Dynamics of indicators of the vascular membrane of the ciliary body in predicting the risk of diabetic retinopathy in pregnant women with diabetes mellitus

Cover Page

Cite item

Full Text

Abstract

BACKGROUND: According to statistics, microvascular complications of diabetes mellitus are registered in a third of patients during their lifetime, and diabetic retinopathy is the main cause of irreversible blindness in people of reproductive age. Changes in the vascular membrane of the eye in patients with diabetes mellitus are currently being studied as predictors of the progression of diabetic retinopathy. Further study of changes in the vascular membrane in pregnant women with type 1 and type 2 diabetes may help in identifying criteria for the manifestation and progression of diabetic microangiopathy.

AIM: To develop a methodology for predicting the risk of diabetic retinopathy progression by analyzing the dynamics of the state of the vascular membrane of the ciliary body.

METHODS: The study was conducted in each trimester of pregnancy. A pregnant patient with confirmed diabetes mellitus 1 or diabetes mellitus 2 underwent a comprehensive ophthalmological examination, including visometry with maximally corrected visual acuity, tonometry, biomicroscopy of the anterior segment of the eye, ophthalmoscopy under conditions of drug-induced mydriasis (phenylephrine) with a high-diopter lens (78–90 D), and optical coherence tomography of the anterior and posterior eye segments.

RESULTS: With an increase in the thickness of the vascular layer of the ciliary body by ≥10% at one or more points compared with the study conducted in the first trimester of pregnancy, the patients exhibited diabetic retinopathy progression during subsequent routine examinations. Quantitative analysis of the vascular layer of ciliary body revealed the transition of diabetic retinopathy to its next stage; however, photoregistration of the fundus did not show obvious signs of transformation into another stage of the disease.

CONCLUSION: Dynamic examination of the thickness of the vascular layer of the ciliary body during gestation and its increase by 10% from the initial one enables prediction of progression of diabetic retinopathy to the next stage.

About the authors

Elena N. Khomiakova

Moscow Regional Research and Clinical Institute

Email: veritas.elena@gmail.com
ORCID iD: 0000-0002-4460-3968
SPIN-code: 2200-0320

MD, PhD, Associate Professor

Russian Federation, Moscow

Anna A. Afanaseva

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: anna_amor@mail.ru
ORCID iD: 0000-0002-6307-5582
SPIN-code: 3539-6607
Russian Federation, Moscow

