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• W2648856468 abstract "The clinical importance of retinal venous loops (RVL) has been subjected to some debate and so it is no longer a referable feature of diabetic retinopathy (DR) in some large screening programmes such as the national programme in the UK. To gain further evidence on the relevance of RVL in DR grading, we conducted a cross-sectional study of patients referred with suspected proliferative DR (PDR) to the Department of Ophthalmology, Odense University Hospital, Denmark. Six 45° non-stereoscopic fundus photos equivalent to the ETDRS 7-standard field were obtained on dilated pupils at our screening clinic (Early Treatment Diabetic Retinopathy Study Research Group 1991). Photos were auto-mosaicked with IMAGEnet (Topcon, Tokyo, Japan) and graded according to the International Clinical DR Disease Severity Scale (Wilkinson et al. 2003) which was modified to also include detection and assessment of RVL. A RVL was defined as a definite looping deviation of the vein from its linear course localized within the third order branching level from the central retinal vein. All patients were re-imaged using UWF imaging and UWF fundus fluorescein angiography (FFA; Optomap, Optos PLC., Dunfermline, Scotland, UK) at the Department of Ophthalmology, Odense University Hospital, Denmark. Twenty-two eyes with RVL of 16 patients were included. Median age and duration of DM was 46.5 (26.5–69.0) and 26 (3–43) years, and median HbA1c was 62.5 (51–76) mmol/mol. None of the patients had previously been diagnosed with PDR. Retinal venous loops (RVL) were located within the field of view of the 7-field ETDRS-standards in all 22 eyes. Based on UWF-FFA, PDR was found in nine of the 22 eyes with RVL. In six of the eyes with PDR, new vessels and RVL were located to the same quadrant, and all nine had coinciding locations to the same hemisphere. In three of the nine cases with PDR, the new vessels were located outside the 7-field ETDRS area. A previous study reported that RVL were only present in 0.7% of patients with diabetes referred to photo screening, but in 7.7% of patients with PDR (Bek 1999). Further, it was observed that venous abnormalities developed before as well as after the formation of new vessels and photocoagulation treatment. Hence, the author suggested that venous abnormalities are not directly linked to new vessel formation (Bek 1999). However, both in our and in Bek's study, all RVL occurred in eyes with preproliferative DR or PDR. Originally, RVL were included as a marker of DR level 41 on the ETDRS interim scale for grading DR. As the predictive value of RVL for progression to PDR was unable to achieve statistical significance it was subsequently placed on severity level 35 in the final scale (Early Treatment Diabetic Retinopathy Study Research Group 1991). However, this corresponds poorly with RVL being a feature of advanced DR. Whether or not directly linked to new vessel formation RVL are consequences of severe ischaemic retinal disease and often coexist with retinal neovascularization. In our cohort, peripheral neovascularization located outside the 7-standard fields area was demonstrated in three of nine cases with PDR whereas RVL were visible within the field of vision in all cases. Hence, detecting loops might be a valid warning sign of peripheral activity in some patients when screening for DR. The potential benefit of RVL as a referable feature of DR is demonstrated in our study and should open up further discussions on the diagnostic value of RVL in the screening of DR. Larger systematic studies on the association between RVL and other predictive features of DR, PDR and patient related outcomes are warranted and for now we would advise screening protocols to consider RVL as a sign of severe disease requiring referral to the eye clinic." @default.
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• W2648856468 date "2017-06-21" @default.
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• W2648856468 title "Venous loops: a benign feature of diabetic retinopathy or cause for concern?" @default.
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• W2648856468 doi "https://doi.org/10.1111/aos.13507" @default.
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