Ophthalmology Department, Lariboisière Hospital, AP-HP, Université Paris 7-Sorbonne Paris Cité, Paris, France.
Internal Medicine Department, Quinze-Vingts Hospital, Paris, France; and.
Retina. 2020 Jun;40(6):1053-1061. doi: 10.1097/IAE.0000000000002557.
To analyze the evolution of macular vessel density (VD) over 1 year, during early worsening of diabetic retinopathy, in patients with uncontrolled Type 1 diabetes (T1D).
Retrospective study of 12 eyes of 9 patients with T1D with early worsening of diabetic retinopathy imaged with optical coherence tomography angiography. The following data were collected at the time of pan retinal photocoagulation initiation and after 6 and 12 months: vessel density within three retinal plexuses-superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus; foveal avascular zone area, acircularity index, and flow density (FD)-300; central macular thickness; and HbA1c levels.
A history of rapid reduction in blood glucose was found in seven of nine cases. Vessel density was significantly decreased at 12 months in all plexuses: from 44.68 ± 4.75 to 40.23 ± 7.13 in the superficial vascular plexus (P = 0.008), from 42.72 ± 4.86 to 37.12 ± 8.64 in the intermediate capillary plexus (P = 0.03), and from 22.68 ± 3.93 to 19.66 ± 4.92 in the deep capillary plexus (P = 0.004). Intermediate capillary plexus and deep capillary plexus changes were strongly correlated (r = 0.86, P < 0.001) and were significant as early as 6 months. The mean foveal avascular zone area increased (P = 0.05) and the FD-300 decreased (P = 0.03). No significant change in acircularity index, central macular thickness, and visual acuity were observed over time.
Early worsening of diabetic retinopathy induces a rapid macular capillary dropout mainly affecting the intermediate capillary plexus and deep capillary plexus.
分析 1 型糖尿病（T1D）患者未经控制的糖尿病视网膜病变早期恶化期间，黄斑血管密度（VD）在 1 年内的变化。
对 9 例 T1D 患者 12 只眼进行回顾性研究，这些患者的糖尿病视网膜病变早期恶化，并用光学相干断层扫描血管造影成像。在全视网膜光凝治疗开始时以及 6 个月和 12 个月时收集以下数据：三个视网膜丛内的血管密度-浅层血管丛、中间毛细血管丛和深层毛细血管丛；中心凹无血管区面积、非圆度指数和血流密度（FD）-300；中央黄斑厚度；以及糖化血红蛋白（HbA1c）水平。
9 例中有 7 例存在血糖快速下降的病史。所有丛的血管密度在 12 个月时均显著降低：浅层血管丛从 44.68±4.75 降至 40.23±7.13（P=0.008），中间毛细血管丛从 42.72±4.86 降至 37.12±8.64（P=0.03），深层毛细血管丛从 22.68±3.93 降至 19.66±4.92（P=0.004）。中间毛细血管丛和深层毛细血管丛的变化具有很强的相关性（r=0.86，P<0.001），并且在 6 个月时就很显著。平均中心凹无血管区面积增加（P=0.05），FD-300 降低（P=0.03）。在整个研究过程中，非圆度指数、中央黄斑厚度和视力均无显著变化。
糖尿病视网膜病变的早期恶化导致黄斑毛细血管迅速丢失，主要影响中间毛细血管丛和深层毛细血管丛。
