RETINAL MICROVASCULAR DIFFERENCES IN TYPE 2 DIABETES WITHOUT CLINICALLY APPARENT RETINOPATHY: AN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY STUDY

Year 2022, , 7 - 13, 01.03.2022

Müjdat Karabulut , Aylin Karalezli , Sinem Karabulut , Sabahattin Sül

https://doi.org/10.17343/sdutfd.912590

Abstract

Objective
We aimed to determine early microvascular changes
in type 2 diabetes mellitus patients without clinically
apparent retinopathy by optical coherence tomography
angiography.
Material and Methods
80 eyes of patients with diabetes mellitus and without
clinically apparent retinopathy, and 80 eyes of age
and sex-matched healthy participants were included
in this observational case-control study. Vessel
density in superficial and deep retinal vessel plexus,
foveal avascular zone area, and choriocapillaris flow
area in a macular 6.00 × 6.00 mm scan size were
evaluated and compared.
Results
The groups were similar for age and gender (p=0.971
and p=1.000, respectively). The mean duration of
diabetes was 10.38±6.31 years (range, 1-25 years)
in the study group. Choriocapillaris flow area was
significantly lower in the study group than in the
control group (p<0.001). Vessel density in the deep
retinal plexus was markedly lower in the study
group in all quadrants except the fovea (p<0.001).
Parafoveal vessel density in superficial retinal plexus
was markedly reduced in the study group (p=0.013).
The mean foveal avascular zone area was similar in
the two groups.
Conclusion
Optical coherence tomography angiography can
detect early microvascular changes in diabetic
patients without clinically apparent retinopathy.

Keywords

Deep capillary plexus, diabetic retinopathy, optical coherence tomography angiography, parafoveal vessel density, vessel density

Thanks

N/A

RETİNOPATİ BULGUSU OLMAYAN TİP 2 DİYABETLİ HASTALARDA RETİNAL MİKROVASKÜLER FARKLILIKLAR: OPTİK KOHERANS TOMOGRAFİ ANJİOGRAFİ ÇALIŞMASI

Abstract

Amaç
Bu çalışmada, klinik olarak tespit edilebilen diyabetik
retinopati bulgusu olmayan tip 2 diyabetli hastalarda
optik koherans tomografi anjiyografi ile mikrovasküler
değişimlerin saptanması amaçlanmıştır.
Gereç ve Yöntem
Çalışma gözlemsel, olgu-kontrol çalışma olarak planlanmıştır.
Klinik olarak tespit edilebilen retinopatisi
olmayan (Dilate fundus muayenesinde ve fundus fluoresein
anjiyografide) 40 tip 2 diyabet hastasının 80
gözü çalışma grubu olarak belirlenmiştir. Yaş ve cinsiyet
açısından benzer 40 sağlıklı hastanın 80 sağlam
gözü kontrol grubu olarak seçilmiştir. Bütün hastalara
tam oftalmolojik muayene sonrası makula merkezli
6x6 mm büyüklüğünde optik koherens tomografi anjiyografi
çekimleri yapılmıştır. Derin ve yüzeyel kapiller
ağlarda vasküler yoğunluk, foveal avasküler alan,
koryokapiller akım alanı parametreleri kontrol grubu
ile karşılaştırılmıştır.
Bulgular
Yaş ve cinsiyet açısından gruplar arasında fark saptanmamıştır
(p=0.971 ve p=1.000; sırasıyla). Ortalama
diyabet süresi 10.38±6.31 yıl (1-25 yıl aralığında)
olarak bulunmuştur. Koryokapiller akım alanı
çalışma grubunda anlamlı olarak düşük bulunmuştur
(p<0.001). Derin kapiller ağdaki vasküler yoğunluk,
fovea dışındaki tüm kadranlarda çalışma grubunda
düşük bulunmuştur (p<0.001).Yüzeyel kapiller ağdaki
vasküler yoğunluk, parafoveal kadranda çalışma grubunda
anlamlı olarak düşük saptanmıştır (p=0.013).
İki grup arasıda foveal avasküler alan açısından fark
saptanmamıştır.
Sonuç
Klinik olarak retinopati bulgusu saptanamayan tip 2
diyabetli hastalarda erken dönem vasküler değişimler
optik koherans tomografi anjiyografi ile saptanabilir.

