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Zhong X, Li H, Tan S, Yang S, Zhu Z, Huang W, Cheng W, Wang W. Initial Retinal Nerve Fiber Layer Loss and Risk of Diabetic Retinopathy Over a Four-Year Period. Invest Ophthalmol Vis Sci 2024; 65:5. [PMID: 39365262 PMCID: PMC11457921 DOI: 10.1167/iovs.65.12.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 09/14/2024] [Indexed: 10/05/2024] Open
Abstract
Purpose The purpose of this study was to investigate whether the rapid rate of peripapillary retinal nerve fiber layer (pRNFL) thinning in short-term is associated with the future risk of developing diabetic retinopathy (DR). Methods This prospective cohort study utilized 4-year follow-up data from the Guangzhou Diabetic Eye Study. The pRNFL thickness was measured by optical coherence tomography (OCT). DR was graded by seven-field fundus photography after dilation of the pupil. Correlations between pRNFL thinning rate and DR were analyzed using logistic regression. The additive predictive value of the prediction model was assessed using the C-index, net reclassification index (NRI), and integrated discriminant improvement index (IDI). Results A total of 1012 patients with diabetes (1012 eyes) without DR at both baseline and 1-year follow-up were included in this study. Over the 4-year follow-up, 132 eyes (13%) developed DR. After adjusting for confounding factors, a faster rate of initial pRNFL thinning was significantly associated with the risk of DR (odds ratio per standard deviation [SD] decrease = 1.15, 95% confidence interval [CI] = 1.08 to 1.23, P < 0.001). Incorporating either the baseline pRNFL thickness or its thinning rate into conventional prediction models significantly improved the discriminatory power. Adding the rate of pRNFL thinning further enhanced the discriminative power compared with models with only baseline pRNFL thickness (C-index increased from 0.685 to 0.731, P = 0.040). The IDI and NRI were 0.114 and 0.463, respectively (P < 0.001). Conclusions The rate of initial pRNFL thinning was associated with DR occurrence and improved discriminatory power of traditional predictive models. This provides new insights into the management and screening of DR.
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Affiliation(s)
- Xiaoying Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huangdong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Shaoying Tan
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
- Study Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong, China
- Centre for Eye and Vision Study (CEVR), Hong Kong, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Ziyu Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, China
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Li Z, Yang F, Deng X, Yang Y, Gong H, Lan Y. ASSOCIATIONS BETWEEN CHOROIDAL ALTERATIONS AND EARLY NEURODEGENERATION IN DIABETES WITHOUT DIABETIC RETINOPATHY: Insights From Ultra-Widefield Optical Coherence Tomography Angiography Imaging. Retina 2024; 44:1288-1297. [PMID: 39047123 DOI: 10.1097/iae.0000000000004126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To identify associations between choroidal alterations and the reduction of peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetes without diabetic retinopathy (nondiabetic retinopathy, NDR). METHODS This retrospective cross-sectional study included 143 eyes from 83 patients with NDR and 124 eyes from 82 matched healthy controls. Ultra-widefield swept-source optical coherence tomography angiography was used to automatically measure retinal and choroidal thickness (ChT), retinal vascular density, and choroidal vascular metrics. Data were analyzed using Student's t-tests, generalized estimating equations, and generalized linear mixed models. RESULTS Patients with NDR exhibited significant reductions in perifoveal ChT (e.g., perifoveal inferior region: 253.42 ± 86.59 µm vs. 281.01 ± 80.25 µm, P = 0.026 in GEE test) compared with the controls. The NDR group showed a significant decrease in the choroidal vascular index (P = 0.012 in GEE test), and an increase in the choroidal stromal index (P = 0.012 in GEE test). The average pRNFL thickness significantly decreased in patients with NDR (114.58 ± 11.88 µm vs. 120.25 ± 16.36 µm, P = 0.005 in GEE test). The thickness of the outer nuclear layer and total retina significantly decreased in patients with NDR (P < 0.05). In multivariate models, ChT was significantly correlated with pRNFL thickness (β = 0.041, P = 0.001), even after adjusting by confounding factors (β = 0.056, P = 0.001). CONCLUSION In NDR, there were decreases in ChT, choroidal vascular index, pRNFL thickness, and outer nuclear layer thickness. The reduction in ChT was independently associated with the reduction in pRNFL thickness, suggesting that ChT could serve as a predictor of retinal neurodegeneration in NDR.
