Parravano Mariacristina, Fragiotta Serena, Costanzo Eliana, Picconi Fabiana, Giorno Paola, De Geronimo Daniele, Giannini Daniela, Varano Monica, Parisi Vincenzo, Ziccardi Lucia
IRCCS-Fondazione Bietti, 00198 Rome, Italy.
Departmental Faculty of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy.
Biomedicines. 2024 Nov 15;12(11):2614. doi: 10.3390/biomedicines12112614.
This study aimed to analyze the potential pathogenic connection between metabolic factors, photoreceptor cell rearrangements, retinal microvascular perfusion, and functional parameters through multifocal electroretinography (mfERG) in type 1 diabetes mellitus (DM1).
This prospective observational cohort study enrolled DM1 patients (40.5 ± 9.1 years) with mild nonproliferative diabetic retinopathy followed for 4 years. Patients were subjected to multimodal imaging, which included color fundus photography, optical coherence tomography (OCT), OCT angiography, adaptive optics (AO), and mfERG. OCTA slabs were analyzed using ImageJ software (software version 2.3.0/1.53f) to calculate perfusion density (PD) at both superficial (SCP) and deep (DCP) capillary plexuses, as well as flow deficit percentage (FD%) at the choriocapillaris (CC). To calculate cone metrics on AO at the parafovea, including cone density (CD), linear dispersion index (LDi), and heterogeneity packing index (Hpi%) in the parafovea, the images were post-processed using a MATLAB algorithm. The mfERG P1 implicit time (IT) and N1-P1 response amplitude density (RAD) from R1 (foveal area), R2 (parafoveal area), and the unified rings R1 + R2 were evaluated.
A total of 22 patients (22 eyes) were enrolled. No significant differences were noted in central mfERG amplitude and implicit time-averaged values ( > 0.05, all). The main factor influencing R1 IT was HbA1c, while R1 RAD was affected by Hpi and CC FD%. R1 + R2 IT was influenced by Hpi, LDi ( > 0.001, all), and modifications in the perfusion density in the SCP ( < 0.001) and DCP ( = 0.03) at the parafovea. In contrast, R1 + R2 RAD were associated with HbA1c ( = 0.02) and Hpi ( < 0.001).
Microvascular changes and glucometabolic factors are key elements influencing the long-term morphofunctional alterations at the photoreceptor level in DM1.
本研究旨在通过多焦视网膜电图（mfERG）分析1型糖尿病（DM1）患者代谢因素、光感受器细胞重排、视网膜微血管灌注和功能参数之间的潜在致病联系。
这项前瞻性观察队列研究纳入了患有轻度非增殖性糖尿病视网膜病变的DM1患者（40.5±9.1岁），随访4年。患者接受了多模态成像检查，包括彩色眼底照相、光学相干断层扫描（OCT）、OCT血管造影、自适应光学（AO）和mfERG。使用ImageJ软件（软件版本2.3.0/1.53f）分析OCTA层片，以计算浅表（SCP）和深层（DCP）毛细血管丛的灌注密度（PD），以及脉络膜毛细血管（CC）的血流缺失百分比（FD%）。为了计算黄斑旁中心凹处AO的视锥细胞指标，包括视锥细胞密度（CD）、线性离散指数（LDi）和黄斑旁中心凹处的异质性堆积指数（Hpi%），使用MATLAB算法对图像进行后处理。评估来自R1（中心凹区域）、R2（黄斑旁区域）以及统一环R1 + R2的mfERG P1隐时（IT）和N1 - P1反应振幅密度（RAD）。
共纳入22例患者（22只眼）。中心mfERG振幅和隐时平均值无显著差异（均P>0.05）。影响R1 IT的主要因素是糖化血红蛋白（HbA1c），而R1 RAD受Hpi和CC FD%影响。R1 + R2 IT受Hpi、LDi（均P<0.001）以及黄斑旁中心凹处SCP（P<0.001）和DCP（P = 0.03）灌注密度变化的影响。相比之下，R1 + R2 RAD与HbA1c（P = 0.02）和Hpi（P<0.001）相关。
微血管变化和糖代谢因素是影响DM1患者光感受器水平长期形态功能改变 的关键因素。
