Abstract
Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p < 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p < 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group.
Highlights
Licensee MDPI, Basel, Switzerland.Diabetic retinopathy (DR) is one of the main causes of blindness worldwide [1]
We studied a group of patients with only moderate DR to evaluate changes in their vessels
These values can modify the data obtained by optical coherence tomography (OCT) and optical tomography angiography (OCTA), in the choroidal thickness and in the CC Vascular density (VD) [23] and in the macular perfusion with a progressive VD diminution and an increase in the foveal avascular zone (FAZ) area [24,25,26]
Summary
Diabetic retinopathy (DR) is one of the main causes of blindness worldwide [1]. It is estimated that the prevalence of diabetes mellitus (DM) will increase, reaching 629 million affected people by 2045 [2]. DR is the most severe and frequent ophthalmic complication, related to diabetes macular oedema (DME) and proliferative DR [3]. The diagnosis and control of DR in daily practice is mainly based on the assessment of visual acuity (VA), the evaluation of the eye fundus, fluorescein angiography. (FA) and macular morphology and thickness using optical coherence tomography (OCT). Despite not finding anatomical retinal changes, visual function could be impaired. Detection of changes in visual function in diabetes mellitus.
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