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Erb C, Erb C, Kazakov A, Umetalieva M, Weisser B. Influence of Diabetes Mellitus on Glaucoma-Relevant Examination Results in Primary Open-Angle Glaucoma. Klin Monbl Augenheilkd 2024; 241:177-185. [PMID: 37643738 DOI: 10.1055/a-2105-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Primary open-angle glaucoma (POAG) is no longer considered an isolated eye pressure-dependent optic neuropathy, but a neurodegenerative disease in which oxidative stress and neuroinflammation are prominent. These processes may be exacerbated by additional systemic diseases. The most common are arterial hypertension, dyslipidemia, and diabetes mellitus. Using diabetes mellitus as an example, it will be shown how far-reaching the influence of such a systemic disease can be on both the functional and the structural diagnostic methods for POAG. This knowledge is essential, since these interferences can lead to misinterpretations of POAG, which can also affect therapeutic decisions.
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Affiliation(s)
- Carl Erb
- Augenklinik am Wittenbergplatz, Berlin, Deutschland
| | | | - Avaz Kazakov
- Department of External Relations and Development, Salymbekov University, Bishkek, Kyrgyzstan
| | - Maana Umetalieva
- Medical Faculty of Medicine, Salymbekov University, Bishkek, Kyrgyzstan
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Cui L, Yang C, Zou H. A two-year longitudinal observational study of the peripapillary microvasculature in pediatric type 1 diabetes mellitus patients without visual impairment or diabetic retinopathy. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:15-22. [PMID: 38327667 PMCID: PMC10847056 DOI: 10.1016/j.aopr.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
•Neurodegeneration precede microcirculatory deterioration in DR. Early signs can be seen in DM patients without visible DR symptoms, such as glial cell apoptosis and thinner retinal nerve fiber layer.•Peripapillary microvascular abnormalities in the peripapillary region may affect the normal metabolism of neurons and eventually aggravate the process of DR.•Prompting ongoing research to monitor the peripapillary microcirculation and microvasculature among T1DM children for early detection and prevention.•In longitudinal observation, the vessel density of the peripapillary superficial capillary plexus were slightly affected, while vessel density, blood flow, vessel morphological abnormalities and flow impairment area were significantly deteriorated in the deep capillary plexus.•The peripapillary deep capillary plexus is more susceptible and vulnerable to DR progression and could be used as a target for DR screening.
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Affiliation(s)
- Lipu Cui
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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Verma S, Singh VK, Rana J, Kumar S, Singh K, Srivastava R. Quantitative measurement of retinal nerve fiber layer thickness and its correlation with optical coherence tomography angiography vascular biomarker changes in preclinical diabetic retinopathy. Indian J Ophthalmol 2024; 72:S11-S15. [PMID: 38131535 PMCID: PMC10833175 DOI: 10.4103/ijo.ijo_340_23] [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: 02/03/2023] [Revised: 06/19/2023] [Accepted: 07/27/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The present study was done to assess the use of optical coherence tomography angiography (OCTA) in detecting earlier stages of diabetic retinopathy and for the early management and effective blood glucose control in preclinical diabetic patients for preventing retinal nerve fiber layer (RNFL) thinning. METHODS A tertiary care center-based prospective observational study was conducted from the year 2021 to 2022 in the Department of Ophthalmology. The study included 50 cases and 50 controls. The parameters analyzed by using OCTA (Topcon 3D OCT-1 Maestro2) were RNFL thickness and peripapillary vessel density. RESULTS We found that the RNFL thickness in the temporal and superior disc in patients with preclinical diabetic retinopathy was significantly (0.041 and 0.044, respectively) decreased. The duration of diabetes and glycated hemoglobin (HbA1c) were the risk factors for peripapillary vessel density reduction in patients with preclinical diabetic retinopathy (P < 0.001). CONCLUSION RNFL thinning is an early sign of retinal neurodegeneration and is associated with peripapillary vessel density reduction. Early management and effective blood glucose control in diabetes patients may be beneficial for preventing RNFL thinning in superior and temporal disc.
