ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2025-3-604-611ophthalmology-2753Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESРезультаты анализа микроциркуляции сетчатки у пациентов с сахарным диабетом после перенесенного COVID-19Results of Retinal Microcirculation Analysis in Patients with Diabetes Mellitus after COVID-19https://orcid.org/0000-0002-9833-6236ФроловМ. А.FrolovM. A.

Фролов Михаил Александрович - доктор медицинских наук, профессор, заведующий кафедрой глазных болезней.

ул. Миклухо-Маклая, 6, Москва, 117198; ул. Миклухо-Маклая, 10, Москва, 117198

Mikhail A. Frolov - MD, Professor, head of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198; Miklukho-Maklaya str., 10, Moscow, 117198

https://orcid.org/0000-0003-2707-8417ВоробьеваИ. В.VorobyevaI. V.

Воробьева Ирина Витальевна - доктор медицинских наук, профессор кафедры глазных болезней.

ул. Миклухо-Маклая, 6, Москва, 117198; ул. Миклухо-Маклая, 10, Москва, 117198

Irina V. Vorobyeva - MD, Professor, Professor of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198; Miklukho-Maklaya str., 10, Moscow, 117198

vorobyeva_iv@pfur.ruhttps://orcid.org/0000-0003-0988-1361ФроловА. М.FrolovA. M.

Фролов Александр Михайлович - кандидат медицинских наук, доцент кафедры глазных болезней.

ул. Миклухо-Маклая, 6, Москва, 117198; ул. Миклухо-Маклая, 10, Москва, 117198

Alexander M. Frolov - PhD, Associate Professor of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198; Miklukho-Maklaya str., 10, Moscow, 117198

https://orcid.org/0009-0003-6567-8779СеминаД. A.SeminaD. A.

Семина Дарья Андреевна - ассистент кафедры глазных болезней.

ул. Миклухо-Маклая, 6, Москва, 117198; ул. Миклухо-Маклая, 10, Москва, 117198

Daria A. Semina - assistant of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198; Miklukho-Maklaya str., 10, Moscow, 117198

https://orcid.org/0000-0001-8591-3746КлименкоА. С.KlimenkoA. S.

Клименко Анна Сергеевна - кандидат медицинских наук, доцент аккредитационно-симуляционного центра.

ул. Миклухо-Маклая, 6, Москва, 117198; ул. Миклухо-Маклая, 10, Москва, 117198

Anna S. Klimenko - PhD, Associate Professor of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198; Miklukho-Maklaya str., 10, Moscow, 117198

https://orcid.org/0000-0003-3576-293XШаллахС.ShallahS.

Шаллах Сами - аспирант кафедры глазных болезней.

ул. Миклухо-Маклая, 6, Москва, 117198

Sami Shallah - postgraduate of the Eye Diseases Department.

Miklukho-Maklaya str., 6, Moscow, 117198

ФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»; Клинико-диагностический центр ФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»РоссияPatrice Lumumba Peoples’ Friendship University of Russia; Clinical and Diagnostic Center of the Patrice Lumumba Peoples’ Friendship University of RussiaRussian FederationФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»РоссияPatrice Lumumba Peoples’ Friendship University of RussiaRussian Federation202501102025223604611Copyright © Фролов М.А., Воробьева И.В., Фролов А.М., Семина Д.A., Клименко А.С., Шаллах С., 20252025Фролов М.А., Воробьева И.В., Фролов А.М., Семина Д.A., Клименко А.С., Шаллах С.Frolov M.A., Vorobyeva I.V., Frolov A.M., Semina D.A., Klimenko A.S., Shallah S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/2753

