Earliest Evidence of Preclinical Diabetic Retinopathy Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density
Earliest Evidence of Preclinical Diabetic Retinopathy Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density
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DOI：
10.1016/j.ajo.2019.01.012
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发表时间：
2019-07-01
影响因子：
4.2
通讯作者：
Chui, Toco Y. P.
中科院分区：
文献类型：
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作者：
Rosen, Richard B.;Romo, Jorge S. Andrade;Chui, Toco Y. P.
目的：使用光学相干断层扫描血管造影 (OCTA) 比较糖尿病患者和健康对照者的毛细血管灌注密度 (PCD)。 方法：使用谱域光学相干断层扫描对 40 名对照者、36 名无临床视网膜病变 (NoDR) 的糖尿病受试者、38 名患有非增殖性视网膜病变 (NPDR) 和 38 名患有增殖性视网膜病变 (PDR) 的受试者进行成像。对每位参与者进行 3 x 3 毫米全层中心凹旁 OCTA 扫描。手动描绘中心凹无血管区 (FAZ) 后，确定 FAZ 面积、周长和无循环指数。以距 FAZ 边缘渐增的偏心率绘制七个连续的等距 200 μm 宽的环形段。环形PCD (%)定义为灌注毛细血管面积除以减去非毛细血管面积后相应的环形面积。对组 PCD 值进行成对比较时，采用 Bonferroni 校正进行非参数 Kruskal-Wallis 检验。 结果：与对照组相比，NoDR 组在所有 7 个环中始终表现出较高的 PCD，在最内环（FAZ 边缘为 200 μm 外）处达到统计显着性（36.6% +/- 3.30% vs 33.6% 3.98%，P = .034）。 NPDR 和 PDR 组表现出 PCD 逐渐降低。 NoDR 组和对照组之间 FAZ 指标的差异未达到统计显着性。 结论：相对于健康对照，NoDR 组中 PCD 值的增加可能代表对代谢需求增加的自动调节反应，而 NPDR 和 PDR 中 PCD 的减少主要是由于毛细血管段的逐渐损失。这些发现与之前的研究一致，证明了 OCTA 作为早期客观检测临床前糖尿病视网膜病变的临床工具的潜力。注：本文的出版由美国眼科学会赞助。 (C) 2019 年由爱思唯尔公司出版
PURPOSE: To compare perfused capillary density (PCD) in diabetic patients and healthy controls using optical coherence tomography angiography (OCTA).METHODS: Forty controls, 36 diabetic subjects without clinical retinopathy (NoDR), 38 with nonproliferative retinopathy (NPDR), and 38 with proliferative retinopathy (PDR) were imaged using spectral-domain optical coherence tomography. A 3 x 3-mm full-thickness parafoveal OCTA scan was obtained from each participant. Following manual delineation of the foveal avascular zone (FAZ), FAZ area, perimeter, and acircularity index were determined. Seven consecutive equidistant 200 mu m-wide annular segments were drawn at increasing eccentricities from the FAZ margin. Annular PCD (%) was defined as perfused capillary area divided by the corresponding annulus area after subtraction of noncapillary blood vessel areas. Nonparametric Kruskal-Wallis testing with Bonferroni correction was performed in pair wise comparisons of group PCD values.RESULTS: The NoDR group demonstrated consistently higher PCD compared to the control group in all 7 annuli, reaching statistical significance (36.6% +/- 3.30% vs 33.6% 3.98%, P = .034) at the innermost annulus (FAZ margin to 200 mu m out). The NPDR and PDR groups demonstrated progressively decreasing PCD. Differences in FAZ metrics between the NoDR and control groups did not reach statistical significance.CONCLUSIONS: Relative to healthy controls, increased PCD values in the NoDR group likely represent an autoregulatory response to increased metabolic demand, while the decrease in PCD that follows in NPDR and PDR results largely from an incremental loss of capillary segments. These findings, consistent with previous studies, demonstrate the potential of OCTA as a clinical tool for earlier objective detection of preclinical diabetic retinopathy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society. (C) 2019 Published by Elsevier Inc.