Тhe Role of Retinal Vascular Reactions in the Development and Regression of Diabetic Retinopathy

Objective : to study retinal vascular reactions (RVR) with a glycemic gradient, vitrectomy (VE) without panretinal photocoagulation (PRP) and after IVI aflibercept in patients with diabetes mellitus (DM). Methods . In three independent groups, variations in retinal vessel (RV) caliber were studied with a glycemic gradient (DR progression factor), after VE without PRP and after IVI (DR/PDR regression factors). Retinal images were obtained using Heidelberg Retinal tomograph HRT II (Germany). Results . With an increase in the level of glycemia, the tendency to increase the diameter of the RV in DM1 and DM2 was revealed both in eyes without DR and in the presence of DR. However, only in DR were the changes significant. After VE without PRP in the eyes with PDR, the diameter of the veins decreased by 7 % 2 months after VE and by 14 % after 18 months (p < 0.01); the arteries had persistent and significant changes in caliber after 2 months. After IVI aflibercept, the caliber of retinal vessels in DMO significantly decreased from the first to the third injection. Conclusion . Patients with DM initially represent a heterogeneous group in terms of the severity of RVR, depending on the presence or absence of ДР. After treatment, BCVA indicators improved against the background of retinal vasoconstriction in all study groups. After VE without PRP there was a persistent and significant reduction of PV diameters. Thus, the dynamics of retinal vessel caliber may reflect the phases of DR/PDR evolution: progression or regression. Persistent PDR remission can be achieved without lasercoagulation of the retinal “avascular zones”.