Changes in Retinal Microcirculation Precede the Clinical Onset of Diabetic Retinopathy in Children With Type 1 Diabetes Mellitus

İnanç, Merve; Tekin, Kemal; Kızıltoprak, Hasan; Özalkak, Şervan; Doğuizi, Sibel; Aycan, Zehra

doi:10.1016/j.ajo.2019.04.011

Cited by 71 publications

(74 citation statements)

References 40 publications

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“… 25 The largest series in type 1 DM have been described in children, and they interestingly have shown controversial results. 26 – 30 Golebiewska et al reported that no differences were seen in the VD or FAZ area in any of the studied plexuses between patients with type 1 DM and controls ( n = 188 vs. 60); however, Niestrata-Ortiz et al described that FAZ area was different between diabetic and healthy children ( n = 112 vs. 30). 27 , 28 In this last paper, a greater FAZ area was also associated with a longer duration of the disease.…”

Section: Discussionmentioning

confidence: 93%

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy

Barraso

Alé-Chilet

Hernandez

et al. 2020

Trans. Vis. Sci. Tech.

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The purpose of this study was to evaluate specifically in type 1 diabetes mellitus (DM) individuals the relationship between perifoveal superficial capillary plexus (SCP) parameters assessed by optical coherence tomography angiography (OCTA) and diabetic retinopathy (DR) grade. Methods: Cross-sectional analysis of a large scale prospective OCTA trial cohort (Clini-calTrials.gov NCT03422965). A total of 1186 eyes (593 individuals), 956 type 1 DM eyes (478 patients), and 230 control eyes (115 healthy volunteers) were included in this study. DR stage was graded according to the International Classification. OCTA imaging was performed with a commercially available device (Cirrus HD-OCT). Vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) area, perimeter and circularity measurements were quantified in the SCP and receiver operating characteristic (ROC) curves were constructed for each OCTA parameter. Results: VD and PD (in both 3 × 3 and 6 × 6 mm captures) were inversely associated with DR stage (P < 0.001 in all cases) in a multiple regression analysis after controlling by age, gender, signal strength index, axial length, and DM duration. Greater FAZ area and perimeter and conversely lower circularity measurements were observed as DR severity increased in both scanning protocols (P < 0.05 in all cases). Conclusions: In type 1 DM individuals, OCTA provides an objective, continuous, and reliable method for accurate quantification of VD, PD, and FAZ parameters in the SCP, which ultimately correlate with DR stages. Translational Relevance: Objective OCTA measurements of the retinal microvasculature could substitute the clinical DR classification in patients with type 1 DM, identify patients at risk of DR progression, and inform treatment decisions to modify the evolution of the disease.

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Section: Discussionmentioning

confidence: 93%

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy

Barraso

Alé-Chilet

Hernandez

et al. 2020

Trans. Vis. Sci. Tech.

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“…23 In studies conducted with changes in FAZ perimetry, AI, and FD, it has been shown that there may be differences in the early stages of the disease even in the preclinical stages. 24 In their study in diabetic children, it is shown that FAZ perimeter, AI, and FD change without retinopathy findings. Similarly, Lynch et al 25 performed a study in children with sickle cell anemia, in whom FAZ perimeter and AI showed a significant increase compared to the control group.…”

Section: Discussionmentioning

confidence: 94%

Optical coherence tomography angiography findings in young β-thalassemia patients

