Оценка макулярного кровотока с помощью оптической когерентной томографии-ангиографии у беременных женщин, страдающих сахарным диабетом

Abstract

Purpose. To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for the manifestation and progression of diabetic retinopathy (DR). Material and methods. 203 pregnant women in the third trimester were examined: 24 – with type 1 and 2 diabetes (T1D and T2D), 143 – with gestational diabetes (GD), 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 was significantly less than in pregnant women with GD and in the control group. In this connection, it can be assume changes of the retinal microvascular regulation, due to chronic disorders of carbohydrate metabolism in patients with diabetes, and development of microangiopathy. Enlargement of FAZ area and decrease of wiVD were revealed in patients with DR, relative to datas obtained in the group of pregnant women with diabetes 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. Conclusion. 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 and allows determining objective indications for timely retinal laser coagulation. Keywords: optical coherence tomography angiography, pregnancy, diabetic retinopathy, gestational diabetes, foveal avascular zone, retinal blood flow