Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Abstract

PURPOSE. To evaluate peripapillary vessel density and morphology in patients with diabetes mellitus (DM) without clinical signs of diabetic retinopathy (DR) and with mild, nonproliferative DR and to correlate with peripapillary nerve fiber layer (NFL) thickness. METHODS. One hundred seventeen eyes (34 healthy controls, 54 patients with DM without DR [noDR group] and 24 patients with mild DR [DR group]) were prospectively evaluated. All subjects underwent peripapillary and macular optical coherence tomography angiography (OCT-A). Peripapillary NFL thickness was also recorded. OCT-A slab of radial peripapillary plexus (RPC) and macular superficial capillary plexus (SCP) were analysed in order to calculate perfusion density (PD) and vessel density (VD). Further an image analysis of RPC slab was performed to identify number of branches (NoB) and total branches length (tBL). RESULTS. In peripapillary area there was a significant decrease in VD (P ¼ 0.003), NoB (P < 0.001), and tBL (P < 0.001) in noDR group versus controls; PD values were not different among groups (P ¼ 0.126); there was a significant decrease in average NFL thickness in DR versus controls (P ¼ 0.008) and in the inferior quadrant in noDR group versus controls (P ¼ 0.03); there was a significant correlation between OCT-A and NFL thickness values (q ranging from 0.19-0.57). In macular region PD and VD were decreased only in DR group (P < 0.05). CONCLUSIONS. There are early changes in the peripapillary vessel morphology and VD of the RPC in patients with DM without DR that correlate to NFL thinning. Earlier changes in superficial vessel density are documented in the peripapillary than in the macular region. These data may confirm a coexistence of an early neuronal and microvascular damage in patients with DM without clinical signs of DR.

Retinal Microcirculation in Predicting Diabetic Nephropathy in Type 2 Diabetic Patients without Retinopathy

“…Developments in analytic software programs have enabled us to better evaluate the vessel density of the disc area. Previous studies have suggested that peripapillary capillary density was reduced in DM patients without DR and may be a useful parameter in the detection of early-stage DR [20][21][22]. In the present study, it was determined that the mean vessel density values of the whole disc and peripapillary area were also reduced in patients with microalbuminuria compared to patients with normoalbuminuria and controls.…”

Effects of Prolonged Type 2 Diabetes on the Inner Retinal Layer and Macular Microvasculature: An Optical Coherence Tomography Angiography Study

“…Vujosevic et al [38] found a significant correlation between OCTA parameters such as perfusion density or VD and RNFL thickness in the peripapillary area. Mase et al [39] explained this correlation that radial peripapillary plexus is the most important structure in maintaining RNFL integrity.…”

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

“…However, the vast majority of studies have been performed in patients with type 2 DM, [7][8][9][10][11][12][13][14][15] and many of them do not distinguish between patients with type 1 DM and patients with type 2 DM. [16][17][18][19][20] The pathophysiology of both DM types is considerably different, and patients present well-differentiated clinical characteristics. Whereas type 1 DM is less frequent, commonly affects younger patients, and it is a lifelong standing disease, patients with type 2 DM are more prevalent, they tend to be older, and frequently present concomitant cardiovascular pathologies, such as blood hypertension, metabolic syndrome, or dyslipidemia.…”