Ribeiro Luísa, Marques Inês P, Coimbra Rita, Santos Torcato, Madeira Maria H, Santos Ana Rita, Barreto Patrícia, Lobo Conceição, Cunha-Vaz José
AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Ophthalmol Ther. 2022 Feb;11(1):333-345. doi: 10.1007/s40123-021-00437-z. Epub 2021 Dec 5.
We characterized the progression of different diabetic retinopathy (DR) phenotypes in type 2 diabetes (T2D).
A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with three visits (baseline, 6 months, and 1 year). Demographic and systemic data included age, sex, diabetes duration, lipid profile, and hemoglobin A1c (HbA1c). Ophthalmological examinations included best-corrected visual acuity (BCVA), color fundus photography (CFP), and optical coherence tomography (OCT and OCTA). Phenotype classification was performed at the 6-month visit based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Only risk phenotypes B (MAT < 6 and increased CRT) and C (MAT ≥ 6 with or without increased CRT) were included. ETDRS grading was performed at the baseline visit based on seven-field CFP.
A total of 133 T2D individuals were included in the study; 81 (60%) eyes were classified as phenotype B and 52 (40%) eyes as phenotype C. Of these, 128 completed the 1-year follow-up. At baseline, eyes with phenotype C showed greater capillary closure (superior capillary plexus, deep capillary plexus, and full retina, p < 0.001) and increased foveal avascular zone (FAZ) area (p < 0.001), indicating more advanced microvascular disease. Neurodegeneration represented by thinning of the ganglion cell layer + inner plexiform layer (GCL + IPL) was present in both phenotypes. When analyzing the 1-year progression of each phenotype, only phenotype C revealed a significant decrease in BCVA (p = 0.02) and enlargement of the FAZ (p = 0.03). A significant progressive decrease in the vessel density of the deep capillary layer and in MAT occurred in both phenotypes, but these changes were particularly relevant in phenotype C and ETDRS grades 43-47. During the 1-year period, both phenotypes B and C showed progression in GCL + IPL thinning (p < 0.001).
In the 1-year period of follow-up, both phenotypes B and C showed progression in retinal neurodegeneration, whereas phenotype C showed more marked disease progression at the microvascular level.
我们对2型糖尿病（T2D）中不同糖尿病视网膜病变（DR）表型的进展进行了特征描述。
进行了一项前瞻性纵向队列研究（CORDIS，NCT03696810），共进行三次随访（基线、6个月和1年）。人口统计学和全身数据包括年龄、性别、糖尿病病程、血脂谱和糖化血红蛋白（HbA1c）。眼科检查包括最佳矫正视力（BCVA）、彩色眼底照相（CFP）和光学相干断层扫描（OCT和OCTA）。在6个月随访时，根据微动脉瘤周转率（MAT，基于CFP）和中心视网膜厚度（CRT，基于OCT）进行表型分类。仅纳入风险表型B（MAT < 6且CRT增加）和表型C（MAT≥6，无论CRT是否增加）。在基线随访时，基于七视野CFP进行ETDRS分级。
该研究共纳入133例T2D个体；81只眼（60%）被分类为表型B，52只眼（40%）被分类为表型C。其中，128例完成了1年随访。在基线时，表型C的眼睛显示出更大程度的毛细血管闭塞（视网膜上毛细血管丛、深层毛细血管丛和整个视网膜，p < 0.001）以及黄斑无血管区（FAZ）面积增加（p < 0.001），表明微血管疾病更严重。两种表型均存在以神经节细胞层+内丛状层（GCL + IPL）变薄为代表 的神经退行性变。在分析每种表型的1年进展时，只有表型C的BCVA出现显著下降（p = 0.02）且FAZ增大（p = 0.03）。两种表型的深层毛细血管层血管密度和MAT均出现显著的进行性下降，但这些变化在表型C和ETDRS 43 - 47级中尤为明显。在1年期间，表型B和C的GCL + IPL变薄均有进展（p < 0.001）。
在1年的随访期内，表型B和C的视网膜神经退行性变均有进展，而表型C在微血管水平上显示出更明显的疾病进展。
