Assessment of early macular microangiopathy in subjects with prediabetes using optical coherence tomography angiography and fundus photography

• Published in: Acta diabetologica Vol. 61; no. 1; pp. 69 - 77
• Main Authors: El Sawy, Shereen, Bekhit, Mirrette, Abdelhamid, Alaa, Esmat, Sohair, Ashraf, Hala, Naguib, Mervat
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.01.2024; Springer Nature B.V
• Subjects: Angiography; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetic retinopathy; Diabetic Retinopathy - diagnostic imaging; Diabetic Retinopathy - etiology; Fluorescein Angiography - methods; Humans; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Original; Original Article; Perfusion; Photography; Prediabetic State - diagnosis; Retina; Retinal Diseases; Retinal Vessels - diagnostic imaging; Retinopathy; Tomography, Optical Coherence - methods; Retinopathy; Optical coherence tomography angiography; Prediabetes; Vascular density
• ISSN: 1432-5233; 0940-5429; 1432-5233
• DOI: 10.1007/s00592-023-02167-z

Aims Early detection of retinal microangiopathy in patients with prediabetes may reduce diabetic retinopathy complications. The aim of this study was to assess early macular vascular changes in prediabetics before development of over diabetes using OCTA and fundus photography. Methods In this cross-sectional study, 66 prediabetic individuals and 66 normal controls underwent clinical, laboratory, and fundus photography evaluation followed by OCTA macular imaging to examine for the foveal avascular zone, and area of capillary non-perfusion, thickness, disorganization of vessels, and vessel density perfusion percentage of superficial capillary plexus and deep capillary plexus. Results Retinal microangiopathy was detected in 36.4% of prediabetics by OCTA and only in 10.6% by fundus photography. None of clinical or laboratory parameters had significant association with DR. Area of capillary non-perfusion and disorganization of SCP were detected in 53.8% and 56.8%, respectively, in prediabetics. VDP of SCP and DCP of whole image, parafoveal, and perifoveal areas was significantly lower in prediabetes group compared to normal control. VDP of DCP of perifoveal area ( β coefficient: − 0.10, OR: 0.91, 95% CI: 0.86–0.96, P  < 0.001) and disorganization of DCP ( β coefficient: 1.93, OR: 6.89, 95% CI: 2.5–18.8, P  < 0.001) were significant predictors of DR in prediabetics. There was no difference in FAZ in prediabetics with and without retinopathy. Conclusions OCTA could detect early retinal vascular changes during the prediabetic state before developing diabetes. VDP was significantly reduced in prediabetic patients. Furthermore, VDP of DCP of perifoveal area and disorganization of DCP were the most important predictors of retinopathy in prediabetic patients .