We investigated the effects of retinal ischemia, neurodegeneration, and subclinical edema on best-corrected visual acuity (BCVA) in the early stages of diabetic retinopathy (DR). Ischemia was evaluated by the microvascular parameters measured by optical coherence tomography angiography. Neurodegeneration and subclinical edema were identified by the intraretinal layer thickness obtained by optical coherence tomography. Eyes with nonproliferative diabetic retinopathy (n = 132) from 89 patients were analyzed. Eyes were classified as having normal BCVA (n = 88 [66.7%], Snellen equivalent ≥ 20/20) or decreased BCVA (n = 44 [33.3%], Snellen equivalent < 20/20). The prevalence of ischemia, neurodegeneration, and subclinical edema was explored in patients with and without decreased BCVA, and correlations between BCVA and these pathological pathways were determined. Vessel density in the deep retinal capillary plexus (DRCP) and thickness of ganglion cell layer plus inner plexiform layer (GCL-IPL) were significantly lower in eyes with decreased BCVA compared with eyes with normal BCVA (both P < 0.05). In the final multiple regression predictive model, age, DRCP vessel density, and GCL-IPL thickness (all P ≤ 0.044) were predictors of BCVA. DRCP vessel density and GCL-IPL thickness have an interactive effect on visual acuity. The proportions of ischemia and neurodegeneration were significantly higher in eyes with decreased BCVA than in eyes with normal BCVA (P = 0.001 and P = 0.004, respectively). During the natural course of the early stages of DR, ischemia and neurodegeneration were the main disease pathways associated with visual acuity, and the mechanisms varied among patients.

中文翻译：

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早期糖尿病视网膜病变患者的视力与缺血和神经变性相关

我们研究了糖尿病视网膜病变 (DR) 早期阶段视网膜缺血、神经变性和亚临床水肿对最佳矫正视力 (BCVA) 的影响。通过光学相干断层扫描血管造影术测量的微血管参数评估缺血。通过光学相干断层扫描获得的视网膜内层厚度确定神经变性和亚临床水肿。对来自 89 名患者的患有非增殖性糖尿病视网膜病变的眼睛 (n = 132) 进行了分析。眼睛被分类为 BCVA 正常（n = 88 [66.7%]，Snellen 等效值 ≥ 20/20）或 BCVA 降低（n = 44 [33.3%]，Snellen 等效值 < 20/20）。在有和没有 BCVA 降低的患者中探索了缺血、神经变性和亚临床水肿的患病率，并且确定了 BCVA 与这些病理途径之间的相关性。与BCVA正常的眼睛相比，BCVA降低的眼睛视网膜深部毛细血管丛（DRCP）的血管密度和神经节细胞层加内丛状层（GCL-IPL）的厚度显着降低（均P < 0.05）。在最终的多元回归预测模型中，年龄、DRCP 血管密度和 GCL-IPL 厚度（所有 P ≤ 0.044）是 BCVA 的预测因子。DRCP 血管密度和 GCL-IPL 厚度对视力有交互作用。BCVA 降低眼的缺血和神经变性比例显着高于 BCVA 正常眼（分别为 P = 0.001 和 P = 0.004）。在 DR 早期阶段的自然过程中，