Evaluation of optical coherence tomography angiography and pattern and flash electroretinography in diabetes mellitus without retinopathy

Abstract

Purpose: To evaluate the findings and the correlation of optical coherence tomography angiography and pattern and flash electroretinography in diabetes mellitus without retinopathy.

Methods: Seventy-six eyes of 38 diabetic patients and age- and gender-matched control subjects were included in the study. The foveal avascular zone (FAZ), whole, foveal, parafoveal and perifoveal vascular densities of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillary plexus (CCP) layers were analyzed using optical coherence tomography angiography (OCTA). The amplitudes and implicit times of P50 and N95 waves of the pattern ERG (pERG) and the amplitudes and implicit times of the scotopic and photopic b-waves and oscillatory potentials (OP) of the flash ERG (fERG) tests were evaluated using the Metrovision brand monpack model device.

Results: The mean age of the patients was 59.7 ± 7.9 [range 43-79] years. Eighteen (47%) of the patients were female and 20 (53%) were male. The mean duration of diabetes was 7.45 ± 6.2 [range 1-20] years. No significant difference in FAZ area was found between study subjects and controls. Vascular density (VD) values of the superficial capillary plexus (SCP) layer were significantly lower (whole VD, 44.7 ± 3.3 vs. 46.6 ± 3.2%, p = 0.01, foveal VD 16.8 ± 6.4 vs. 24.9 ± 6.1%, p < 0.01, parafoveal VD 45.6 ± 4.5 vs. 47.1 ± 4.4%, p = 0.27 and perifoveal VD 45.5 ± 3.3 vs. 47.3 ± 3.1%, p = 0.01, respectively) in the diabetic group except the parafoveal area. VD measurements in deep and choriocapillary plexuses did not significantly differ between the groups (p > 0.05). ERG tests revealed significantly lower scotopic b-wave amplitudes (130.2 ± 39.3 µV vs.163.3 ± 47.8 µV, p < 0.01) and photopic b-wave amplitudes (83.2 ± 20.7 µV vs. 99.6 ± 29.4 µV, p < 0.01) in the diabetic patients. The implicit time of the photopic responses was significantly prolonged (28.9 ± 1.3 ms vs. 27.8 ± 2.1 ms, p = 0.01) in the patients. Oscillatory potentials in all components consisting of O1 to O4 and the sum of the OP potentials were lower in the diabetic group than the control subjects (p < 0.001). The P50 and N95 amplitudes and implicit times were comparable between the groups (p > 0.05). Correlation analysis showed a positive correlation between N95 amplitudes in pERG and the superficial vessel densities in OCTA (r = 0.26, p = 0.04). A negative correlation was found between photopic implicit times in fERG and the choriocapillary vessel densities (r=-0.27, p = 0.03).

Conclusion: OCTA revealed decreased superficial vascular densities with the onset of the metabolic process of diabetes mellitus. As a result of these structural changes, lower scotopic and photopic amplitudes, decreased OP amplitudes, and prolonged implicit times in flash ERG were obtained.

Keywords: Diabetes mellitus; flash electroretinography; optical coherence tomography angiography; pattern electroretinography; retinopathy.

Figure 1.

Representative ERGs in the diabetic without retinopathy.