Metabolic disorders and their impact on retinal blood flow in patients with age-related macular degeneration and diabetes mellitus: data from optical coherence tomography angiography
DOI:
https://doi.org/10.14739/2310-1210.2025.1.313930Keywords:
age-related macular degeneration, insulin resistance, diabetes, metabolic disorders, metabolic syndrome, retinal plexuses, blood flow density, optical coherence tomography angiographyAbstract
Aim – to examine the impact of metabolic disorders on retinal blood flow in patients with age-related macular degeneration (AMD) and diabetes mellitus using optical coherence tomography angiography (OCT-A).
Materials and methods. The study included 98 eyes (62 patients) with early dry AMD. OCT-A examinations assessed retinal blood flow density in different areas with manual segmentation to define superficial (SCP), intermediate (ICP), and deep (DCP) capillary plexuses. Laboratory tests evaluated glucose and lipid profiles and homocysteine. Morphometric measurements were also conducted: waist circumference (WC) and body mass index (BMI). Patients were grouped based on carbohydrate metabolism impairment: Group 1 (no abnormalities), Group 2 (insulin resistance (IR)), and Group 3 (type 2 diabetes mellitus (DM)).
Results. The study has identified higher glucose levels in the type 2 DM group (10.67 ± 5.11 mmol/L, p = 0.05) and elevated HOMA index in both IR (4.48 ± 2.17, p = 0.03) and diabetes groups (4.89 ± 1.13, p = 0.04). Homocysteine levels were lower in DM patients (6.36 ± 2.57 µMol/L, p = 0.02). No significant differences have been found in lipid profiles or morphometric parameters (p > 0.05). WC and BMI were strongly correlated with reduced blood flow in the SCP middle / far periphery (r = -0.747, p = 0.001). Elevated blood glucose (r = -0.606, p = 0.017) and HOMA index (r = -0.664, p = 0.013) were associated with reduced macular blood flow in the SCP macular region. Triglycerides have shown the most significant negative effect on the blood flow, especially in the SCP macular area (r = -0.883, p = 0.0001). Homocysteine and cholesterol have also been linked to reduced blood flow in the DCP, while high-density lipoprotein has been found to be protective.
Conclusions. The results suggest that glucose metabolism abnormalities, IR, and elevated lipid and homocysteine levels significantly impair retinal blood flow, particularly in the macula and peripheral regions, emphasizing the importance of metabolic control in patients with AMD and DM.
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