Evaluation of the effect of full-process blood glucose management on T2DM cataract patients based on visual electrophysiology and OCTA

Abstract

To investigate the difference in preoperative retinal function in patients with type 2 diabetes cataract (DC) without obvious retinopathy and to explore the clinical application of full blood glucose management for improving the postoperative vision in DC patients. This was a retrospective analysis in which we estimated the changes in visual electrophysiology (N75, P100, photopic flash electroretinogram(FERG), and scotopic FERG, paraoptic retinal nerve fibre layer thickness (pRNFL) and paraoptic radial capillary network blood flow density (ppVD) of type 2 diabetes (T2DM) patients at different phases of disease progression along with fasting blood glucose (FBG) and glycosylated haemoglobin (HbAlC) levels before and after DC surgery at Ziyang Central Hospital from January 2020 to December 2022. Additionally, trends in the above data throughout the entire process of glucose management intervention were examined. As the course of T2DM progressed, FBG and HbA1c increased, the N75 and P100 latency periods of patients gradually increased, and the values of photopic FERG, scotopic FERG, pRNFL, and ppVD gradually decreased at each postoperative time point. Moreover, the best corrected visual acuity(BCVA) of patients after surgery gradually decreased ( P < 0.05). The BCVA of Group B (with full process blood glucose management) gradually stabilized at 1 month after surgery, and the BCVA of Group B was better than that of Group A at all time points after surgery. The results revealed that N75 and P100 in Group A were greater than those in Group B, whereas the photopic and scotopic FERG, pRNFL, and ppVD (%) values in Group A were lower than those in Group B. In addition, N75 and P100 in Group A gradually increased at various time points after surgery, whereas the photopic FERG, scotopic FERG, pRNFL, and ppVD (%) values gradually decreased. In the state of full blood glucose management, although N75 and P100 both reached their longest durations at one week after surgery, N75, the P100, photopic FERG, scotopic FERG, and pRNFL showed a gradually decreasing trend at 1 month and 3 months after surgery, whereas ppVD (%) gradually increased ( P < 0.05). According to the results of the quantitative analysis of visual electrophysiology and OCTA, with the aggravation of diabetes, the retinal function of DC patients without obvious retinopathy tends to decrease, but full-process blood glucose management can effectively recover the retinal function of DC patients and improve visual quality after surgery.