Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Eye Clinic, IRCCS MultiMedica, Milan, Italy.
Retina. 2023 Oct 1;43(10):1723-1731. doi: 10.1097/IAE.0000000000003880.
To evaluate microvascular and neuronal changes over 3 years in patients with Type 1/2 diabetes mellitus (DM1/DM2), good metabolic control, and no signs of diabetic retinopathy.
In this prospective, longitudinal study, 20 DM1, 48 DM2, and 24 controls underwent macular optical coherence tomography and optical coherence tomography angiography at baseline and after 3 years. Following parameters were considered: thickness of the central macula, retinal nerve fiber layer, ganglion cell (GCL+/GCL++) complex; perfusion and vessel density and fractal dimension at the superficial and deep capillary plexuses; choriocapillaris flow deficits; and foveal avascular zone metrics. MATLAB and ImageJ were used for optical coherence tomography angiography scans analyses.
The mean HbA1c was 7.4 ± 0.8% in DM1 and 7.2 ± 0.8% in DM2 at baseline, with no change at 3 years. No eye developed diabetic retinopathy. In longitudinal analyses, perfusion density at superficial capillary plexuses ( P = 0.03) and foveal avascular zone area and perimeter ( P < 0.0001) significantly increased in DM2 compared with other groups. No longitudinal changes occurred in optical coherence tomography parameters. In comparisons within groups, DM2 had a significant thinning of GCL++ in the outer ring, decreased perfusion density at deep capillary plexuses and choriocapillaris flow deficits, and increase in foveal avascular zone perimeter and area in deep capillary plexuses; DM1 had an increase in foveal avascular zone perimeter in deep capillary plexuses ( P < 0.001 for all comparisons).
Longitudinal data showed significant microvascular retinal changes in DM2. No changes were detected in neuronal parameters and in DM1. Longer and larger studies are needed to confirm these preliminary data.
评估 1 型/2 型糖尿病（DM1/DM2）、良好代谢控制且无糖尿病视网膜病变迹象的患者在 3 年内微血管和神经元的变化。
在这项前瞻性、纵向研究中，20 名 DM1 患者、48 名 DM2 患者和 24 名对照者在基线和 3 年后接受黄斑光学相干断层扫描和光学相干断层扫描血管造影检查。考虑了以下参数：中央黄斑厚度、视网膜神经纤维层、节细胞（GCL+/GCL++）复合体；浅层和深层毛细血管丛的灌注和血管密度及分形维数；脉络膜毛细血管血流不足；以及中心凹无血管区的指标。MATLAB 和 ImageJ 用于光学相干断层扫描血管造影扫描分析。
DM1 的平均 HbA1c 为 7.4±0.8%，DM2 为 7.2±0.8%，3 年后无变化。没有眼睛发生糖尿病视网膜病变。在纵向分析中，与其他组相比，DM2 的浅层毛细血管丛灌注密度（P=0.03）和中心凹无血管区面积和周长（P<0.0001）显著增加。光学相干断层扫描参数没有纵向变化。在组内比较中，DM2 外层 GCL++变薄，深层毛细血管丛灌注密度和脉络膜毛细血管血流不足降低，深层毛细血管丛中心凹无血管区周长和面积增加；DM1 深层毛细血管丛中心凹无血管区周长增加（所有比较均 P<0.001）。
纵向数据显示 DM2 存在明显的视网膜微血管变化。神经元参数和 DM1 未检测到变化。需要进行更长和更大的研究来证实这些初步数据。
