Frizziero Luisa, Parrozzani Raffaele, Londei Davide, Pilotto Elisabetta, Midena Edoardo
IRCCS - Fondazione Bietti, Rome, Italy.
Department of Ophthalmology, University of Padova, Padova, Italy.
Br J Ophthalmol. 2021 Nov;105(11):1577-1583. doi: 10.1136/bjophthalmol-2020-316468. Epub 2020 Sep 15.
To investigate and quantify peripapillary vascular and neuronal changes secondary to diabetic retinopathy, using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA).
This was a cross-sectional study.
51 eyes of 51 patients affected by non-proliferative diabetic retinopathy (NPDR) and 19 age-matched healthy control eyes underwent full ophthalmic examination, including OCT and OCTA in the peripapillary area. Vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI) were quantified in a ring-shaped region of interest of each OCTA image. Capillaries and larger vessels were separately analysed. The thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell complex (GCC) was also analysed.
VAD and VLF of peripapillary capillaries were significantly reduced in NPDR eyes, along with the progression of NPDR (p<0.05). VDI was significantly reduced in mild (p=0.0093) and moderate (p=0.0190) NPDR eyes, but not in severe NPDR (p=0.0841). Larger peripapillary vessels showed a significant increase of both VAD and VDI in NPDR eyes. pRNFL and GCC thickness decreased in NPDR eyes, reaching statistical significance only for GCC. No statistically significant correlation was found between perfusion parameters and pRNFL and GCC thickness.
Retinal capillary remodelling in NPDR involves the peripapillary vascularisation too, as confirmed by OCTA quantitative parameters. The peripapillary macrovasculature and microvasculature need to be separately evaluated. The lack of direct correlation between peripapillary capillaries changes and the loss of retinal nerve fibres suggests that neuronal damage cannot be simply considered secondary to the microvascular one.
使用光谱域光学相干断层扫描（OCT）和 OCT 血管造影（OCTA）来研究和量化糖尿病性视网膜病变继发的视乳头周围血管和神经元变化。
这是一项横断面研究。
对 51 例非增殖性糖尿病性视网膜病变（NPDR）患者的 51 只眼和 19 只年龄匹配的健康对照眼进行了全面的眼科检查，包括视乳头周围区域的 OCT 和 OCTA。在每个 OCTA 图像的环形感兴趣区域中量化血管面积密度（VAD）、血管长度分数（VLF）和血管直径指数（VDI）。分别分析毛细血管和较大血管。还对视乳头周围视网膜神经纤维层（pRNFL）和黄斑神经节细胞复合体（GCC）的厚度进行了分析。
NPDR 眼中视乳头周围毛细血管的 VAD 和 VLF 随着 NPDR 的进展而显著降低（p<0.05）。轻度（p = 0.0093）和中度（p = 0.0190）NPDR 眼中的 VDI 显著降低，但重度 NPDR 眼中未降低（p = 0.0841）。NPDR 眼中较大的视乳头周围血管显示 VAD 和 VDI 均显著增加。NPDR 眼中 pRNFL 和 GCC 厚度降低，仅 GCC 达到统计学显著性。灌注参数与 pRNFL 和 GCC 厚度之间未发现统计学显著相关性。
OCTA 定量参数证实，NPDR 中的视网膜毛细血管重塑也涉及视乳头周围血管化。视乳头周围的大血管和微血管需要分别评估。视乳头周围毛细血管变化与视网膜神经纤维丢失之间缺乏直接相关性，这表明神经元损伤不能简单地被认为是微血管损伤的继发结果。
