Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Surv Ophthalmol. 2018 Sep-Oct;63(5):601-608. doi: 10.1016/j.survophthal.2018.04.003. Epub 2018 Apr 19.
Diabetic retinopathy (DR) is a primary cause of visual impairment worldwide. Diabetes mellitus may be associated with ophthalmoscopically nonvisible neurovascular damage that progresses before the first clinical signs of DR appear. Reduction of the inner neuroretinal layer thickness on macular optical coherence tomography, reduced contrast sensitivity primarily at low spatial frequencies, abnormal results in color vision and microperimetry tests, and a prolonged implicit time recorded by multifocal electroretinography have been proposed for detection of early functional and nonvisible structural neuroretinal changes. Vascular abnormalities such as changes in the retinal vessel caliber, architectural indices, and blood flow have been investigated to evaluate the early stages of DR. The results of optical coherence tomography angiography, retinal vessel oxygen saturation patterns, and elevated levels of circulating blood markers and cytokines have been suggested as early signs of DR. Light-based molecular imaging in rodents has been developed to demonstrate changes in protein expressions in the retinal microvessels as diagnostic biomarkers. Future clinical studies will examine the safety and efficacy of this approach in humans. We summarize all the studies related to subclinical DR biomarkers.
糖尿病视网膜病变（DR）是全球范围内导致视力损害的主要原因。糖尿病可能与眼底检查无法发现的神经血管损伤有关，这种损伤在 DR 出现首个临床症状之前就已经发生了。黄斑光学相干断层扫描显示内层神经视网膜层厚度减少，对比敏感度主要在低空间频率降低，色觉和微视野检查结果异常，多焦视网膜电图记录的潜伏期延长，这些都被提出用于检测早期功能性和不可见的结构性神经视网膜变化。已经研究了血管异常，如视网膜血管口径、结构指数和血流的变化，以评估 DR 的早期阶段。光学相干断层扫描血管造影、视网膜血管氧饱和度模式以及循环血液标志物和细胞因子水平升高被认为是 DR 的早期迹象。已经开发了基于光的分子成像在啮齿动物中，以证明视网膜微血管中蛋白质表达的变化作为诊断生物标志物。未来的临床研究将检查这种方法在人类中的安全性和有效性。我们总结了所有与亚临床 DR 生物标志物相关的研究。
