Mitamura Mizuho, Endo Hiroaki, Kase Satoru, Dong Zhenyu, Takahashi Mitsuo, Katsuta Satoshi, Kase Manabu, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan.
Graefes Arch Clin Exp Ophthalmol. 2023 Jan;261(1):85-95. doi: 10.1007/s00417-022-05773-9. Epub 2022 Jul 25.
The aim of this study was to compare the timing of peripapillary vascular damage between functional and structural parameters and examine their involvement with neurovascular coupling at different stages of diabetic retinopathy (DR).
One hundred ninety eyes of 143 patients with type 2 diabetes mellitus (DM) and 88 healthy control eyes were enrolled. Eyes of DM patients were divided into 3 stages with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). NPDR and PDR eyes were treatment-naive. OCT angiography was used to calculate radial peripapillary capillary (RPC)-flux index (FI) and RPC-perfusion density (PD). Spectral domain OCT was used to measure retinal nerve fiber layer (RNFL) thickness within the corresponding RPC areas.
RPC-FI significantly decreased in NDR eyes compared to control eyes and thereafter remained unchanged among DM (NDR, NPDR, and PDR) eyes. In contrast, RPC-PD stayed unaltered between control and NDR eyes and significantly decreased in NPDR followed by PDR eyes at similar levels. From control to NPDR eyes, RNFL thickness showed positive correlations with both RPC-FI and RPC-PD, indicative of functional and structural neurovascular coupling. These vascular parameters were also correlated with each other in control and NPDR eyes but not NDR eyes, consistent with the difference in the timing of vascular damage between functional and structural parameters.
Circulatory dysfunction preceded structural loss while maintaining peripapillary neurovascular coupling during progression of DR stages. RPC-FI would likely be more sensitive than RPC-PD in detecting early vascular damage in DR.
本研究旨在比较功能性和结构性参数之间视乳头周围血管损伤的时间，并研究它们在糖尿病视网膜病变（DR）不同阶段与神经血管耦合的关系。
纳入143例2型糖尿病（DM）患者的190只眼和88只健康对照眼。DM患者的眼睛分为3个阶段：无糖尿病视网膜病变（NDR）、非增殖性糖尿病视网膜病变（NPDR）和增殖性糖尿病视网膜病变（PDR）。NPDR和PDR眼均未接受过治疗。使用光学相干断层扫描血管造影术计算视乳头周围放射状毛细血管（RPC）-流量指数（FI）和RPC-灌注密度（PD）。使用光谱域光学相干断层扫描测量相应RPC区域内的视网膜神经纤维层（RNFL）厚度。
与对照眼相比，NDR眼中RPC-FI显著降低，此后在DM（NDR、NPDR和PDR）眼中保持不变。相比之下，对照眼和NDR眼中RPC-PD保持不变，NPDR眼中显著降低，随后PDR眼中也以相似水平降低。从对照眼到NPDR眼，RNFL厚度与RPC-FI和RPC-PD均呈正相关，表明存在功能性和结构性神经血管耦合。在对照眼和NPDR眼中，这些血管参数也相互相关，但在NDR眼中不相关，这与功能性和结构性参数之间血管损伤时间的差异一致。
在DR各阶段进展过程中，循环功能障碍先于结构损伤，同时维持视乳头周围神经血管耦合。在检测DR早期血管损伤方面，RPC-FI可能比RPC-PD更敏感。
