Retinal Perfusion Analysis of Children with Diabetes Mellitus Type 1 Using Optical Coherence Tomography Angiography

Area of Science:

• Ophthalmology
• Endocrinology
• Diabetology

Background:

• Type 1 diabetes (T1D) poses risks for microvascular complications, including diabetic retinopathy (DR).
• Early detection of retinal changes in T1D pediatric patients is crucial for management.
• Optical coherence tomography angiography (OCTA) allows non-invasive evaluation of retinal microvasculature.

Purpose of the Study:

• To assess retinal perfusion using OCTA in pediatric patients with T1D but no DR.
• To correlate OCTA parameters with metabolic factors (BMI, HbA1c) and insulin therapy type (MDI vs. CSII).

Main Methods:

• Thirty-one pediatric T1D patients were evaluated using OCTA.
• Analysis included foveal avascular zone (FAZ) and superficial/deep macular vessel density (VD).
• Correlation with BMI, HbA1c, and insulin delivery method (MDI/CSII) was determined.

Main Results:

• No significant differences in FAZ or VD were found between groups based on metabolic factors.
• HbA1c levels did not correlate with any OCTA parameters.
• Multiple daily injections (MDI) showed a trend towards reduced deep parafoveal/perifoveal vessel density compared to continuous subcutaneous insulin infusion (CSII).
• Elevated BMI correlated with increased deep macular and perifoveal vessel density.

Conclusions:

• Macular vessel density and FAZ are normal in T1D children without DR.
• Continuous subcutaneous insulin infusion (CSII) may offer protective benefits against retinal microvascular changes compared to MDI.
• Current glycemic control metrics like HbA1c may be insufficient; novel parameters are needed to assess DR risk.