Microvascular retinal changes in pre-clinical diabetic retinopathy as detected by optical coherence tomographic angiography

Yang, Jing; Wang, Qian; Yan, Yan Ni; Zhou, Wen; Wang, Ya Xing; Wu, Shou Ling; Yuan, Ming Xia; Wei, Wen Bin; Jonas, Jost B.

doi:10.1007/s00417-019-04590-x

Cited by 25 publications

(27 citation statements)

References 32 publications

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“…Blood glucose levels affect retinal blood VD. The study has shown that low VD around the optic disc is related to high FBG levels [ 8 ]. Lavia found a rapid decrease in macular VD over 12 months that was associated with a rapid improvement in blood glucose levels [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Early neurovascular changes in the retina in preclinical diabetic retinopathy and its relation with blood glucose

Zheng

et al. 2021

BMC Ophthalmol

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Background To investigate the changes in retinal nerve fiber layer thickness and macular blood flow density during the preclinical stage of diabetic retinopathy and their relationship with blood glucose. Methods In this cross-sectional study, 97 diabetic patients (total of 188 eyes; 144 eyes in no diabetic retinopathy group, 44 eyes in mild diabetic non-proliferative retinopathy group) and 35 healthy people (70 eyes) were enrolled, All the subjects were divided into different groups based on their HbA1c levels, and they underwent optical coherence tomography angiography. We compared the optical coherence tomography angiography parameters and retinal nerve fiber layer thickness among the different glucose groups. Results The parafoveal vessel density and the temporal retinal nerve fiber layer thickness were lower (p < 0.05) in the diabetic group than in the normal group. The diabetic group showed a higher acircularity index than the normal group. The normal group had the highest vessel density and the lowest acircularity index, followed by the no-diabetic retinopathy group and the mild non-proliferative retinopathy group, (p < 0.001). Foveal vascular density and parafoveal vessel density decreased with an increase in HbA1c. There was a negative correlation between parafoveal vessel density in the deep retinal vascular layer and fasting blood glucose (p < 0.01). The temporal retinal nerve fiber layer thickness decreased across the HbA1c level groups, and was positively correlated with the parafoveal vessel density in the superficial retinal vascular layer (p < 0.05). Conclusions This study shows that retinal microvasculopathy and neuropathy can be present in the absence of retinopathy. The vessel density of the deep retinal vascular layer was negatively correlated with fasting blood glucose, and the temporal retinal nerve fiber layer thickness was positively correlated with the vessel density of the superficial retinal vascular layer. These indicators are helpful for endocrinologists and ophthalmologists in detecting early diabetic retinal pathological lesions.

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Section: Discussionmentioning

confidence: 99%

Early neurovascular changes in the retina in preclinical diabetic retinopathy and its relation with blood glucose

Zheng

et al. 2021

BMC Ophthalmol

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“…These preclinical findings may facilitate earlier intervention for improved glycemic control and prevention of the onset of clinical retinopathy. However, neural dysfunction that is detected by mfERG precedes preclinical vascular changes that can be detected by OCTA which allows earlier intervention to protect the patients [14][15][16]. In this study, we aimed to assess the neural function of the retinal in diabetic patients using mfERG comparing its responses in DM patients without DR to healthy control participants from the Egyptian population.…”

Section: Introductionmentioning

confidence: 99%

Functional assessment of early retinal changes in diabetic patients without clinical retinopathy using multifocal electroretinogram

et al. 2020

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Background We aimed to assess early retinal changes in diabetic subjects without clinical retinopathy using multifocal electroretinogram (mfERG). Methods Twenty eyes of 20 diabetic subjects type 2 without retinopathy and 20 eyes of 20 healthy controls of the same age and sex were eligible for our study and underwent mfERG. MfERG responses were recorded; N1–P1 amplitude and P1 implicit time of the 5 rings recorded were measured and analyzed. Results The reduction in N1–P1 amplitude and the delay in P1-implicit time in type 2 diabetic subjects were statistically significant in most of the assessed rings compared to controls (p < 0.001). Moreover, N1–P1 amplitude was negatively correlated with diabetes duration. However, there was a positive correlation between P1-implicit time and diabetes duration in type 2 diabetic subjects in four out of five rings (p < 0.001). Conclusions Our study showed reduced mfERG N1–P1 amplitude and delayed P1-implicit time indiabetic patients without retinopathy compared to normal controls. Implicit time andamplitude were significantly affected by diabetes duration. These results propose a valuable role of mfERG in evaluating the expected neuroretinal dysfunction before the clinical development of diabetic retinopathy. Early detection of functional abnormalities indicates that the patients need more tight medical control of diabetes. More well-designed studies are needed to assert upon these results.

