Li Yingying, Hu Xinxin, Ye Xueqiong, Zhong Qingya, Zhang Xixi, Zhu Jinglin, Jiang Jiahui, Wang Dandan, Zhang Juntao, Ren Weina, Zhao Yitian, Lu Qinkang, Zhao Na
Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, Ningbo, China.
Ningbo Clinical Research Center for Ophthalmology, Ningbo, China.
Front Cell Dev Biol. 2024 Dec 4;12:1501625. doi: 10.3389/fcell.2024.1501625. eCollection 2024.
To explore the relationship between peripapillary atrophy (PPA) and diabetic retinopathy (DR), and to uncover potential mechanisms using swept-source optical coherence tomography (SS-OCT) angiography.
This cross-sectional study included 845 patients with type 2 diabetes (T2DM), who underwent detailed systemic and ophthalmic evaluations. A state-of-the-art deep learning method was employed to precisely identify the parapapillary beta and gamma zones. Based on PPA characteristics, eyes were categorized into four groups: without beta or gamma zone (Group A), isolated beta zone (Group B), isolated gamma zone (Group C), and with both beta and gamma zone (Group D). Digital fundus photography was utilized to diagnose and stage DR severity, while SS-OCT angiography quantified retinal and choroidal vasculature.
Participants had a mean age of 66 ± 8.8 years, with 437 (51.7%) male. Beta and gamma PPA zones were observed in 574 (67.9%) and 256 (30.3%) eyes, respectively. Beta zone PPA was associated with older age, whereas gamma zone PPA was correlated with longer axial length (AL), lower vessel density, and reduced choroidal thickness. Adjusted analyses revealed that eyes with isolated (Group C) or concurrent (Group D) gamma zone PPA conferred significantly lower DR grade, independent of known risk factors including systemic diabetes risk factors and AL.
This study finds that gamma zone PPA is linked to a reduced risk of developing DR. These results imply that the gamma zone may reflect progressive myopia-associated thinning and microvascular depletion in posterior ocular tissues, potentially contributing to structural resilience against DR. This novel insight offers a promising avenue for understanding the interplay between PPA and DR.
探讨视盘周围萎缩（PPA）与糖尿病视网膜病变（DR）之间的关系，并利用扫频光学相干断层扫描（SS-OCT）血管造影术揭示潜在机制。
这项横断面研究纳入了845例2型糖尿病（T2DM）患者，他们接受了详细的全身和眼科评估。采用先进的深度学习方法精确识别视盘周围的β区和γ区。根据PPA特征，将眼睛分为四组：无β区或γ区（A组）、孤立β区（B组）、孤立γ区（C组）以及同时有β区和γ区（D组）。利用数字眼底摄影诊断DR严重程度并进行分期，同时SS-OCT血管造影术对视网膜和脉络膜血管系统进行量化。
参与者的平均年龄为66±8.8岁，其中男性437例（51.7%）。分别在574只（67.9%）和256只（30.3%）眼睛中观察到β区和γ区PPA。β区PPA与年龄较大有关，而γ区PPA与眼轴长度（AL）较长、血管密度较低和脉络膜厚度降低相关。校正分析显示，孤立（C组）或同时存在（D组）γ区PPA的眼睛DR分级显著较低，独立于包括全身糖尿病危险因素和AL在内的已知危险因素。
本研究发现γ区PPA与DR发生风险降低有关。这些结果表明，γ区可能反映了后段眼组织中与进行性近视相关的变薄和微血管耗竭，可能有助于对DR的结构弹性。这一新见解为理解PPA与DR之间的相互作用提供了一个有前景的途径。
