Abstract
The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 years) were included. Another cohort of 27 eyes (27 healthy control subjects matched with age and sex) was also recruited. All patients underwent multimodal imaging evaluation using structural optical coherence tomography (OCT), OCT-angiography (OCT-A), dynamic vessel analyzer (DVA) and microperimetry. No significant differences were disclosed comparing diabetics and controls for visual acuity, central macular thickness, and subfoveal choroidal thickness. On retinal nerve fiber layer and ganglion cell complex thickness, no significant differences were disclosed comparing each 3-mm-diameter macular and peripapillary subfield between two groups. Using OCT-A, deep capillary plexus perfusion density (PD) of diabetics was significantly lower compared to control group, whereas PD of other retinal/choriocapillaris plexuses and foveal avascular zone area did not show any significant difference. Using DVA, diabetic eyes revealed a significantly decreased vessel response to flicker light in comparison to controls. No differences were disclosed using microperimetry analysis. Taken together, these results suggest that vascular alterations could be the first detectable retinal change in the development of DR.
Highlights
Diabetic retinopathy (DR) is a leading cause of visual impairment in the working-age population worldwide [1]
Cao et al [9] analyzed the eyes of 71 patients with type 2 diabetes mellitus (T2DM) with no signs of DR and 67 control subjects, and disclosed that T2DM patients had a reduced vessel density in superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris compared to healthy subjects, suggesting an involvement of both retinal and choroidal circulation before clinical manifestation of DR
Our group previously analyzed the retinal microvasculature of young type 1 diabetes mellitus (T1DM) patients without any signs of DR by means of standard deviation (SD)-optical coherence tomography (OCT)-A and disclosed that vessel density was reduced in the DCP, but not in SCP and choriocapillaris plexus (CCP) compared to controls [8]
Summary
Diabetic retinopathy (DR) is a leading cause of visual impairment in the working-age population worldwide [1]. Detection of retinal alterations in diabetic patients and prompt treatment are key factors for the prevention of vision loss [5]. Several studies have identified alterations in the inner retinal layers of patients without or with minimal DR using structural OCT, suggesting that detectable damage arising from diabetic neuroretinopathy could precede microvascular changes [6,12,13]. We reported a significantly decreased vessel density in eyes of patients with type 1 diabetes mellitus (T1DM) compared to control eyes at the level of DCP using OCT-A [8]
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