ABSTRACT
In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers.
Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Retinopathy , Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy/complications , Diabetic Retinopathy/etiology , Humans , Retina , Tomography, Optical Coherence/methods , Vision, OcularABSTRACT
La retinopatía diabética (RD) tradicionalmente se ha considerado parte de un proceso vascular. Investigaciones recientes sugieren que la degeneración de la retina en la diabetes mellitus (DM) podría ser causada también por una neuropatía y que la neurodegeneración retiniana precedería a las alteraciones microvasculares. El presente artículo revisa la bibliografía existente sobre neurodegeneración en pacientes con DM tipo 2 (DM2) sin RD. En los pacientes con DM2 no severa, temprana, con buen control metabólico y sin RD, las pruebas de función visual muestran anormalidades precoces que anteceden a la aparición de la RD clínica (la que diagnosticamos con una exploración oftalmológica convencional). Utilizando la tomografía de coherencia óptica (OCT) se observa que en estos pacientes existe una disminución en el espesor de distintas capas de la retina, tanto en el área macular como peripapilar. Recientes estudios sugieren que las complicaciones sistémicas (especialmente la isquemia) y una posible alteración microvascular contribuyen a la neurodegeneración retiniana, lo que abre la puerta a nuevos estudios que incluyan nuevas técnicas de evaluación de la microvascularización de las capas internas de la retina como la angio-OCT (AU)
In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers (AU)
Subject(s)
Humans , Diabetes Mellitus, Type 2 , Retinal Diseases/diagnostic imaging , Neurodegenerative Diseases/diagnostic imaging , Tomography, Optical CoherenceABSTRACT
Purpose: To describe swept-source optical coherence tomography angiography (OCTA) findings in uveitic cystoid macular edema (CME).Methods: Prospective study of 36 eyes.Results: Cystoid black spaces were shown in the deep capillary plexus (DCP) in 36 eyes (100%) and in the superficial capillary plexus (SCP) in 6 eyes (16.7%). Grayish areas of capillary non perfusion/hypoperfusion were seen in 69.4% of eyes in the DCP (vs 25% in the SCP, p < .001). The foveal avascular zone was larger than in the control healthy eyes in the DCP (p < .001). Capillary density was lower than in the control group in the SCP (p = .001) and the DCP (p < .001). Of 11 eyes with resolved CME on OCT, 4 eyes showed complete recovery of both plexuses on OCTA. There was a persistence of areas of capillary rarefaction in 4 eyes, and of hypoperfusion/nonperfusion in 3 eyes.Conclusion: OCTA visualizes perifoveal microvascular changes in uveitic CME.
