Quantitative Analysis Of Macular And Optic Disc Parameters By OCTA In Patients With Diabetic Kidney Disease

Objective:Optical coherence tomography angiography(OCTA)was used to quantitatively analyze the microvascular and neurological parameters of macula and optic disc in patients with diabetic kidney disease(DKD),and to evaluate the application value of OCTA in predicting the risk of DKD progression.Methods:This study is a cross-sectional study.According to the inclusion and exclusion criteria,we collected 41 patients(75 eyes)who were diagnosed with DKD in our hospital from January 2021 to January 2022(including 8 patients in low risk group(16 eyes),11 patients in high risk group(21 eyes)and 22 patients in very high risk group(38 eyes)),17 patients with non-DKD diabetes(32 eyes)and 11 normal subjects(21 eyes).Macular and optic disc areas of all subjects were scanned with OCTA.The vessel density of each zone of the superficial and deep capillary plexus of retina,the area of fovea avascular area(FAZ),the perimeter of FAZ,the central foveal vascular density of the 300-μm area around the FAZ(FD-300),the vessel density of each zone around the peripapillary and the thickness of the retinal nerve fiber layer(RNFL)were measured,and the data were compared among the healthy control group,the non-DKD diabetes group and the DKD group.Compare whether there are significant differences and change trends in the data of different DKD groups,analyze the differences and trends statistically,and explore the correlation between parameters and DKD progression risk.Results:1.In healthy control group,diabetic non-DKD group and DKD group,the vessel density of SCP-parafovea,DCP,DCP-fovea,DCP-parafovea and Inside disc decreased gradually among the three groups,while the FAZ area and FAZ perimeter increased gradually among the three groups(P<0.05).2.In DKD group,the vessel density of SCP,SCP-perifovea,SCP-perifovea-nasal,SCP-perifovea-inferior,DCP-fovea,DCP-perifovea-nasal and Inside disc decreased gradually among the three groups,while FAZ area and FAZ perimeter increased gradually among the three groups(P<0.05).3.In OCTA parameters,SCP(r=-0.278,P=0.016),SCP-parafovea(r=-0.232,P=0.045),SCP-parafovea-nasal(r=-0.283,P=0.014),SCP-perifovea(r=-0.268,P=0.020)and SCP-perifovea-superior(r=-0.253,P=0.028),SCP-perifovea-nasal(r=-0.355,P=0.002),SCP-perifovea-inferior(r=-0.234,P=0.044),DCP(r=-0.241,P=0.036),DCP-fovea(r=-0.269,P=0.019),DCP-perifovea(r=-0.240,P=0.039)and DCP-perifovea-tempo(r=-0.244,P=0.035),DCP-perifovea-superior(r=-0.246,P=0.033),DCP-perifovea-nasal(r=-0.321,P=0.005),DCP-perifovea-inferior(r=-0.258,P=0.026),Inside disc(r=-0.350,P=0.002),peripapillary-tempo inferior(r=-0.241,P=0.037)vessel density were negatively correlated with DKD stage.There was a negative correlation between vessel density and DKD stage.FAZ area(r=0.473,P<0.001)and FAZ perimeter(r=0.398,P<0.001)were positively correlated with DKD stage.Conclusion:Compared with normal subjects,diabetic patients with or without renal dysfunction have a certain degree of decrease in retinal vascular density,and the decrease of retinal vessel density is mostly manifested in DCP.In patients with DKD,part of the retinal vessel density measured by OCTA decreased with the increase of the risk of DKD progression.Some parameters of OCTA are significantly correlated with the risk of DKD progression.OCTA detection of retinal macular and optic disc vessel density changes in patients with DKD has predictive value for disease progression.