Kazancı

Korkmaz

Can

2020

European Journal of Ophthalmology

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Purpose: The purpose was to evaluate retinal vascular parameters by optical coherence tomography angiography in β-thalassemia major patients. Methods: Thirty-three patients with β-thalassemia major (study group) and 29 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. The mean foveal avascular zone, non-flow area, foveal avascular zone perimeter, acircularity index of foveal avascular zone, foveal density, the superficial capillary plexus, and deep capillary plexus were scanned using 6 × 6 mm optical coherence tomography angiography scans centered on the macula. Superficial capillary plexus and deep capillary plexus were also scanned centered on the optic disk. We collected data on histories of patients, and hemoglobin and ferritin were also studied from both groups. Results: The mean age was 13.85 ± 4.69 years (range: 4–21 years) in β-thalassemia major group and 12.59 ± 3.66 years (range: 6–18 years) in the control group. The mean foveal avascular zone value was 0.265 ± 0.11 mm2 in the study group and 0.296 ± 0.12 mm2 in the control group. The mean non-flow area value was 0.468 ± 0.12 mm2 in the study group and 0.479 ± 0.14 mm2 in the control group ( p > 0.05). Differences in the mean values for foveal density and acircularity index were statistically significant between the study group and control group ( p < 0.05, p = 0.026, and p = 0.026, respectively). Superficial capillary plexus and deep capillary plexus were not a significant difference between the study and control groups in 6 × 6 mm scans on macula and 4.5 × 4.5 mm scans on optic disk area ( p > 0.05). Acircularity index was negatively correlated ( r = −0.292, p = 0.026), and foveal density was positively correlated with hemoglobin ( r = 0.292, p = 0.026). Conclusion: By using optical coherence tomography angiography, we detected foveal microvascular changes in young β-thalassemia patients before significant ocular anomalies development.

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“…Zpomalení průtoku v MA způsobí jen 40% znázornitelnost na OCT-A vyšetření na rozdíl od FAG [40]. OCT-A ukazuje u pacientů bez DR snížení celkové denzity kapilár [41] a časné mikrovaskulární změny [38], a to bez rozdílu použitého přístroje [42], především v parafoveální oblasti DCP [43,44]. Tyto nálezy jsme také pozorovali.…”

Section: Metodikaunclassified

Changes of the Foveal Avascular Zone and Macular Microvasculature within the Framework of OCT Angiography Examination in Young Patients with Type 1 Diabetes (Pilot Study)

Magera

Pluhovský

et al. 2020

CSO

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Aim: Learn about the development and changes in foveal avascular zone (FAZ) and vascularity of retina in the surrounding zone, depending on the duration in young diabetic patients type 1 (T1DM). Methods: As part of regular one-year examinations of young T1DM patients at the Eye Clinic of the University Hospital Královské Vinohrady in Prague (Czech Republic, EU) from January to December 2019, OCT angiography using the device Spectralis (Heidelberg Engineering) was included. Forty patients aged 18 to 30 years were examined, median 21 years. T1DM was diagnosed in childhood and lasted for more than 10 years. At the same time, a control group of forty individuals of similar age, without metabolic and other general disease was examined, normal visual acuity and physiological fundoscopic finding were obligatory. The FAZ size was evaluated in both groups (using built-in function "Draw Region"), also its shape, density decrease and change in character of vascularity of the retina was assessed. Results: In the control group, the FAZ area ranged from 0.06 to 0.4 mm², with an average of 0.253 ± 0.092 mm² and a median of 0.27 mm². It was not affected by a fundamental change in its round shape and the surrounding capillary netting was regular and reasonably dense. In T1DM patients, the FAZ area was in a wider range, from 0.05 to 0.64 mm², an average of 0.300 ± 0.132 mm², and a median of 0.31 mm². The difference in FAZ across-the-board evaluation was statistically significant (p = 0, 009). Diabetic preretinopathy (DpR) was defined by the irregularity of the capillary density up to the manifestation of non-perfusion, in 61% of cases the size of the FAZ was changed. In diabetic retinopathy (DR) there was always an irregularity of the FAZ shape with its enlargement, manifestation of non-perfusion, capillary dilatation and rare microaneurysms. Conclusion: Changes in FAZ size corresponded to the stage of T1DM on the fundoscopic finding of the eye depending on its duration. The initial increased amount of foveal capillaries, which resulted in decreased FAZ area, was followed by a gradual decrease in capillaries and increased FAZ area, consistent with the manifestations of DpR. It was accompanied by a change in capillary density in macula to eventual non-perfusion. On the contrary, the increase in the FAZ area and its irregularity accompanied by non-perfusion of the capillary net and microaneurysms corresponded to the development of DR already.

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Changes in Retinal Microcirculation Precede the Clinical Onset of Diabetic Retinopathy in Children With Type 1 Diabetes Mellitus

Cited by 71 publications

References 40 publications

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy

Optical coherence tomography angiography findings in young β-thalassemia patients

Changes of the Foveal Avascular Zone and Macular Microvasculature within the Framework of OCT Angiography Examination in Young Patients with Type 1 Diabetes (Pilot Study)

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