Observation of macular microvascular changes in eyes of patients of type 2 diabetes without clinical features of diabetic retinopathy by optical coherence tomography angiography_Chinese Journal of Ocular Fundus Diseases

Authors：

WangJian ,  ChenSong , HeGuanghui , HanMei , LiYan , WuBin , SunXiaoli

Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key lab of Ophthalmology and Visual Science, Tianjin Institute of Ophthalmology, Tianjin 300020, China;

Corresponding author：

ChenSong, Email: chensong20@hotmail.com

Keywords：

Diabetic retinopathy/diagnosis; Macula lutea/injuries; Microvessels/injuries; Tomography, optical coherence

DOI：

10.3760/cma.j.issn.1005-1015.2017.01.005

Video：

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Objective To observe the morphological changes of macular capillary in type 2 diabetic mellitus (DM) patients without clinical features of diabetic retinopathy (DR) by optical coherence tomography angiography (OCTA). Methods This is a prospective clinical case-control study. Forty-three eyes of 22 patients with DM without clinical features of DR (case group) and 40 control eyes of 20 age- and sex-matched healthy physical examination subjects (control group) were enrolled in this study. All subjects underwent OCTA examination with mode of retinal blood flow imaging, macular 3 mm×3 mm and 6 mm×6 mm area, signal strength ＞45. Foveal avascular zone (FAZ) area, foveal capillary density, parafovea capillary non-perfusion, and micro-aneurysm in shallow capillary vessel layer were evaluated. Results In case group, the mean FAZ area was (0.397±0.141) mm² and the mean foveal capillary density was (44.6±0.62) %. In control group, the mean FAZ area was (0.253±0.112) mm² and the mean foveal capillary density was (48.6±0.58) %. FAZ area of eyes in case group was larger than that in control group (t=1.017,P＜0.05). There was no difference of foveal capillary density between two groups (t=1.499,P＞0.05). The spider web-like FAZ and normal foveolar avascular zone were observed in eyes of control group. The parafovea capillary non-perfusion, abnormal foveolar avascular zone, micro-aneurysm and tortuosity of vessels were observed in eyes of case group. Parafovea capillary non-perfusion (χ²=4.542), micro-aneurysms (χ²=5.183) were seen more often in case group than control group (P＜0.05). Conclusion Type 2 DM patients have abnormal retinal vascular microcirculation before DR using OCTA, including larger FAZ area, parafovea capillary non-perfusion, abnormal foveolar avascular zone, micro-aneurysm and tortuosity of vessels.

Citation： WangJian, ChenSong, HeGuanghui, HanMei, LiYan, WuBin, SunXiaoli. Observation of macular microvascular changes in eyes of patients of type 2 diabetes without clinical features of diabetic retinopathy by optical coherence tomography angiography. Chinese Journal of Ocular Fundus Diseases, 2017, 33(1): 15-18. doi: 10.3760/cma.j.issn.1005-1015.2017.01.005 Copy

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5.	Jia Y, Bailey ST, Wilson DJ, et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration[J].Ophthalmology, 2014, 121(7): 1435-1444. DOI: 10.1016/j.ophtha.2014.01.034.
6.	Nelson DA, Burgansky-Eliash Z, Barash H, et al. High-resolution wide-field imaging of perfused capillaries without the use of contrast agent[J].Clin Ophthalmol, 2011, 5: 1095-1106. DOI: 10.2147/OPTH.S20103.
7.	Tam J, Dhamdhere KP, Tiruveedhula P, et al. Disruption of the retinal parafoveal capillary network in type 2 diabetes before the onset of diabetic retinopathy[J].Invest Ophthalmol Vis Sci, 2011, 52(12): 9257-9266. DOI: 10.1167/iovs.11-8481.
8.	Kim DY, Fingler J, Zawadzki RJ, et al. Noninvasive imaging of the foveal avascular zone with high-speed, phase-variance optical coherence tomography[J].Invest Ophthalmol Vis Sci, 2012, 53(1): 85-92. DOI: 10.1167/iovs.11-8249.
9.	Tam J, Dhamdhere KP, Tiruveedhula P, et al. Subclinical capillary changes in non-proliferative diabetic retinopathy[J].Optom Vis Sci, 2012, 89(5): 692-703. DOI: 10.1097/OPX.0b013e3182548b07.
10.	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med, 1998, 15(7): 539-553.
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12.	于强, 刘万丽, 闫宏, 等. 糖尿病视网膜病变筛查的方法比较研究[J].中华眼底病杂志, 2006, 22(1): 45-46.Yu Q, Liu WL, Yan H, et al. Comparative study on screening methods of diabetic retinopathy[J].Chin J Ocul Fundus Dis, 2006, 22(1): 45-46.
13.	陈喆, 张丽芳, 广崎真史, 等. 糖尿病视网膜病变眼底彩色照片的读片可信度分析[J].中华眼底病杂志, 2006, 22(1): 47-48.Chen Z, Zhang LF, Guang QZS, et al. Reading reliability analysis of fundus photographs of diabetic retinopathy[J].Chin J Ocul Fundus Dis, 2006, 22(1): 47-48.
14.	McLeod DS, Lefer DJ, Merges C, et al. Enhanced expression of intracellular adhesion molecule-1 and P-selectin in the diabetic human retina and choroid[J]. Am J Pathol, 1995, 147(3): 642-653.
15.	Miyamoto K, Khosrof S, Bursell SE, et al. Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition[J]. Proc Natl Acad Sci USA, 1999, 96(19): 10836-10841.
16.	Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J].Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
17.	黄江, 徐国旭, 魏晓红, 等. 无明显糖尿病视网膜病变的2型糖尿病患者多焦视网膜电图特征分析[J].中华眼底病杂志, 2013, 29(5): 487-489. DOI: 10.3760/cma.j.issn.1005-1015.2013.05.010.Huang J, Xu GX, Wei XH, et al. Characteristics of the multifocal electroretinogram in type 2 diabetes without clinically apparent retinopathy[J]. Chin J Ocul Fundus Dis, 2013, 29(5): 487-489. DOI: 10.3760/cma.j.issn.1005-1015.2013.05.010.

