| Objective: To observe the changes of retinal thickness and superficial vascular blood density in the macula of patients with hyperglycemia in pregnancy(HIP)using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA).pregnancy(HIP)patients,and to analyze the changes of retinal thickness and superficial vascular blood flow density in the macula,and to analyze the physiopathological changes of the retina in HIP patients.METHODS: This was a cross-sectional observational clinical study.A total of 60 patients,30 healthy pregnant women and 35 age-matched healthy women of childbearing age,were collected from 01,2021 to 01,2023,at Qingdao Municipal Hospital for obstetric examination and diagnosed with HIP.The retinal structure part of the study included 112 eyes of 56 patients with HIP,48 eyes of 24 healthy pregnant women,and 66 eyes of 33 healthy women of childbearing age;the retinal circulation part of the study included 106 eyes of 55 patients with HIP,43 eyes of 25 healthy pregnant women,and 43 eyes of 25 healthy women of childbearing age.Pregnancy and control groups were included,and the pregnancy group was divided into a hyperglycemia group(HIP group),a normoglycemia group(IP group),and healthy women of childbearing age as a control group(NP group)according to whether they had diabetes before pregnancy and the glycemic status of the glucose tolerance test.The hyperglycemic group was divided into two groups:pregestational diabetes mellitus(PGDM)and gestational diabetes mellitus(GDM).A total of 115 subjects participated in the study: age 23-42(32.97 ± 4.65)years,equivalent spheroscopic degree of-5.25-+2.25(-2.92±1.60)D.Among them,33 cases in the NP group,with a mean age of(32.80±4.86)years and a mean equivalent spheroscopic In the IP group,there were 25 cases with a mean age of(32.56±3.34)years,a mean equivalent spheroscopic degree of(-3.01±1.50)D,a mean gestational week of(25.20±7.56)weeks,a mean fasting glucose of(4.19±0.18)mmol/L,a mean glucose of(6.69±1.34)mmol/L1 h after sugar administration,and a mean glucose of(6.69±1.34)mmol/L 1 h after sugar administration.In the GDM group,the mean age was(32.20 ± 4.59)years,the mean equivalent spheroscopic degree was(-3.00 ± 1.54)D,the mean gestational week was(28.50±4.09)weeks,the mean fasting glucose was(4.71±0.50)mmol/L,and the mean glucose was(4.71±0.50)mmol/L.In the PGDM group,the mean age was(35.06±5.66)years,the mean equivalent sphericity was(-2.49±1.16)D,the mean gestational week was(32.22±2.88)weeks,and the mean fasting The mean blood glucose was(5.17±0.92)mmol/L,the mean glucose 1 h after sugar administration was(11.74±0.19)mmol/L,and the mean glucose 2 h after sugar administration was(11.35±0.14)mmol/L.OCT and OCTA of the macula in both eyes were performed on all study subjects,and the macula was analyzed for central The thickness of the central retinal thickness(CRT),the retimal nerve fiber layer(RNFL)in each quadrant of the macula,and the vessel length density(VLD),vascular perfusion density(VLD)and vascular plexus(SCP)in the superficial capillary plexus(SCP)of the macula were analyzed.density(VLD),vessel perfusion density(VPD)and foveal avascular zone(FAZ)of the macular central recess.The data were analyzed using SPSS27.0 statistical software,and the measurement data were expressed as mean ± standard deviation,using one-way analysis of variance(ANOVA)and least significant difference(LSD)analysis for two-way comparison.The difference was considered statistically significant at P < 0.05.RESULTS: General: There were 115 cases and 226 eyes in this study.Retinal structure part: 56 cases and 112 eyes(49.56%)in the HIP group,including 17 cases and 34 eyes in the PGDM group and 39 cases and 78 eyes in the GDM group;24 cases and 48 eyes(21.24%)in the IP group and 33 cases and 66 eyes(29.20%)in the NP group.Retinal circulation fraction: 48 cases and 92 eyes(50.27%)in the HIP group,including 18 cases and 34 eyes in the PGDM group and 30 cases and 58 eyes in the GDM group;25 cases and 48 eyes(26.23%)in the IP group and 25 cases and 43 eyes(23.50%)in the NP group.The differences between the groups in age and equivalent spherical lens degree were not statistically significant(P > 0.05),and the differences in gestational week and blood glucose in the pregnancy group were statistically significant(P < 0.001).Retinal thickness was analyzed by OCT examination: the differences in CRT and RNFL thickness in each quadrant between the four groups were statistically significant(P <0.001).the differences in CRT and RNFL thickness in each quadrant were higher in the PGDM group than in the other three groups,and the differences were statistically significant(P < 0.001).in the GDM group,in CRT and RNFL thickness in each quadrant compared with the IP group,the differences in CRT,RNFL thickness in the GDM group were statistically significant(P < 0.001).RNFL thickness in the upper outer(SOM),lower outer(IOM),and temporal outer(TOM)of the GDM group decreased compared with the IP group,and the thickness of the remaining quadrants were higher than that of the IP group,but the difference was not statistically significant(P > 0.05);in the comparison with the NP group,the CRT of the GDM group decreased compared with the NP group,and the difference was statistically significant(P = 0.024),and the difference of RNFL thickness in the remaining quadrants was not In the IP group,CRT and RNFL thickness in all quadrants decreased compared with the NP group,among which the decrease was especially obvious in the two quadrants of intra-temporal(SIM)and upper internal(IIM)RNFL thickness,and the difference was statistically significant(P=0.029,P=0.011),while the difference in the remaining quadrants was not statistically significant(P>0.05).Quantitative analysis of superficial vascular blood flow density by OCTA examination:the differences in SCP-VLD and SCP-VPD were statistically significant between the four groups in each region(P < 0.001).the SCP-VLD and SCP-VPD in the macular region of the PGDM group were lower than those in the other three groups,and the differences between the inner outer layer and intact region of SCP-VLD and GDM were not statistically significant,and the differences between the rest and each region in each group were In the comparison of SCP-VLD and SCP-VPD in the macular region of the GDM group,there were statistically significant differences with the NP group except for the central region,and statistically significant differences with the IP group.There was no statistically significant difference between the IP group and the NP group in the comparison of SCP-VLD and SCP-VPD in the macular area and other groups,and there was a statistically significant difference between the inner and outer regions of SCP-VLD and the NP group;there was a statistically significant difference between the SCP-VPD and the NP group in other regions except the central region.Quantitative analysis of the central concave avascular zone by OCTA examination: the differences in FAZ area and circumference were not statistically significant(P > 0.05);the differences in FAZ filling were statistically significant(P < 0.05).the FAZ filling in the PGDM group was smaller than that in the NP group and the GDM group,and the differences were statistically significant(P = 0.001;P = 0.026).the FAZ area and circumference in the GDM group were were smaller than those of the IP group,and the difference was statistically significant(P=0.012;P=0.012).CONCLUSION: Adaptive changes during pregnancy include the retinal vascular system,and changes in retinal structure and function occur in HIP patients,especially in PGDM patients with more severe damage.The macular retinal thickness decreases compared to normal in the gestational state and increases under the influence of persistent hyperglycemia compared to healthy pregnant women.The macular superficial blood flow density is significantly reduced and the peripheral areas are more susceptible,and this change is exacerbated by the persistent hyperglycemic state. |
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