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Affiliation(s)
- Shweta Verma
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
| | - Vinod Kumar Singh
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
| | - Jagriti Rana
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
| | - Santosh Kumar
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
| | - Kamaljeet Singh
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
| | - Ratnapriya Srivastava
- Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagaraj, Uttar Pradesh, India
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Emre S, Altin C, Ulusoy MO, Aydin E. Optical coherence tomography-angiography findings of prediabetic patients. Oman J Ophthalmol 2024; 17:96-101. [PMID: 38524313 PMCID: PMC10957036 DOI: 10.4103/ojo.ojo_197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/17/2023] [Accepted: 01/02/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate prediabetic patients for microvascular changes using optical coherence tomography-angiography (OCT-A) and compare with diabetic patients and healthy controls. METHODS OCT-A images of 60 eyes of 30 patients with diabetes mellitus (DM), 72 eyes of 36 prediabetic patients, and 108 eyes of 54 healthy controls were retrospectively evaluated and compared in this study. A swept-source OCTA (Triton, Topcon) instrument was used for collecting OCT-A images. Duration of the diabetic or prediabetic period, glycated hemoglobin, fasting blood glucose level, postprandial glucose (PPG) level, high-density lipoprotein, low-density lipoprotein, triglyceride, and creatinine values of all participants were recorded. RESULTS Microaneurysm, nonperfusion areas, perifoveal capillary disruption, and capillary network disorganization were detected in both prediabetics and diabetics but statistically more common in diabetic patients. Neovascularization and intraretinal microvascular anomalies were detected only in diabetic patients. CONCLUSIONS OCT-A seemed to be effective in detecting microvascular changes in diabetic patients. More importantly, results showed us that in prediabetic patients, microvascular changes can be seen before the onset of DM and before or concurrently with neurodegenerative changes.
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Affiliation(s)
- Sinan Emre
- Department of Ophthalmology, School of Medicine, Baskent University, Izmir, Turkey
| | - Cihan Altin
- Department of Cardiology, School of Medicine, Baskent University, Izmir, Turkey
| | - Mahmut Oguz Ulusoy
- Department of Ophthalmology, Bursa Yüksek Ihtisas Research Hospital, Bursa, Turkey
| | - Elcin Aydin
- Department of Radiology, School of Medicine, Baskent University, Izmir, Turkey
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Boned-Murillo A, Fernández-Espinosa G, Orduna-Hospital E, Díaz-Barreda MD, Sánchez-Cano A, Sopeña-Pinilla M, Bielsa-Alonso S, Pinilla I. Changes in Inner Retina Thickness and Macular Sensitivity in Patients with Type 2 Diabetes with Moderate Diabetic Retinopathy. Biomedicines 2023; 11:2972. [PMID: 38001971 PMCID: PMC10669203 DOI: 10.3390/biomedicines11112972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
The increase in diabetic retinopathy (DR) prevalence demonstrates the need for the determination of biomarkers for assessing disease development to obtain an early diagnosis and stop its progression. We aimed to analyse total retinal (RT) and inner retinal layer (IRL) thicknesses in type 2 diabetes mellitus (DM2) patients and correlate these results with retinal sensitivity using swept-source OCT (SS-OCT) and microperimetry. For this purpose, a total of 54 DM2 subjects with moderate diabetic retinopathy (DR) with no signs of diabetic macular oedema (DME) and 73 age-matched healthy individuals were assessed using SS-OCT to quantify retinal thickness in the nine macular areas of the ETDRS grid. Retinal sensitivity was measured via microperimetry with a Macular Integrity Assessment Device (MAIA). The mean ages were 64.06 ± 11.98 years for the DM2 group and 60.79 ± 8.62 years for the control group. DM2 patients presented lower visual acuity (p < 0.001) and a thicker RT (260.70 ± 19.22 μm in the control group vs. 271.90 ± 37.61 μm in the DM2 group, p = 0.01). The retinal nerve fibre layer (RNFL) was significantly lower in the outer nasal area (50.38 ± 8.20 μm vs. 45.17 ± 11.25 μm, p = 0.005) in ganglion cells and inner plexiform layers (GCL+) in DM2. A positive correlation between the LDL-C and RNFL and a negative correlation between HDL-C levels and the inner temporal and central RNFL thickness were detected. The central (p = 0.021) and inner nasal (p = 0.01) areas were negatively correlated between the RNFL and MAIA, while GCL++ was positively correlated with the outer inferior (p = 0.015) and outer nasal areas (p = 0.024). Retinal sensitivity and macular RNFL thickness decrease in DM2 patients with moderate DR with no DME, and this study enables an accurate approach to this disease with personalised assessment based on the DR course or stage. Thus, GCL+ and GCL++ thinning may support ganglion cell loss before the RNFL is affected.
