Automated, Quantitative and Area-based Analysis of Microaneurysm and Non-perfusion by Gisung Son, Suwhan Lee, Yoon Jeon Kim, Joo Yong Lee, Young Hee Yoon, June-Gone Kim, South Korea


Background & Objective:

Accurate quantification of diabetic characteristics such as microaneurysms (MA) or non-perfusion from ultra-widefield (UWF) fluorescein angiography (FA) images is challenging due to its laborious work of analyzing an extensive number of MA or manual drawing non-perfusion area. To solve this, we developed a novel software calculating MA and non-perfusion automatically and quantitatively analyzed based on different retinal regions.


200 UWF FA images of 120 patients with treatment-naïve severe NPDR/PDR were analyzed for a precise number of MA, area of capillary non-perfusion (ischemic index) and number of neovascularization (NV). Each result was compared based on its retinal region, posterior pole/mid-peripheral/far-peripheral or superior/nasal/inferior/temporal.


120 patients, 80 males and 40 females were 54.66 (Â±12.48) years old who had been diagnosed with diabetes for 12.98 (Â±8.42) years. 200 UWF FA images were composed of 38 eyes with PDR and 162 eyes with severe NPDR. Total number of MA was 292.02 (Â±176.57), which was larger in PDR group than severe NPDR group (376.39Â±153.621 vs 272.22Â±174.93, p=0.001). Most number of MA was located in mid-peripheral retina (80.54%), however, the density of MA was highest in posterior pole when divided by pixel area. (7.60Â±4.79 * 10-6, p<0.001) Nasal area (42.82%) presented most number of MA, which was followed by temporal (29.50%), inferior (14.81%) and superior (12.88%). Ischemic index was 59.42Â±14.78% in total, larger in PDR than in NPDR (67.17 (Â±10.78)% vs 57.60 (Â±57.60)%, p<0.001). Ischemic index was higher in peripheral retina, as posterior pole (1.84Â±7.43%), mid-periphery (50.64Â±18.29%) and Far-periphery (89.19Â±12.98%). Superior (69.05Â±12.62%) and inferior (72.53Â±13.22%) retina pr esented more ischemic retina than nasal (48.59Â±18.38%) and temporal retina (52.23Â±19.49%). Most number of NV is in nasal retina (1.74Â±1.54) and mid-peripheral retina (3.50Â±3.21). Patients with more MA also had higher ischemic index (r=0.299, p<0.001). 13 patients who had MA in far-peripheral retina dominantly, who did not present significant difference in prevalence (38.46% vs 39.57%, p=0.119), however had longer period of hypertension (10.19Â±2.94 years vs 6.12Â±0.48 years, p<0.001) than the other patients.


Number of MA was highest in mid-peripheral & nasal retina, but most crowded in posterior pole. Ischemic index was higher in superior and inferior retina and increased in more peripheral retina. In PDR group, most NV was located mid-peripheral & nasal retina. Patients who had MA in far peripheral area dominantly seems to have longer period of hypertension.


Asan Medical Center, University, Department of Ophthalmology
South Korea
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