Doppler da artéria oftálmica em gestantes portadoras de diabetes mellitus com e sem retinopatia

Abstract

Diabetes mellitus is a group of metabolic disorders, having in common the hyperglycemia that chronically leads to the development of microvascular changes. Diabetic retinopathy the most serious of these complications. The Doppler is a method to assess the ocular blood flow velocity. Evaluate the Doppler patterns of ophthalmic artery in pregnant women with diabetes mellitus before pregnancy with and without retinopathy, comparing them with the findings in pregnant women without complications during prenatal care. It is a cross-sectional observational study that analyzed Doppler indices of ophthalmic arteries, resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), second systolic velocity peak (P2), ratio between velocity peaks (RVP) and final diastolic velocity (EDV) in three groups of pregnant women: group 1: 12 diabetic patients with retinopathy, group 2: 85 diabetic patients without retinopathy and group 3: 63 pregnant women without intercurrences during prenatal care. The patients were submitted to ultrasound with Doppler of ophthalmic artery from 25 weeks. For statistical analysis, the Kruskal-Wallis test. The level of significance was 95%. The average age of diabetic pregnant women with and without retinopathy and the control group was 31.9 ± 6.4 years, 28.8 ± 7.4 years and 24.6 ± 5.8 years, respectively. The average age of the control group was lower than that of the diabetic groups (p = 0.001), but there were no differences among the diabetic groups (p = 0.178). At the time of the Doppler examination, the average gestational age of pregnant women with and without retinopathy was 28.8 ± 2.2 weeks, 29.7 ± 2.7 weeks and 36.3 ± 3.9 weeks respectively, while the average gestational age of the control group was higher than the diabetic groups (p = 0.000), but there were no significant differences between the gestational averages of the diabetics (p = 1,000). The averages with standard deviation of the Doppler variables of the ophthalmic artery of the diabetes group with and without retinopathy and control were respectively: IR = 0.80 ± 0.07 / 0.77± 0.08 / 0.75 ± 0, 06 (p = 0.030); IP = 2.14 ± 0.63 / 1.87 ± 0.51 / 1.79 ± 0.47 (p = 0.337); PVS (cm / s) = 28.91 ± 8.31) / 32.03 ± 10.06 / 33.36 ± 8.93 (p = 0.201); P2 (cm / s) = 15.32 ± 6.48 / 18.67 ± 7.60 / 17.13 ± 6.0 (p = 0.473); RPV = 0.52 ± 0.15 / 0.56 ± 0.12 / 0.51 ± 0.11 (p = 0.064); EDV (cm / s) = 5.94 ± 3.64 / 6.85 ± 3.23 / 8.04 ± 4.15 (p = 0.015). The average RI of the ophthalmic artery in the group of pre-gestational diabetic pregnant women with retinopathy was significantly higher (p = 0.030) when compared to the control group, but without significant difference when compared to the group without retinopathy (p = 0.204). The RI of the control group did not differ from the group without retinopathy (p = 0.079). The EDV was significantly lower in group 1 (p = 0.015) in relation to the control group but without difference when compared to group 2 (p = 0.217). There was no significant difference in the PI, PSV, P2 and RVP indices when compared to the three groups (p> 0.05). Pregnant women with pre-gestational diabetes mellitus and retinopathy presented increased vascular resistance index in the ophthalmic artery associated with EDV reduction, probably related to ischemia, thrombosis and neovascularization of retinal vessels.