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Affiliation(s)
- Zhenping Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; and
| | - Fan Yang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; and
| | - Xiaowen Deng
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; and
| | - Yao Yang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, 100730, China
| | - Haijun Gong
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; and
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou 510060, China; and
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Wu Y, Ning K, He M, Huang W, Wang W. Myopia and Rate of Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Patients Without Retinopathy: A 2-Year Longitudinal Study. Curr Eye Res 2024; 49:742-749. [PMID: 38647053 DOI: 10.1080/02713683.2024.2327087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The aim of this study was to investigate the association between myopia and longitudinal changes in peripapillary retinal nerve fiber layer (pRNFL) thickness in type 2 diabetic patients without diabetic retinopathy (DR). METHODS A total of 1069 participants with a median follow-up time of 1.9 years were included in this study. The participants were categorized into four groups based on the presence of myopia (≤ -0.5 diopter [D]) and diabetes without DR, including a control group (n = 412), diabetes group (n = 416), myopia group (n = 115), and diabetes + myopia group (n = 126). Peripapillary average and sectoral RNFL measurements were obtained using 6 × 6 mm swept-source optical coherence tomography (SS-OCT) scans centered at the optic disc. The change rate of pRNFL, adjusted for age and sex, was calculated and compared among the four groups to investigate the impact of myopia and diabetes. RESULTS The baseline estimated pRNFL thickness after adjustment for covariates was 113.7 μm, 116.2 μm, 108.0 μm, and 105.6 μm in the control, diabetes, myopia, and diabetes + myopia group, respectively (diabetes > control > myopia = diabetes + myopia, p < 0.001). The respective average pRNFL loss in the four groups was -0.48 μm/year, -1.11 μm/year, -1.23 μm/year, and -2.62 μm/year (all p < 0.01). The diabetes + myopia group exhibited a greater rate of average pRNFL reduction compared to the other groups (all p < 0.001). Multivariate analysis using a linear mixed-effects model showed that age, diabetes, axial length (AL), and baseline pRNFL thickness were significantly associated with the rate of average pRNFL reduction. CONCLUSIONS The diabetes group showed a faster rate of average pRNFL thickness reduction compared to healthy controls, regardless of the presence of myopia. The average pRNFL thickness decreased more rapidly when diabetes and myopia were present simultaneously than in the individual diabetes or myopia group. Both diabetes and myopia were associated with accelerated pRNFL loss.
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Affiliation(s)
- Yi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kang Ning
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mingguang He
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan Province, China
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Wang M, Luan R, Liu B, Gong Y, Zhao J, Chen X, Yang Q, Liu J, Liu J, Shao Y, Li X. The Anatomic and Functional Outcomes of Ozurdex-Aided Vitrectomy in Proliferative Diabetic Retinopathy. Diabetes Metab Syndr Obes 2024; 17:1199-1213. [PMID: 38476345 PMCID: PMC10929653 DOI: 10.2147/dmso.s445607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose To investigate the 3-months outcomes of patients who underwent intraoperative intravitreal injection of Ozurdex for proliferative diabetic retinopathy (PDR). Methods This is a prospective randomized controlled clinical trial (ChiCTR2100043399). Seventy-one patients with PDR who had indications for surgery without intravitreal injection history within 3 months preoperatively were enrolled. Patients were randomly divided into three groups based on the medicine injected intraoperatively: Ozurdex, Conbercept, and Control group. The primary outcome is the best-corrected visual acuity (BCVA) within 3 months postoperatively. The secondary outcomes include the intraocular pressure (IOP), mean sensitivity, central retinal thickness and vessels perfusion. Results The BCVA and the mean sensitivity improved in the three groups (F = 130.8, P < 0.0001; F = 34.18, P < 0.0001), but there was no statistical difference among the three groups (F = 0.858, P = 0.552; F = 0.964, P = 0.452). The IOP was no significant differences among the three groups within 3 months postoperatively (F = 0.881, P = 0.533). Compared with the other two groups, central retinal thickness (CRT) and outer retinal layer (ORL) thickness decreased significantly in patients of the Ozurdex group (F = 3.037, P = 0.008; F = 2.626, P = 0.018), especially in the diabetic macular edema (DME) patients (F = 2.761, P = 0.0164; F = 2.572, P = 0.0240). In macular region, superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) perfusion were not shown statistical difference at 3 months postoperatively in the all three groups compared with 1 day postoperatively (P > 0.05). Conclusion Compared with the other two groups, anatomical outcomes was improved significantly in Ozurdex group for DR patients. Ozurdex may help to improve the visual acuity and visual sensitivity, and there is no significant difference in the change of IOP and microvascular improvement. Clinical Trial Registration This trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn, registration number ChiCTR2100043399).
