Mitamura Mizuho, Kase Satoru, Endo Hiroaki, Saito Michiyuki, Katsuta Satoshi, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Nara Medical University, Nara, Japan.
Invest Ophthalmol Vis Sci. 2025 Jul 1;66(9):10. doi: 10.1167/iovs.66.9.10.
The aim of this study was to investigate the impact of diabetic retinopathy (DR) on macular and peripapillary neurovascular units (NVUs) by assessing optical coherence tomography (OCT)/OCT angiography-based macular and peripapillary NVU parameters.
This study enrolled 182 eyes with type 2 diabetes mellitus (DM) eyes and 202 healthy control eyes. The eyes of DM patients were divided into DM without DR (DM/noDR; n = 136) and DR stage groups (n = 46). Macular NVU parameters consisted of ganglion cell-inner plexiform layer (GCIPL) thickness and macular perfusion density (PD). As for peripapillary NVU parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, together with radial peripapillary capillary perfusion density (RPC-PD) and RPC flux index (RPC-FI), represented by peripapillary structural and functional vascular parameters, were also examined. Macular and peripapillary parameters were compared among three stages, and correlations between macular and peripapillary parameters were examined for each stage.
Macular GCIPL thickness and macular PD decreased with stage progression, preserving positive correlations (i.e., preserving macular NVU) with each other in all eyes, but correlation coefficients were the lowest in DM/noDR eyes. Macular GCIPL thickness, as well as macular PD, positively correlated with peripapillary NVU parameters over the entire stages except macular PD and RNFL thickness in DR eyes (i.e., preserving macular and peripapillary NVU), but correlation coefficients were the lowest in DM/noDR eyes.
Macular and peripapillary NVU were preserved throughout the stages: control, DM/noDR, and DR groups, but the linkage weakened at the onset of DM, suggesting diabetes-induced dysregulation of macular and peripapillary NVUs in subclinical DR.
本研究旨在通过评估基于光学相干断层扫描（OCT）/OCT血管造影的黄斑和视乳头周围神经血管单元（NVU）参数，来研究糖尿病视网膜病变（DR）对黄斑和视乳头周围神经血管单元的影响。
本研究纳入了182只2型糖尿病（DM）患者的眼睛和202只健康对照眼睛。DM患者的眼睛被分为无DR的DM（DM/noDR；n = 136）和DR分期组（n = 46）。黄斑NVU参数包括神经节细胞-内丛状层（GCIPL）厚度和黄斑灌注密度（PD）。对于视乳头周围NVU参数，还检查了视乳头周围视网膜神经纤维层（RNFL）厚度，以及由视乳头周围结构和功能血管参数表示的径向视乳头周围毛细血管灌注密度（RPC-PD）和RPC通量指数（RPC-FI）。比较三个阶段的黄斑和视乳头周围参数，并检查每个阶段黄斑和视乳头周围参数之间的相关性。
黄斑GCIPL厚度和黄斑PD随分期进展而降低，在所有眼睛中彼此保持正相关（即保持黄斑NVU），但在DM/noDR眼中相关系数最低。除DR眼中黄斑PD和RNFL厚度外，在整个阶段黄斑GCIPL厚度以及黄斑PD与视乳头周围NVU参数呈正相关（即保持黄斑和视乳头周围NVU），但在DM/noDR眼中相关系数最低。
在整个阶段（对照组、DM/noDR组和DR组）黄斑和视乳头周围NVU均得以保留，但在DM发病时这种联系减弱，提示在亚临床DR中糖尿病引起黄斑和视乳头周围NVU的调节异常。
