Central retinal thickness and retinal vascular filling state of diabetic patients without retinopathy or with nonproliferative diabetic retinopathy
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Objective To study the relationship between central retinal thickness and retinal vascular filling state of patients with non-proliferative diabetic retinopathy (NPDR).Methods A total of 248 diabetic patients without retinopathy or with NPDR in the hospital were enrolled in the study.Only the right eye of these patients were examined by optical coherence tomography (OCT),fundus fluorescein angiography (FFA),color Doppler flow imaging (CDFI).Patients with central retinal edema,hemorrhage and exudation were excluded from this study.Central retinal thickness was measured by OCT at the points of 1 mm,1 to 3 mm,and 3 to 6 mm from the fovea.The patients were divided into retinal thickness normal,thinning and thickening groups according to their central retinal thickness.The normal range of central retinal thickness was defined as 216.4-304.9 μm in this study.The arm retinal circulation time and retinal arterial phase and venous phase (A-V) fluorescence filling time were recorded by FFA examination.The peak systolic velocity (PSV),pulsatility index (PI) and resistance index (RI) of ophthalmic artery (OA),central retinal artery (CRA) and posterior ciliary artery (PCA) were measured by CDFI examination.The retinal fundus vascular filling state and ocular hemodynamic indexes were compared between different groups.Results The arm retinal circulation time of retinal thickness normal,thinning,thickening groups was (10.42±0.51),(10.36±0.64),(12.94±0.46) seconds respectively; the retinal A-V fluorescence filling time was (9.15±1.36),(6.36±1.15),(13.56±2.04) seconds.The difference of the arm retinal circulation time was statistically significant between the thickening and normal groups (t=1.93,P=0.04),and between the thickening and thinning groups (t=4.49,P=0.00).The retinal A-V fluorescence filling time was statistically significant between the thinning and normal groups (t=2.13,P=0.03),and between the thickening and normal groups (t=2.49,P=0.02),and between the thickening and thinning groups (t=5.38,P=0.00).The difference of PSV (t=3.290,-5.520,-4.900),PI (t=-4.310,-5.230,-4.390) and RI (t=4.970,6.160,5.990) of OA,CRA and PCA was statistically significant between the thickening and thinning groups (P＜0.05).Conclusion Central retinal thickness can affect the retinal vascular filling state of diabetic patients without retinopathy or with NPDR.
Key words:
Retinal vessels/physiopathology; Fluorescein angiography; Diabetic retinopathyKeywords:
Central retinal artery
Fundus (uterus)
Hypertensive retinopathy
Objective To investigate the correlation between the ocular hemodynamic changes and diabetic retinopathy in type 2 diabetic patients.Methods Eighty-two eyes in 41 type 2 diabetic patients with diabetic retinopathy were examined by color Doppler imaging to investigate hemodynamic changes of ophthalmic artery(OA),central retinal artery(CRA)and posterior ciliary artery (PCA).Slit-lamp,ophthalmoscope and fundus fluorescein angiography examination were applied on all the patients,and the patients were divided into NPDR group,PDR group and NDR group according to the ocular fundi changes.The results were compared with those of the normal control group.Results The peak systolic velocity(PSV),end diastolic velocity(EDV)and VM of OA,CRA and PCA in type 2 diabetic patients with diabetic retinopathy were lower than those of the normal control group while RI inereased.The difference between NPDR group ,NDR group and control group was significant(P0.05)while the difference between PDR group and control group more significant(P0.01).Conclusion There is a close relationship between ocular hemodynamic changes and the development of diabetic retinopathy in type 2 diahetic patients.Color Doppler imaging can provide valuable information about retinal perfusion and retinal function changes,and it is also significant for evaluating degrees of diabetic retinopathy.
