[关键词]
[摘要]
糖尿病视神经病变(DON)是糖尿病(DM)常见但易被忽视的并发症，起病隐匿、临床表现不典型，且常与糖尿病视网膜病变(DR)共存，导致早期诊断困难，多数患者就诊时已出现不可逆性视神经损伤。光学相干断层扫描(OCT)及其血流成像技术(OCTA)能够无创、高分辨率地显示视网膜、脉络膜及视盘的各层结构与微血管形态，为DON的早期识别与机制研究提供了关键工具。文章系统综述了OCT/OCTA在评估DON患者视盘周围神经纤维层(pRNFL)厚度、神经节细胞复合体(GCC)结构及血管密度(VD)等方面的最新研究进展，揭示了微循环障碍可能先于结构损伤出现的病理特征。文章还探讨了OCT/OCTA在疾病分期、疗效评估及联合人工智能(AI)实现早期筛查与预测的潜力。通过整合结构与血流参数，OCT/OCTA有望推动DON的早期诊断、风险分层及精准干预，最终改善患者视功能预后。
[Key word]
[Abstract]
Diabetic optic neuropathy(DON)is a common yet frequently overlooked complication of diabetes mellitus(DM), characterized by an insidious onset, nonspecific clinical manifestations, and frequent co-occurrence with diabetic retinopathy(DR), which often leads to delayed diagnosis and irreversible optic nerve damage. Optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)provide non-invasive, high-resolution imaging of the retinal layers, choroid, and optic nerve head, enabling detailed visualization of structural and microvascular changes in DON. This review summarizes recent advances in the application of OCT/OCTA for evaluating peripapillary retinal nerve fiber layer(pRNFL)thickness, ganglion cell complex(GCC)integrity and vessel density(VD)in DON, highlighting that microvascular impairment may precede measurable structural loss. Furthermore, the potential of OCT/OCTA in disease staging, treatment monitoring, and its integration with artificial intelligence(AI)for early screening and risk prediction is discussed. By combining structural and hemodynamic metrics, OCT/OCTA holds promise for improving early detection, risk stratification, and precision management of DON, thereby helping to preserve visual function in affected patients.
[中图分类号]
[基金项目]
河南省研究生教育改革与质量提升工程项目(No.YJS2025AL51)