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Affiliation(s)
- Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Rong Luan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Boshi Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Yi Gong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Jinzhi Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Xiteng Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Qianhui Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Jingjie Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Juping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
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Hui Z, Guo X, Bulloch G, Yuan M, Xiong K, Zhang S, Chen Y, Li Y, Liao H, Huang W, Zhu Z, Wang W. Rates of choroidal loss and ganglion cell-inner plexiform layer thinning in type 2 diabetes mellitus and healthy individuals: a 2-year prospective study. Br J Ophthalmol 2023; 108:84-90. [PMID: 36385002 DOI: 10.1136/bjo-2022-321603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
AIMS To investigate longitudinal choroid and ganglion cell-inner plexiform layer (GCIPL) changes in type 2 diabetes mellitus (T2DM) patients and healthy populations across 2 years. METHODS This prospective cohort study included T2DM patients and healthy controls. T2DM patients were divided into mild non-proliferative diabetic retinopathy (NPDR) or non-DR (NDR) groups. Macular choroidal and GCIPL thickness was measured using swept-source optical coherence tomography at baseline and follow-up after 2 years. A linear-mixed effect model compared rates of change in choroidal and GCIPL thicknesses between the three groups. RESULTS 895 T2DM patients (770 in the NDR group and 125 in the NPDR group) and 847 healthy controls were included. Following 2 years, choroidal thinning occurred at a rate of -7.7±9.2 µm/year, -8.1±8.7 µm/year and -5.2±8.1 µm/year in NDR, NPDR and control groups, respectively (p<0.001). GCIPL loss occurred quickest in NPDR patients (-0.97±0.97 µm/year), followed by NDR (-0.91±0.89 µm/year) and the control group (-0.04±0.55 µm/year) (p<0.001). Following multivariate adjustment, choroidal thinning was -2.04 µm/year (95% CI: -4.05 to -0.03; p=0.047) and -1.95 µm/year (95% CI: -3.14 to -0.75; p=0.001) faster in NPDR and NDR groups than in the control group, respectively, and GCIPL thinning was -1.02 µm/year (95% CI: -1.19 to -0.84; p<0.001) and -0.88 µm/year (95% CI: -0.98 to -0.78; p<0.001) faster in the NPDR and NDR groups than in the control group, respectively. CONCLUSION Progressive choroidal and GCIPL thinning occurs in healthy individuals and T2DM patients; however, T2DM undergoes accelerated choroidal and GCIPL loss in NPDR patients.
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Affiliation(s)
- Ziwen Hui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Zhongs School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Meng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | | | - Yuting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huan Liao
- University of Melbourne, Melbourne, Victoria, Australia
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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Xiong K, Gong X, Xie L, Wang L, Guo X, Li W, Zhong P, Liang X, Huang W, Wang W. Influence of Serum Uric Acid on Macular Choroidal Thickness and Ganglion Cell Inner Plexiform Layer Thickness. Transl Vis Sci Technol 2023; 12:13. [PMID: 37171795 PMCID: PMC10184778 DOI: 10.1167/tvst.12.5.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Purpose The purpose of this study was to determine the influence of serum uric acid (UA) on macular choroidal and ganglion cell inner plexiform layer (GC-IPL) thickness. Methods This cross-sectional study enrolled adult individuals in communities in Guangzhou, China. All participants underwent a comprehensive ophthalmologic examination. They were divided into four groups according to UA quartiles. The choroidal and GC-IPL thickness was measured by swept-source optical coherence tomography (SS-OCT). Results A total of 719 subjects (1389 eyes) were included in the study. The average UA was 348.50 ± 86.16 mmol/L. The average choroidal and GC-IPL thickness decreased with UA quartiles (P < 0.001). Multivariate linear regression analyses showed that UA was negatively associated with average choroidal (β = -0.073, 95% confidence interval [CI] = -0.117 to -0.028, P = 0.001) and GC-IPL thickness (β = -0.006, 95% CI = -0.009 to -0.002, P = 0.001). After adjusting for confounding factors, the average choroidal thickness was decreased in quartile 4 as compared with quartile 1 by -14.737 µm (95% CI = -24.460 to -5.015, P = 0.003). The average GC-IPL thickness was decreased in quartile 4 versus quartile 1 by -1.028 (95% CI = -1.873 to -0.290, P = 0.007). Conclusions Higher UA levels were independently associated with macular choroid and GC-IPL thinning. These contribute to a better understanding of ocular pathological mechanisms. Translational Relevance The associated UA with choroidal and GC-IPL thickness helps to understand the ocular pathological and retinal neurodegenerative mechanism.
