Open AccessAssociation between Neurodegeneration and Macular Perfusion in the Progression of Diabetic Retinopathy: A 3-Year Longitudinal Study
Author(s) -
Inês Marques,
Sónia Ferreira,
Torcato Santos,
Maria Madeira,
Ana Rita Santos,
Luís Mendes,
Conceição Lobo,
José CunhaVaz
Publication year - 2022
Publication title -
ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.639
H-Index - 60
eISSN - 1423-0267
pISSN - 0030-3755
DOI - 10.1159/000522527
Subject(s) - diabetic retinopathy , medicine , ophthalmology , retinal , fundus photography , population , diabetes mellitus , retinopathy , ganglion , ganglion cell layer , fundus (uterus) , retina , plexus , fluorescein angiography , anatomy , endocrinology , psychology , environmental health , neuroscience
Objective and purpose: To explore the relation between retinal neurodegenerative changes and vessel closure (VC) in individuals with non-proliferative diabetic retinopathy (NPDR) in a follow-up period of 3 years.Design: 3-year prospective longitudinal study with four annual visits.Participants: 74 individuals with type 2 diabetes, NPDR and ETDRS grades from 10 to 47, one eye/person. An age-matched healthy control population of 84 eyes was used as control group.Methods: Participants were annually examined by color fundus photography (CFP), spectral domain-optical coherence tomography (SD-OCT) and OCT-Angiography (OCTA). Vessel closure was assessed by OCTA vessel density maps. SD-OCT segmentations was performed to access central retinal thickness (CRT) and retinal neurodegeneration considered as thinning of the ganglion cell plus inner plexiform layer (GCL+IPL). Results: Type 2 diabetic individuals presented significantly higher CRT (p=0.001), GCL+IPL thinning (p=0.042), and decreased vessel density at the superficial capillary plexus (p<0.001) and full retina (p=0.001). When looking at changes occurring over the 3-year period of follow up (Table 2), there were statistically significant decreases in GCL+IPL thickness (-0.438 µm/year; p=0.038), foveal avascular zone circularity (-0.009; p=0.047), and vessel density, in superficial capillary plexus (-0.172 mm-1/year; p<0.001), deep capillary plexus (-0.350 mm-1/year; p<0.001) and full retina (-0.182 mm-1/year; p<0.001). A statistically significant association was identified between GCL+IPL thinning and decrease in deep capillary plexus vessel density (β = 0.196 [95% CI 0.037, 0.355], z = 2.410, p = 0.016), after controlling for age, gender, diabetes duration, hemoglobin A1c level, and CRT. Conclusions: Retinal neurodegenerative changes show a steady progression during a 3-year period of follow-up in eyes with NPDR and appear to be directly associated with progression in decreased vessel density including vascular closure through preferential involvement of the deep capillary plexus. Our findings provide evidence that retinal neuropathy is linked with microvascular changes occurring in diabetic patients.