ArticleEye (London, England)2026
Retinal non-perfusion progression in severe non-proliferative and proliferative diabetic retinopathy over time: INSPIRED study report 2.
Article in Eye (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
BACKGROUND/
objectivesTo determine the topographic distribution of retinal non-perfusion (RNP) progression in patients with severe non-proliferative diabetic retinopathy (sNPDR) and proliferative diabetic retinopathy (PDR). SUBJECTS/
methodsThis retrospective study was conducted at Moorfields Eye Hospital in the United Kingdom. Patients with diabetic retinopathy (DR) who had two sets of ultra-widefield fundus fluorescein angiography were included. A grid comprising seven concentric rings was superimposed on the images. RNP areas were annotated using Optos' proprietary tool. Total and zonal non-perfusion index (NPI) were calculated as the RNP area divided by the gradable retinal area. Adjusted linear mixed-effects models (LMEMs) were used to estimate progression, accounting for repeated measures and inter-eye correlation.
resultsA total of 53 patients (67 eyes) were included in the analyses. This cohort comprised 19 (28%) eyes with PDR, 31 (46%) with sNPDR, and 17 (25%) with mild-to-moderate NPDR. Focusing on sNPDR and PDR, the nasal 20-30 mm zone had the largest NPI (0.37 ± 0.26) at baseline. Over time, the total NPI increased significantly, with an estimated change of +0.027 (12.42 mm²) per year (95% confidence interval [CI] = 0.008 to 0.045, P = 0.005). The inferior 10-20 mm ring showed the fastest NPI progression ( + 0.049/year; P = 0.007).
conclusionsThis study demonstrates that NPI increased with time in DR. Notably, the inferior 10-20 mm zone was most vulnerable to NPI progression. Of note, this study was limited by the confounding effect of anti-vascular endothelial growth factor (anti-VEGF) treatment; therefore, a future prospective study to control for treatment exposure would be warranted.
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