This prospective cohort study evaluated whether two OCTA-derived diabetic macular ischemia metrics—deep capillary plexus geometric perfusion deficit (GPDd) and foveal avascular zone enlargement (FAZe)—predicted diabetic retinopathy (DR) complication risk and timing over 2 years in 265 eyes (175 patients) across the DR severity spectrum.
Each +1 SD increase in baseline GPDd (3.62%) was associated with a 77% higher hazard of DR complications (p<0.001) and a 70-day shorter complication-free survival (95% CI, −103.9 to −36.0). Eyes with high GPDd developed complications ~4 months earlier than low-GPDd eyes (117.2 days; p=0.001). FAZe was not independently predictive after adjusting for GPDd.
DR severity was excluded from the primary Cox model due to collinearity with OCTA metrics, which may limit confounding adjustment. The 2-year follow-up window may miss later complications. Single-center prospective cohort design limits generalizability.
Consider quantifying deep capillary plexus GPDd on OCTA at baseline to identify diabetic patients at highest risk for earlier complications—high GPDd eyes may warrant more frequent monitoring intervals. FAZe alone does not add independent prognostic value over GPDd.
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