Цель: мониторинг офтальмологических показателей и микроциркуляции сетчатки у пациентов с сахарным диабетом после перенесенного COVID-19. Пациенты и методы. Были использованы традиционные офтальмологические методы, включая оптическую когерентную томографию с ангиографией. Результаты. Обследованы 86 пациентов (86 глаз), которые были распределены на 4 подгруппы в зависимости от наличия или отсутствия диабета и COVID-19: подгруппа Iа: СД2(–) + COVID-19(-) — 22 человека (22 глаза) — контроль; подгруппа Iб: СД2(+) + COVID-19 (–) — 21 пациент (21 глаз); подгруппа Iв: СД2(–) + COVID-19 (+) — 20 пациентов (20 глаз); подгруппа Iг: СД2(+) + COVID-19 (+) — 23 пациента (23 глаза). Все пациенты перенесли COVID-19 дома и не госпитализировались в стационар. МКОЗ у всех пациентов составлял 0,9–1,0. Выявлено статистически значимое увеличение фовеолярной аваскулярной зоны и наибольшие ее показатели в подгруппе диабета и COVID-19. Так, показатели площади фовеолярной аваскулярной зоны в группе СД2 + COVID-19 (0,301 ± 0,004 мм2) были статистически значимо выше, чем в группе COVID-19 (0,260 ± 0,003 мм2) (p < 0,05), чем в группе СД2 (0,244 ± 0,004 мм2) (p < 0,05), чем в группе контроля (0,216 ± 0,005 мм2) (p < 0,05), а также определено статистически значимое увеличение С-реактивного белка (p < 0,05) и D-димера (p < 0,05). Лечение выявленных нарушений микроциркуляции сетчатки в подгруппе диабета и COVID-19, проводили по новому предложенному способу с применением лекарственной терапии сулодексидом в дозировке 250 ЛЕ 2 раза в сутки в течение 40 дней, когда значения площади и периметра фовеаолярной аваскулярной зоны статистически значимо снижаются (p < 0,05), что подтверждает эффективность предложенного способа лечения. Заключение. Выявлено, что у пациентов при сахарном диабете после перенесенного COVID-19 происходит нарушение микроциркуляции сетчатки, которое доказано размерами фовеолярной аваскулярной зоны статистически более высокими в сравнении с пациентами с сахарным диабетом (p < 0,05). Доказано, что на фоне лечения препаратом сулодексид в дозировке 250 ЛЕ 2 раза в сутки в течение 40 дней значения площади и периметра фовеолярной аваскулярной зоны сетчатки статистически значимо снижаются (p < 0,05), что подтверждает эффективность предложенного способа лечения.

Objective. Monitoring ophthalmological parameters and retinal microcirculation in patients with diabetes mellitus after COVID-19. Patients and methods. Traditional ophthalmological methods, including optical coherence tomography with angiography. Results: 86 patients (86 eyes) were examined and divided into 4 subgroups depending on the presence or absence of diabetes and COVID-19: subgroup Ia: T2DM (–) + Covid-19 (–) — 22 patients (22 eyes) — control; subgroup Ib: T2DM (+) + COVID-19 (–) — 21 patients (21 eyes); subgroup Ic: T2DM (–) + COVID-19 (+) — 20 patients (20 eyes); subgroup Ig: T2DM (+) + COVID-19 (+) — 23 patients (23 eyes). All patients had COVID-19 at home and were not hospitalized. BCVA in all patients was 0.9–1.0. A statistically significant increase in the foveal avascular zone and its highest values were found in the diabetes and COVID-19 subgroup. Thus, the foveal avascular zone area values in the T2DM + COVID-19 group (0.301 ± 0.004 mm2) were statistically significantly higher than in the COVID-19 group (0.260 ± 0.003 mm2) (p < 0.05), than in the T2DM group (0.244 ± 0.004 mm2) (p < 0.05), than in the control group (0.216 ± 0.005 mm2) (p < 0.05), and a statistically significant increase in C-reactive protein (p < 0.05) and D-dimer (p < 0.05) was also found. Treatment of the identified retinal microcirculation disorders in the diabetes and COVID-19 subgroup was carried out according to the new proposed method using drug therapy with Sulodexide at a dosage of 250 LE 2 times a day for forty days, when the values of the area and perimeter of the foveal avascular zone statistically significantly decrease (p < 0.05), which confirms the effectiveness of the proposed treatment method. Conclusion. It was revealed that in patients with diabetes mellitus after suffering COVID-19, there is a violation of retinal microcirculation, which is proven by the size of the foveal avascular zone, which is statistically higher in comparison with patients with diabetes mellitus (p < 0.05). It has been proven that against the background of treatment with Sulodexide at a dosage of 250 LE 2 times a day for forty days, the values of the area and perimeter of the foveal avascular zone of the retina statistically significantly decrease (p < 0.05).

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The authors declare that there are no conflicts of interest present.