الفهرس 
Detection of early macular vascular affection in prediabetics using Optical Coherence Tomography Angiography (OCTA) and fundus photography
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Abstract
Diabetes, a major health problem, is preceded by a stage called prediabetes. Prediabetes is an intermediate state of hyperglycemia between normal glucose tolerance and overt T2DM, theoretically microvascular complications of diabetes can develop during the stage of prediabetes. Diabetic retinopathy is the leading cause of blindness among working aged adults around the world. The ophthalmoscopy and color fundus photography are the gold standards for diagnosis and staging of diabetic retinopathy. OCTA is rapid, noninvasive diagnostic tool and does not need dye injection.
Objectives: The aim of the study is to assess early macular vascular affection using OCTA and fundus photography in prediabetics.
Methods: 132 subjects who were nondiabetics, normotensives with normal kidney functions and no previous ocular surgeries, were divided by FBS, 2hr pp HbA1C into prediabetic study group and normoglycemic control group. They were all subjected to thorough history taking, full examination, BMI calculation, retinal imaging by color fundus photography and OCTA in addition to laboratory tests including A/C ratio, urea, creatinine, FBS,2 hr pp and HbA1C.
Results: Our results showed that 36.4 % of the prediabetic group showed only signs of mild proliferative retinopathy (in the form of microaneurysms) by OCTA and 10.6% by fundus photography but none of the control group showed any signs of retinopathy. Also, microalbuminuria affected 12.1% of the prediabetic group with zero % in the control group. None of the age, sex, BMI, HbA1C, A/C ratio was significantly correlated to the retinopathy detected in prediabetics. Among the most correlated OCTA parameters with DR are the perfusion percentages of the vessel density of the deep capillary plexus whole area, deep capillary plexus parafoveal and deep capillary plexus perifoveal with cut off values ˂ 45.8%, ˂52.5%, ˂45.4% respectively and P value ˂ 0.001.
Conclusion: Retinal and renal microvascular complications can start to develop before the diagnosis of overt type 2 diabetes, which makes screening for diabetic complications in the prediabetics mandatory for its prevention or delay.