Effects of Prolonged Type 2 Diabetes on the Inner Retinal Layer and Macular Microvasculature: An Optical Coherence Tomography Angiography Study

Purpose: To identify the effects of prolonged type 2 diabetes (T2DM) on macular microcirculation and the inner retinal layer in diabetic eyes without clinical diabetic retinopathy (DR). Methods: 97, 92, and 57 eyes in the control, patients with T2DM < 10 years (DM group one), and patients with T2DM >= 10 years (DM group two) were enrolled. The ganglion cell-inner plexiform layer (GC-IPL) thickness and superficial vessel density (VD) were compared. Linear regression analyses were performed to identify factors associated with VD in T2DM patients. Results: GC-IPL thicknesses in the control, DM group one, and DM group two were 84.58 +/- 0.89, 83.49 +/- 0.70, and 79.04 +/- 0.96 mu m, respectively (p< 0.001). The VDs of the full area were 20.32 +/- 0.15, 19.46 +/- 0.17, and 18.46 +/- 0.23 mm(-1)(p< 0.001). Post-hoc analyses revealed that the VDs of the full area was significantly different in the control vs. DM group one (p= 0.001), control vs. DM group two (p< 0.001), and DM group one vs. DM group two (p= 0.001). Multivariate linear regression analyses revealed that DM duration (p= 0.037), visual acuity (p= 0.013), and GC-IPL thickness (p< 0.001) were significantly associated with the VD of T2DM patients. Conclusions: We confirmed GC-IPL thinning and decreased superficial VD in the macular areas using OCTA in T2DM patients. Patients with T2DM >= 10 years exhibited significantly more severe macular microcirculation impairment compared to patients with T2DM < 10 years and normal controls.