OCT Angiography of Chorioretinal Microvasculature in Children with Type 1 and Type 2 Diabetes without Retinopathy

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-08-18 DOI:10.1016/j.xops.2025.100917

Sarah Aman MBBS , Melat Asebot MD, MPH , Dhruva Patel BS , Elizabeth A. Brown MPH , Ana Collazo Martinez MPH , Edward Kuwera MD , Viet-Hoan Le PhD , Yi Zhang MS , Ruikang K. Wang PhD , Risa M. Wolf MD , Amir H. Kashani MD, PhD

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Abstract

Objective

To evaluate chorioretinal microvasculature using OCT angiography (OCTA) in children with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) without diabetic retinopathy (DR), compared with healthy controls.

Design

A cross-sectional, observational study.

Participants

Subjects with T1DM and T2DM without DR were recruited from the pediatric diabetes center, and nondiabetic controls were recruited from the pediatric eye clinic from 2022 to 2024.

Methods

All participants underwent color fundus and 1050 nm swept-source OCTA imaging (3 × 3, 6 × 6, and 12 × 12 mm²). Quantitative OCTA analyses were performed using a custom MATLAB algorithm. Retinal segmentation was performed for the superficial retinal layer, the deep retinal layer, the whole retina, and the choroid. A linear mixed effects regression model was used to compare the results between youth with diabetes and controls, adjusting for age.

Main Outcome Measures

Mean values for retinal thickness, vessel skeleton density (VSD), vessel diameter index (VDI), mean choroidal thickness (MCT), choroidal vascularity index (CVI), choroidal vascular volume (CVV), and choriocapillaris thickness.

Results

A total of 32 subjects (44% females, 57 eyes) were included as follows: 10 T1DM, 7 T2DM, and 15 without diabetes. For youth with T1DM, age was 16 ± 2 years, glycated hemoglobin was 7.7 ± 0.9%, and diabetes mellitus (DM) duration was 8.0 ± 4 years. For youth with T2DM, age was 16 ± 2 years, mean glycated hemoglobin was 8.7 ± 3.5%, and mean DM duration was 2.4 ± 1.3 years. Age for youth without diabetes was 12 ± 5 years. Choroidal vascularity index and CVV were significantly higher in T1DM compared with controls (CVI: 0.69 ± 0.04 vs. 0.63 ± 0.05, P = 0.001; CVV: 18.9 ± 5.0 vs. 16.2 ± 2.0 mm³, P = 0.001) but not in T2DM. Choriocapillaris thickness was also significantly higher in T1DM (9.5 ± 1.2 μm) compared with controls (8.4 ± 1.0 μm, P = 0.003), with no significant difference in T2DM. Retinal thickness, MCT, VSD, VDI, and flux were not different among groups (P > 0.05).

Conclusions

Children with T1DM without DR exhibited larger choroidal and choriocapillaris vascularity than controls and no contemporaneous differences in retinal vascularity measures. This suggests that subclinical choroidal changes are present in pediatric diabetic patients before clinical or subclinical signs of DR.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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无视网膜病变的1型和2型糖尿病儿童绒毛膜视网膜微血管的OCT血管造影

目的应用OCT血管造影（OCTA）评价无糖尿病视网膜病变（DR）的1型糖尿病（T1DM）和2型糖尿病（T2DM）患儿的绒毛膜视网膜微血管状况，并与健康对照组进行比较。设计一项横断面观察性研究。从儿科糖尿病中心招募T1DM和T2DM无DR的受试者，从儿科眼科门诊招募非糖尿病对照组，时间为2022 - 2024年。方法所有受试者均行眼底彩色扫描和1050 nm扫描源OCTA成像（3 × 3、6 × 6和12 × 12 mm2）。使用定制的MATLAB算法进行定量OCTA分析。分别对视网膜浅层、深层、全视网膜、脉络膜进行视网膜分割。采用线性混合效应回归模型比较青年糖尿病患者和对照组之间的结果，调整年龄。主要观察指标视网膜厚度、血管骨架密度（VSD）、血管直径指数（VDI）、平均脉络膜厚度（MCT）、脉络膜血管密度指数（CVI）、脉络膜血管体积（CVV）和脉络膜毛细血管厚度的平均值。结果共纳入32例（女性44%，57眼），其中T1DM 10例，T2DM 7例，非糖尿病15例。青年T1DM患者年龄16±2岁，糖化血红蛋白7.7±0.9%，糖尿病病程8.0±4年。青年T2DM患者年龄为16±2岁，平均糖化血红蛋白为8.7±3.5%，平均糖尿病病程为2.4±1.3年。无糖尿病青年年龄为12±5岁。T1DM组脉络膜血管指数和CVV明显高于对照组（CVI: 0.69±0.04比0.63±0.05,P = 0.001; CVV: 18.9±5.0比16.2±2.0 mm3, P = 0.001）， T2DM组无明显差异。T1DM组绒毛膜厚度（9.5±1.2 μm）显著高于对照组（8.4±1.0 μm, P = 0.003）， T2DM组差异无统计学意义。各组间视网膜厚度、MCT、VSD、VDI、通量无显著差异（P > 0.05）。结论无DR的T1DM患儿脉络膜和绒毛膜毛细血管比对照组大，视网膜血管测量无同期差异。这表明，在dr的临床或亚临床症状出现之前，儿科糖尿病患者就已经出现了亚临床脉络膜改变。财务披露：本文末尾的脚注和披露中可能包含专利或商业披露。

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