Department of Retina and Vitreous, Fundação Altino Ventura, Recife, PE, Brazil.
Universidade Federal de Pernambuco, Recife, PE, Brazil.
Arq Bras Oftalmol. 2021 Mar-Apr;84(2):149-157. doi: 10.5935/0004-2749.20210023.
To describe microvascular changes in the maculas of individuals with type 2 diabetes observed on optical coherence tomography angiography (OCTA) images. We compared the maculas of diabetic subjects without diabetic retinopathy with those of healthy subjects and correlated the findings with the clinical profiles of diabetic subjects.
One eye each of 30 patients with diabetes and 30 healthy individuals were examined. The patients with diabetes underwent funduscopy, retinography, and fluorescein angiography to rule out retinopathy. All subjects underwent optical coherence tomography angiography of a macular area (6×6 mm2), and the foveal and parafoveal vascular densities were analyzed in the superficial and deep retinal vascular plexus. The foveal and parafoveal thicknesses, foveal avascular zone of the superficial plexus, and choriocapillaris flow area were also examined. The optical coherence tomography angiography results were compared between the two study groups and correlated with the following parameters: visual acuity, time since diabetes diagnosis, glycemic control, lipid profile, and renal function of patients with diabetes.
A minimal increase in the choriocapillaris flow area was observed in the patients with diabetes (mean area, 22.3 ± 4.6 mm2 in controls; 22.6 ± 3.9 mm2 in patients with diabetes) (p=0.017). No significant differences were observed between other optical coherence tomography angiography parameters analyzed in the two groups. Glycosylated hemoglobin and fasting blood glucose levels were significantly negatively correlated with the foveal vascular density of both plexuses; conversely, fasting blood glucose levels were positively correlated with the choriocapillaris flow area (p=0.034). The other clinical parameters were not correlated with the optical coherence tomography angiography findings.
Optical coherence tomography angiography may not be the most appropriate tool for detecting preclinical changes in patients with diabetes, moreover, optical coherence tomography angiography; does not replace clinical examinations. Glycemic control should be the primary clinical parameter considered during retinopathy screening. Larger studies are necessary to confirm these findings.
描述在光学相干断层扫描血管造影（OCTA）图像上观察到的 2 型糖尿病患者黄斑区微血管变化。我们比较了无糖尿病视网膜病变的糖尿病患者和健康受试者的黄斑，并将这些发现与糖尿病患者的临床特征相关联。
检查了 30 名糖尿病患者和 30 名健康个体的每只眼睛。对糖尿病患者进行眼底检查、视网膜照相和荧光素血管造影以排除视网膜病变。所有受试者均接受黄斑区（6×6mm2）的光学相干断层扫描血管造影检查，并分析深层和浅层视网膜血管丛的中心凹和旁中心凹血管密度。还检查了中心凹和旁中心凹厚度、浅层丛的中心凹无血管区和脉络膜毛细血管血流面积。比较了两组研究对象之间的光学相干断层扫描血管造影结果，并与以下参数相关联：视力、糖尿病诊断时间、血糖控制、血脂谱和糖尿病患者的肾功能。
糖尿病患者的脉络膜毛细血管血流面积略有增加（对照组平均面积为 22.3±4.6mm2，糖尿病患者为 22.6±3.9mm2）（p=0.017）。两组之间分析的其他光学相干断层扫描血管造影参数没有显著差异。糖化血红蛋白和空腹血糖水平与两个丛的中心凹血管密度呈显著负相关；相反，空腹血糖水平与脉络膜毛细血管血流面积呈正相关（p=0.034）。其他临床参数与光学相干断层扫描血管造影结果无关。
光学相干断层扫描血管造影可能不是检测糖尿病患者临床前变化的最适当工具，此外，光学相干断层扫描血管造影并不能替代临床检查。在进行视网膜病变筛查时，应将血糖控制作为首要的临床参数考虑。需要更大的研究来证实这些发现。