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Affiliation(s)
- Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Liqiong Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Pingting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Huang Y, Zhang N, Bulloch G, Zhang S, Shang X, Chen Y, Liao H, Zhu Z, Wang W. Rates of Choroidal and Neurodegenerative Changes Over Time in Diabetic Patients Without Retinopathy: A 3-Year Prospective Study. Am J Ophthalmol 2023; 246:10-19. [PMID: 35870490 DOI: 10.1016/j.ajo.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the longitudinal changes of retinal neurodegeneration and choroidal thickness in diabetic patients with and without diabetic retinopathy (DR). DESIGN Prospective observational cohort study. METHODS This prospective observational cohort study recruited type 2 diabetic patients from a community registry in Guangzhou. All participants underwent annual ocular examinations via swept-source optical coherence tomography that obtained choroid thickness (CT), retinal thickness (RT), and ganglion cell-inner plexiform layer (GC-IPL) thickness. The changes in GC-IPL, CT, and RT between patients who developed incident DR (IDR) or remained non-DR (NDR) were compared during a 3-year follow-up. RESULTS Among 924 patients, 159 (17.2%) patients developed IDR within the 3-year follow-up. A reduction in GC-IPL, RT, and CT was observed in NDR and IDR; however, CT thinning in patients with IDR was significantly accelerated, with an average CT reduction of -6.98 (95% CI: -8.26, -5.71) μm/y in patients with IDR and -3.98 (95% CI: -4.60, -3.36) μm/y in NDR patients (P < .001). Reductions in average GC-IPL thickness over 3 years were -0.97 (95% CI: -1.24, -0.70) μm/y in patients with IDR and -0.76 (95% CI: -0.82, -0.70) μm/y in NDR patients (P = .025). After adjusting for confounding factors, the average CT and GC-IPL thinning were significantly faster in patients with IDR compared with those who remained NDR by 2.09 μm/y (95% CI: 1.01, 3.16; P = .004) and -0.29 μm/y (95% CI: -0.49, -0.09; P = .004), respectively. The RT in the IDR group increased, whereas the RT in the NDR group decreased over time, with the adjusted difference of 2.09 μm/y (95% CI: 1.01, 3.16; P < .001) for central field RT. CONCLUSIONS The rate of retinal neurodegeneration and CT thinning were significantly different between the eyes that developed IDR and remained NDR during the 3-year follow-up, but both groups observed thickness reduction. This indicates that GC-IPL and CTs may decrease before the clinical manifestations of DR.
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Affiliation(s)
- Yining Huang
- From the Nanshan School, Guangzhou Medical University (Y.H.), Guangzhou, China
| | - Nuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.)
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China
| | - Xianwen Shang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.)
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.C.)
| | - Huan Liao
- and Epigenetics and Neural Plasticity Laboratory, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.L.)
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.).
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China.
