The impairment of the deep vascular complex in prolonged type 2 diabetes patients without clinical diabetic retinopathy

Purpose To identify the effects of prolonged type 2 diabetes (T2DM) on the retinal microvasculature of each retinal capillary plexus in patients without clinical diabetic retinopathy (DR). Methods Subjects were divided into three groups: the control group (98 eyes), patients with T2DM < 10 years (DM group 1, 84 eyes), and patients with T2DM >= 10 years (DM group 2, 55 eyes). The vessel densities (VD) of the superficial and deep capillary plexus (SCP and DCP) were compared. Linear regression analyses were performed to identify factors associated with the VD. Results The mean VDs of the SCP in the control group, DM group 1, and DM group 2 were 35.9 +/- 4.2, 34.9 +/- 3.9, and 34.6 +/- 5.1, respectively (P = 0.042). The mean VDs of the DCP in the three groups were 36.1 +/- 3.1, 35.9 +/- 3.0, and 34.0 +/- 3.3, respectively (P < 0.001). In multivariate analyses, the BCVA was a significant factor associated with both the superficial VD (B = -7.10, P = 0.019) and deep VD (B = -5.70, P = 0.039). Hypertension (B = -1.22, P = 0.021) and DM duration (B = -0.20, P < 0.001) were significant factors associated with deep VD. Conclusions T2DM patients without DR showed decreased VD in the SCP and DCP. The microvascular impairment of the DCP in patients with T2DM >= 10 years was in particular, more severe. Additionally, ischemia caused by hypertension and accumulated impairment of microvasculature due to prolonged T2DM would affect the DCP.