Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
RS Mehta Jain Department of Biochemistry, Vision Research Foundation, Chennai, Tamil Nadu, India.
Indian J Ophthalmol. 2021 Nov;69(11):3226-3234. doi: 10.4103/ijo.IJO_1254_21.
To evaluate and correlate retinal microvascular changes in prediabetic and diabetic patients with functional and systemic parameters.
Optical coherence tomography angiography (OCTA) was performed on all subjects after medical evaluation and laboratory investigations for blood sugar, glycosylated hemoglobin, and others. Automated quantification of vascular indices of the superficial plexus were analyzed.
Hundred and eleven persons (222 eyes) were grouped into prediabetic (PDM) (60 eyes), diabetic without retinopathy (NDR) (56 eyes), diabetic with retinopathy (DR) (66 eyes), and healthy controls (CTR) (40 eyes). The superficial retinal capillary plexus showed no significant changes in the prediabetic and NDR groups; however, central foveal thickness (CFT) was significantly reduced in PDM (P = 0.04). The circularity of the foveal avascular zone (FAZ) (P = 0.03) and the vessel density (VD) (P = 0.01) showed significant reduction from PDM to NDR. All vascular parameters were significantly reduced in DR and correlated with disease severity. The CFT correlated significantly with FAZ area. The VD and perfusion density were seen to correlate significantly with HbA1c and contrast sensitivity. The visual acuity was significantly correlated with the FAZ. Logistic regression revealed VD [OR 20.42 (7.9-53)] and FAZ perimeter [OR 9.8 (4.2-23.2)] as the strongest predictors of DR.
The changes in OCTA can help predict onset of DR. FAZ changes are seen in early stages and are correlated well with systemic parameters, making it an easy target to monitor and screen for severity of DR. Significant reduction in the CFT in PDM suggests that neuronal damage precedes vascular changes.
评估和关联糖尿病前期和糖尿病患者的视网膜微血管变化与功能和系统参数。
对所有受试者进行医学评估和血糖、糖化血红蛋白等实验室检查后，进行光相干断层扫描血管造影（OCTA）。分析浅层血管丛的血管指数自动定量。
111 人（222 只眼）分为糖尿病前期（PDM）组（60 只眼）、无糖尿病视网膜病变（NDR）组（56 只眼）、糖尿病视网膜病变（DR）组（66 只眼）和健康对照组（CTR）组（40 只眼）。浅层视网膜毛细血管丛在糖尿病前期和 NDR 组无明显变化；然而，PDM 组中央视网膜厚度（CFT）显著降低（P=0.04）。黄斑无血管区（FAZ）的圆度（P=0.03）和血管密度（VD）（P=0.01）从 PDM 到 NDR 显著降低。所有血管参数在 DR 中均显著降低，并与疾病严重程度相关。CFT 与 FAZ 面积显著相关。VD 和灌注密度与 HbA1c 和对比敏感度显著相关。视力与 FAZ 显著相关。Logistic 回归显示 VD[OR 20.42（7.9-53）]和 FAZ 周长[OR 9.8（4.2-23.2）]是 DR 的最强预测因子。
OCTA 的变化有助于预测 DR 的发生。FAZ 的变化在早期就可以看到，并且与系统参数相关性良好，使其成为监测和筛查 DR 严重程度的一个容易的目标。PDM 中 CFT 的显著降低表明神经元损伤先于血管变化。