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Guo X, Chen Y, Bulloch G, Xiong K, Chen Y, Li Y, Liao H, Huang W, Zhu Z, Wang W. Parapapillary Choroidal Microvasculature Predicts Diabetic Retinopathy Progression and Diabetic Macular Edema Development: A Three-Year Prospective Study. Am J Ophthalmol 2023; 245:164-173. [PMID: 35863493 DOI: 10.1016/j.ajo.2022.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the predictive value of the microcirculation of the optic nerve head by swept-source optical coherence tomography angiography for identifying individuals with high risk of diabetic retinopathy (DR) progression and diabetic macular edema (DME) development. DESIGN Prospective observational cohort study. METHODS A total of 946 patients (1879 eyes) with type 2 diabetes mellitus were recruited who had no DR or mild nonproliferative DR at baseline, and no DME. All subjects underwent 3 × 3 mm swept-source optical coherence tomography angiography centered on the optic nerve head to generate angiograms in 4 layers: radial peripapillary plexus, superficial retinal capillary plexus (SCP), deep retinal capillary plexus, and choriocapillaris (CC). The CC flow deficit percentage (CC FD%), vessel density (VD), and perfusion density (PD) were quantified. RESULTS During the 3 consecutive years of follow-up, 312 eyes (16.60%) experienced DR progression and 115 eyes (6.12%) developed DME. The DR progression was related to a lower VD of the SCP (relative risk per standard deviation decrease, 95% confidence interval): 1.30, 1.14-1.48; P < .001), a lower PD of the SCP (1.41, 1.24-1.60; P < .001), a lower VD of the radial peripapillary plexus (1.23, 1.08-1.40; P = .002), and an elevated CC FD% (1.62, 1.40-1.88; P < .001). The DME occurrence was associated with a lower VD of SCP (1.35, 1.09-1.66; P = .005), a lower PD of SCP (1.29, 1.05-1.59; P = .016), and a higher CC FD% (1.29, 1.03-1.61; P < .001). The CC FD% significantly improved the predictive power, with the increase of the C-statistic for DR progression and DME occurrence by 3.83% (P = .002) and 5.24% (P < .001), respectively. CONCLUSIONS This study provides the first longitudinal evidence suggesting that peripapillary CC FD% can improve the prediction of DR progression and DME development beyond traditional risk factors.
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Affiliation(s)
- Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yanping Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia (G.B., Z.Z.), Melbourne, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.C.)
| | - Yuting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Huan Liao
- Epigenetics and Neural Plasticity Laboratory, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.L.)
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
| | - Zhuoting Zhu
- Centre for Eye Research Australia (G.B., Z.Z.), Melbourne, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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PROGRESSIVE PERIPAPILLARY CHOROID THINNING AND RETINAL NEURODEGENERATION IN PATIENTS WITH DIABETES. Retina 2022; 42:2401-2410. [DOI: 10.1097/iae.0000000000003613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Yang S, Guo X, Cheng W, Seth I, Bulloch G, Chen Y, Shang X, Zhu Z, Huang W, Wang W. Genome-wide DNA methylation analysis of extreme phenotypes in the identification of novel epigenetic modifications in diabetic retinopathy. Clin Epigenetics 2022; 14:137. [PMID: 36316758 PMCID: PMC9623976 DOI: 10.1186/s13148-022-01354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Aberrant epigenetic modifications such as DNA methylation may contribute to the pathogenesis of DR. We aimed at elucidating the role of novel DNA methylation modifications in diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) using an extreme phenotypic design. Methods/results Two consecutive studies were conducted. A cross-sectional study using an extreme phenotypic design was conducted to identify rare methylation modifications that might contribute to DR pathogenesis. A 2-year longitudinal nested case–control study was conducted to validate the results and assess whether these novel methylation modifications could be used as biomarkers for predicting DR onset. A large number of differentially methylated CpG sites were identified in the cross-sectional study, and two (cg12869254 and cg04026387) corresponding to known genes were replicated in the longitudinal study. Higher methylation of cg12869254 significantly correlated with macular RNFL thinning in the superior and nasal subregions, and that of cg04026387 correlated with reduced deep capillary plexus VD in the superior and inferior subregions after adjusting for covariates. Conclusions Cg12869254 and cg04026387 hypermethylation may complement the known risk factors that contribute to the pathogenesis of DR and as novel biomarkers for disease prediction. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-022-01354-z.
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Affiliation(s)
- Shaopeng Yang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiao Guo
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Weijing Cheng
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ishith Seth
- grid.1008.90000 0001 2179 088XCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Level 7, 32 Gisborne Street, East Melbourne, VIC 3002 Australia
| | - Gabriella Bulloch
- grid.1008.90000 0001 2179 088XCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Level 7, 32 Gisborne Street, East Melbourne, VIC 3002 Australia
| | - Yifan Chen
- grid.410556.30000 0001 0440 1440John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xianwen Shang
- grid.1008.90000 0001 2179 088XCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Level 7, 32 Gisborne Street, East Melbourne, VIC 3002 Australia
| | - Zhuoting Zhu
- grid.1008.90000 0001 2179 088XCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Level 7, 32 Gisborne Street, East Melbourne, VIC 3002 Australia
| | - Wenyong Huang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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