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2017 ; 139
(ä): 161-167
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Diabetic choroidopathy
#MMPMID28535994
Lutty GA
Vision Res
2017[Oct]; 139
(ä): 161-167
PMID28535994
show ga
Early histopathological studies of diabetic choroids demonstrated loss of
choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits
on Bruchs membrane, and choroidal neovascularization. The preponderance of
histopathological changes were at and beyond equator. Studies from my lab suggest
that diabetic choroidopathy is an inflammatory disease in that leukocyte adhesion
molecules are elevated in the choroidal vasculature and polymorphonuclear
neutrophils are often associated with sites of vascular loss. Modern imaging
techniques demonstrate that blood flow is reduced in subfoveal choroidal
vasculature. Angiography has shown areas of hypofluorescence and late filling
that probably represent areas of vascular loss and/or compromise. Perhaps, as a
result of vascular insufficiency, the choroid appears to thin in DC unless
macular edema is present. Enhanced depth imaging (EDI-SD) OCT and swept source
(SS) OCT have documented the tortuosity and loss in intermediate and large blood
vessels in Sattler's and Haller's layer seen previously with histological
techniques. The risk factors for DC include diabetic retinopathy, degree of
diabetic control, and the treatment regimen. In the future, OCT angiography could
be used to document loss of CC. Because most of the measurement and imaging are
in the posterior pole, the severity of DC may be underappreciated in the
published accounts of DC assessed with imaging techniques. However, it is now
possible to document DC and quantify these changes clinically. This suggests that
DC should be evaluated in future clinical trials of drugs targeting DR because
vascular changes similar to those in DR are occurring in DC.
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