Fursova A Zh, Derbeneva A S, Vasilyeva M V, Tarasov M S, Nikulich I F, Gamza Yu A
Novosibirsk State Region Hospital, Novosibirsk, Russia.
Novosibirsk State Medical University, Novosibirsk, Russia.
Vestn Oftalmol. 2021;137(6):99-108. doi: 10.17116/oftalma202113706199.
To study the main structural and microvascular changes in the retina and choroid in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD), and their relationship with impaired renal function.
The study included 158 patients (304 eyes). The 1 group consisted of 50 patients with CKD (97 eyes); group 2 - 65 patients with DR (119 eyes), group 3 - 43 patients with CKD and DR (86 eyes). All study patients underwent complete ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular region.
The analysis of structural parameters in groups of patients showed a decrease in the thickness of the ganglion cell layer and the inner plexiform layer of the retina in patients with DR (70.85±14.49 μm), with the lowest value in the CKD+DR group (65.84±15.34 μm) in comparison with the CKD group (75.64±10.32 μm). In the groups of patients with CKD, the thickness of the choroid (207.3±40.36 μm) was significantly reduced in comparison with the group of patients with DR (258.8±26.63 μm) and correlated with the stage of the disease. Patients in the CKD+DR group had the lowest perfusion and vascular density in the macular region (31.23±10.91% and 13.15±2.73 mm), an increase in the area and perimeter of the foveal avascular zone (0.55±0.26 mm, 3.30±0.84 mm). Pronounced correlations of decrease in choroidal thickness, vascular density, and perfusion volume with low glomerular filtration rate and CKD stage, as well as urea and creatinine levels were determined. An increase in the area of the foveal avascular zone correlated with lower retinal capillary density, decreased perfusion volume, and the stage of both DR and CKD.
Structural and hemodynamic disorders of the retina and choroid can be recognized as significant biomarkers for non-invasive diagnosis of microvascular complications of diabetes mellitus and impaired renal function.
研究糖尿病视网膜病变（DR）和慢性肾脏病（CKD）患者视网膜和脉络膜的主要结构及微血管变化，以及它们与肾功能受损的关系。
该研究纳入158例患者（304只眼）。第1组由50例CKD患者（97只眼）组成；第2组 - 65例DR患者（119只眼），第3组 - 43例CKD合并DR患者（86只眼）。所有研究患者均接受了全面的眼科检查，包括黄斑区光学相干断层扫描（OCT）和OCT血管造影（OCTA）。
对患者组结构参数的分析显示，DR患者视网膜神经节细胞层和内网状层厚度降低（70.85±14.49μm），与CKD组（75.64±10.32μm）相比，CKD+DR组（65.84±15.34μm）的值最低。在CKD患者组中，脉络膜厚度（207.3±40.36μm）与DR患者组（258.8±26.63μm）相比显著降低，且与疾病分期相关。CKD+DR组患者黄斑区灌注和血管密度最低（31.23±10.91%和13.15±2.73mm），黄斑无血管区面积和周长增加（0.55±0.26mm，3.30±0.84mm）。确定了脉络膜厚度、血管密度和灌注量降低与低肾小球滤过率、CKD分期以及尿素和肌酐水平之间存在显著相关性。黄斑无血管区面积增加与视网膜毛细血管密度降低、灌注量减少以及DR和CKD分期相关。
视网膜和脉络膜的结构及血流动力学紊乱可被视为糖尿病微血管并发症和肾功能受损无创诊断的重要生物标志物。
