Changes in Retinal Microcirculation Precede the Clinical Onset of Diabetic Retinopathy in Children With Type 1 Diabetes Mellitus (original) (raw)

2019, American Journal of Ophthalmology

To investigate whether abnormal glucose metabolism in diabetes mellitus (DM) affects the retinal microcirculation of children with wellcontrolled type 1 DM and to compare these results with those obtained from healthy children. DESIGN: Cross-sectional prospective study. METHODS: This study enrolled 60 patients with DM without clinically detectable diabetic retinopathy (DR) and who met 57 age-matched controls. Optical coherence tomography angiography (OCT-A) was performed using AngioVue (Avanti, Optivue). Foveal avascular zone (FAZ) area, non-flow area, superficial and deep vessel densities, FAZ perimeter, acircularity index of FAZ (AI; the ratio of the perimeter of FAZ and the perimeter of a circle with equal area), and foveal density (FD-300; vessel density in 300 microns around FAZ) were analyzed. Correlations between the investigated OCT-A parameters with DM duration and glycated hemoglobin (HbA1c) levels were evaluated among patients with type 1 DM. RESULTS: Differences in the mean values for FAZ perimeter, AI, and FD-300 were statistically significant between DM group and control group (P<0.001, P=0.001 and P=0.009, respectively). There were also statistically significant differences between the groups for vessel densities of deep superior hemiparafovea, deep temporal parafovea, and deep superior parafoveal zones (P=0.008, P=0.015 and P=0.005, respectively). There were no significant correlations between DM duration and HbA1c levels with the investigated OCT-A parameters. CONCLUSION: Diabetic eyes without clinically detectable DR exhibited alterations in FD-300, AI, perimeter, and vessel density of parafoveal capillaries in deep capillary plexus preceding the enlargement of FAZ; therefore, these new parameters might be sensitive imaging biomarkers to define early DR.