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Affiliation(s)
- Ana Boned-Murillo
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Ophthalmology, Infanta Sofía University Hospital, 28703 Madrid, Spain
| | - Guisela Fernández-Espinosa
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
| | - Elvira Orduna-Hospital
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Maria Dolores Díaz-Barreda
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Ophthalmology, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - Ana Sánchez-Cano
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Sopeña-Pinilla
- Department of Ophthalmology, Miguel-Servet University Hospital, 50009 Zaragoza, Spain;
| | | | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain;
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Tatsumi T. Current Treatments for Diabetic Macular Edema. Int J Mol Sci 2023; 24:ijms24119591. [PMID: 37298544 DOI: 10.3390/ijms24119591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diabetic retinopathy is a major retinal disorder and a leading cause of blindness. Diabetic macular edema (DME) is an ocular complication in patients with diabetes, and it can impair vision significantly. DME is a disorder of the neurovascular system, and it causes obstructions of the retinal capillaries, damage of the blood vessels, and hyperpermeability due to the expression and action of vascular endothelial growth factor (VEGF). These changes result in hemorrhages and leakages of the serous components of blood that result in failures of the neurovascular units (NVUs). Persistent edema of the retina around the macula causes damage to the neural cells that constitute the NVUs resulting in diabetic neuropathy of the retina and a reduction in vision quality. The macular edema and NVU disorders can be monitored by optical coherence tomography (OCT). Neuronal cell death and axonal degeneration are irreversible, and their development can result in permanent visual loss. Treating the edema before these changes are detected in the OCT images is necessary for neuroprotection and maintenance of good vision. This review describes the effective treatments for the macular edema that are therefore neuroprotective.
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Affiliation(s)
- Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba 260-8670, Japan
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Rafati S, Khabazkhoob M, Mortazavi M, Asharlous A. Peripapillary Retinal Nerve Fiber Layer Thickness and its Ocular and Systemic Determinants in an Elderly Population: A Population-Based Study. J Curr Ophthalmol 2023; 35:135-144. [PMID: 38250493 PMCID: PMC10795815 DOI: 10.4103/joco.joco_49_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To determine the distribution, ocular, and systemic determinants of peripapillary retinal nerve fiber layer thickness (pRNFLT) using spectral-domain optical coherence tomography (SD-OCT) in an elderly population. Methods This report is a part of the Tehran Geriatric Eye Study, a population-based cross-sectional study conducted in Tehran, the capital of Iran. The study population was all residents aged 60 years and above in Tehran. The sampling was performed using a multi-stage stratified random cluster sampling method. All study participants underwent ocular examination (including measurement of visual acuity, objective and subjective refraction, and slit-lamp biomicroscopy), anterior segment imaging using Pentacam HR, and ocular biometry using IOLMaster 500. The OCT imaging was performed for a random subsample (1307 individuals) using Spectralis SD-OCT. Results Two thousand two hundred and forty-six eyes of 1189 individuals were analyzed for this report. Of these, 691 (58.1%) were female, and the mean age of the participants was 67.3 ± 5.9 years (60-94 years). The mean overall pRNFLT was 98.6 μ (95% confidence interval [CI]: 98.0-99.3). There was a statistically significant difference in pRNFLT between different quadrants; the highest and lowest mean pRNFLT was related to inferior and temporal quadrants, respectively (P < 0.001). The multiple generalized estimating equation model showed that older age (coefficient: -0.15 [95% CI: -0.24 to -0.06], P = 0.001), diabetes (coefficient: -1.69 [95% CI: -2.82 to -0.55], P = 0.004), and longer axial length (coefficient: -0.52 [95% CI: -0.83 to -0.22], P < 0.001) were significantly associated with a decreased overall pRNFLT. Higher body mass index was significantly related to an increased overall pRNFLT (coefficient: 0.19 [95% CI: 0.07 to 0.30], P = 0.002). Conclusions The results of the present study can be used as a reference database for pRNFLT in the elderly population. Considering ocular and systemic determinants of pRNFLT is necessary for correct clinical interpretation of this parameter.
