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ORIGINAL RESEARCH article

Front. Cell Dev. Biol.
Sec. Molecular and Cellular Pathology
Volume 12 - 2024 | doi: 10.3389/fcell.2024.1501625
This article is part of the Research Topic Artificial Intelligence Applications in Chronic Ocular Diseases, Volume II View all 11 articles

The Protective Role of Gamma Zone Peripapillary Atrophy in Diabetic Retinopathy: Insights from Deep Learning and SS-OCT Angiography

Provisionally accepted
Yingying Li Yingying Li 1Xinxin Hu Xinxin Hu 1Xueqiong Ye Xueqiong Ye 1Qingya Zhong Qingya Zhong 1Xixi Zhang Xixi Zhang 1Jinglin Zhu Jinglin Zhu 1Jiahui Jiang Jiahui Jiang 1Dandan Wang Dandan Wang 1Juntao Zhang Juntao Zhang 1Weina Ren Weina Ren 1Yitian Zhao Yitian Zhao 2*Qinkang Lu Qinkang Lu 1*Na Zhao Na Zhao 1*
  • 1 The Affiliated People's Hospital of Ningbo University, Ningbo Yinzhou People's Hospital, Ningbo, China
  • 2 Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo, Zhejiang Province, China

The final, formatted version of the article will be published soon.

    To explore the relationship between peripapillary atrophy (PPA) and diabetic retinopathy (DR), and to uncover potential mechanisms using swept-source optical coherence tomography (SS-OCT) angiography.Methods: This cross-sectional study included 845 patients with type 2 diabetes (T2DM), who underwent detailed systemic and ophthalmic evaluations. A state-of-the-art deep learning method was employed to precisely identify the parapapillary beta and gamma zones. Based on PPA characteristics, eyes were categorized into four groups: without beta or gamma zone (Group A), isolated beta zone (Group B), isolated gamma zone (Group C), and with both beta and gamma zone (Group D). Digital fundus photography was utilized to diagnose and stage DR severity , while SS-OCT angiography quantified retinal and choroidal vasculature.Results: Participants had a mean age of 66 ± 8.8 years, with 437 (51.7%) male. Beta and gamma PPA zones were observed in 574 (67.9%) and 256 (30.3%) eyes, respectively. Beta zone PPA was associated with older age, whereas gamma zone PPA was correlated with longer axial length (AL), lower vessel density, and reduced choroidal thickness. Adjusted analyses revealed that eyes with isolated (Group C) or concurrent (Group D) gamma zone PPA conferred significantly lower DR grade, independent of known risk factors including systemic diabetes risk factors and AL.Conclusion: This study finds that gamma zone PPA is linked to a reduced risk of developing DR. These results imply that the gamma zone may reflect progressive myopia-associated thinning and microvascular depletion in posterior ocular tissues, potentially contributing to structural resilience against DR. This novel insight offers a promising avenue for understanding the interplay between PPA and DR.

    Keywords: Gamma zone, Peripapillary atrophy, Diabetic Retinopathy, deep learning, optical coherence tomography angiography

    Received: 25 Sep 2024; Accepted: 07 Nov 2024.

    Copyright: © 2024 Li, Hu, Ye, Zhong, Zhang, Zhu, Jiang, Wang, Zhang, Ren, Zhao, Lu and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Yitian Zhao, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo, 315201, Zhejiang Province, China
    Qinkang Lu, The Affiliated People's Hospital of Ningbo University, Ningbo Yinzhou People's Hospital, Ningbo, China
    Na Zhao, The Affiliated People's Hospital of Ningbo University, Ningbo Yinzhou People's Hospital, Ningbo, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.