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Cross-sectionalPhotodiagnosis and photodynamic therapy · 2026

Duration-Dependent Decoupling of the Macular Neurovascular Unit in Type 2 Diabetes Without Retinopathy: A Topographic Analysis Using Ultra-Widefield OCT Angiography.

Cong Chen, Wen-Jing Zhang, Shu-Min Shen … Yan-Ping Song

OphthalmologyCross-sectional

Deep retinal vessel density moderately distinguishes long-standing diabetic eyes from healthy eyes before retinopathy appears

Duration-Dependent Decoupling of the Macular Neurovascular Unit in Type 2 Diabetes Without Retinopathy: A Topographic Analysis Using Ultra-Widefield OCT Angiography.

Cong Chen … Yan-Ping Song

Photodiagnosis and photodynamic therapy · 2026

Purpose

To characterize duration-dependent topographic macular neurovascular unit (neurovascular unit) alterations in type 2 diabetes (T2DM) without diabetic retinopathy (diabetic retinopathy) using 26×21 mm ultra-widefield swept-source OCT angiography (ultra-widefield swept-source OCT angiography) and evaluate its diagnostic utility for long-duration eyes.

Methods

This cross-sectional study included 295 eyes (69 controls; 226 T2DM without diabetic retinopathy stratified by duration: <5, 5-10, ≥10 years).

n = 295 eyes

Results

Deep-layer blood vessel density test moderately told apart long-duration diabetic eyes from healthy controls

AUC 0.72 (95% CI 0.63 to 0.81)

CI excludes the null - significant

More results

Longer duration was associated with progressive ganglion cell-inner plexiform layer thinning and deep-predominant deep vascular density reduction across nearly all macular zones (q<0.05); the deep vascular density deficit was most pronounced in the outer ring.

Superficial vascular density showed nasal-temporal asymmetry; selective nasal inner loss in ≥10-year group.

More results

GCIPL-DVD coupling, present in controls, attenuated in ≥10-year group, indicating neurovascular unit decoupling.

Duration independently predicted ganglion cell-inner plexiform layer (β=-0.21) and deep vascular density (β=-0.27) after adjustment (P<0.01).

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Conclusion · 1 of 2

Preclinical neurovascular unit decoupling-predominantly in the deep capillary plexus and nasally asymmetric-already occurs in T2DM without fundoscopic diabetic retinopathy and progresses with disease duration.

Conclusion · 2 of 2

Deep-layer ultra-widefield swept-source OCT angiography metrics may strengthen risk stratification before clinical retinopathy.

Post

Duration-Dependent Decoupling of the Macular Neurovascular Unit in Type 2 Diabetes Without Retinopathy: A Topographic Analysis Using Ultra-Widefield OCT Angiography.

Deep retinal vessel density moderately distinguishes long-standing diabetic eyes from healthy eyes before retinopathy appears

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