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Retinal Capillary Nonperfusion in Preclinical Diabetic Retinopathy.

Torcato Santos1, Ana Rita Santos1,2, Ana Catarina Almeida1

  • 1AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.

Ophthalmic Research
|October 11, 2023
PubMed
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Optical coherence tomography angiography (OCTA) detects early retinal microvascular changes in type 2 diabetes (T2D) patients before visible retinopathy appears. This allows for early identification of the ischemic phenotype in preclinical diabetic retinal disease.

Area of Science:

  • Ophthalmology
  • Diabetology
  • Medical Imaging

Background:

  • Type 2 diabetes (T2D) poses a significant risk for developing diabetic retinopathy.
  • Early detection of microvascular changes is crucial for managing T2D complications.
  • Ultra-widefield fundus photography (UWF-FP) can identify preclinical retinopathy.

Purpose of the Study:

  • To identify retinal microvascular changes using OCTA in T2D patients with preclinical retinopathy.
  • To correlate UWF-FP findings with OCTA metrics in early diabetic changes.

Main Methods:

  • Cross-sectional observational study.
  • UWF-FP (200°) and spectral-domain OCTA (SD-OCTA) 3x3 mm acquisitions were performed.
  • Analysis included skeletonized vessel density (SVD), perfusion density (PD), and capillary nonperfusion (CNP) in superficial (SCP) and deep (DCP) capillary plexuses.
Keywords:
Diabetic retinopathyOptical coherence tomography angiographyPreclinical diabetic retinopathyRetina nonperfusionUltra-widefield imaging

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Main Results:

  • SD-OCTA revealed significantly decreased SVD and PD, and increased CNP in T2D patients compared to healthy controls (p<0.001).
  • Microvascular changes, particularly decreased SVD and CNP, were more prevalent in the SCP (35-45%) than the DCP (9-15%).
  • These findings indicate earlier changes in the SCP, suggesting an ischemic phenotype in preclinical diabetic retinal disease.

Conclusions:

  • Retinal capillary nonperfusion, assessed by OCTA metrics (SVD, CNP), is detectable in the central retina of T2D patients before visible lesions manifest.
  • OCTA is highly relevant for identifying macular microvascular alterations in the early stages of diabetic retinopathy.
  • This enables very early identification of the ischemic phenotype in the disease progression.