Evolution of Quantitative Optical Coherence Tomography Angiography Markers with Glycemic Control: A Pilot Study

Aim: We aimed to analyze changes in retinal microvascularization with intensive reduction of glycated hemoglobin A1c (HbA1c) in patients with poorly controlled diabetes using quantitative optical coherence tomography angiography (OCT-A) metrics. Method: This was a retrospective observational study in patients with uncontrolled diabetes admitted to the hospital for glycemic control. A second set of 15 healthy volunteers was included to serve as a control group. OCT-A was performed at inclusion and at 3 months to measure foveal avascular zone area (FAZA), vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), acircularity index (AI), and fractal dimension (FD). Results: This analysis included 35 patients (35 eyes): 28 type-2 diabetics and 7 type-1 diabetics. Mean HbA1c was 13.1 +/- 2.0% at inclusion and 7.0 +/- 1.5% at 3 months. In the short period from inclusion to 3 months post-inclusion, patients showed significant decrease in VD-DCP (28.8% vs. 27.8%; p = 0.014), a significant increase in FAZA (0.300 mm(2) vs. 0.310 mm(2); p < 0.001), and a significant increase in AI (1.31 vs. 1.34; p < 0.01). Multivariate analysis found an increase in FAZA was correlated with baseline HbA1c level and age (R-2 = 0.330), and a decrease in VD-DCP was correlated with HbA1c decrease and diabetes duration (R-2 = 0.286). Conclusions: Rapid glycemic control in patients with uncontrolled diabetes led to possible short-term microvascular damage that correlated to both initial and decreased HbA1c.