Central retinal artery
Fundus (uterus)
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Background and Objectives: In patients with diabetes mellitus (DM), the neural retina is starting to degenerate before the development of vascular lesions. Our purpose was to investigate the correlation between the retinal arterial morphometric parameters and structural neurodegeneration in patients with type 2 DM with no or mild diabetic retinopathy (DR). Materials and Methods: This is a prospective study including 53 eyes of patients with type 2 DM and 32 eyes of healthy controls. Based on SD-OCT (spectral domain—optical coherence tomography) images, using a micro-densitometry method, we measured the outer and luminal diameter of retinal arteries and calculated the AWT (arterial wall thickness), WLR (wall-to-lumen ratio), and WCSA (wall cross-sectional area). GCL (ganglion cell layer) and RNFL (retinal nerve fiber layer) thickness were analyzed in correlation with the retinal arterial morphometric parameters mentioned above. Results: GCL was thinner in the inner quadrants in the NDR (no DR) group compared to controls (p < 0.05). RAOD (retinal artery outer diameter), RALD (retinal artery lumen diameter), AWT, WLR, and WCSA were similar between groups. A regression model considering age, gender, duration of DM, and HbA1C was carried out. Central GCL thickness was correlated positively with RAOD (coefficient 0.360 per µm, p = 0.011), RALD (coefficient 0.283 per µm, p = 0.050), AWT (coefficient 0.304 per µm, p = 0.029), and WCSA (coefficient 3.90 per µm, p = 0.005). Duration of DM was positively correlated with WCSA (coefficient 0.311 per one year duration of diabetes, p = 0.043). Conclusions: Significant GCL thinning in the inner quadrants preceded the morphological retinal arterial morphometric changes, supporting the neurodegeneration as primary pathogenic mechanism in DR.
Lumen (anatomy)
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Retinal circulation times were measured in all measurable retinal areas using fluorescein video angiography and image analysis systems. The subjects cornsted of 16 non-proliferative diabetic retinopathy eyes and 31 normal eyes. In the diabetic eyes no non-perfusion area was found on fluorescein angiograms. Retinal circulation times were measured when 16%, 33%, 50%, 66% or 83% of the total fluorescence volume was reached. Measured retinal areas consisted of 61 areas in diabetic eyes and 120 areas in normal eyes. Retinal circulation times of 50% and under flowed were found significantly shorter in the diabetic eyes than in the normal eyes (p less than 0.03). These results showed that blood flow volume of the shorter way in retinal circulation might increase in non-proliferative diabetic retinopathy.
Circulation (fluid dynamics)
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To determine the contribution of retinal vessel density (VD), central retinal vessel diameter and retinal oxygen (O2 ) saturation independently of other known risk factors in the development of non-proliferative diabetic retinopathy (NPDR).Macular optical coherence tomography angiography (OCTA), central retinal artery/vein equivalent diameter (CRAE/CRVE) measurements and retinal oximetry were performed in a cross-sectional study of 166 eyes from 166 individuals with type 1 diabetes (T1D) aged 14-30 years. Multiple logistic regression analysis was used to investigate whether O2 saturation, retinal vessel diameters and vessel density in the deep capillary plexus (VD-DCP) were associated with NPDR, when adjusting for known risk factors. The individuals were allocated to one group without and one group with NPDR.Multiple logistic regression analysis showed that age (OR = 1.25, 95% CI: 1.04-1.49) and AV-difference in O2 saturation (OR = 0.85, 95% CI 0.77-0.93) were significantly associated with NPDR.Our findings suggest that age and lower AV-O2 saturation difference contribute to explaining the grade of NPDR independently of other well-known risk factors. Reduced delivery of O2 to the retinal tissue is associated with the development of NPDR in young patients with T1D and should be given appropriate weight in the risk stratification at early stages of the disease.
Oxygen Saturation
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Objectives: To investigate the damage to the retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GCL+) in diabetic patients without retinal microangioma and to determine the kind of nerve damage more likely to indicate early injury. Subjects and methods: We included 360 patients (360 eyes) with type 2 diabetes mellitus and 168 healthy volunteers (168 eyes). Patients with retinal microangioma were excluded by fundus fluorescein angiography (FFA). The parameters around the optic disc and macular area were measured by optical coherence tomography (OCT). Results: The peripapillary RNFL thickness was thinner in the temporal (72.98 ± 13.76 μm, P < 0.0001) and inferior (120.71 ± 21.43 μm, P = 0.0103) sectors in patients with no diabetic retinopathy (NDR) compared to healthy controls. The reduction of retinal thickness in the macular region was prominent in the inferior sector in patients (34.74 ± 4.92 μm, P < 0.0001) compared to normal controls. Thinning of GCL+ in the second region of the macular area was significant in patients with NDR compared to normal controls (P < 0.05). However, no difference in the GCL+ and retinal thicknesses of the central macular region was observed between the patients with NDR and healthy controls. Using the 5th percentile (P5) of normal controls as the reference value, we found that the parameters with the highest indices in patients with NDR were the inferior and temporal peripapillary RNFL thickness (13.0%), the inferior RNFL thickness in the macular area (20%), the inferior retinal thickness in the outer ring of the macular area (10.8%), and the inferior GCL+ thickness in the macular area (10.6%). The GCL+ and RNFL thicknesses in the central macular area accounted for the smallest proportion in P5 of normal controls (3%). Conclusions: Retinal nerve injury can occur in patients without retinal microangioma. The inferior RNFL in the macular area and the inferior and temporal peripapillary RNFL were most sensitive to glucose damage. These areas might be associated with early detection of diabetic retinopathy (DR) as they are more likely to indicate early damage.
