Widefield Swept-source OCT Angiography Metrics Associated with the Development of Diabetic Vitreous Hemorrhage A Prospective Study.

Abstract Objective To investigate the association among widefield swept-source optical coherence tomography angiography (WF SS-OCTA) metrics and systemic parameters and the occurrence of vitreous hemorrhage (VH) in eyes with proliferative diabetic retinopathy (PDR). Design Prospective, observational study. Participants Fifty-five eyes from 45 adults with PDR, with no history of VH, followed for at least 3 months. Methods All patients were imaged with WF SS-OCTA (Montage 15×15mm and HD-51 Line scan). Images were independently evaluated by two graders for quantitative and qualitative WF SS-OCTA metrics defined a priori. Systemic and ocular parameters and WF SS-OCTA metrics were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and Logistic/Cox regression for variable selection. Firth’s Bias-Reduced logistic regression models (outcome: occurrence of VH) and Cox regression models (outcome: time to occurrence of VH) were used to identify parameters associated with the occurrence of VH. Main outcome measures Occurrence of VH. Results Over a median follow-up of 363 days (range: 28-710 days), 13 of 55 (24%) PDR eyes developed VH during the follow-up period. Presence of extensive neovascularizations (NVs) (odds ratio [OR]=8.05, 95% confidence interval [CI]:1.43-58.56, P=0.02), defined as NVs with total area greater than 4 disc diameters, and forward NVs (OR=5.42, 95%CI:1.26-35.16, P=0.02) that traversed the posterior hyaloid face into the the vitreous were associated with the occurrence of VH. The presence of flat NVs (OR=0.25, 95%CI:0.04-1.01, P=0.05) confined to the posterior hyaloid face was associated with a lower risk of VH with borderline significance. Similarly, presence of extensive NVs (hazard ratio [HR]=18.24, 95% CI:3.51-119.47, P Conclusions WF SS-OCTA is useful to evaluate NVs and their relationship with the vitreous. The presence of forward NVs and extensive NVs were associated with the occurrence of VH in patients with PDR. Larger samples and longer follow-up are needed to verify the risk factors and imaging biomarkers for diabetic VH.