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Affiliation(s)
- Shokoofeh Rafati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mortazavi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Amir Asharlous
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
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El-Tawab SS, Ibrahim IK, Megallaa MH, Mgeed RMA, Elemary WS. Neutrophil–lymphocyte ratio as a reliable marker to predict pre-clinical retinopathy among type 2 diabetic patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Abstract
Background
Diabetic retinopathy is now recognized as a neurovascular in lieu of a microvascular complication. Visual evoked potentials (VEPs) are greatly valuable in detecting early diabetic retinal functional changes before the occurrence of structural damage. Low-grade inflammation plays a fundamental part in the development and progression of retinopathy in diabetics. Detecting diabetic patients with early retinopathy before the occurrence of clinical symptoms provides a window of opportunity to ensure the best prognosis for these eyes. Neutrophil–lymphocyte ratio (NLR) has recently been introduced as a novel marker of inflammation in various diseases. Indeed, the presence of a cheap, available, and reliable marker of inflammation that is capable to detect pre-clinical diabetic retinopathy (P-DR) is crucial for early intervention to retard the progression of ocular damage. As far as we know no previous studies investigated the role of NLR in the detection of P-DR. The aim of this study was to investigate the quality of prediction of NLR in detecting pre-clinical retinopathy in type 2 diabetic patients.
Results
In this case–control study, VEPs results showed a significant delay in P100 latencies of the patients’ group compared to the control group. According to the VEPs results, the patient group was further subdivided into two: diabetic with VEPs changes (a group with P-DR) and diabetic without VEPs changes. NLR was significantly elevated in patients with P-DR (p < 0.001). NLR cut-off point ≥ 1.97 is able to predict P-DR with 89.29% sensitivity and 84.37% specificity. Linear regression model revealed that NLR is the only independent factor that predicts P-DR. (odds ratio 3.312; 95% confidence interval 1.262–8.696, p = 0.015*.
Conclusions
Visual evoked potentials have an important role to evaluate the visual pathway in diabetics and to diagnose pre-clinical diabetic retinopathy before the occurrence of structural damage. Neutrophil–lymphocyte ratio is a reliable marker for the detection of pre-clinical diabetic retinopathy with good sensitivity (89.29%) and specificity (84.37%). Finding a reliable available laboratory test to predict P-DR could be of help to save diabetic patients from serious ocular complications.
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Chai Q, Yao Y, Guo C, Lu H, Ma J. Structural and functional retinal changes in patients with type 2 diabetes without diabetic retinopathy. Ann Med 2022; 54:1816-1825. [PMID: 35786137 PMCID: PMC9258434 DOI: 10.1080/07853890.2022.2095010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The characteristics of the early changes in preclinical diabetic retinopathy (DR) are poorly known. This study aimed to analyse the changes in the structure and function of the fundus in diabetic patients without diabetic retinopathy (NDR). METHODS This prospective study enrolled patients with type 2 diabetes and healthy controls from April to December 2020. Retinal sensitivity was measured by microperimetry. The peripapillary retinal nerve fibre layer (p-RNFL) thickness, macular retinal thickness, and retinal volume were measured by optical coherence tomography (OCT). The vessel density (VD) and perfusion density (PD) of the peripapillary area, as well as the foveal avascular zone (FAZ) area, FAZ perimeter, and FAZ circularity, were measured by optical coherence tomographic angiography (OCTA). RESULTS A total of 71 cases (100 eyes) were enrolled in the study, including 34 cases (51 eyes) in the NDR group and 37 cases (49 eyes) in the control group. The mean retinal sensitivity was lower in the NDR group than in the control group for all sectors (all p < .001). Compared with controls, the NDR group showed thinner p-RNFL in the T sector (76.24 ± 14.29 vs. 85.47 ± 19.66 µm, p = .035). The NDR group had a thinner retina in the N2 sector (304.55 ± 16.07 vs. 312.02 ± 12.30 µm, p = .010). The PD of DCP was lower in the N2 sector in the NDR group (44.92 ± 11.77 vs. 50.27 ± 6.37%, p = .044). The VD was higher in the NDR group in RPCP-S/N/I, and the PD was higher in the RPCP-S/N (all p < .05). The frequencies of perifoveal capillary drop-out, notched or punched out borders of the superficial FAZ, and loss of smooth contour were all higher in the NDR group (all p < .05). CONCLUSION The structure (p-RNFL thickness, VD, and PD) and function (retinal sensitivity) display some changes in diabetic patients even if they had not been found to have DR.Key messagesDecreased retinal sensitivity was observed in diabetic patients before the onset of diabetic retinopathy.Compared with the control group, we found the changes in vessel density or perfusion density in a certain area, whether in SCP, DCP, or RPCP in the NDR group.Before the onset of diabetic retinopathy, the structure and function of the retina in diabetic patients had changed.