Fundus (uterus)
Ganglion cell layer
Optic disc
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Using adaptive optics scanning laser ophthalmoscopy (AOSLO), we measured retinal blood velocity and flow in healthy control eyes and eyes of diabetic patients with or without retinopathy. This cross-sectional study included 39 eyes of 30 patients with diabetes (DM) with mild non-proliferative diabetic retinopathy (NPDR) or without retinopathy (DM no DR) and 21 eyes of 17 healthy age-matched controls. Participants were imaged with a commercial optical coherence tomography angiography (OCTA) device (RTVue-XR Avanti) and AOSLO device (Apaeros Retinal Imaging System, Boston Micromachines). We analyzed AOSLO-based retinal blood velocity and flow, and OCTA-based vessel density of the superficial (SCP), deep retinal capillary plexus (DCP), and full retina. Retinal blood velocity was significantly higher in eyes with DM no DR and lower in NPDR across all vessel diameters compared to controls. Retinal blood flow was significantly higher in DM no DR and lower in NPDR in vessel diameters up to 60 μm compared to controls. When comparing flow outliers (low-flow DM no DR eyes and high-flow NPDR eyes), we found they had a significantly different retinal vessel density compared to the remaining eyes in the respective groups. Retinal blood velocity and flow is increased in eyes with DM no DR, while these parameters are decreased in eyes with mild NPDR compared to healthy age-matched controls. The similarity of OCTA vessel density among outliers in the two diabetic groups suggests an initial increase followed by progressive decline in blood flow and OCTA vessel density with progression to clinical retinopathy, which warrants further investigation.
Scanning laser ophthalmoscopy
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Abstract Background To investigate the changes in retinal nerve fiber layer thickness and macular blood flow density during the preclinical stage of diabetic retinopathy and their relationship with blood glucose. Methods In this cross-sectional study, 97 diabetic patients (total of 188 eyes; 144 eyes in no diabetic retinopathy group, 44 eyes in mild diabetic non-proliferative retinopathy group) and 35 healthy people (70 eyes) were enrolled, All the subjects were divided into different groups based on their HbA1c levels, and they underwent optical coherence tomography angiography. We compared the optical coherence tomography angiography parameters and retinal nerve fiber layer thickness among the different glucose groups. Results The parafoveal vessel density and the temporal retinal nerve fiber layer thickness were lower ( p < 0.05) in the diabetic group than in the normal group. The diabetic group showed a higher acircularity index than the normal group. The normal group had the highest vessel density and the lowest acircularity index, followed by the no-diabetic retinopathy group and the mild non-proliferative retinopathy group, ( p < 0.001). Foveal vascular density and parafoveal vessel density decreased with an increase in HbA1c. There was a negative correlation between parafoveal vessel density in the deep retinal vascular layer and fasting blood glucose ( p < 0.01). The temporal retinal nerve fiber layer thickness decreased across the HbA1c level groups, and was positively correlated with the parafoveal vessel density in the superficial retinal vascular layer ( p < 0.05). Conclusions This study shows that retinal microvasculopathy and neuropathy can be present in the absence of retinopathy. The vessel density of the deep retinal vascular layer was negatively correlated with fasting blood glucose, and the temporal retinal nerve fiber layer thickness was positively correlated with the vessel density of the superficial retinal vascular layer. These indicators are helpful for endocrinologists and ophthalmologists in detecting early diabetic retinal pathological lesions.
