Evliyaoglu F, Kurt M M, Yilmaz M, Akpolat C
Department of Ophthalmology, Umraniye Training and Research Hospital, Istanbul, Turkey.
Department of Ophthalmology, Samsun Gazi State Hospital, Samsun, Turkey.
J Fr Ophtalmol. 2022 Apr;45(4):430-437. doi: 10.1016/j.jfo.2021.06.014. Epub 2022 Feb 18.
To assess foveal and parafoveal retinal and choroidal microvascular changes using optical coherence tomography angiography (OCTA) and changes in retinal vessel caliber in pregnant women with gestational diabetes mellitus (GDM), non-pregnant female patients with type 2 diabetes mellitus (DM2), and healthy pregnant female subjects.
The study was conducted cross-sectionally and composed of three age-matched groups: 32 near-term pregnant women with GDM (GDM group), 32 non-pregnant female patients with a recent diagnosis of DM2 (DM2 group), and 32 healthy near-term pregnant female subjects. Vessel density (VD) and vessel diameter were the main outcomes. Detailed ophthalmic examinations were performed for each participant, including swept-source OCTA measurements consisting of superficial, deep, outer retinal and choroidal vessel density.
The average VD values in the central fovea of the superficial and deep retina were significantly lower in the GDM group (P=0.001 for both, between the three groups), whereas the mean VD in the parafoveal nasal sector of the deep retina was significantly lower in the DM2 group (P=0.008, between the three groups). There were no significant differences in the foveal or parafoveal VD measurements of the outer retina and choriocapillaris (P>0.05 for all). There were statistically significant differences in the retinal venous diameter and arterial vein ratio in the GDM and DM2 groups compared to the control group (P=0.001 for all).
The microvascular density changes seen on OCTA images of pregnant women with GDM are remarkable. These changes in retinal vessels appeared to occur rapidly after the onset of the metabolic impairment or might be the reflection of previous insulin resistance as well, as in recent diabetes. Our results also suggest that these changes may be more significant in a GDM pregnant woman than in a pregnant, established diabetic patient.
使用光学相干断层扫描血管造影（OCTA）评估妊娠糖尿病（GDM）孕妇、非妊娠2型糖尿病（DM2）女性患者和健康妊娠女性受试者的黄斑及黄斑旁视网膜和脉络膜微血管变化，以及视网膜血管管径变化。
本研究为横断面研究，由三个年龄匹配的组组成：32例孕晚期GDM孕妇（GDM组）、32例近期诊断为DM2的非妊娠女性患者（DM2组）和32例健康孕晚期女性受试者。血管密度（VD）和血管直径为主要观察指标。对每位参与者进行详细的眼科检查，包括扫频源OCTA测量，测量内容包括浅表、深层、外层视网膜和脉络膜血管密度。
GDM组浅表和深层视网膜中央凹的平均VD值显著低于其他两组（三组间比较，P均为0.001），而DM2组深层视网膜黄斑旁鼻侧区域的平均VD显著低于其他两组（三组间比较，P = 0.008）。外层视网膜和脉络膜毛细血管的黄斑或黄斑旁VD测量值无显著差异（所有P>0.05）。与对照组相比，GDM组和DM2组的视网膜静脉直径和动静脉比有统计学显著差异（所有P = 0.001）。
GDM孕妇OCTA图像上可见微血管密度变化显著。这些视网膜血管变化似乎在代谢损害发生后迅速出现，也可能是既往胰岛素抵抗的反映，如同近期发生的糖尿病一样。我们的结果还表明，这些变化在GDM孕妇中可能比在已确诊糖尿病的孕妇中更为显著。
