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EARLY MICROVASCULAR AND NEURAL CHANGES IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS WITHOUT CLINICAL SIGNS OF DIABETIC RETINOPATHY

Vujosevic, Stela MD, PhD*; Muraca, Andrea MD*; Alkabes, Micol MD*; Villani, Edoardo MD†,‡; Cavarzeran, Fabiano ScD§; Rossetti, Luca MD; De Cilla', Stefano MD*,**

doi: 10.1097/IAE.0000000000001990
Original Study
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Purpose: To assess and compare early modifications in inner retinal layer thickness and optical coherence tomography angiography parameters in patients with diabetes mellitus (DM) Types 1 and 2 without clinical signs of diabetic retinopathy.

Methods: Ninety eyes of 90 subjects (24 Type 1 DM, 36 Type 2 DM, and 30 healthy controls) were prospectively evaluated with spectral domain OCT, swept-source OCT angiography, and color fundus photography (on the same day). Retinal nerve fiber layer, ganglion cell layer (GCL+), and nerve fiber layer + GCL+ (GCL++) thickness were automatically determined by the instrument in the 1, 3, and 6 central mm. On OCT angiography, the following parameters were evaluated: area of foveal avascular zone, number of focally dilated endings of the capillaries (detected only on OCT angiography), presence of regular/irregular foveal avascular zone, capillary loss, and capillary network irregularities in the superficial capillary plexus (SCP) and deep capillary plexus (DCP).

Results: Ganglion cell layer+ (P = 0.0099) and GCL++ (P = 0.0367) were significantly thicker in DM Type 1 versus DM Type 2 in 1 central mm, after adjustment for age and DM duration. The area of foveal avascular zone was significantly larger in DM Type 1 versus controls in both SCP and DCP and in DM Type 1 versus Type 2 only in DCP (P < 0.05 for all); the number of focally dilated endings of the capillaries was higher in DM Type 1 versus controls in both SCP and DCP (P < 0.01 for all); and in DM Type 2 versus controls only in DCP (P = 0.007). Perifoveal capillary loss in SCP and inner retinal layer thickness had the highest correlation in both DM types.

Conclusion: There are specific neural and microvascular modifications even before clinical signs of diabetic retinopathy in DM Types 1 and 2. Perifoveal capillary loss in the SCP is highly correlated with inner retinal layer. These data may help in characterization of patients at the preclinical stage of diabetic retinopathy.

In diabetes mellitus Type 1 and Type 2, specifi c neural and microvascular alterations occur at the preclinical stage of diabetic retinopathy as recorded by optical coherence tomography and optical coherence tomography angiography. These data may help in better characterization of early neurovascular changes in diabetes mellitus.

*Eye Unit, University Hospital Maggiore della Carita', Novara, Italy;

Department of Clinical Science and Community Health, University of Milan, Milan, Italy;

Eye Clinic, San Giuseppe Hospital, Milan, Italy;

§Department of Neuroscience, University of Padova, Padova, Italy;

Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy; and

**Department of Health Science, University East Piedmont “A. Avogadro”, Novara, Italy.

Reprint requests: Stela Vujosevic, MD, PhD, University Hospital Maggiore della Carita', Eye Unit, Corso Mazzini 18, 28100 Novara, Italy; e-mail: stela.vujosevic@gmail.com

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.