Neurovascular bundle
Nerve fiber
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To explore the influence factors of retinal vascular changes in diabetes patients.Case control study. One hundred and fifty-five type 2 diabetes patients were divided into NDR group (n=80) and DR group (n=70) according to the presence of diabetic retinopathy. Fundus photographs were taken after pupil dilated, the diameter of retinal arterioles and venules were measured between 1.0 PD and 1.5 PD. To analyze the relationship between retinal artery diameter, vein diameter and hypertension, diabetes duration, and DR stage. With retinal artery and vein diameter as the dependent variable, DR stage, hypertension, diabetes duration, insulin using time and age as independent variables, using step method, multiple linear regression was undergoing.The diameter of retinal vein in DR group and NDR group were (90.37+7.95) and (83.45±7.80) μm, the difference was statistically significant (t=5.446, P=0.000). Retinal vein diameter was positively correlated with DR stage and diabetes duration (r=0.377, 0.250; P=0.000, 0.002). DR stage (b=2.382, P=0.000) had a linear relationship with retinal vein diameter (R(2)=0.142, F=25.285). The regression equation was: retinal vein diameter =84.269+ 2.382 · DR stage. Retinal artery diameter was negatively correlated with DR stage, diabetes duration, and hypertension duration (r=-0.453, -0.343, -0.199. P=0.000, 0.000, 0.013). DR stage (b=-2.091, P=0.000) and age (b=-0.182, P=0.000) has a linear relationship with retinal artery diameter (R(2)=0.290, F=31.088). The regression equation was: retinal artery diameter =64.011-2.091·DR stage -0.182·age.With DR developed, retinal vein diameter increases, retinal artery diameter decreases in diabetic patients. The duration of diabetes mellitus and hypertension were not related to the diameter of retinal artery and vein.
Fundus (uterus)
Central retinal artery
Retinal Artery
Retinal Vein
Central retinal vein
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Objective We evaluated the retrobulbar haemodynamics changes of retinal detachment patients using color Doppler ultrasound technique. Methods Color Doppler ultrasound were used to measure peak systolic velocity (PSV) ,end diastolic velocity(EDV) ,average velocity(AV) , resistance index (RI) and pulsation index (PI) of ophthalmic artery(OA),central retinal artery(CRA) and posterior ciliaries (PCA) in 60 retinal detachment patients of 62 rhegmat-ogenous eyes and also 58 normal control of 38 healthy eyes. Results The flow rates of ophthalmic artery( OA ) in retinal detachment patients had no difference compare with normal control( P 0.05). The PSV, EDV and AV of CRA and PCA in different retinal detachment patients all decreased( P 0.01 = but the PI and RI had no difference( P 0. 05) . The degree of decrease were relatived with the damaging degree of retinal detachment, but they had no difference( P 0.05). Conclusions The haemodynamics changes of retinal detachment have direct influence on microcirulation condition of retinal. This can provide significant foundations of retinal detachment pathological mechanism research and clinic phamic assisted therapy.
Central retinal artery
Retinal Artery
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In the present study, the retinal and choroidal vascular densities (VDs) in type 2 diabetes mellitus (DM) patients were analyzed using optical coherence tomography angiography (OCTA).The study included 282 eyes of 152 patients with type 2 DM (114 without retinopathy, 79 nonproliferative diabetic retinopathy (NPDR), 48 severe NPDR, and 41 proliferative diabetic retinopathy (PDR) eyes). The superficial and deep retinal vessel, choriocapillaris, and choroidal VDs were measured using a binarization method on OCTA images. VDs were compared based on retinopathy severity. Correlations among densities were analyzed.Retinal and choriocapillaris VDs were lower in PDR than in NPDR (all P < 0.05). Correlation analysis showed significant positive correlations among densities of superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Choroidal VD showed a negative correlation with superficial and deep retinal vessels and choriocapillaris (all P < 0.001). Retinal and choriocapillaris VDs showed a negative correlation with diabetic retinopathy (DR) grade (all P < 0.001); however, the choroidal VD showed a weak positive correlation (P=0.030).Choroidal VD increased as retinal and choriocapillaris VDs decreased, indicating that the outer layer of the choroid is less affected by DR severity and VD of larger choroidal vessels may even be increased as a compensatory mechanism for decreased retinal and choriocapillaris VDs in type 2 DM patients.
Choroid
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