Keywords

Derin kapiller ağ, Derin kapiller ağ, Diyabetik retinopati, Optik koherans tomografi anjiyografi, Parafoveal vasküler yoğunluk, Vasküler yoğunluk

References

• Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103:137-49.
• Knowles JW, Reaven G. Usual blood pressure and new-onset diabetes risk: Evidence from 4.1 million adults and a meta-analysis. J Am Coll Cardiol. 2016;67:1656-7.
• Krauss RM. Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care. 2004;27:1496-504.
• Stehouwer CDA. Microvascular dysfunction and hyperglycemia: A vicious cycle with widespread consequences. Diabetes. 2018;67:1729-41.
• Tarr JM, Kaul K, Chopra M, Kohner EM, Chibber R. Pathophysiology of diabetic retinopathy. ISRN Ophthalmol. 2013;2013:343560.
• You Q, Freeman WR, Weinreb RN, Zangwill L, Manalastas PIC, Saunders LJ, et al. Reproducibility of vessel density measurement with optical coherence tomography angiography in eyes with and without retinopathy. Retina. 2017;37:1475-82.
• C. Czako M, Ecsedy Z, Récsán Z, Szepessy M, Resch Á, Borbándy, et al. Bilateral quantification of vascular density in diabetic patients using optical coherence tomography angiography. Acta Ophthalmol. 2017;95:259.
• Dimitrova G, Chihara E, Takahashi H, Amano H, Okazaki K. Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy. Invest Ophthalmol Vis Sci. 2017;58:190-6.
• Simonett JM, Scarinci F, Picconi F, Giorno P, De Geronimo D, Di Renzo A, et al. Early microvascular retinal changes in optical coherence tomography angiography in patients with type 1 diabetes mellitus. Acta Ophthalmol. 2017;95:e751-e5.
• Carnevali A, Sacconi R, Corbelli E, Tomasso L, Querques L, Zerbini G, et al. Optical coherence tomography angiography analysis of retinal vascular plexuses and choriocapillaris in patients with type 1 diabetes without diabetic retinopathy. Acta Diabetol. 2017;54:695-702.
• Cao D, Yang D, Huang Z, Zeng Y, Wang J, Hu Y, et al. Optical coherence tomography angiography discerns preclinical diabetic retinopathy in the eyes of patients with type 2 diabetes without clinical diabetic retinopathy. Acta Diabetol. 2018;55:469-77.
• Cicinelli MV, Carnevali A, Rabiolo A, Querques L, Zucchiatti I, Scorcia V, et al. Clinical spectrum of macular-foveal capillaries evaluated with optical coherence tomography angiography. Retina. 2017;37:436-43.
• Ting DSW, Tan GSW, Agrawal R, Yanagi Y, Sie NM, Wong CW, et al. Optical coherence tomographic angiography in type 2 diabetes and diabetic retinopathy. JAMA Ophthalmol. 2017;135:306-12.
• De Carlo TE, Chin AT, Bonini Filho MA, Adhi M, Branchini L, Salz DA, et al. Detection of microvascular changes in the eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography. Retina. 2015;35:2364–70.
• Freiberg FJ, Pfau M, Wons J, Wirth MA, Becker MD, Michels S. Optical coherence tomography angiography of the foveal avascular zone in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2016;254:1051-8.
• Hwang TS, Gao SS, Liu L, Lauer AK, Bailey ST, Flaxel CJ, et al. Automated quantification of capillary nonperfusion using optical coherence tomography angiography in diabetic retinopathy. JAMA Ophthalmol. 2016;134:367-73.
• Di G, Weihong Y, Xiao Z, Zhikun Y, Xuan Z, Yi Q, et al. A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol. 2016;254:873-9.
• Takase N, Nozaki M, Kato A, Ozeki H, Yoshida M, Ogura Y. Enlargement of the foveal avascular zone in diabetic eyes evaluated by en face optical coherence tomography angiography. Retina. 2015;35:2377-2383.
• Goudot MM, Sikorav A, Semoun O, Miere A, Jung C, Courbebaisse B, et al. Parafoveal OCT angiography features in diabetic patients without clinical diabetic retinopathy: A qualitative and quantitative analysis. J Ophthalmol. 2017;2017:8676091.
• Lee DH, Yi HC, Bae HS, Cho JH, Choi SW, Kim H. Risk factors for retinal microvascular impairment in type 2 diabetic patients without diabetic retinopathy. PLoS One. 2018;13:e0202103.
• Pemp B, Schmetterer L. Ocular blood flow in diabetes and age-related macular degeneration. Can J Ophthalmol. 2008;43:295-301.
• Lutty GA. Diabetic choroidopathy. Vision Res. 2017;139:161-7.
• Li Z, Alzogool M, Xiao J, Zhang S, Zeng P, Lan Y. Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy. Acta Diabetol. 2018;55:1075-82.
• Lim LS, Cheung CY, Lin X, Mitchell P, Wong TY, Mei-Saw S. Influence of refractive error and axial length on retinal vessel geometric characteristics. Invest Ophthalmol Vis Sci. 2011;52(2):669-678.
• Sampson DM, Gong P, An D, Menghini M, Hansen A, Mackey DA, et al. Axial length variation impacts on superficial retinal vessel density and foveal avascular zone area measurements using optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2017;58(7):3065-3072.