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Affiliation(s)
- Qiannan Chai
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yimin Yao
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Congrong Guo
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingxue Ma
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Trinh M, Eshow N, Alonso-Caneiro D, Kalloniatis M, Nivison-Smith L. Reticular Pseudodrusen Are Associated With More Advanced Para-Central Photoreceptor Degeneration in Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2022; 63:12. [PMID: 36251316 PMCID: PMC9586134 DOI: 10.1167/iovs.63.11.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to examine retinal topographical differences between intermediate age-related macular degeneration (iAMD) with reticular pseudodrusen (RPD) versus iAMD without RPD, using high-density optical coherence tomography (OCT) cluster analysis. Methods Single eyes from 153 individuals (51 with iAMD+RPD, 51 with iAMD, and 51 healthy) were propensity-score matched by age, sex, and refraction. High-density OCT grid-wise (60 × 60 grids, each approximately 0.01 mm2 area) thicknesses were custom-extracted from macular cube scans, then compared between iAMD+RPD and iAMD eyes with correction for confounding factors. These "differences (µm)" were clustered and results de-convoluted to reveal mean difference (95% confidence interval [CI]) and topography of the inner retina (retinal nerve fiber, ganglion cell, inner plexiform, and inner nuclear layers) and outer retina (outer plexiform/Henle's fiber/outer nuclear layers, inner and outer segments, and retinal pigment epithelium-to-Bruch's membrane [RPE-BM]). Differences were also converted to Z-scores using normal data. Results In iAMD+RPD compared to iAMD eyes, the inner retina was thicker (up to +5.89 [95% CI = +2.44 to +9.35] µm, P < 0.0001 to 0.05), the outer para-central retina was thinner (up to -3.21 [95% CI = -5.39 to -1.03] µm, P < 0.01 to 0.001), and the RPE-BM was thicker (+3.38 [95% CI = +1.05 to +5.71] µm, P < 0.05). The majority of effect sizes (Z-scores) were large (-3.13 to +1.91). Conclusions OCT retinal topography differed across all retinal layers between iAMD eyes with versus without RPD. Greater para-central photoreceptor thinning in RPD eyes was suggestive of more advanced degeneration, whereas the significance of inner retinal thickening was unclear. In the future, quantitative evaluation of photoreceptor thicknesses may help clinicians monitor the potential deleterious effects of RPD on retinal integrity.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Eshow
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine (Optometry), Deakin University, Geelong, Victoria, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Fang W, Huang X, Wu K, Zong Y, Yu J, Xu H, Shi J, Wei J, Zhou X, Jiang C. Activation of the GABA-alpha receptor by berberine rescues retinal ganglion cells to attenuate experimental diabetic retinopathy. Front Mol Neurosci 2022; 15:930599. [PMID: 36017075 PMCID: PMC9396352 DOI: 10.3389/fnmol.2022.930599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe aim of this study was to investigate the role and mechanism of berberine (BBR) in the protection of injured retinal ganglion cells (RGCs) in diabetic retinopathy (DR).MethodsExperimental diabetic retinopathy rat model was successfully induced by a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg) in male SD rats with sufficient food and water for 8 weeks. Animals were randomly divided into four groups: (1) non-diabetic, (2) diabetic, (3) diabetic + BBR + PBS, and (4) diabetic + BBR + SR95531. BBR (100 mg/kg) was given daily by gavage to rats in the group (3) and group (4) for 8 weeks, and weekly intravitreal injections were conducted to rats in the group (3) with 5 μL of 1×PBS and rats in the group (4) with 5 μL of GABA-alpha receptor antagonist SR95531 to investigate the underlying mechanisms. The survival and apoptosis of