Early Retinal Microvasculopathy in Prediabetic Patients and Correlated Factors

Abstract

Introduction: We aimed to detect early retinal microcirculation changes in prediabetic patients and investigate their correlation with clinical examinations. Methods: Forty-seven prediabetic individuals, 29 controls, and 81 type 2 diabetic mellitus (T2DM) patients were enrolled in this study. A review of clinical data and spectral-domain optical coherence tomography angiography (SD-OCTA) parameters of macular vessel diameter (VD), foveal avascular zone (FAZ), and macular vessel area density (VAD) was performed. Results: Levels of low-density lipoprotein cholesterol and triglycerides in prediabetes and T2DM groups were significantly higher than those in the control group. Urine microalbumin-to-creatinine ratio (ACR) was mildly and moderately increased in the prediabetes and T2DM groups, respectively. Estimated glomerular filtration rate of the three groups were within the normal range. SD-OCTA showed that VAD in the superficial macular area was decreased in the prediabetes group compared to the control group (p=0.01). The FAZ size, particularly in the deep layer, was expanded in the prediabetes group. In the deep retinal layer of the macular area, VD and FAZ size in the prediabetes group were larger than those in the control group. In the prediabetes group, the axial length was significantly correlated with macular VD and FAZ size (p<0.05), and ACR was correlated with FAZ size (p<0.05). Age had a negative correlation with VAD (p<0.01). ACR had a positive correlation with FAZ size (p<0.05). Conclusions: Enlargement and irregularity of the FAZ area, deep capillary dilation, and decrease in VAD occur in the retina of prediabetes patients with mild kidney function impairment.

Assessment of early macular microangiopathy in subjects with prediabetes using optical coherence tomography angiography and fundus photography

“…Only a few studies have been conducted on subjects with prediabetes. Xu et al [ 30 ] reported a decrease in vessel area density and a widening of the mean vessel density within the SCP and DCP in prediabetes eyes . Similarly, we found a reduction in VDP in both SCP and DCP in prediabetes eyes compared to normal control.…”

Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy

“…Although Xu et al reported FAZ area to be significantly enlarged in patients with prediabetes [132], most studies have found no significant change in FAZ area and circularity in pre-diabetic patients compared to controls [129,130,133,134]. Ratra et al did, however, find that logmarBCVA was positively correlated with FAZ area in the pre-diabetic group [134].…”

“…A cross-sectional study found that only the VD in the SCP was decreased in patients with pre-diabetes compared to controls, whereas VD in the DCP was decreased in the diabetic group [131]. However, Xu et al found that the VD and vessel area density were similar between patients with pre-diabetes and controls [132].…”

Microvascular and Endothelial Dysfunction in Prediabetes

“…Xu et al showed that some parameters of the OCTA, more specifically, the size of focal avascular zone and the macular vessel diameter, were larger in the prediabetic patients compared to the control group. Moreover, the vessel area density in superficial macular area decreased in prediabetes [ 63 ]. In accordance with this study, Ratra et al found that the decreased vessel diameter was positively correlated with HbA1c [ 64 ].…”