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“…Blood glucose level affects retinal blood VD.The study has shown that low VD around optic disc is related to high FBG [8]. Lavia found a rapid decrease in macular VD was observed over 12 months and were associated with a rapid improvement in blood glucose level [9].…”

Section: Discussionmentioning

confidence: 95%

“…Hyperglycemia leads to retinal microvascular disorder, non-perfusion in capillary plexus and macular ischemia. In the past, we found microaneurysms by fundus uorescein angiography to diagnose early diabetic retinopathy, but many recent studies have shown that the retinal capillaries have changed before the clinical diagnosis of diabetic retinopathy, including the decrease of parafoveal VD and irregular FAZ [7][8]10].…”

Section: Discussionmentioning

confidence: 99%

“…As for the changes of FAZ area in diabetic patients, the results are not consistent. Some studies have shown that there is no signi cant change in FAZ area in diabetic patients without retinopathy [7][8]10], while other studies have found that FAZ area in diabetic patients without retinopathy is signi cantly higher than that in normal people [12][13][14][15].Previous studies have shown that there are individual differences in FAZ area [16,17], and the AUC area of FAZ is small, so it is di cult to evaluate whether FAZ is pathologically enlarged by area measurement [18].Therefore, FAZ area may not be a sensitive marker for the diagnosis of early diabetic retinopathy. The irregular shape of FAZ caused by the decrease of capillary network perfusion and the macular ischemia may better re ect the ischemia in the fovea.…”

Section: Discussionmentioning

confidence: 99%

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Early Neurovascular Changes in the Retina in Preclinical Diabetic Retinopathy and Relation to Blood Glucose

Zheng

et al. 2020

Preprint

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Aim: To investigate the changes of retinal optic disc nerve fiber layer thickness and macular blood flow density in preclinical stage of diabetic retinopathy and their relationship with blood glucose. Methods: In this cross-sectional study,97 diabetic patients(total 188 eyes,144 eyes in no diabetic retinopathy group, 44 eyes in mild diabetic non-proliferative retinopathy group ) and 35 healthy people (70 eyes) were enrolled, All the subjects were divided into different group by HbA1c , and underwent ocular examination by optical coherence tomography angiography. We compare optical coherence tomography angiography parameter and retinal nerve fiber layer thickness among different glucose group.Results: The parafoveal vessel density and the temporal retinal nerve fiber layer thickness were lower (P < 0.05) in the diabetic group than in the normal group. The diabetic group showed a higher acircularity index as compared with the normal group. From the normal group to no diabetic retinopathy group and then to mild non-proliferative retinopathy group, vessel density decreased and acircularity index increased (P < 0.001). Foveal vascular density and parafoveal vessel density decreased with the increase of HbA1c. There was a negative correlation between parafoveal vessel density of the deep retinal vascular layer and FBG (P<0.01). The temporal retinal nerve fiber layer thickness decreased among different HbA1c levels groups and was positively correlated with the parafoveal vessel density in superficial retinal vascular layer(P<0.05).Conclusions: This study shows retinal microvasculopathy and neuropathy has been present during no retinopathy. The vessel density of the deep retinal vascular layer was negatively correlated with fasting blood glucose, and the temporal RNFL thickness was positively correlated with the vessel density of superficial retinal vascular layer. These indicators are helpful for endocrinologists and ophthalmologists to detect early diabetic retinal pathological lesions.

show abstract

Microvascular retinal changes in pre-clinical diabetic retinopathy as detected by optical coherence tomographic angiography

Cited by 25 publications

References 32 publications

Early neurovascular changes in the retina in preclinical diabetic retinopathy and its relation with blood glucose

Early neurovascular changes in the retina in preclinical diabetic retinopathy and its relation with blood glucose

Functional assessment of early retinal changes in diabetic patients without clinical retinopathy using multifocal electroretinogram

Early Neurovascular Changes in the Retina in Preclinical Diabetic Retinopathy and Relation to Blood Glucose

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