helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2021-14-3-124-130helmholtzeyeinstitute-733Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSСовременные подходы к выявлению доклинических признаков диабетической ретинопатии с помощью ОКТ-ангиографииOCT angiography in detecting preclinical diabetic retinopathyhttps://orcid.org/0000-0002-5121-803XСтуловаА. Н.StulovaA. N.

 аспирант

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Ломоносовский пр-т., дом 27, корп. 1, Москва, 119991, Россия 

PhD Student

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 27/1 Lomonosov Ave., Moscow, 119991, Russia

anna_stulova@mail.ruhttps://orcid.org/0000-0002-7928-5410СеменоваН. С.SemenovaN. S.

 канд. мед. наук, доцент кафедры офтальмологии факультета фундаментальной медицины,

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Ломоносовский пр-т., дом 27, корп. 1, Москва, 119991, Россия 

Cand. of Med. Sci., associate professor, chair of ophthalmology, faculty of fundamental medicine

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 27/1 Lomonosov Ave., Moscow, 119991, Russia

https://orcid.org/0000-0002-9524-0124ЖелезняковаА. В.ZheleznyakovaA. V.

 канд. мед. наук, старший научный сотрудник

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ул. Дмитрия Ульянова, д. 11, Москва, 117036, Россия

 Cand. of Med. Sci., senior research

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11 Dmitry Ulyanov St., Moscow, 117036, Russia

https://orcid.org/0000-0003-0481-3642АкопянВ. С.AkopyanV. S.

 д-р мед. наук, профессор, заведующий кафедрой офтальмологии факультета фундаментальной медицины

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Ломоносовский пр-т., дом 27, корп. 1, Москва, 119991, Россия 

 Dr. of Med. Sci., professor, head of chair of ophthalmology, faculty of fundamental medicine

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 27/1 Lomonosov Ave., Moscow, 119991, Russia

https://orcid.org/0000-0002-2998-3392ЛипатовД. В.LipatovD. V.

 д-р мед. наук, профессор, заведующий отделением диабетической ретинопатии и офтальмохирургии, профессор кафедры офтальмологии 

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ул. Дмитрия Ульянова, д. 11, Москва, 117036, Россия

ул. Миклухо-Маклая, д. 6, Москва, 117198, Россия 

 Dr. of Med. Sci., professor, chair of the department of diabetic retinopathy and ophthalmosurgery, professor, chair of ophthalmology

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11 Dmitry Ulyanov St., Moscow, 117036, Russia

6, Miklukho-Maklaya St., Moscow, 117198, Russia 

ФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»РоссияLomonosov Moscow State UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава РоссииРоссияEndocrinology Research CenterRussian FederationФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России; ФГАОУ ВО «Российский университет дружбы народов»РоссияEndocrinology Research Center; Peoples’ Friendship University of RussiaRussian Federation202114092021143124130Copyright © Стулова А.Н., Семенова Н.С., Железнякова А.В., Акопян В.С., Липатов Д.В., 20212021Стулова А.Н., Семенова Н.С., Железнякова А.В., Акопян В.С., Липатов Д.В.Stulova A.N., Semenova N.S., Zheleznyakova A.V., Akopyan V.S., Lipatov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/733

 Изобретение оптической когерентной томографии с функцией ангиографии (ОКТА) позволило по-новому  взглянуть на ранние стадии диабетической ретинопатии (ДР). Результаты последних исследований демонстрируют значимые изменения фовеальной аваскулярной зоны (ФАЗ) — ее площади, индекса ациркулярности, соотношения осей и угла ФАЗ до возникновения офтальмоскопических проявлений. Большое количество работ посвящено оценке сосудистой плотности на уровне отдельных сосудистых  сплетений, причем зачастую авторы используют разные  методы обработки изображений, разные количественные и качественные параметры. Не менее важным признаком доклинической ДР является формирование  неперфузируемых зон. ОКТА позволяет детектировать их на разных уровнях и вычислять их площадь. Изменение  извитости ретинальных сосудов, описанное ранее при анализе изображений глазного дна, может быть  зарегистрировано и количественно подсчитано на ОКТА- сканах. Кроме того, в отдельных исследованиях у пациентов без офтальмоскопических признаков ДР выявляются  микроаневризмы. В обзоре представлен анализ современных подходов к оценке ранних ангиографических  изменений сетчатки, а также дана оценка перспектив  использования ОКТА для совершенствования  диагностических алгоритмов ДР.

 The invention of OCT angiography (OCTA) was a milestone in studying the early stages of diabetic retinopathy (DR). The latest findings show significant changes in foveal avascular zone (FAZ) parameters (FAZ area, FAZ perimeter, acirculatory index, axis ratio, FAZ angle) in diabetes mellitus patients with no ophthalmoscopic signs of DR. Many studies evaluate vessel density in superficial and deep plexuses in these patients using different methods of image processing and different qualitative and quantitative parameters. Nonperfusion areas (NA) are very  important findings at the preclinical stage of DR, which can be detected in superficial and deep layers. With OCT-A it is possible not only to reveal them but also to calculate their area. Vascular tortuosity (VT) was described earlier using fundus photography. Nowadays VT can be assessed at the microcirculation level in OCT-A scans. Microaneurysms are the earliest clinical sign of DR. They can be missed in fundus photos, but easily detected with OCT-A. The aim of the current review is to analyze the latest OCT-A findings at the preclinical stage of DR and to discuss the future diagnostic value of OCT-A in DR. 

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The authors declare that there are no conflicts of interest present.