Liu Jiahui, Kang Dan, Xu Zhiyi, Xian Qianhong, Chen Shuhui, Zhao Shulun, Li Jiali, Huang Xuewen, Wang Wei, Huang Wenyong, Chen Minyu, Wang Lanhua
The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China.
Shenzhen Shendong Aier Eye Hospital, Shenzhen, China.
BMJ Open. 2025 Mar 29;15(3):e079572. doi: 10.1136/bmjopen-2023-079572.
To evaluate changes in the peripapillary retinal microvasculature and retinal nerve fibre layer (RNFL) in diabetic participants with various stages of diabetic retinopathy (DR) using swept-source optical coherence tomographic angiography (OCTA).
Community-based, cross-sectional study.
This study was conducted in a tertiary teaching hospital in Guangzhou, China.
A total of 1325 ocular-treatment-naive participants, of whom 1115 had no DR and 210 had DR, were recruited in a community in Guangzhou, China.
A commercially available OCTA device was used to obtain various peripapillary retinal microvascular metrics centred on the optic disc, including vessel density (VD), vessel length density (VLD) and vessel diameter index (VDI). The peripapillary RNFL thickness was automatically obtained using built-in software. Linear regression analyses were used to evaluate the association of the peripapillary OCTA parameters (VD, VLD and VDI), RNFL thickness with various DR stages and average RNFL thickness with peripapillary OCTA parameters.
Moderate and severe DR had progressively decreased VD in the peripapillary ring (β = -0.72, 95% CI = -1.31 to -0.14 and -1.79, 95% CI = -2.81 to -0.77, respectively) and other regions (all p<0.05). Similar changes were observed between peripapillary VLD and moderate and severe DR (all p<0.05). Moderate (β = -4.56, 95% CI = -8.97 to -0.15, p=0.043) and severe DR (β = -10.12, 95% CI = -18.29 to -1.95, p=0.015) had significant thinner peripapillary RNFL in the inferior quadrant. VD and VLD were linearly associated with the average RNFL in the peripapillary ring and average peripapillary area (all p<0.05).
The peripapillary retinal microvasculature and RNFL were significantly reduced with the progression of DR, which suggests that monitoring differences in peripapillary microvasculature and the RNFL may be a promising approach to detecting DR progression.
使用扫频光学相干断层扫描血管造影（OCTA）评估不同糖尿病视网膜病变（DR）阶段的糖尿病患者视乳头周围视网膜微血管和视网膜神经纤维层（RNFL）的变化。
基于社区的横断面研究。
本研究在中国广州的一家三级教学医院进行。
在中国广州的一个社区招募了总共1325名未接受过眼部治疗的参与者，其中1115人无DR，210人患有DR。
使用商用OCTA设备获取以视盘为中心的各种视乳头周围视网膜微血管指标，包括血管密度（VD）、血管长度密度（VLD）和血管直径指数（VDI）。使用内置软件自动获取视乳头周围RNFL厚度。采用线性回归分析评估视乳头周围OCTA参数（VD、VLD和VDI）、RNFL厚度与不同DR阶段的关联，以及平均RNFL厚度与视乳头周围OCTA参数的关联。
中度和重度DR患者视乳头周围环的VD逐渐降低（β = -0.72，95%CI = -1.31至-0.14；β = -1.79，95%CI = -2.81至-0.77），其他区域也有类似变化（均p<0.05）。视乳头周围VLD与中度和重度DR之间也观察到类似变化（均p<0.05）。中度（β = -4.56，95%CI = -8.97至-0.15；p = 0.043）和重度DR（β = -10.12，95%CI = -18.29至-1.95；p = 0.015）患者视乳头周围RNFL在下象限明显变薄。VD和VLD与视乳头周围环的平均RNFL以及视乳头周围平均面积呈线性相关（均p<0.05）。
随着DR的进展，视乳头周围视网膜微血管和RNFL显著减少，这表明监测视乳头周围微血管和RNFL的差异可能是检测DR进展的一种有前景的方法。
