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Barbara E K Klein, Kristine E Lee, Stacy M Meuer, Anne Mosher, Andy Ewen, Ronald Klein; Association of retinal vessel diameters and diabetic retinopathy in pregnancy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1040. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the association of retinal vessel diameters to severity of diabetic retinopathy in pregnant women with type 1 diabetes (T1D).
Retinal vessel diameters and severity of diabetic retinopathy in 144 women in the first trimester of pregnancy with T1D and 257 non-pregnant women of similar age with T1D were measured by protocols from standardized retinal images. Both eyes were available in 90% of the women, resulting in 778 eyes for analyses.
Proliferative retinopathy (PDR) was present in 103 eyes (13%) including 38 with laser treatment, which were excluded from analyses. Among the 275 eyes of pregnant women, retinal venule diameters (CRVE) were wider with increasing severity of diabetic retinopathy ranging from 236.9 µm in those with no retinopathy to 274.5 µm in those with PDR while retinal arteriolar diameters (CRAE) varied from 164.3 µm in those with no DR to 166.3µm in those with PDR. While adjusting for duration of diabetes the trend in CRVE was significant (p<0.001) but the trend for CRAE was not (p=0.15). Adjustment for glycemia and blood pressure had no material effect on these trends. Among the 465 eyes of non-pregnant women, there were smaller differences in CRVE (from 246.4 to 250.8 µm, trend p=0.26) and non-significant differences in CRAE (167.6 to 154.6 µm, trend p=0.32). Follow-up data are available for 215 eyes of pregnant women and 394 eyes of non-pregnant women. While the changes over time are small, there is a significant (p<0.001) difference between pregnant and non-pregnant women for CRAE, but not for CRVE (p=0.14). Pregnant women have a small narrowing of the arterioles (mean, SD change 2.8, 13.9) while non-pregnant women have a slight widening of the arterioles (mean, SD change 1.5, 10.7).
Severity of diabetic retinopathy was significantly associated with CRVE in the first trimester of pregnancy in women with type 1 diabetes. However, a significant pattern was not found in the non-pregnant group in this study. Changes in retinal vessel diameter are small, but appear to differ in pregnant women compared to non-pregnant. Increase in CRVE over a 4 year interval has been found to be associated with increased severity of diabetic retinopathy 6 years later. We do not know whether changes in retinal vascular patterns diameter during pregnancy are associated with increased severity of subsequent diabetic retinopathy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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