A Study On The Correlation Between Choroidopathy And Retinopathy In Diabetic Patients

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Study about the relationship between the change of choroidal thickness and the degree of retinopathy in diabetic patientsObjective:To investigate the relationship between choroidal thickness(CT)and diabetic retinopathy(DR),to analyze the correlation between foveal avascular zone(FAZ)area,macular vascular density(MVD),retinal nerve fiber layer(RNFL)thickness and choroidal thickness,and to explore the significance of choroidal thickness in early detection and early intervention of DR.Methods:The subjects of this study were recruited in the department of ophthalmology and endocrinology of our hospital,and healthy volunteers,no history of systemic diseases such as diabetes and no history of eye diseases were selected as normal controls.In addition,select the patients who were diagnosed as non-diabetic retinopathy(NDR)patients and diabetic retinopathy(DR)in the department of endocrinology and ophthalmology.This study was compared among different groups:first,demographic data and clinical data of the control group,diabetic NDR group and DR group;DR group was divided into non-proliferative diabetic retinopathy(NPDR)patients and proliferative diabetic retinopathy(PDR)patients;NPDR was further divided into mild,moderate and severe;in addition,according to the presence of diabetic macular edema(DME),it was divided into DR with DME and DR without DME.The choroidal thickness(CT)at different groups was measured by the enhanced depth imaging optical coherence tomography(EDI-OCT)technique.The area of FAZ,macular vascular density,temporal RNFL thickness and average RNFL thickness were examined by optical coherence tomography angiography(OCTA).And the correlation between FAZ,MVD,RNFL thickness and choroidal thickness was analyzed.Results:(1)In the age index,there was no significant difference between patients in DR group and those in control and NDR group;The age of the group without DME was significantly larger than that of the group with DME(P<0.01).In the gender index,there was no statistically significant difference between patients in DR group and those in control and NDR group.In the duration of diabetes index,the duration of patients in DR group was significantly longer than that in NDR group(P<0.01).The age of PDR patients was younger than NPDR group,and the sex ratio of female patients was significantly higher,and with the prolong history of diabetes was significantly longer(P<0.01).(2)In the subfoveal choroidal thickness index,compared with the control group and NDR group,the choroidal thickness in DR group was significantly thinner(P<0.01);Compared with the NPDR group,the choroid thickness in the PDR group was significantly thinner(P<0.01).Compared with mild NPDR group,choroidal thickness in moderate NPDR,severe NPDR and PDR group was significantly thinner(P<0.05).Compared with mild NPDR,moderate NPDR and severe NPDR group,choroidal thickness in PDR group was significantly thinner(p<0.01).There was no difference in choroidal thickness between the patients with DME and without DME,but the choroidal thickness of the two groups was significantly thinner than that of the control group(P<0.001).(3)FAZ:Compared with the control group,the FAZ of NDR group,NPDR group and PDR group was larger(P<0.05);The area of FAZ in NPDR group was larger than that in NDR grouP(P<0.05);The area of FAZ in PDR group was significantly larger than that in NPDR group,and there was significant difference between the two groups(P<0.05).(4)Macular vascular density:Compared with the control group,the vascular density of superficial capillary plexus(SCP)in NDR group,NPDR group and PDR group decreased significantly(P<0.05),but there was no significant difference between NDR group and NPDR group in superficial capillary plexus(SCP)(P>O.05).Compared with the control group,the vascular density of deep capillary plexus(DCP)in NDR group,NPDR group and PDR group decreased significantly(P<0.05),but there was no significant difference between NDR group and NPDR group in vascular density of deep capillary plexus(DCP)(P>0.05).(5)RNFL thickness:Compared with the control group,the average RNFL thickness of the optic disc in NDR group,NPDR group and PDR group decreased significantly(P<0.05);Compared with NDR group,the average RNFL thickness of the optic disc in NPDR group decreased significantly(P<0.05);There was no significant difference in temporal RNFL thickness between NDR group and control group(P>0.05).Compared with the control,the temporal RNFL thickness in NPDR and PDR group was thinner(P<0.05);The temporal RNFL thickness in NPDR group was thinner than that in NDR group(P<0.05).(6)The effects of diabetes duration on FAZ,macular vascular density,RNFL thickness and choroidal thickness:FAZ of diabetic patients with course>10 years was significantly larger than that of diabetic patients with course ?10 years,and the difference was statistically significant between the two groups(P<0.05).The blood flow densities of SCP and DCP in diabetic patients with course>10 years were significantly lower than those in diabetic patients with course ?10 years(P<0.05).The average RNFL thickness of the optic disc in diabetic patients with course>10years was significantly thinner than that in diabetic patients with course ?10 years,and the difference was statistically significant between the two groups(P<0.05);the choroidal thickness of diabetic patients with course>10 years was significantly thinner than that of diabetic patients with course ?10 years,the difference was statistically significant between the two groups(P<0.05).