RGCs were observed by fluorescence gold labeling technology and TUNEL staining. Visual function was evaluated by visual electrophysiological examination. Western blotting and immunofluorescence staining were used to analyze the expression of GABA-alpha receptors in RGCs.ResultsIn an animal model, BBR can increase the survival of RGCs, reduce RGCs apoptosis, and significantly improve the visual function. The reduction of GABA, PKC-α, and Bcl-2 protein expression caused by DR can be considerably increased by BBR. SR95531 inhibits BBR's protective effect on RGC and visual function, as well as its upregulation of PKC-α and Bcl-2.ConclusionBBR is a promising preventive or adjuvant treatment for DR complications, and its key protective effect may involve the regulation of RGC apoptosis through the GABA-alpha receptor/protein kinase C-alpha (GABAAR/PKC-α) pathway.
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Affiliation(s)
- Wangyi Fang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojing Huang
- Department of Ophthalmology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Huan Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Jiemei Shi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Jiaojiao Wei
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xujiao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- Eye Institute, Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- Xujiao Zhou
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- *Correspondence: Chunhui Jiang
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12
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Yu Q, Xiao Y, Lin Q, Xiang Z, Cui L, Chen Z, Sun J, Li S, Qin X, Yang C, Zou H. Two-year longitudinal study on changes in thickness of the retinal nerve fiber layer and ganglion cell layer in children with type 1 diabetes mellitus without visual impairment or diabetic retinopathy. Curr Eye Res 2022; 47:1218-1225. [PMID: 35642554 DOI: 10.1080/02713683.2022.2079142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To study changes in the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) in children with type 1 diabetes mellitus (T1DM) without visual impairment or diabetic retinopathy (DR) after 2 years of follow-up and analyze the associated factors. METHODS Thirty-seven children with T1DM were enrolled in this study. All children underwent a complete ophthalmologic evaluation that included swept-source optical coherence tomography at baseline and follow-up. Changes in RNFL and GCL thickness were compared among the children at baseline and follow-up. RESULTS The peripapillary RNFL thickness was greater in the temporal (inner, p = 0.015; outer, p = 0.004) and inner superior (p = 0.043) sectors in the follow-up group than in the baseline group. The macular RNFL thickness in the fovea, inner nasal sector, inner inferior sector, and outer ring and the average thickness (all p < 0.05) were greater in the follow-up group than in the baseline group. The peripapillary GCL thickness decreased in the temporal sector (inner, p = 0.049; outer, p = 0.041) and increased in the inner nasal sector (p = 0.006) in the follow-up group compared with the baseline group, and the thickness of the inner temporal, inner superior, inner inferior, outer nasal, and outer inferior sectors and average thickness in the macula were lower in the follow-up group than in the baseline group (all p < 0.05). The total retinal thickness around optic disc in the follow-up group increased in the inner superior sectors (p = 0.006). The total retinal thickness of the macula decreased in inner temporal sector, inner superior sector and outer nasal sector, and increased in outer superior sector (all p < 0.05). CONCLUSIONS Retinal neurodegenerative changes preceded microvascular changes in children with T1DM in the early stage. Peripapillary RNFL thickness in the nasal sector may be lower in children with T1DM without visual impairment or other ocular pathologies.
