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Diabetic retinopathy (DR) is a microvascular complication of diabetes and the most common cause of acquired vision loss in adults worldwide. DR is associated with long-term chronic hyperglycaemia and its detrimental effects on the neurovascular structure and function of the retina. Direct imaging of the retinal vasculature and staging of DR has been traditionally based on fundoscopy and fluorescein angiography, which provide only 2D views of the retina, and in the case of fluorescein angiography, requires an invasive dye injection. In contrast, advanced retinal imaging modalities like optical coherence tomography angiography (OCTA) and adaptive optics (AO) are non-invasive and provide depth-resolved, 3D visualization of retinal vessel structure as well as blood flow. Recent studies utilizing these imaging techniques have shown promise in evaluating quantitative vascular parameters that correlate tightly to clinical DR staging, elucidating functional changes in early diabetes, and monitoring DR treatment response. In this article, we discuss and synthesize the results of advanced retinal imaging studies in DR and their implications for our clinical and pathophysiologic understanding of the disease. Based on the recent literature, we also propose a model to describe the differential changes in vascular structure and flow that have been described on advanced retinal imaging as DR progresses. Future studies of these imaging modalities in larger and more diverse populations, as well as corroboration with histological and functional studies, will be important to further our understanding of DR.摘要: 糖尿病性视网膜 (DR) 为糖尿病微血管并发症, 也是全球成年人获得性视力丧失的最常见原因。DR与长期慢性高糖血症及其对视网膜神经血管结构与功能的损伤有关。视网膜血管的直接成像以及针对DR的分期传统上是基于眼底镜检查和荧光素血管造影, 但它们仅仅提供了视网膜的2维图像, 且荧光素血管造影需要注射侵入性的染料。相反, 先进的视网膜血管成像模式如相干光断层血管成像(OCTA)技术和自适应光学 (AO) 成像技术都是非侵入性的检查, 且可以提供高分辨的、3D可视化的视网膜血管结构和血流。最近的研究利用这些影像技术在评估与临床DR分期紧密相关的定量血管参数、阐明糖尿病早期的功能改变和监测DR治疗反应等方面展现出良好的前景。在这篇文章中, 基于已发表的文献, 我们讨论并整合了先进的视网膜成像技术在DR研究中应用的研究结果, 以及这些研究结果对于深入理解DR的临床和其病理生理的作用。根据最近文献, 我们同样提出了一个新的模型, 用于描述在DR进展中利用先进的视网膜成像来阐述血管结构和血流的改变。未来在更大更多样的人群中, 影像模式研究联合组织学和功能学的研究将会对我们理解DR非常重要。. |
