Diyabetik Retinopatide Görüntüleme ve Biyobelirteçler
Özet
Diyabetik retinopati (DR), orta yaş popülasyonunda körlüğün ve görme kaybının en sık nedenlerinden biridir. Günümüzde spektral alan ve taramalı optik koherens tomografi (OCT), fundus otofloresan (FAF), OCT anjiyografi (OCTA) ve fundus floresein anjiyografi (FFA) gibi retinal görüntüleme modaliteleri, hastalığın erken evrede tanımlanmasında, tedavi protokolüne karar vermede ve prognozu tahmin etmede paha biçilmez bir rol oynamaktadır. Yapısal OCT; retina iç katmanlarının düzensizliği (DRIL), hiperreflektif retina odakları (HRF), kistoid boşluklar ve subfoveal nörosensoriyel dekolman gibi mikro yapısal ve inflamatuar biyobelirteçlerin invaziv olmayan bir şekilde değerlendirilmesini sağlar. Retina damarlarının incelenmesinde altın standart olan FFA; kapiller non-perfüzyon alanlarını, foveal avasküler zon (FAZ) düzensizliklerini ve neovaskülarizasyon sızıntılarını ayırt etmede başarılıdır. Yeni bir teknoloji olan OCTA ise boya kullanılmadan retinokoroidal mikrovasküler yapıların ve damar yoğunluğunun üç boyutlu analizine imkan tanıyarak derin ve yüzeysel kapiller pleksusları ayrı ayrı değerlendirir. FAF ise lokal oküler inflamasyonu ve retinal kistlerin metabolik etkilerini lipofuscin ve melanin sinyalleri üzerinden izlemeyi kolaylaştırır. Sonuç olarak bu multimodal görüntüleme teknikleri, subklinik retinal vasküler değişikliklerin taranmasında ve tedavi yanıtının izlenmesinde kritik öneme sahiptir.
Diabetic retinopathy (DR) is one of the leading causes of blindness and vision loss in the middle-aged population. Today, retinal imaging modalities such as spectral-domain and swept-source optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography (OCTA), and fundus fluorescein angiography (FFA) play an invaluable role in identifying the disease at an early stage, deciding on treatment protocols, and predicting prognosis. Structural OCT allows for the non-invasive evaluation of microstructural and inflammatory biomarkers, including the disorganization of retinal inner layers (DRIL), hyperreflective retinal foci (HRF), cystoid spaces, and subfoveal neurosensory detachment. As the gold standard for examining retinal vessels, FFA is highly successful in distinguishing capillary non-perfusion areas, foveal avascular zone (FAZ) irregularities, and neovascularization leakage. OCTA, an emerging technology, enables the three-dimensional analysis of retinochoroidal microvascular structures and vessel density without the use of dye, evaluating deep and superficial capillary plexuses individually. Furthermore, FAF facilitates monitoring local ocular inflammation and the metabolic effects of retinal cysts through lipofuscin and melanin signals. Consequently, these multimodal imaging techniques are critical for screening subclinical retinal vascular changes and monitoring treatment response.
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