1. 胡立影, 李志清, 李筱荣, 等. 前部缺血性视神经病变患眼视盘血流灌注的光相干断层扫描血管成像观察[J].中华眼底病杂志, 2016, 32(3): 275-277. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.011.Hu LY, Li ZQ, Li XR, et al. Optical coherence tomography angiography in anterior ischemic optic neuropathy[J].Chin J Ocul Fundus Dis, 2016, 32(3): 275-277. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.011.
2. 曾苗, 陈晓, 宋艳萍, 等. 视网膜中央静脉阻塞患眼光相干断层扫描血管成像与荧光素眼底血管造影检查结果对比分析[J].中华眼底病杂志, 2016, 32(4): 362-366. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.005.Zeng M, Chen X, Song YP, et al. Consistency analysis of optical coherence tomography angiography and fundus fluorescein angiography in the diagnosis of central retinal vein occlusion[J].Chin J Ocul Fundus Dis, 2016, 32(4): 362-366. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.005.
3. 苏钰, 陈长征, 易佐慧子, 等. 视网膜静脉阻塞患眼光相干断层扫描血管成像观察[J].中华眼底病杂志, 2016, 32(4): 357-361. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.004.Su Y, Chen CZ, Yi ZHZ, et al. Optical coherence tomography angiography in retinal vein occlusion[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 357-361. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.004.
4. Jia Y, Wei E, Wang X, et al. Optical coherence tomography angiography of optic disc perfusion in glaucoma[J].Ophthalmology, 2014, 121(7): 1322-1332. DOI: 10.1016/j.ophtha.2014.01.021.
5. Jia Y, Bailey ST, Wilson DJ, et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration[J].Ophthalmology, 2014, 121(7): 1435-1444. DOI: 10.1016/j.ophtha.2014.01.034.
6. Nelson DA, Burgansky-Eliash Z, Barash H, et al. High-resolution wide-field imaging of perfused capillaries without the use of contrast agent[J].Clin Ophthalmol, 2011, 5: 1095-1106. DOI: 10.2147/OPTH.S20103.
7. Tam J, Dhamdhere KP, Tiruveedhula P, et al. Disruption of the retinal parafoveal capillary network in type 2 diabetes before the onset of diabetic retinopathy[J].Invest Ophthalmol Vis Sci, 2011, 52(12): 9257-9266. DOI: 10.1167/iovs.11-8481.
8. Kim DY, Fingler J, Zawadzki RJ, et al. Noninvasive imaging of the foveal avascular zone with high-speed, phase-variance optical coherence tomography[J].Invest Ophthalmol Vis Sci, 2012, 53(1): 85-92. DOI: 10.1167/iovs.11-8249.
9. Tam J, Dhamdhere KP, Tiruveedhula P, et al. Subclinical capillary changes in non-proliferative diabetic retinopathy[J].Optom Vis Sci, 2012, 89(5): 692-703. DOI: 10.1097/OPX.0b013e3182548b07.
10. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med, 1998, 15(7): 539-553.
11. Shahlaee A, Pefkianaki M, Hsu J, et al. Measurement of foveal avascular zone dimensions and its reliability in healthy eyes using optical coherence tomography angiography[J].Am J Ophthalmol, 2016, 161: 50-55. DOI: 10.1016/j.ajo.2015.09.026.
12. 于强, 刘万丽, 闫宏, 等. 糖尿病视网膜病变筛查的方法比较研究[J].中华眼底病杂志, 2006, 22(1): 45-46.Yu Q, Liu WL, Yan H, et al. Comparative study on screening methods of diabetic retinopathy[J].Chin J Ocul Fundus Dis, 2006, 22(1): 45-46.
13. 陈喆, 张丽芳, 广崎真史, 等. 糖尿病视网膜病变眼底彩色照片的读片可信度分析[J].中华眼底病杂志, 2006, 22(1): 47-48.Chen Z, Zhang LF, Guang QZS, et al. Reading reliability analysis of fundus photographs of diabetic retinopathy[J].Chin J Ocul Fundus Dis, 2006, 22(1): 47-48.
14. McLeod DS, Lefer DJ, Merges C, et al. Enhanced expression of intracellular adhesion molecule-1 and P-selectin in the diabetic human retina and choroid[J]. Am J Pathol, 1995, 147(3): 642-653.
15. Miyamoto K, Khosrof S, Bursell SE, et al. Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition[J]. Proc Natl Acad Sci USA, 1999, 96(19): 10836-10841.
16. Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study[J].Am J Ophthalmol, 2015, 160(1): 35-44. DOI: 10.1016/j.ajo.2015.04.021.
17. 黄江, 徐国旭, 魏晓红, 等. 无明显糖尿病视网膜病变的2型糖尿病患者多焦视网膜电图特征分析[J].中华眼底病杂志, 2013, 29(5): 487-489. DOI: 10.3760/cma.j.issn.1005-1015.2013.05.010.Huang J, Xu GX, Wei XH, et al. Characteristics of the multifocal electroretinogram in type 2 diabetes without clinically apparent retinopathy[J]. Chin J Ocul Fundus Dis, 2013, 29(5): 487-489. DOI: 10.3760/cma.j.issn.1005-1015.2013.05.010.

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Observation of macular microvascular changes in eyes of patients of type 2 diabetes without clinical features of diabetic retinopathy by optical coherence tomography angiography

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