(7)The correlation among FAZ,SCP vascular density,DCP vascular density,RNFL thickness and choroidal thickness:In PDR group,choroidal thickness was significantly correlated with FAZ,SCP vascular density,DCP vascular density and average RNFL thickness(P<0.05).In NPDR group,choroidal thickness was significantly correlated with FAZ,SCP vascular density,DCP vascular density and average RNFL thickness(P<0.05).In the control group and NDR group,choroidal thickness had no correlation with FAZ,SCP vascular density,DCP vascular density and average RNFL thickness(P>0.05).Conclusion:The changes of choroidal thickness,FAZ,SCP vascular density,DCP vascular density and RNFL thickness are closely related to the severity of DR,which can be used as the detection index of DR.Early DR patients have appeared the changes of choroidal thickness and FAZ,SCP vascular density,DCP vascular density,RNFL thickness,which can be used as early detection indicators of diabetic retinopathy.Part ? Study about the correlation between the hemodynamics of posterior ciliary arteries index,the level of the patient's HbAlc and choroidal thickness,retinopathy in diabetic patientsObjective:To investigate the relationship between the subfoveal choroidal thickness(SFCT)of the macular and the hemodynamics of posterior ciliary arteries index and the level of the patient's glycated hemoglobin(HbAlc)in diabetic patients.To further reveal the pathogenesis and change rules of diabetic retinopathy and provide theoretical bases for the prevention and treatment of diabetic retinopathy.Methods:Patients with type 2 diabetes who were hospitalized in ophthalmology and endocrinology in our hospital were selected as subjects.The patients were divided into no retinopathy group,mild to moderate NPDR group,severe NPDR group and PDR group.EDI-OCT was used to measure choroidal thickness of each group of patients,and ultrasonic Doppler was used to measure hemodynamics of posterior ciliary arteries indexes,and recorded the blood glycosylated hemoglobin content of all patients.The observating parameters included peak systolic velocity(PSV),enddiastolic velocity(EDV)and resistance index(RI),and the blood glycated hemoglobin content of all patients.Multiple linear regression analysis was used to analyze the correlation between SFCT and hemodynamics of posterior ciliary arteries index and glycated hemoglobin in patients.Results:(1)In peak systolic velocity(PSV)index:there was no significant difference among different groups,and there was no statistical significance in comparison(P>0.05).(2)In enddiastolic velocity(EDV)index:the mild NPDR?severe NPDR and PDR groups were significantly lower than the NDR group(P<0.001).(3)In terms of resistance index(RI):the mild NPDR,severe NPDR and PDR groups are significantly higher than the NDR group(P<0.001).(4)In subfoveal choroidal thickness(SFCT)index:the mild NPDR,severe NPDR and PDR groups were significantly thinner than the NDR group(P<0.001).(5)Peak systolic velocity(PSV)and end diastolic velocity(EDV)in posterior ciliary artery blood flow index have no correlation with subfoveal choroidal thickness(SFCT)(P>0.05).(6)Resistance index(RI)has a related trend to subfoveal choroidal thickness(SFCT),but there was no statistical significance(P>0.05).(7)Glycated hemoglobin(HbAlc)index was highly correlated with SFCT,and the correlation with SFCT was statistically significant(P<0.001).Conclusion:There was no correlation between subfoveal choroidal thickness(SFCT)and each hemodynamic index of posterior ciliary artery in diabetic patients.Glycated hemoglobin(HbAlc)was one of the influencing factors of subfoveal choroidal thickness(SFCT)in diabetic patients.Part ? The effect of conbercept on choroidal thickness and retina in patients with diabetic macular edemaObjective:Enhanced depth imaging-optical coherence tomography(EDI-OCT)and optical coherence tomography angiography(OCTA)were used to observe the subfoveal choroidal thickness(SFCT),macular vascular density(MVD)of superficial retinal capillary plexus,average retinal nerve fiber layer(RNFL)around optic disc and changes in thickness of macular ganglion cell complex(GCC)in diabetic macular edema(DME)patients before and after intravatreal injection of conbercept.So as to evaluate the relationship among these indexes and the severity of retinopathy and its significance in judging the therapeutic effect.Methods:To observe the clinical indexes of 32 DME patients who were treated by intravitreal injection of anti-VEGF drugs(conbercept).EDI-OCT was used to measure subfoveal choroidal thickness(SFCT)before injection,1 week after injection and 1 month after injection.OCTA was used to measure the macular vascular density(MVD)of superficial retinal capillary plexus,the average retinal nerve fiber layer(RNFL)thickness around optic disc and the thickness of macular ganglion cell complex(GCC).All patients were injected with conbercept injection(0.5mg/0.05mL)into vitreous cavity,and EDI-OCT and OCTA were performed before injection,1 week after injection and 1 month after injection to check the above clinical indicators.Tracking mode was adopted for each scan to ensure that the scanning position was in the same position.The change rule of subfoveal choroidal thickness of macular foveal,macular vascular density of superficial retinal capillary plexus,average nerve fiber layer thickness around optic disc and thickness of macular ganglion cell complex were observed.Results:(1)Comparison of vascular density of superficial retinal capillary plexus at different time points before and after anti-VEGF therapy:the retinal vascular density at the time point of 1 week and 1 month after injection were significantly lower than those before injection,and the difference was statistically significant(P<0.05);(2)Comparison of subfoveal choroidal thickness of macular foveal at different time points before and after anti-VEGF therapy:the subfoveal choroidal thickness of macular foveal at the time point of 1 week and 1 month after injection were significantly thinner than those before injection(P<0.05);(3)Comparison of average nerve fiber layer thickness around optic disc at different time points before and after anti-VEGF therapy:the average nerve fiber layer thickness around optic disc at the time point of 1 week and 1 month after injection were significantly thinner than those before injection,and the difference was statistically significant(P<0.05);(4)Comparison of thickness of macular ganglion cell complex at different time points before and after anti-VEGF therapy:the thickness of macular ganglion cell complex at the time point of 1 week and l month after injection were significantly thinner than those before injection(P<0.05).Conclusion:Anti-VEGF drugs treat DME by reducing vascular leakage and decreasing average nerve fiber layer thickness around optic disc,thickness of macular ganglion cell complex and subfoveal choroidal thiekness.Macular vascular density of retina,average retinal nerve fiber layer thickness around optic disc,thickness of macular ganglion cell complex and subfoveal choroidal thickness can be used as detection indexes for evaluating therapeutic effect of DME.