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

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

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

References

1. 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.
2. 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.
3. Krauss RM. Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care. 2004;27:1496-504.
4. Stehouwer CDA. Microvascular dysfunction and hyperglycemia: A vicious cycle with widespread consequences. Diabetes. 2018;67:1729-41.
5. Tarr JM, Kaul K, Chopra M, Kohner EM, Chibber R. Pathophysiology of diabetic retinopathy. ISRN Ophthalmol. 2013;2013:343560.
6. 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.
7. 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.
8. 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.

9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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.
21. Pemp B, Schmetterer L. Ocular blood flow in diabetes and age-related macular degeneration. Can J Ophthalmol. 2008;43:295-301.
22. Lutty GA. Diabetic choroidopathy. Vision Res. 2017;139:161-7.
23. 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.
24. 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.
25. 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.