Retinal neurodegeneration, macular circulation and morphology of the foveal avascular zone in diabetic patients: quantitative cross-sectional study using OCT-A
Retinal neurodegeneration, macular circulation and morphology of the foveal avascular zone in diabetic patients: quantitative cross-sectional study using OCT-A
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DOI：
10.1111/aos.14754
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发表时间：
2021-01-10
影响因子：
3.4
通讯作者：
Peto, Tunde
中科院分区：
文献类型：
--
作者：
Bontzos, Georgios;Kabanarou, Stamatina A.;Peto, Tunde
目的应用OCT-A研究糖尿病视网膜病变（DR）神经退行性变与血管形态学的关系。入选162例患者，眼底镜检查后根据DR严重程度分为两组：54例患者为无DR临床体征组（noDR），54例为非增殖性DR（NPDR）组。54名年龄匹配的无糖尿病患者被招募为对照组。患者接受全面眼科检查，随后接受OCT-A。测量视网膜中央厚度（CRT）、视网膜浅、深层血管密度（VD）及中心凹无血管区（FAZ）面积。此外，神经节细胞复合体（GCC）层的厚度沿着与全球损失量（GLV）和局灶性损失量（FLV）indicatorsmeasured.Results，共85名男性，平均年龄为51.93 +/- 9.03和77名女性，年龄为50.14 +/- 10.35。平均糖尿病病程在noDR组为4.62 +/- 2.16年，在NPDR组为11.34 +/- 2.73年（p < 0.001）。浅表VD（sVD）和深部VD（dVD）仅在noDR和NPDR组之间存在显著差异（两种比较均为p < 0.001），但在对照组和DR组之间未观察到统计学显著差异。与noDR组（3.24 +/- 1.76; p < 0.03）相比，NPDR组（4.38 +/- 2.22）的总体损失量显著更高。与对照组相比，noDR组（1.22 +/- 1.03）和NPDR组（2.09 +/- 1.72）的病灶丢失体积显著更高（0.95 +/- 0.83; noDR组和NPDR组之间p < 0.001，对照组和noDR组之间p = 0.02）。发现GLV与深VD之间存在显著相关性（p < 0.01，r = -0.48），FLV和浅表VD（p < 0.01，r = -0.42）和FLV伴深VD结论DR对视网膜血管层和神经成分的影响，以FAZ、SVD、dVD和GCC厚度，FLV和GLV使用OCT-A。我们发现，FLV在noDR和NPDR组中均显著较高，表明在进行性DR阶段，FLV值可能会增加，这可能是糖尿病患者神经元损伤的早期指标，即使在没有明显DR体征的情况下。
Purpose Using OCT-A to investigate the association between neurodegeneration and vascular morphology in diabetic retinopathy (DR).Methods Cross-sectional study. One hundred and sixty-two patients were enrolled and following fundoscopy were assigned to two groups according to DR severity: 54 patients to the group of no clinical signs of DR (noDR) and 54 to the non-proliferative DR (NPDR) group. Fifty-four age-matched patients without known diabetes were recruited as the control group. Patients underwent full ophthalmic examination followed by OCT-A. Central retinal thickness (CRT), vessel density (VD) in the superficial and deep retinal layers and foveal avascular zone (FAZ) area were measured. Additionally, ganglion cell complex (GCC) layer thickness along with global loss volume (GLV) and focal loss volume (FLV) indices was measured.Results In total, 85 men with mean age of 51.93 +/- 9.03 and 77 women with age of 50.14 +/- 10.35 were examined. Mean diabetes duration was 4.62 +/- 2.16 years in the noDR group and 11.34 +/- 2.73 years in the NPDR group (p < 0.001). Superficial VD (sVD) and deep VD (dVD) were significantly different only between noDR and NPDR groups (p < 0.001 for both comparisons), but no statistically significant difference was observed between the controls and the DR groups. Global loss volume was significantly higher in the NPDR (4.38 +/- 2.22) compared to the noDR group (3.24 +/- 1.76; p < 0.03). Focal loss volume was significantly higher in both noDR (1.22 +/- 1.03) and NPDR (2.09 +/- 1.72) groups compared to controls (0.95 +/- 0.83; p < 0.001 between noDR and NPDR and p = 0.02 between control and noDR groups). Significant associations were found between GLV and deep VD (p < 0.01, r = -0.48), FLV and superficial VD (p < 0.01, r = -0.42) and FLV with deep VD (p < 0.01, r = -0.64).Conclusion In this study, we evaluated the impact of DR in both the vascular layers and neural components of the retina as expressed by FAZ, sVD, dVD and GCC thickness, FLV and GLV using OCT-A. We found that FLV was significantly higher in both noDR and NPDR groups indicating that in progressive DR stages FLV values might be increased, which might serve as an early index of neuronal damage in patients with diabetes even in the absence of overt DR signs.