School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Invest Ophthalmol Vis Sci. 2018 Apr 1;59(5):2110-2118. doi: 10.1167/iovs.17-23193.
To investigate early retinal structural and microvascular changes in patients with type 2 diabetes mellitus (DM) and to analyze relationships among the retinal structure, microvasculature, and choroid.
Seventy-seven patients with type 2 DM (40 with no diabetic retinopathy [DR], 37 with nonproliferative diabetic retinopathy [NPDR]), and 34 control subjects were enrolled. Spectral-domain optical coherence tomography, operating in radial 18-line mode, obtained macular images of the eight intraretinal layers and the choroid. The same system was equipped with Angiovue to obtain angiography images of the whole, superficial, and deep retinal capillary layers (WRCL, SRCL, and DRCL) in a 3-mm-diameter area around the macula. Algorithms quantified the thicknesses of the intraretinal layers and choroid as well as fractal dimensions (Dbox values) of the retinal capillary layers. Pearson's correlation was used to analyze the relationships.
The choroidal thickness was significantly decreased in all the regions of the DM patients with no DR (P < 0.05). Compared to controls, the Dbox values of the SRCL and DRCL were significantly decreased in diabetic patients with no DR; however, only the nerve fiber layer in this group was slightly thinner than in the controls (P < 0.05). In the two diabetic groups, there was a weak correlation between the ganglion cell complex thickness and the SRCL (P < 0.05).
In DM, changes of retinal microvasculature might occur earlier than changes in retinal structure. Thinning of the choroid may be the earliest sign in the diabetic patients with no clinical DR.
观察 2 型糖尿病（DM）患者早期视网膜结构和微血管的变化，并分析视网膜结构、微血管和脉络膜之间的关系。
纳入 77 例 2 型 DM 患者（无糖尿病视网膜病变[DR]组 40 例，非增生性 DR 组 37 例）和 34 例对照者。采用频域光相干断层扫描，以 18 线径向模式获取黄斑区 8 层视网膜和脉络膜图像。同一系统配备 Angiovue，可在黄斑区周围 3mm 直径范围内获得全层视网膜毛细血管层（WRCL）、浅层视网膜毛细血管层（SRCL）和深层视网膜毛细血管层（DRCL）的血管造影图像。算法可定量分析视网膜各层和脉络膜的厚度以及视网膜毛细血管层的分形维数（Dbox 值）。采用 Pearson 相关分析进行相关性分析。
无 DR 的 DM 患者各区域脉络膜厚度均明显变薄（P < 0.05）。与对照组相比，无 DR 糖尿病患者的 SRCL 和 DRCL 的 Dbox 值明显降低；然而，仅该组的神经纤维层稍薄于对照组（P < 0.05）。在两组糖尿病患者中，节细胞复合体厚度与 SRCL 之间存在弱相关性（P < 0.05）。
在 DM 中，视网膜微血管的变化可能早于视网膜结构的变化。脉络膜变薄可能是无临床 DR 的糖尿病患者的最早征象。
