Klinik olarak diyabetik retinopatisi olmayan tip 2 diyabetes mellitus hastalarında OKT angiografi ve edı okt ölçümleri ile retinal mikrovasküler değişikliklerin gösterilmesi
Yükleniyor...
Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Diyabetik retinopatisi (DR) olmayan tip 2 diyabetes mellitus (DM) hastalarında optik koherens tomografi angiografi (OKTA) ve yüksek çözünürlüklü optik koherens tomografi (EDI OKT) ölçümleri ile retinal mikrovasküler değişikliklerin gösterilmesi ve DR'nin erken evrede tespit edilmesini amaçladık. Gereç Ve Yöntem: Bu retrospektif çalışmaya kliniğimiz Retina Birimi'nde Ocak 2019- Ekim 2019 tarihleri arasında tip 2 DM olup kontrol amacıyla polikliniğimize müracaat eden DR bulgusu olmayan 48 hastanın 48 gözü dahil edildi. Kontrol grubu olarak grupla benzer özellikleri olan 47 sağlıklı bireyin 47 gözü dahil edildi. Hastaların demografik özellikleri, diyabetin türü, diyabetin süresi, DM için kullandığı ilaçlar ve HbA1c değerleri ile ilgili bilgiler, hastaların dosyalarından ve DM polikliniğindeki kayıtlarından, kontrol grubunun verileri dosyalarından ve sistemdeki kayıtlı verilerinden elde edildi. Hastaların OKTA ölçümlerinde, foveal avasküler zone (FAZ) (mm²), perim değeri (mm), foveal dansite (FD), santral maküla kalınlık (SMK), parafoveal ve perifoveal bölgede yüzeyel kapiller pleksus (YKP) ve derin kapiller pleksusdaki (DKP) superior, inferior, temporal ve nazal kadranlardaki vasküler dansite (VD) ölçümleri yapıldı. EDI OKT ile subfoveal koroid kalınlık (SFKK) ölçümü yapıldı. Elde edilen ölçümler hasta ve kontrol gruplarında karşılaştırıldı. Ayrıca DM grubu kendi içinde HbA1c, kullandığı ilaç, cinsiyet ve hastalık süresine göre de değerlendirildi. Bulgular: DM grubu ve kontrol grubu karşılaştırıldığında FAZ (mm²) ve perim (mm) ortalamalarının istatistiksel açıdan anlamlı derecede farklı olmadığı bulundu (sırasıyla p=0.825, p=0.871). FD ortalamaları diyabetik grupta istatistiksel açıdan anlamlı olarak düşük bulundu (p=0.015). YKP perifovea, perifovea temporal, nazal ve inferior VD ortalamaları diyabetik grupta istatistiksel açıdan anlamlı olarak düşük bulundu (sırasıyla p=0.039, p=0.044, p=0.024, p=0.025). DKP parafovea, parafovea temporal ve nazal VD (%) ortalamaları diyabetik grupta istatistiksel açıdan anlamlı olarak düşük bulundu (sırasıyla p=0.036, p=0.023, p=0.010). Subfoveal koroid kalınlığı (SFKK) (μm), foveal kalınlık (μm) ve göz içi basıncı (GİB) (mm Hg) ortalamalarının istatistiksel açıdan anlamlı derecede farklı olmadığı bulundu (sırasıyla p=0.236, p=0.351, p=0.128). DM olan katılımcılar arasında HbA1c'ye göre ölçümlerde anlamlı farklılık saptanmadı. DM olan erkek ve kadınlar arasında YKP fovea ve DKP fovea VD (%) değerleri kadınlarda erkeklere göre istatistiksel açıdan anlamlı olarak düşük saptandı (sırasıyla p=0.010, p=0.029). DM olan kadınlar ve DM olmayan kadınlar arasında YKP inferior yarı değeri, fovea, parafovea nazal ve inferior VD (%) değeri ortalamalarının istatistiksel açıdan anlamlı olarak diyabetli kadın hastalarda düşük saptandı (sırasıyla p=0.019, p=0.024, p=0.022, p=0.003). 1-5 yıl arası hastalık süresi olan diyabetli kişiler ve 6-10 yıl hastalık süresi olan diyabetli kişiler arasında FAZ (mm²) ve perim değeri (mm) ortalamalarının istatistiksel açıdan anlamlı derecede farklı olduğu bulunmuştur (sırasıyla p=0.029, p=0,012). Sonuç: Klinik olarak saptanabilir DR olmayan DM hastalarında OKTA bulgularından FD ve VD' nin etkilendiği gösterilmiştir. Bu durum bize diyabetik hastalarda OKTA'nın tarama için kullanılabileceğini düşündürmektedir. EDI OKT ve OKTA verileri ile diyabetteki vasküler değişimler arasındaki ilişkinin aydınlatılabilmesi için daha fazla sayıda hastanın katıldığı, prospektif, randomize kontrollü çalışmalara ihtiyaç vardır.
