Исследование ретинального кровотока у беременных с сахарным и гестационным диабетом

Abstract

Purpose. To study retinal blood flow in pregnant women with diabetes mellitus and gestational diabetes mellitus using optical coherence tomography angiography (OCTA). Material and methods. 203 pregnant women in the third trimester were examined: 24 – with type 1 and 2 diabetes mellitus (T1DM and T2DM), 143 – with gestational diabetes mellitus (GDM), and 36 apparently healthy women with physiological pregnancy, who consisted the control group. OCTA imaging was performed using the RTVue XR Avanti OCT 6 mm × 6 mm "Angio Retina" scan protocols (Optovue, USA). The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied. Results. FVD in pregnant women with diabetes mellitus was significantly less than in pregnant women with GDM and in the control group, in this connection, it can be assume changes of the retinal microvascular regulation because of chronic disturbances of carbohydrate metabolism in such patients and due to microangiopathy development. FAZ area extension and wiVD diminution were revealed in patients with diabetic retinopathy (DR) compared to datas of the group of pregnant women with diabetes mellitus and absence of DR, in the absence of differences in FVD indexes. In 2 patients with T1D and the absence of ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye. Conclusions. A significant FVD decrease in the superficial capillary plexus was revealed in pregnant women with diabetes mellitus, compared with pregnant women with GDM and healthy women with physiological pregnancy in the absence of significant difference in wiVD in the superficial capillary plexus and FAZ area. Patients with DR showed an expansion of FAZ area and decrease in wiVD in the superficial capillary plexus relative to the group of pregnant women with diabetes mellitus without DR. OCTA helps to identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes in the absence of ophthalmoscopic signs of DR. Keywords: optical coherence tomography angiography, pregnancy, diabetic retinopathy, gestational diabetes, foveal avascular zone, retinal blood flow.