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AIM: To investigate the relationship among the fasting plasma glucose coefficient of variation(FPG-CV)and macular morphology and microcirculation in patients with nonproliferative diabetic retinopathy(NPDR).METHODS: A retrospective analysis of 82 cases(82 eyes)with NPDR admitted to our hospital from February 2018 to June 2022 was the research object, and another 82 cases(82 eyes)of non-diabetic retinopathy(NDR)patients during the same period were selected as the control group, and the clinical data of the two groups of patients were analyzed. Multivariate Logistic regression was used to analyze the risk factors affecting the incidence of NPDR, and the back propagation(BP)neural network model was established and evaluated. Pearson correlation was used to analyze the correlation among FPG-CV and macular morphology and microcirculation in patients. RESULTS: The results of multivariate Logistic regression analysis showed that the disease duration ≥7.2a, glycated hemoglobin A1c(HbA1c)≥7.7%, triglyceride(TG)≥1.9 mmol/L, microalbuminuria(MALB)≥24.5 mg/L, FPG-CV ≥9.8%, superficial capillary plexus-vessel density(SCP-VD)<27.6%, deep capillary plexus-vessel density(DCP-VD)<47.7%, foveal avascular zone(FAZ)area ≥0.38 mm2, central retinal thickness(CRT)≥197.7 μm and subfoveal choroidal thickness(SFCT)<227.7 μm were risk factors for NPDR(P<0.05). The number of hidden layer nodes is 5, and the receiver operating characteristic(ROC)curve, calibration curve and clinical decision curve show that the prediction model has good discrimination, accuracy and validity. The results of Pearson correlation analysis showed that FPG-CV was negatively correlated with SCP-VD, DCP-VD and SFCT(P<0.05); FPG-CV was positively correlated with FAZ area and CRT(P<0.05).CONCLUSION: The course of disease, HbA1c, TG, MALB, FPG-CV, SCP-VD, DCP-VD, FAZ area, CRT and SFCT are all related to the pathogenesis of NPDR. With the increase of FPG-CV, the indexes of macular morphology and microcirculation changed. FPG-CV was negatively correlated with SCP-VD, DCP-VD and SFCT and positively correlated with FAZ area and CRT.
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AIM: To evaluate the macular microcirculation changes in patients with diabetic retinopathy(DR)by optical coherence tomography angiography(OCTA), and correlate the risk factors that may affect the macular microcirculation, so as to provide a clinical basis for early screening, diagnosis and therapeutic intervention for DR.METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1～3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all P<0.017), and the VD of the parafoveal was decreased in each quadrant(P<0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(P<0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(P<0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(P<0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(P<0.05), while total cholesterol and central macular thickness had no significant correlation with VD(P>0.05).CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.
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@#AIM:To compare the changes of macular microcirculation in eyes with idiopathic and diabetic macular epiretinal membrane(ERM)before and after pars plana vitrectomy(PPV), and to evaluate the prognosis of the two types of ERM.<p>METHODS:We conducted a retrospective study on 24 patients(24 eyes), 12 patients(12 eyes)with idiopathic macular epiretinal membrane(iERM)and 12 patients(12 eyes)with diabetic macular epiretinal membrane(dERM)who underwent PPV combined with ERM and internal limiting membrane(ILM)peeling from April 2020 to July 2020. In addition, 16 contralateral healthy eyes of iERM patients who underwent PPV combined with ERM and ILM removal from September 2019 to July 2020 were selected as the normal control group. All patients were followed up for more than 3mo. The area of foveal avascular zone(FAZ)and the macular vascular density(MVD), including superficial macular vascular density(SVD)and deep macular vascular density(DVD)were compared before and after surgery. And the prognosis was also analysed.<p>RESULTS: The area of FAZ in the iERM group and dERM group before surgery were significantly smaller than that in the control group(<i>P</i><0.05); The total SVD in the iERM and dERM groups were lower than that in the control group, and the dERM group was lower than that in the iERM group, but no statistically significant difference was found. The total DVD in the iERM and dERM groups was significantly lower than that in the control group(<i>P</i><0.05). The foveal SVD in the iERM was significantly higher than that in the dERM and control groups, and the foveal DVD in the iERM was significantly higher than that in the control group(<i>P</i><0.05). The parafoveal SVD in the iERM and dERM groups were lower than that in the control group, but only the difference was obvious between the dERM and the control group(<i>P</i><0.05). The parafoveal DVD in the iERM and dERM groups were significantly lower than that in the control group(<i>P</i><0.05). Postoperative visual acuity was significantly improved in the iERM group and dERM group(<i>P</i><0.05), but the SVD was barely changed. The total and parafoveal DVD in the iERM group were statistically higher than those before surgery(<i>P</i><0.05). DVD in the dERM group was higher than it was before surgery, but with no statistically difference. There were no differences in the visual acuity, SVD and DVD between the iERM and dERM groups after operation.<p>CONCLUSION: The changes of macular microcirculation in dERM were more obvious than those in iERM. DVD in the iERM patients was improved at the early stage after operation, while the improvement was not obvious in the dERM patients.
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We investigated the effects of panretinal photocoagulation (PRP)on macular microcirculation in diabetic retinopathy. PRP using argon blue green laser was performed in 23 eyes of 15 patients with early proliferative diabetic etinopathy and very severe nonproliferative diabetic retinopathy without significant macular edema. The changes in volume, flow, velocity of macular microcirculation were measured before PRP, 1 hour, 1 day, 1 week, and 1 month following PRP, using Heidelberg Retina Flowmeter(HRF). Mean volume, flow, velocity of macular microcirculation decreased to a maximal degree 1 hour following PRP, from 14.87+/-0.40, 387.45 +/-101.40, 1.40+/-0.28(before PRP)to 12.44+/-1.39, 347. 33+/-100.39, 1.27+/-0.34(p<0.05). From 1hour to 1 month after PRP, macular microcirculation gradually increased. However, throughout this period, all parameters of macular microcirculation remained lower than pre-PRP level(p<0.05). Our study suggests that panretinal photocoagulation reduces the macular microcirculation in diabetic retinopathy.