Abstract
PurposeTo assess the optical coherence tomography angiography (OCTA) retinal vessel density and foveal avascular zone (FAZ) in children with type 1 diabetes (T1D) and compare potential pathologic early changes in this population to healthy age-matched controls.MethodsThis study included 130 pubescent children: 94 with T1D (188 eyes) and 36 of their age-matched control group (60 eyes). OCTA was performed using AngioVue (Avanti, Optivue). FAZ area (mm2) in superficial plexus, whole superficial capillary vessel density (wsVD), fovea superficial vessel density (fsVD), parafovea superficial vessel density (psVD), whole deep vessel density (wdVD), fovea deep vessel density (fdVD), parafovea deep vessel density (pdVD), foveal thickness (FT) (μm) and parafoveal thickness (PFT) (μm) were taken into analysis. Among the studied patients with T1D there were assessed codependences regarding the investigated foveal and parafoveal parameters and selected potential predictors, i.e. patient’s age (years), diabetes duration time (years), age of onset of the disease (years), mean level of glycated hemoglobin (HbA1C) (%), and concentration of serum creatinine (mg/dL).ResultsNone of the abovementioned OCT and OCTA parameters was statistically significantly different between the groups. The patient’s age statistically significantly did not influent any of the OCT and OCTA parameters. Yet an elevated level of HbA1C tended to reduce the parafovea superficial vessel density (p = 0.039), and parafoveal thickness (p = 0.003) and an increased serum creatinine level correlated with the decreased whole deep vessel density (p < 0.001). The parafovea deep vessel density in the diabetic patients decreased when the serum creatinine level (p = 0.008), age of onset of the disease (p = 0.028), and diabetes duration time (p = 0.014) rose.ConclusionsVessel density, both in superficial and deep plexuses, and FAZ area are normal in pubescent children with T1D comparing to healthy subjects. An elevated level of HbA1C correlated with reduced psVD and PFT. Longitudinal observation of these young patients is needed to determine if any of these OCTA measurements are predictive of future DR severity.
Highlights
Diabetes mellitus is the third most common chronic disease among children
An elevated level of HbA1C tended to reduce the parafovea superficial vessel density (p = 0.039), and parafoveal thickness (p = 0.003) and an increased serum creatinine level correlated with the decreased whole deep vessel density (p < 0.001)
Optical coherence tomography angiography (OCTA) vessel density in children with type 1 diabetes serum creatinine level (p = 0.008), age of onset of the disease (p = 0.028), and diabetes duration time (p = 0.014) rose. Both in superficial and deep plexuses, and foveal avascular zone (FAZ) area are normal in pubescent children with T1D comparing to healthy subjects
Summary
Diabetes mellitus is the third most common chronic disease among children. Pediatric populations would appear to be at low risk for DR, but some adolescents develop either clinically significant macular edema or even proliferative retinopathy. [1,2,3,4] Pubertal status and the prepubertal duration of diabetes influence the risk of developing DR, as children under the age of 10 years have minimal risk, and no cases of proliferative DR in the first decade of life were noted. [5,6,7] early detection of DR through screening programs is crucial for preserving vision in patients with diabetes. [8,9]Indirect ophthalmoscopy and stereoscopic fundus photography through dilated pupils, a practice commonly used worldwide, provides the great diagnostic accuracy in detecting DR. [9,10] Over the years fluorescein angiography (FA) is the gold standard in diabetic retinopathy diagnosis and classification, but this method requires an intravenous dye injection and causes significant discomfort and stress. [11,12] Optical coherence tomography angiography (OCTA) is a new, non-invasive tool, based on split-spectrum amplitude-decorrelation angiography (SSADA), involving the detection and measurement of intravascular erythrocyte movement. [13] OCTA enables reproducible, quantitative assessment of the microcirculation in the macula and in the optic nerve head and may be used in diagnosing of glaucoma and different retinal vascular diseases, such as diabetic retinopathy, retinal vein occlusion, central serous chorioretinopathy and age-related macular degeneration. [14,15,16] OCTA provides threedimensional maps of the macular perfusion and seems to be promising method in the detection of early microcirculation disorders. [13] OCTA enables reproducible, quantitative assessment of the microcirculation in the macula and in the optic nerve head and may be used in diagnosing of glaucoma and different retinal vascular diseases, such as diabetic retinopathy, retinal vein occlusion, central serous chorioretinopathy and age-related macular degeneration. The aim of the present study was to assess the OCTA retinal vessel density and FAZ area in children with T1D and compare potential pathologic early changes in this population to healthy age matched controls. This prospective, observational study was conducted in The Children’s Memorial Health Institute in Warsaw and enrolled all consecutive patients available between March 2015 and September 2016 in the Department of Endocrinology and Diabetology, who met inclusion criteria. A written informed consent was obtained from the patient’s legal guardian and from patients > 16 years old after
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