The purpose of our study is to demonstrate retinal microvascular changes and early detection of diabetic retinopathy (DR) by optical coherence tomography angiography (OCTA) and high resolution optical coherence tomography (EDI OCT) measurements in with patients type 2 diabetes mellitus (DM) without DR. Materials and Methods: A total of 95 eyes of 95 subjects were included in this retrospective study who applied the Retina Unit of our clinic between January and October 2019. Forty eight eyes of 48 patients with type 2 DM who applied to our outpatient clinic for routine control with no evidence of diabetic retinopathy were our patient group. Forty seven eyes of 47 healthy individuals with similar sociodemographic features with our DM group were accepted as our control group. Patients demographic features, type of diabetes, duration of diabetes, drugs used for diabetes and HbA1c information on their values was obtained from patients' files and records at the DM outpatient clinic. The data of the control group is obtained from their files and the recorded data in the system. Vascular density (VD) measurements of superior, inferior, temporal and nasal quadrants in the parafoveal and perifoveal regions of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ) area (mm²), perim (mm), foveal density % (FD), central macular thickness (SMK) measurements were made in OCTA. Choroidal thickness measurement was done with OCT. In addition, the DM group was evaluated according to the HbA1c, prescription, gender and duration of diabetes. Results: DM group and control group were compared, it was found that the mean of phase (mm²) and perim (mm) did not differ statistically significantly (respectively p = 0.825, p = 0.871). FD averages were found statistically significantly lower in the diabetic group. (p <0.015). Vessel density of the perifovea, perifovea temporal, nasal and inferior in the SCP were found to be statistically significantly lower in the diabetic group (respectively p=0.039, p=0.044, p=0.024, p=0.025). Vessel density of parafovea, parafovea temporal and nasal in the DCP were statistically significantly lower in the diabetic group (respectively p=0.036, p=0.023, p=0.010). The mean of subfoveal choroidal thickness (SFCT) (μm), fovea thickness (μm) and IOP (mmHg) were not statistically different (respectively p=0.236, p=0.351, p=0.128). No significant difference was found among the patients with diabetes compared to HbA1c. Vessel density of the fovea in the SCP and DCP, between men and women with diabetes were statistically significantly lower in the diabetic women (respectively p=0.010, p=0.029). Vessel density inferior half, fovea, parafovea nasal and inferior in the SCP between women with and without diabetes were evaluated to be statistically significantly different (respectively p=0.019, p=0.024, p=0.022, p=0.003). It was found that the mean of phase (mm²) and perim value (mm) were statistically significantly different between people with diabetes with disease duration of 1-5 years and those with diabetes with disease duration of 6-10 years (respectively p=0.029, p=0.012). Conclusion: Foveal density and vessel density of are affected by OCTA findings in DM patients without clinically detectable DR. This situation makes us think that OCTA can be used for screening in diabetic patients. More prospective, randomized controlled trials are needed to elucidate the relationship between EDI OCT and OCTA data and vascular changes in diabetes.
The purpose of our study is to demonstrate retinal microvascular changes and early detection of diabetic retinopathy (DR) by optical coherence tomography angiography (OCTA) and high resolution optical coherence tomography (EDI OCT) measurements in with patients type 2 diabetes mellitus (DM) without DR. Materials and Methods: A total of 95 eyes of 95 subjects were included in this retrospective study who applied the Retina Unit of our clinic between January and October 2019. Forty eight eyes of 48 patients with type 2 DM who applied to our outpatient clinic for routine control with no evidence of diabetic retinopathy were our patient group. Forty seven eyes of 47 healthy individuals with similar sociodemographic features with our DM group were accepted as our control group. Patients demographic features, type of diabetes, duration of diabetes, drugs used for diabetes and HbA1c information on their values was obtained from patients' files and records at the DM outpatient clinic. The data of the control group is obtained from their files and the recorded data in the system. Vascular density (VD) measurements of superior, inferior, temporal and nasal quadrants in the parafoveal and perifoveal regions of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ) area (mm²), perim (mm), foveal density % (FD), central macular thickness (SMK) measurements were made in OCTA. Choroidal thickness measurement was done with OCT. In addition, the DM group was evaluated according to the HbA1c, prescription, gender and duration of diabetes. Results: DM group and control group were compared, it was found that the mean of phase (mm²) and perim (mm) did not differ statistically significantly (respectively p = 0.825, p = 0.871). FD averages were found statistically significantly lower in the diabetic group. (p <0.015). Vessel density of the perifovea, perifovea temporal, nasal and inferior in the SCP were found to be statistically significantly lower in the diabetic group (respectively p=0.039, p=0.044, p=0.024, p=0.025). Vessel density of parafovea, parafovea temporal and nasal in the DCP were statistically significantly lower in the diabetic group (respectively p=0.036, p=0.023, p=0.010). The mean of subfoveal choroidal thickness (SFCT) (μm), fovea thickness (μm) and IOP (mmHg) were not statistically different (respectively p=0.236, p=0.351, p=0.128). No significant difference was found among the patients with diabetes compared to HbA1c. Vessel density of the fovea in the SCP and DCP, between men and women with diabetes were statistically significantly lower in the diabetic women (respectively p=0.010, p=0.029). Vessel density inferior half, fovea, parafovea nasal and inferior in the SCP between women with and without diabetes were evaluated to be statistically significantly different (respectively p=0.019, p=0.024, p=0.022, p=0.003). It was found that the mean of phase (mm²) and perim value (mm) were statistically significantly different between people with diabetes with disease duration of 1-5 years and those with diabetes with disease duration of 6-10 years (respectively p=0.029, p=0.012). Conclusion: Foveal density and vessel density of are affected by OCTA findings in DM patients without clinically detectable DR. This situation makes us think that OCTA can be used for screening in diabetic patients. More prospective, randomized controlled trials are needed to elucidate the relationship between EDI OCT and OCTA data and vascular changes in diabetes.
Açıklama
Anahtar Kelimeler
Diyabetes mellitus, Retina, Optik koherens tomografi angiografi, Diabetes mellitus, Retina, Optical coherence tomography angiography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çınar, R. (2020). Klinik olarak diyabetik retinopatisi olmayan tip 2 diyabetes mellitus hastalarında OKT angiografi ve edı okt ölçümleri ile retinal mikrovasküler değişikliklerin gösterilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Göz Hastalıkları Anabilim Dalı, Konya.
