Retinal Vascular Fractals and Microvascular and Macrovascular Complications in Type 1 Diabetes

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• 作者：Jakob Grauslund ; Anders Green ; Ryo Kawasaki ; Lauren Hodgson ; Anne Katrin Sjø ; lie ; Tien Y. Wong
• 刊名：Ophthalmology
• 出版年：2010
• 出版时间：July 2010
• 年：2010
• 卷：117
• 期：7
• 页码：1400-1405
• 全文大小：559 K

文摘

Purpose

Fractal analysis is a method to quantify the geometric pattern and complexity of the retinal vessels. This study examined the association of retinal fractal dimension (D_f) and microvascular and macrovascular complications in a population-based cohort of Danish patients with type 1 diabetes.

Design

Cross-sectional study.

Participants

This was a cross-sectional study of 208 long-term surviving type 1 diabetes patients from a population-based Danish cohort identified in 1973.

Methods

Retinal photographs were obtained at a clinical examination in 2007 or 2008. D_f was measured with a semiautomatic computer-based program (International Retinal Imaging Software; National University of Singapore, Republic of Singapore; University of Sydney, Sydney, and University of Melbourne, Melbourne, Australia). D_f of the retinal vasculature was measured within a predefined circular region of 3.5 optic disc radii centered on the optic disc. Line tracing of the vasculature was provided by the program. Any artifacts were removed by the grader, and the box-counting method then was used by the program to calculate D_f.

Main Outcome Measures

The association of D_f with proliferative retinopathy, nephropathy, neuropathy, and macrovascular disease (coronary heart disease, stroke, peripheral artery disease) was examined.

Results

Retinal fractals were gradable in at least 1 eye in 178 (86.6 % ) of 208 patients. Median age and duration of diabetes for these patients were 57.8 years and 42 years, respectively. Median D_f was 1.4610 (range, 1.3774–1.5188). After adjustments for age, gender, duration of diabetes, systolic blood pressure, and smoking, persons with lower D_f were more likely to have proliferative retinopathy (odds ratio [OR], 1.45 per standard deviation [SD] decrease in D_f; 95 % confidence interval [CI], 1.04–2.03) and neuropathy (OR, 1.42 per SD decrease in D_f; 95 % CI, 1.01–2.01). There was also a trend of an association between lower D_f and nephropathy (OR, 1.39 per SD decrease in D_f; 95 % CI, 0.97–2.01) but not macrovascular disease. Furthermore, persons with lower D_f were older.

Conclusions

This study adds to the evidence that D_f may have some role as a global measure of retinal vasculature and its association with systemic disease. Prospective studies clarifying this role are needed.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.