.sim@moorfields.nhs.uk.
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Sim
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.forename: Javier
authors.initials: J
authors.lastname: Zarranz-Ventura
authors.forename: Catey V
authors.initials: CV
authors.lastname: Bunce
authors.forename: Marcus
authors.initials: M
authors.lastname: Fruttiger
authors.forename: Praveen J
authors.initials: PJ
authors.lastname: Patel
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Egan
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity / Q000502:physiology