Zhang Jing, Yu Yao, Zhou Xian-Mei, Liao Xuan, Hu Jin-Yu, Ling Qian, Zou Jie, Chen Cheng, He Liang-Qi, Wei Hong, Chen Xu, Wang Yi-Xin, Shao Yi, Li Rui-Man
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China.
Department of Obstetrics and Gynecology, Changde Hospital, Xiangya School of Medicine, Central South University (the First People's Hospital of Changde City), Changde 415000, Hunan Province, China.
Int J Ophthalmol. 2025 Mar 18;18(3):435-448. doi: 10.18240/ijo.2025.03.10. eCollection 2025.
AIM: To evaluate alterations in conjunctival vascular density (CVD) and macular capillary density (MCD) in female patients with type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) using optical coherence tomography angiography (OCTA). METHODS: A total of 60 female participants were recruited, comprising 20 patients with T2DM, 20 patients with GDM, and 20 healthy age-matched controls (HCs). OCTA was used to assess superficial and deep retinal and conjunctival capillary plexuses. Subsequently, changes in MCD were analyzed using a circular segmentation method (C1-C6), a hemispheric quadrant segmentation method [superior right (SR), superior left (SL), inferior left (IL), and inferior right (IR)], and the early treatment diabetic retinopathy study (ETDRS) segmentation method (S, I, R, L). RESULTS: OCTA unequivocally demonstrated that the variations in CVD among HCs, T2DM, and GDM groups were statistically significant (<0.001). In the superficial retinal capillary plexus (sRCP), significant differences were observed in the densities of total microvascular (TMI), microvasculature (MIR), and macrovascular (MAR) between patients with T2DM and HCs (<0.05). Furthermore, the GDM group exhibited a more substantial reduction in MIR density compared to the T2DM group (<0.01). In the deep retinal capillary plexus (dRCP), significant differences in the densities of TMI and MIR were identified between the T2DM group and HCs (<0.05), with a notable difference in TMI density also observed between the GDM and T2DM groups (<0.01). In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve (AUC) for TMI in sRCP between the T2DM group and HCs was 0.975, with a 95% confidence interval (CI) of 0.941-1. The AUC for MIR was highest in dRCP, with an AUC value of 0.914 and a 95%CI ranging from 0.847 to 0.981. In comparing the GDM and T2DM groups, the AUC for I region was maximized in sRCP, achieving a value of 0.978 with a 95%CI of 0.953-1. Additionally, the AUC for R region was maximized in dRCP, reaching a value of 0.99 with a 95%CI of 0.975 to 1. CONCLUSION: The sRCP and dRCP densities show higher diagnostic sensitivity for T2DM and GDM. OCTA holds potential as a significant instrument for the early diagnosis and differentiation of T2DM and GDM.
目的：使用光学相干断层扫描血管造影（OCTA）评估2型糖尿病（T2DM）和妊娠期糖尿病（GDM）女性患者的结膜血管密度（CVD）和黄斑毛细血管密度（MCD）的变化。 方法：共招募60名女性参与者，包括20名T2DM患者、20名GDM患者和20名年龄匹配的健康对照者（HCs）。使用OCTA评估视网膜浅层和深层以及结膜毛细血管丛。随后，采用圆形分割法（C1 - C6）、半球象限分割法[右上（SR）、左上（SL）、左下（IL）和右下（IR）]以及早期糖尿病视网膜病变研究（ETDRS）分割法（S、I、R、L）分析MCD的变化。 结果：OCTA明确显示，HCs、T2DM和GDM组之间的CVD差异具有统计学意义（<0.001）。在视网膜浅层毛细血管丛（sRCP）中，T2DM患者与HCs之间的总微血管（TMI）、微血管（MIR）和大血管（MAR）密度存在显著差异（<0.05）。此外，与T2DM组相比，GDM组的MIR密度降低更为显著（<0.01）。在视网膜深层毛细血管丛（dRCP）中，T2DM组与HCs之间的TMI和MIR密度存在显著差异（<0.05），GDM组与T2DM组之间的TMI密度也存在显著差异（<0.01）。在受试者工作特征（ROC）曲线分析中，T2DM组与HCs之间sRCP中TMI的ROC曲线下面积（AUC）为0.975，95%置信区间（CI）为0.941 - 1。MIR的AUC在dRCP中最高，AUC值为0.914，95%CI为0.847至0.981。在比较GDM组和T2DM组时，sRCP中I区域的AUC最大，达到0.978，95%CI为0.953 - 1。此外，dRCP中R区域的AUC最大，达到0.99，95%CI为0.975至1。 结论：sRCP和dRCP密度对T2DM和GDM具有较高的诊断敏感性。OCTA有望成为T2DM和GDM早期诊断和鉴别诊断的重要工具。
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