Сітківка як мішень ранніх змін при цукровому діабеті, метаболічному синдромі та інсулінорезистентності (огляд літератури)

Diabetes mellitus, metabolic syndrome, and insulin resistance represent a broad spectrum of metabolic disorders sharing common pathophysiological mechanisms and associated with chronic inflammation, oxidative stress, and endothelial dysfunction. Biochemical markers of microvascular damage are not routinely used in clinical practice for large-scale screening of the general population. The neurovascular structure of the retina may serve as a sensitive indicator of early changes in systemic metabolic dysfunction. The aim: to summarize and analyze literature data on the possibility of detecting preclinical retinal disorders in patients with diabetes mellitus, insulin resistance, and metabolic syndrome. Materials and methods. A literature review was conducted in the scientific databases PubMed, Google Scholar, and specialized ophthalmological journals. The following keywords were used: diabetes mellitus, metabolic syndrome, insulin resistance, early retinal changes, microvascular changes, neurodegeneration, and optical coherence tomography. Results. The analyzed literature sources demonstrate that retinal changes occur at preclinical stages of the studied conditions. Optical coherence tomography (OCT) reveals early signs of neurodegeneration manifested by thinning of the retinal nerve fiber layer and the retinal ganglion cell complex. OCT angiography indicates changes in capillary density within different vascular plexuses and a change of the foveal avascular zone prior to the development of clinically apparent retinopathy. Conclusions. The retina is a sensitive indicator of early metabolic impairment, and OCT and OCT angiography enable the detection of microvascular and neurovascular alterations before the onset of overt clinical manifestations.