The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, No. 4655 Da-Xue Road, Jinan, 250355, Shandong Province, People's Republic of China.
Ophthalmology Department of Shandong Hospital of Traditional Chinese Medicine, No. 16369 Jing-Shi Road, Jinan, 250013, Shandong Province, People's Republic of China.
Acta Diabetol. 2023 Aug;60(8):1063-1074. doi: 10.1007/s00592-023-02086-z. Epub 2023 May 5.
To quantitatively analyze and compare the differences in retinal neurovascular units (NVUs) between healthy individuals and patients with type 2 diabetes mellitus (DM) by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) techniques and to determine the value of this technique for the early diagnosis of retinal neurovascular damage in patients with diabetes mellitus without retinopathy (NDR).
This observational case‒control study was conducted from July 1, 2022, to November 30, 2022, at the outpatient ophthalmology clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. All subjects underwent baseline data entry and mean thickness of the peripapillary retinal nerve fiber layer (pRNFL), the thickness of each retinal layer in the macula 3 × 3 mm, and vascular density (VD) examination.
The study included 35 healthy individuals and 48 patients with DM. The retinal VD as well as partial pRNFL, macular nerve fiber layer (NFL), and macular ganglion cell layer (GCL) thickness in DM patients exhibited significantly lower VD in the DM group than in the control group (p < 0.05). Age and disease duration of DM patients showed a negative trend with pRNFL thickness, macular NFL thickness, macular GCL thickness, and VD. However, a positive trend was observed between DM duration and partial inner nuclear layer (INL) thickness. Moreover, there was a positive correlation between macular NFL and GCL thickness and VD for the most part, while a negative correlation was shown between INL temporal thickness and DVC-VD. pRNFL-TI and GCL-superior thickness were screened as two variables in the analysis of the predictors of retinal damage in DM according to the presence or absence of DM. The AUCs were 0.765 and 0.673, respectively. By combining the two indicators for diagnosis, the model predicted prognosis with an AUC of 0.831. In the analysis of retinal damage indicators associated with the duration of DM, after regression logistic analysis according to the duration of DM within 5 years and more than 5 years, the model incorporated two indicators, DVC-VD and pRNFL-N thickness, and the AUCs were 0.764 and 0.852, respectively. Combining the two indicators for diagnosis, the AUC reached 0.925.
Retinal NVU may have been compromised in patients with DM without retinopathy. Basic clinical information and rapid noninvasive OCT and OCTA techniques are useful for the quantitative assessment of retinal NVU prognosis in patients with DM without retinopathy.
通过光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA）技术定量分析和比较 2 型糖尿病（DM）患者与健康个体之间视网膜神经血管单位（NVU）的差异，并确定该技术在糖尿病无视网膜病变（NDR）患者早期诊断视网膜神经血管损伤中的价值。
本观察性病例对照研究于 2022 年 7 月 1 日至 2022 年 11 月 30 日在山东中医药大学附属医院门诊眼科进行。所有受试者均进行基线数据录入以及视盘周围视网膜神经纤维层（pRNFL）平均厚度、黄斑 3×3mm 内各视网膜层厚度和血管密度（VD）检查。
研究纳入 35 名健康个体和 48 名 DM 患者。DM 组患者的视网膜 VD 以及部分 pRNFL、黄斑神经纤维层（NFL）和黄斑神经节细胞层（GCL）厚度均显著低于对照组（p<0.05）。DM 患者的年龄和疾病持续时间与 pRNFL 厚度、黄斑 NFL 厚度、黄斑 GCL 厚度和 VD 呈负相关。然而，DM 持续时间与部分内核层（INL）厚度呈正相关。此外，大部分情况下黄斑 NFL 和 GCL 厚度与 VD 呈正相关，而 INL 颞侧厚度与 DVC-VD 呈负相关。根据 DM 的有无，分析 DM 患者视网膜损伤的预测因素，筛选出 pRNFL-TI 和 GCL-上象限厚度作为两个变量。AUC 分别为 0.765 和 0.673。通过结合这两个指标进行诊断，模型预测的 AUC 为 0.831。在分析与 DM 持续时间相关的视网膜损伤指标时，根据 DM 持续时间 5 年及以上和 5 年以下进行回归逻辑分析后，模型纳入了 DVC-VD 和 pRNFL-N 厚度两个指标，AUC 分别为 0.764 和 0.852。结合这两个指标进行诊断，AUC 达到 0.925。
糖尿病无视网膜病变患者的视网膜 NVU 可能受损。基本临床信息和快速无创的 OCT 和 OCTA 技术可用于定量评估糖尿病无视网膜病变患者的视网膜 NVU 预后。
