Features of retinal blood flow in pregnant women with carbohydrate metabolism disorders

Close metadata

PURPOSE

To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for manifestation and progression of DR.

MATERIAL AND METHODS

The study examined 203 pregnant women in the third trimester: 24 — with type 1 and 2 diabetes (T1D and T2D), 143 — with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy that comprised the control group. OCTA imaging was performed on RTVue XR Avanti (“Optovue”, USA) system using HD Angio Retina 6.0 mm² scan protocol. The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied.

RESULTS

FVD was significantly lower in pregnant women with diabetes than in pregnant women with GD and in the control group, prompting an assumption that retinal microvascular regulation changes because of chronic disturbances of carbohydrate metabolism in such patients and due to development of microangiopathy. Statistically significant increase in FAZ area and decrease in wiVD were revealed in patients with DR compared to data from the group of pregnant women with diabetes but without DR, in the absence of differences in FVD. In 2 patients with T1D and no ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye.

CONCLUSION

OCTA can help identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes and no ophthalmoscopic signs of DR, and determine objective indications for timely retinal laser coagulation.

Keywords:

optical coherence tomography angiography

pregnancy

diabetic retinopathy

gestational diabetes

foveal avascular zone

retinal blood flow

Authors:

Pomytkina N.V.

Khabarovsk branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”;
Far-Eastern State Medical University

ORCID: 0000-0001-8161-8643

Sorokin E.L.

Khabarovsk branch of S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”;
Far-Eastern State Medical University

ORCID: 0000-0002-2028-1140

Pashentsev Y.E.

Khabarovsk branch of S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery»

Received:

25.01.2021

Accepted:

09.03.2021

List of references:

De Carlo TE, Chin AT, Bonini Filho MA, Adhi M, Branchini L, Salz DA, Baumal CR, Crawford C, Reichel E, Witkin AJ, Duker JS, Waheed NK. Detection of microvascular changes in eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography. Retina. 2015;35(11):2364-2370. https://doi.org/10.1097/IAE.0000000000000882
Ishibazawa A, Nagaoka T, Takahashi A, Omae T, Tani T, Sogawa K, Yokota H, Yoshida A. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study. Am J Ophthalmol. 2015;160(1):35-44. https://doi.org/10.1016/j.ajo.2015.04.021
Jia Y, Tan O, Tokayer J, Potsaid B, Wang Y, Liu JJ, Kraus MF, Subhash H, Fujimoto JG, Hornegger J, Huang D. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express. 2012;20(4): 4710-4725. https://doi.org/10.1364/OE.20.004710
Koustenis A Jr, Harris A, Gross J, Januleviciene I, Shah A, Siesky B. Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research. Br J Ophthalmol. 2017; 101(1):16-20. https://doi.org/10.1136/bjophthalmol-2016-309389
Chanwimol K, Balasubramanian S, Nassisi M, Gaw SL, Janzen C, Sarraf D, Sadda SR, Tsui I. Retinal vascular changes during pregnancy detected with optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2019; 60(7):2726-2732. https://doi.org/10.1167/iovs.19-26956
Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012;30(3):317-329. https://doi.org/10.1016/j.ccl.2012.05.004
Provis JM, Hendrickson AE. The foveal avascular region of developing human retina. Arch Ophthalmol. 2008;126(4):507-511. https://doi.org/10.1001/archopht.126.4.507
Conrad KP. Emerging role of relaxin in the maternal adaptations to normal pregnancy: implications for preeclampsia. Semin Nephrol. 2011;31(1):15-32. https://doi.org/10.1016/j.semnephrol.2010.10.003
Gant NF, Worley RJ, Everett RB, MacDonald PC. Control of vascular responsiveness during human pregnancy. Kidney Int. 1980;18(2):253-258. https://doi.org/10.1038/ki.1980.133
Kolenko OV, Sorokin EL, Khodzhaev SN, Chizhova GV, Fil AA, Pomytkina NV, Pashentsev YaE. The state of indicators of the angio-OCT of the macular area in pregnant women with preeclampsia in conjunction with the content of the factor of endothelial dysfunction, their importance for predicting vascular retinal pathology in the postpartum period. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya. 2019;(3):63-71. (In Russ.). https://doi.org/10.25276/0235-4160-2019-3-63-71
Ioyleva EE, Safonenko AYu. Tactics of neuro-retinopathy treatment as a result of severe preeclampsia. Rossiyskaya detskaya oftal’mologiya. 2017;(4):20-23. (In Russ.). https://eyepress.ru/article.aspx?26168
Motulsky E, Zheng F, Liu G, Gregori G, Rosenfeld PJ. Swept-source OCT angiographic imaging of a central retinal vein occlusion during pregnancy. Ophthalmic Surg Lasers Imaging Retina. 2018;49(3):206-208. https://doi.org/10.3928/23258160-20180221-09
Best RM, Chakravarthy U. Diabetic retinopathy in pregnancy. Br J Ophthalmol. 1997;81(3):249-251. https://doi.org/10.1136/bjo.81.3.249
Egan AM, McVicker L, Heerey A, Carmody L, Harney F, Dunne FP. Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes. J Diabetes Res. 2015;2015:310239. https://doi.org/10.1155/2015/310239
Borovik NV. Vliyaniye beremennosti na mikrososudistyye oslozhneniya sakharnogo diabeta [The influence of pregnancy on microvascular complications of diabetes mellitus]: Dis. ... kand. med. nauk. SPb. 2010. (In Russ.). https://rusneb.ru/catalog/000200_000018_RU_NLR_bibl_1800404/
Spaide RF, Klancnik JM, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol. 2015;133(1):45-50. https://doi.org/10.1001/jamaophthalmol.2014.3616
Agemy SA, Scripsema NK, Shah CM, Chui T, Garcia PM, Lee JG, Gentile RC, Hsiao Y-S, Zhou Q, Ko T, Rosen RB. Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina. 2015;35(11):2353-2363. https://doi.org/10.1097/IAE.0000000000000862
Bresnick GH, Condit R, Syrjala S, Palta M, Groo A, Korth K. Abnormalities of the foveal avascular zone in diabetic retinopathy. Arch Ophthalmol. 1984;102(9):1286-1293. https://doi.org/10.1001/archopht.1984.01040031036019
Neroev VV, Okhotsimskaya TD, Fadeeva VA. OCT angiography in diabetic retinopathy diagnosis. Tochka zreniya. Vostok—Zapad. 2016;(1):111-113. (In Russ.). https://eyepress.ru/article.aspx?20655
Carpineto P, Mastropasqua R, Marchini G, Toto L, Di Nicola M, Di Antonio L. Reproducibility and repeatability of foveal avascular zone measurements in healthy subjects by optical coherence tomography angiography. Br J Ophthalmol. 2016;100(5):671-676. https://doi.org/10.1136/bjophthalmol-2015-307330
Ho J, Dans K, You Q, Nudleman ED, Freeman WR. Comparison of 3 mm × 3 mm versus 6 mm × 6 mm optical coherence tomography angiography scan sizes in the evaluation of non-proliferative diabetic retinopathy. Retina. 2019;39(2):259-264. https://doi.org/10.1097/IAE.0000000000001951
Goudot MM, Sikorav A, Semoun O, Miere A, Jung C, Courbebaisse B, Srour M, Freiha JG, Souied EH. Parafoveal OCT angiography features in diabetic patients without clinical diabetic retinopathy: a qualitative and quantitative analysis. J Ophthalmol. 2017;2017:8676091. https://doi.org/10.1155/2017/8676091
Burnasheva MA, Maltsev DS, Kulikov AN. Personalized assessment of the area of the foveal avascular zone using optical coherence tomography-angiography. Sovremennyye tekhnologii v oftal’mologii. 2017;(7):19-21. (In Russ.). https://eyepress.ru/article.aspx?25764
Durbin MK, An L, Shemonski ND, Soares M, Santos T, Lopes M, Neves C, Cunha-Vaz J. Quantification of retinal microvascular density in optical coherence tomographic angiography images in diabetic retinopathy. JAMA Ophthalmol. 2017;135(4):370-376. https://doi.org/10.1001/jamaophthalmol.2017.0080
Scarinci F, Nesper PL, Fawzi AA. Deep retinal capillary non-perfusion is associated with photoreceptor disruption in diabetic macular ischemia. Am J Ophthalmol. 2016;168:129-138. https://doi.org/10.1016/j.ajo.2016.05.002
Oian P, Maltau JM. Calculated capillary hydrostatic pressure in normal pregnancy and preeclampsia. Am J Obstet Gynecol. 1987;157(1):102-106. https://doi.org/10.1016/s0002-9378(87)80355-1
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89-94. https://doi.org/10.5830/CVJA-2016-021
Arend O, Wolf S, Jung F, Bertram B, Postgens H, Toonen H, Reim M. Retinal microcirculation in patients with diabetes mellitus: dynamic and morphological analysis of perifoveal capillary network. Br J Ophthalmol. 1991; 75(9):514-518. https://doi.org/10.1136/bjo.75.9.514
Conti FF, Qin VL, Rodrigues EB, Sharma S, Rachitskaya AV, Ehlers JP, Singh RP. Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography. Br J Ophthalmol. 2019;103(4):452-456. https://doi.org/10.1136/bjophthalmol-2018-311903
Fabrikantov OL, Pronichkina MM, Yablokova NV, Ovsyannikova NV. Innovative capabilities of non-invasive vital assessment of vascular status of microcirculatory bed in diabetic retinopathy. Vestnik Volgogradskogo Gosudarstvennogo meditsinskogo universiteta. 2018;(4):41-45. (In Russ.). https://doi.org/10.19163/1994-9480-2018-4(68)-41-45

Close metadata