Igor A. Loskutov

Moscow Regional Research and Clinical Institute

Email: loskoutigor@mail.ru
ORCID iD: 0000-0003-0057-3338
SPIN-code: 5845-6058

MD, PhD

Russian Federation, Moscow

References

  1. Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol. 2007;14(4):179–183. doi: 10.1080/09286580701396720
  2. Мустафина Г.А., Слепцов А.Р. Особенности кровотока в центральной артерии сетчатки при неосложненной беременности // Эхография. 2003. Т. 4, № 1. С. 103–105. [Mustafina GA, Sleptsov AR. Features of blood flow in the central retinal artery in uncomplicated pregnancy. Echography. 2003;4(1):103–105. (In Russ).]
  3. Morrison JL, Hodgson LA, Lim LL, Al-Qureshi S. Diabetic retinopathy in pregnancy: A review. Clin Exp Ophthalmol. 2016;44(4):321–334. doi: 10.1111/ceo.12760
  4. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000;23(8):1084–1091. doi: 10.2337/diacare.23.8.1084
  5. Widyaputri F, Rogers SL, Kandasamy R, et al. Global estimates of diabetic retinopathy prevalence and progression in pregnant women with preexisting diabetes: A systematic review and meta-analysis. JAMA Ophthalmol. 2022;140(5):486–494. doi: 10.1001/jamaophthalmol.2022.0050
  6. Goldenberg RL, McClure EM, Harrison MS, Miodovnik M. Diabetes during pregnancy in low- and middle-income countries. Am J Perinatol. 2016;33(13):1227–1235. EDN: XYXGJJ doi: 10.1055/s-0036-1584152
  7. McCarthy EA, Williamson R, Shub A. Pregnancy outcomes for women with pre-pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review. Aust NZ J Obstet Gynaecol. 2019;59(2):183–194. doi: 10.1111/ajo.12913
  8. Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;(2):17. EDN: FOCIDU doi: 10.1186/s40662-015-0026-2
  9. Elaraoud I, Attawan A, Quhill F. Case series investigating the efficacy and safety of bilateral fluocinolone acetonide (ILUVIEN) in patients with diabetic macular edema. Ophthalmol Ther. 2016;5(1):95–104. doi: 10.1007/s40123-016-0045-7
  10. Giocanti-Auregan A, Tadayoni R, Grenet T, et al. Estimation of the need for bilateral intravitreal anti-VEGF injections in clinical practice. BMC Ophthalmol. 2016;(16):142. EDN: HBQHTD doi: 10.1186/s12886-016-0317-y
  11. Vestgaard M, Ringholm L, Laugesen CS, et al. Pregnancy-induced sight-threatening diabetic retinopathy in women with type 1 diabetes. Diabet Med. 2010;27(4):431–435. doi: 10.1111/j.1464-5491.2010.02958.x
  12. Cavan D, Makaroff L, da Rocha Fernandes J, et al. The diabetic retinopathy barometer study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract. 2017;(129):16–24. doi: 10.1016/j.diabres.2017.03.023
  13. Hidayat AA, Fine BS. Diabetic choroidopathy. Light and electron microscopic observations of seven cases. Ophthalmology. 1985;92(4):512–522.
  14. Laíns I, Figueira J, Santos AR, et al. Choroidal thickness in diabetic retinopathy: The influence of antiangiogenic therapy. Retina. 2014;34(6):1199–1207. doi: 10.1097/IAE.0000000000000053
  15. Kim JT, Lee DH, Joe SG, et al. Changes in choroidal thickness in relation to the severity of retinopathy and macular edema in type 2 diabetic patients. Invest Ophthalmol Vis Sci. 2013;54(5): 3378–3384. doi: 10.1167/iovs.12-11503
  16. Помыткина Н.В., Сорокин Е.Л. Морфометрия хориоидеи у беременных с нарушениями углеводного обмена // Вестник офтальмологии. 2020. Т. 136, № 6. С. 165–170. [Pomytkina NV, Sorokin EL. Morphometry of chorioidea in pregnant women with disorders of carbohydrate metabolism. Russ Ann Ophthalmol. 2020;136(6):165–170. (In Russ).] EDN: DTCKRH doi: 10.17116/oftalma2020136062165
  17. Патент РФ на изобретение № 2809639 С1. Хомякова Е.Н., Лоскутов И.А., Афанасьева А.А., Сергушев С.Г. Способ прогнозирования риска прогрессии диабетической ретинопатии у беременных с сахарным диабетом. [Patent RUS № 2809639 С1. Khomyakova EN, Loskutov IA, Afanasyeva AA, Sergushev SG. Method of predicting the risk of progression of diabetic retinopathy in pregnant women with diabetes mellitus. (In Russ).] Режим доступа: https://patents.google.com/patent/RU2809639C1/ru. Дата обращения: 15.04.2024.
  18. Hirano T, Hoshiyama K, Hirabayashi K, et al. Vitreoretinal interface slab in OCT angiography for detecting diabetic retinal neovascularization. Ophthalmol Retina. 2020;4(6):588–594. doi: 10.1016/j.oret.2020.01.004
  19. Шкляров Е.Б., Григорьева Н.Н., Шадричев Ф.Е., Астахов Ю.С. Новые технологии визуализации диабетических изменений сетчатки // Сахарный диабет. 2008. Т. 11, № 3. С. 28–29. [Shklyarov EB, Grigorieva NN, Shadrichev FE, Astakhov YS. New imaging technologies of diabetic retinal changes. Diabetes Mellitus. 2008;11(3):28–29. (In Russ).] doi: 10.14341/2072-0351-5356

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Study design: observation groups, time characteristics and study methods. СД1/СД2 — type 1/2 diabetes mellitus; АД — blood pressure; МКОЗ — maximum corrected visual acuity; ЦТС — central retinal thickness; ОПМП — optical density of macular pigment; ЦТ — ciliary body

Download (1MB)
Indexing metadata
3. Fig. 2. Distribution of diabetic retinopathy variants in the studied groups. НДР/ПреДР/ПДР — nonproliferative / preproliferative / proliferative diabetic retinopathy

Download (1MB)
Indexing metadata
4. Fig. 3. Dynamics of diabetic retinopathy development by trimesters of pregnancy. НДР/ПреДР/ПДР — nonproliferative / preproliferative / proliferative diabetic retinopathy

Download (1MB)
Indexing metadata
5. Fig. 4. Roc-analysis of the predictive power of the ciliary body vascular layer thickness index in pregnant women with type 1/2 diabetes mellitus

Download (1MB)
Indexing metadata
6. Fig. 5. Thickness of the vascular layer of the ciliary body in the inner part of the right eye at 19 weeks of gestation

Download (1MB)
Indexing metadata
7. Fig. 6. Thickness of the vascular layer of the ciliary body in the inner part of the right eye at 30 weeks of gestation

Download (1MB)
Indexing metadata
8. Fig. 7. Thickness of the vascular layer of the ciliary body in the inner part of the right eye at 35 weeks of gestation

Download (1MB)
Indexing metadata

Copyright (c) 2024 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies