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In vivo assessment of associations between photoreceptors structure and macular perfusion in type 1 diabetes
  1. Pasquale Viggiano1,
  2. Eliana Costanzo1,
  3. Daniela Giannini1,
  4. Serena Fragiotta2,
  5. Daniele De Geronimo1,
  6. Paola Giorno1,
  7. Fabiana Picconi3,
  8. Simona Frontoni3,
  9. Monica Varano1,
  10. Mariacristina Parravano1
  1. 1 Ophthalmology, IRCCS-Fondazione Bietti, Rome, Italy
  2. 2 Department of Medicine and Surgery, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
  3. 3 Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
  1. Correspondence to Dr Mariacristina Parravano, Fondazione Bietti, Roma, Italy; mcparravano{at}


Purpose To explore the potential relationships between macular vascular network and different adaptive optics (AO) metrics in patients with type 1 diabetes mellitus (DM1) with no signs (NoDR) or mild non-proliferative diabetic retinopathy (NPDR).

Design Observational cross-sectional study.

Methods Forty eyes of consecutive patients with DM1 (12 NoDR and 28 NPDR) and 10 healthy age-matched control subjects were included. All patients and controls were imaged using AO retinal camera and PLEX Elite 9000 optical coherence tomography (OCT) angiography (OCTA). The AO outcome measures to evaluate the cone photoreceptor mosaic characteristics were as follows: (1) Cone density (CD); (2) Linear Dispersion Index (LDi) and (3) Heterogeneity Packing Index (HPi). The OCTA outcome measures included: (1) superficial capillary plexus (SCP) perfusion density (PD); (2) deep capillary plexus (DCP) PD and (3) the choriocapillaris (CC) flow deficit percentage (FD%).

Results NPDR group exhibited a close relationship between cone metrics and CC FD. Notably, CC FD% increase along with LDi (p=0.035), while the increasing CC FD% were associated with reducing CD (p=0.042) and the HPi (p=0.017). Furthermore, the OCTA parameters, including PD SCP and DCP, showed a significant negative correlation with CD.

Conclusions Our results demonstrated the relationship between macular perfusion at both retinal and choroidal levels and the cone mosaic in patients with DM1 interpolating swept-source-OCTA and AO metrics. In NPDR eyes, the photoreceptor damage was accompanied by CC insufficiency since the early stages of the disease.

  • Choroid
  • Imaging
  • Macula
  • Retina

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors Study concept and design: PV, MP and MV. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: PV, SF and MP. Statistical analysis: DG. Guarantor is MP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MP reports personal fees from Allergan, Novartis, Bayer, Roche, Zeiss, Omikron, Alfaintes outside the submitted work. MV reports personal fees from Allergan, Bayer, Novartis and SIFI outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.