Adaptive Optics Reveals Photoreceptor Abnormalities in Diabetic Macular Ischemia.
Adaptive Optics Reveals Photoreceptor Abnormalities in Diabetic Macular Ischemia.
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自适应光学器件揭示了糖尿病黄斑缺血的感光异常。
DOI：
10.1371/journal.pone.0169926
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Fawzi AA
中科院分区：
文献类型：
--
作者：
Nesper PL;Scarinci F;Fawzi AA
糖尿病黄斑缺血（DMI）是糖尿病视网膜病变（DR）的一种表型，与视网膜组织的慢性缺氧有关。本前瞻性观察研究的目的是报告在深毛细血管丛（DCP）非灌注情况下，使用自适应光学扫描激光检眼镜（AOSLO）观察DR眼的光感受器异常的证据。11例无黄斑水肿的DR患者（6例女性，年龄31-68岁）11只眼行光学相干断层血管造影（OCTA）和AOSLO成像。一名没有OCTA成像的患者接受了荧光素血管造影，以表征中央凹无血管区扩大。研究的参数包括AOSLO上的光感受器非均匀性堆积指数（HPi）， OCTA上的DCP非灌注和血管密度。利用OCTA、OCTA和SD-OCT观察，未灌注DCP的眼在OCTA上发现AOSLO和SD-OCT上的光感受器异常。8只眼在OCTA上均表现为DCP无血流的光感受器异常。SD-OCT显示，8只眼中有6只眼视网膜外异常。3只眼DR， DCP毛细血管灌注强劲，SD-OCT和AOSLO光感受器正常。与无DCP不流动的DR眼相比，DCP不流动的8只眼的HPi （P = 0.013）和中央凹旁DCP血管密度（P = 0.016）显著降低。我们发现锥体HPi与正中凹旁DCP血管密度有显著相关性（r = 0.681, P = 0.030）。本研究采用一种新颖的方法，利用AOSLO和OCTA，显示了DCP毛细血管非灌注与dr眼部光感受器层异常之间的关联。这一观察结果对于确认DCP对DMI中光感受器氧需氧量的重要贡献非常重要，同时也强调了AOSLO检测SD-OCT上并不总是可见的细微光感受器变化的能力。
Diabetic macular ischemia (DMI) is a phenotype of diabetic retinopathy (DR) associated with chronic hypoxia of retinal tissue. The goal of this prospective observational study was to report evidence of photoreceptor abnormalities using adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with DR in the setting of deep capillary plexus (DCP) non-perfusion. Eleven eyes from 11 patients (6 women, age 31–68), diagnosed with DR without macular edema, underwent optical coherence tomography angiography (OCTA) and AOSLO imaging. One patient without OCTA imaging underwent fluorescein angiography to characterize the enlargement of the foveal avascular zone. The parameters studied included photoreceptor heterogeneity packing index (HPi) on AOSLO, as well as DCP non-perfusion and vessel density on OCTA. Using AOSLO, OCTA and spectral domain (SD)-OCT, we observed that photoreceptor abnormalities on AOSLO and SD-OCT were found in eyes with non-perfusion of the DCP on OCTA. All eight eyes with DCP non-flow on OCTA showed photoreceptor abnormalities on AOSLO. Six of the eight eyes also had outer retinal abnormalities on SD-OCT. Three eyes with DR and robust capillary perfusion of the DCP had normal photoreceptors on SD-OCT and AOSLO. Compared to eyes with DR without DCP non-flow, the eight eyes with DCP non-flow had significantly lower HPi (P = 0.013) and parafoveal DCP vessel density (P = 0.016). We found a significant correlation between cone HPi and parafoveal DCP vessel density (r = 0.681, P = 0.030). Using a novel approach with AOSLO and OCTA, this study shows an association between capillary non-perfusion of the DCP and abnormalities in the photoreceptor layer in eyes with DR. This observation is important in confirming the significant contribution of the DCP to oxygen requirements of photoreceptors in DMI, while highlighting the ability of AOSLO to detect subtle photoreceptor changes not always visible on SD-OCT.