Gozlan Julien, Ingrand Pierre, Lichtwitz Olivier, Cazet-Supervielle Agathe, Benoudis Léa, Boissonnot Michele, Hadjadj Samy, Leveziel Nicolas
Department of Ophthalmology, CHU Poitiers Public Health Department, University of Poitiers University of Poitiers, UFR de Médecine et Pharmacie Biostatistics, INSERM CIC 1402, Centre d'investigation clinique, University Hospital of Poitiers Diabetology Department, Poitiers - Coordinating Center of the DIAB2NEPHROGENE Study INSERM 1084, University of Poitiers, France.
Medicine (Baltimore). 2017 Apr;96(15):e6427. doi: 10.1097/MD.0000000000006427.
Fluorescein angiography has been so far the gold-standard test to assess diabetic macular ischemia (DMI), a cause of irreversible visual impairment in diabetic patients. The aim of this study was to investigate foveal avascular zone (FAZ) and perifoveal microcirculation changes in eyes with nonproliferative diabetic retinopathy (NPDR) using optical coherence tomography angiography (OCTA), a new and noninvasive vascular imaging technique.Cross-sectional study including eyes of diabetic patients with NPDR.All patients underwent medical history, best-corrected visual acuity (BCVA) measurement, slit-lamp and fundus examination, multicolor imaging, SD-OCT, and swept-source OCT. OCTA was performed in order to assess macular superficial and deep capillary plexus, and swept-source OCT was performed to evaluate the central choroidal thickness.Fifty-eight eyes of 35 patients with a mean age of 61.8 years (±12.1) with mean HbA1C level of 7.6% (±1.5) were included in this study. Among them, 19 eyes had mild NPDR, 24 eyes had moderate NPDR, and 15 eyes had severe NPDR. There was a significant progression between NPDR stages for FAZ grade (P < 0.0001), surface (P = 0.0036) and perimeter (P = 0.0001), and for superficial capillary plexus nonperfusion index (NPI) (P = 0.0009). Moreover, a significant correlation was found between NPI and BCVA (P = 0.007).OCT angiography is a useful noninvasive tool to explore early phases of diabetic retinopathy, which are not routinely explore with fluorescein angiography and not precisely enough with color photographs. NPI and foveal avascular zone parameters are correlated with glycated hemoglobin in patients with NPDR. If confirmed by further studies, these results could represent a mean to sensibilize diabetic patients to their disease.
荧光素血管造影术一直是评估糖尿病性黄斑缺血（DMI）的金标准检查，DMI是糖尿病患者不可逆视力损害的一个原因。本研究的目的是使用光学相干断层扫描血管造影术（OCTA）这一新型非侵入性血管成像技术，研究非增殖性糖尿病视网膜病变（NPDR）患者眼睛的黄斑无血管区（FAZ）和黄斑周围微循环变化。
横断面研究，纳入患有NPDR的糖尿病患者的眼睛。
所有患者均接受病史采集、最佳矫正视力（BCVA）测量、裂隙灯和眼底检查、多色成像、SD-OCT以及扫频源OCT检查。进行OCTA以评估黄斑浅层和深层毛细血管丛，进行扫频源OCT以评估中心脉络膜厚度。
本研究纳入了35例平均年龄61.8岁（±12.1）、平均糖化血红蛋白（HbA1C）水平为7.6%（±1.5）的患者的58只眼睛。其中，19只眼睛患有轻度NPDR，24只眼睛患有中度NPDR，15只眼睛患有重度NPDR。FAZ分级（P<0.0001）、面积（P=0.0036）和周长（P=0.0001）以及浅层毛细血管丛无灌注指数（NPI）（P=0.0009）在NPDR各阶段之间有显著进展。此外, 发现NPI与BCVA之间存在显著相关性（P=0.007）。
OCT血管造影术是探索糖尿病视网膜病变早期阶段的一种有用的非侵入性工具，而荧光素血管造影术通常不会对这些早期阶段进行检查，彩色照片对其检查又不够精确。NPDR患者的NPI和黄斑无血管区参数与糖化血红蛋白相关。如果进一步的研究证实了这些结果，那么这些结果可能代表了一种提高糖尿病患者对自身疾病认识的手段。
