Fursova A Zh, Vasilyeva M A, Tarasov M S, Zubkova M Y, Derbeneva A S, Nikulich I F, Gamza Yu A
Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.
Novosibirsk State Medical University, Novosibirsk, Russia.
Vestn Oftalmol. 2022;138(2):47-56. doi: 10.17116/oftalma202213802147.
To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure.
The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography.
In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus.
Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.
研究慢性肾脏病（CKD）、糖尿病视网膜病变（DR）和动脉高血压（AH）患者脉络膜的结构和微血管变化，以及它们与肾功能水平、糖代谢和血压的关系。
本研究纳入172例患者（325只眼）：56例CKD患者（109只眼）；66例DR患者（121只眼）；50例AH患者（95只眼）。所有患者均接受了包括视力测量、生物显微镜检查、检眼镜检查、光学相干断层扫描（OCT）和OCT血管造影在内的全面眼科检查。
在DR和CKD患者中，观察到神经节细胞复合体和内丛状层（GCL+IPL）厚度降低：增殖性DR（PDR）患者为62.45±4.25 µm，4-5期CKD患者为75.23±6.43 µm；4-5期CKD（179.9±37.72 µm）和PDR（211.0±40.7 µm）患者脉络膜厚度（CT）降至最小值。脉络膜血管指数（CVI）的降低取决于CKD和PDR的阶段（PDR患者为63.47±1.37，4-5期CKD患者为65.93±2.01）。DR患者的灌注密度和血管密度下降最为明显（分别为37.22±9.00%和15.11±3.39 mm）。所有组均观察到黄斑无血管区（FAZ）面积、周长增加，圆形度指数降低，PDR和4-5期CKD患者变化最为显著。发现CKD患者的CT和CVI与肌酐、尿素、蛋白尿和肾小球滤过率（GFR）密切相关。糖尿病和PDR患者的CT、CVI、GCL+IPL、FAZ面积和周长与肌酐水平及糖尿病病程密切相关。
脉络膜厚度和脉络膜血管指数是脉络膜视网膜微循环障碍的重要诊断标志物，可用于对慢性肾脏病和糖尿病视网膜病变进展的个体危险因素进行分层评估。
