Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China.
Shantou University Medical College, Shantou, China.
Acta Diabetol. 2018 May;55(5):469-477. doi: 10.1007/s00592-018-1115-1. Epub 2018 Feb 16.
To investigate changes in retinal vascular plexuses and choriocapillaris in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy (DR) and healthy controls using optical coherence tomography angiography (OCTA).
A total of 71 DM2 and 67 healthy control subjects were included. All subjects underwent OCTA examination (RTVue-XR Avanti; Optovue, Fremont, CA, USA). Average vessel density in superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris, parafoveal vessel density in SCP and DCP, FAZ area (mm) in SCP, microaneurysms and capillary nonperfusion were taken into analysis.
Parafoveal vessel density in both SCP and DCP decreased in the eyes without clinical DR compared to normal controls (p < 0.001). Diabetic patients with no signs of DR also had a significant reduction in average vessel density of SCP, DCP and choriocapillaris (p < 0.001, p < 0.001 and p = 0.006, respectively). No significant difference was found in FAZ area of SCP between DM2 eyes and healthy controls (p = 0.253). The average vessel density of SCP and DCP is not correlated with HbA1c or serum creatinine in DM2 patients. Microaneurysms seen in OCTA but not in fundus examination were found in 8 out of the 71 (11.3%) diabetic eyes, and capillary nonperfusion was noted in 18 of 71 diabetic eyes.
We demonstrated that OCTA can identify preclinical DR before the manifestation of clinically apparent retinopathy in diabetic eyes. DM2 patients without DR have SCP, DCP and choriocapillaris impairment. Our results suggested that OCTA might be a promising tool for regular screening of diabetic eyes for DR.
使用光相干断层扫描血管造影术（OCTA）研究 2 型糖尿病（DM2）无糖尿病视网膜病变（DR）患者和健康对照者视网膜血管丛和脉络膜毛细血管的变化。
共纳入 71 例 DM2 患者和 67 例健康对照者。所有受试者均接受 OCTA 检查（RTVue-XR Avanti；Optovue，弗里蒙特，加利福尼亚州，美国）。分析了浅层毛细血管丛（SCP）、深层毛细血管丛（DCP）和脉络膜毛细血管的平均血管密度、SCP 和 DCP 旁中心血管密度、SCP 中 FAZ 面积（mm）、微动脉瘤和毛细血管无灌注。
与正常对照组相比，无临床 DR 的眼 SCP 和 DCP 的旁中心血管密度均降低（p<0.001）。无 DR 迹象的糖尿病患者 SCP、DCP 和脉络膜毛细血管的平均血管密度也显著降低（p<0.001、p<0.001 和 p=0.006）。DM2 眼和健康对照组之间 SCP 的 FAZ 面积无显著差异（p=0.253）。DM2 患者 SCP 和 DCP 的平均血管密度与 HbA1c 或血清肌酐无关。在 71 只糖尿病眼中，有 8 只（11.3%）眼在 OCTA 中发现了眼底检查未见的微动脉瘤，18 只（18/71，25.4%）眼出现了毛细血管无灌注。
我们发现，OCTA 可以在糖尿病患者出现临床明显视网膜病变之前识别出临床前 DR。无 DR 的 DM2 患者存在 SCP、DCP 和脉络膜毛细血管损伤。我们的结果表明，OCTA 可能是一种有前途的 DR 常规筛查糖尿病患者的工具。