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Affiliation(s)
- Qian Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Xiao
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Qiurong Lin
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyu Xiang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lipu Cui
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhangling Chen
- Department of Ophthalmology, Shanghai General Hospital Affiliated Nanjing Medical University, Shanghai, China.,Department of Ophthalmology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Jiaqi Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sicong Li
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinran Qin
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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13
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Tan T, Finkelstein MT, Tan GSW, Tan ACS, Chan CM, Mathur R, Wong EYM, Cheung CMG, Wong TY, Milea D, Najjar RP. Retinal neural dysfunction in diabetes revealed with handheld chromatic pupillometry. Clin Exp Ophthalmol 2022; 50:745-756. [PMID: 35616273 PMCID: PMC9796882 DOI: 10.1111/ceo.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To evaluate the ability of handheld chromatic pupillometry to reveal and localise retinal neural dysfunction in diabetic patients with and without diabetic retinopathy (DR). METHODS This cross-sectional study included 82 diabetics (DM) and 93 controls (60.4 ± 8.4 years, 44.1% males). DM patients included those without (n = 25, 64.7 ± 6.3 years, 44.0% males) and with DR (n = 57, 60.3 ± 8.5 years, 64.9% males). Changes in horizontal pupil radius in response to blue (469 nm) and red (640 nm) light stimuli were assessed monocularly, in clinics, using a custom-built handheld pupillometer. Pupillometric parameters (phasic constriction amplitudes [predominantly from the outer retina], maximal constriction amplitudes [from the inner and outer retina] and post-illumination pupillary responses [PIPRs; predominantly from the inner retina]) were extracted from baseline-adjusted pupillary light response traces and compared between controls, DM without DR, and DR. Net PIPR was defined as the difference between blue and red PIPRs. RESULTS Phasic constriction amplitudes to blue and red lights were decreased in DR compared to controls (p < 0.001; p < 0.001). Maximal constriction amplitudes to blue and red lights were decreased in DR compared to DM without DR (p < 0.001; p = 0.02), and in DM without DR compared to controls (p < 0.001; p = 0.005). Net PIPR was decreased in both DR and DM without DR compared to controls (p = 0.02; p = 0.03), suggesting a wavelength-dependent (and hence retinal) pupillometric dysfunction in diabetic patients with or without DR. CONCLUSIONS Handheld chromatic pupillometry can reveal retinal neural dysfunction in diabetes, even without DR. Patients with DM but no DR displayed primarily inner retinal dysfunction, while patients with DR showed both inner and outer retinal dysfunction.
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Affiliation(s)
- Tien‐En Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Maxwell T. Finkelstein
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Anna Cheng Sim Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Choi Mun Chan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Dan Milea
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Raymond P. Najjar
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore,Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
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14
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Tan TE, Wong TY. Diabetic retinopathy: Looking forward to 2030. Front Endocrinol (Lausanne) 2022; 13:1077669. [PMID: 36699020 PMCID: PMC9868457 DOI: 10.3389/fendo.2022.1077669] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
Diabetic retinopathy (DR) is the major ocular complication of diabetes mellitus, and is a problem with significant global health impact. Major advances in diagnostics, technology and treatment have already revolutionized how we manage DR in the early part of the 21st century. For example, the accessibility of imaging with optical coherence tomography, and the development of anti-vascular endothelial growth factor (VEGF) treatment are just some of the landmark developments that have shaped the DR landscape over the last few decades. Yet, there are still more exciting advances being made. Looking forward to 2030, many of these ongoing developments are likely to further transform the field. First, epidemiologic projections show that the global burden of DR is not only increasing, but also shifting from high-income countries towards middle- and low-income areas. Second, better understanding of disease pathophysiology is placing greater emphasis on retinal neural dysfunction and non-vascular aspects of diabetic retinal disease. Third, a wealth of information is becoming available from newer imaging modalities such as widefield imaging systems and optical coherence tomography angiography. Fourth, artificial intelligence for screening, diagnosis and prognostication of DR will become increasingly accessible and important. Fifth, new pharmacologic agents targeting other non-VEGF-driven pathways, and novel therapeutic strategies such as gene therapy are being developed for DR. Finally, the classification system for diabetic retinal disease will need to be continually updated to keep pace with new developments. In this article, we discuss these major trends in DR that we expect to see in 2030 and beyond.
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Affiliation(s)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- *Correspondence: Tien Yin Wong,
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15
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Neurovascular Impairment and Therapeutic Strategies in Diabetic Retinopathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010439. [PMID: 35010703 PMCID: PMC8744686 DOI: 10.3390/ijerph19010439] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
Diabetic retinopathy has recently been defined as a highly specific neurovascular complication of diabetes. The chronic progression of the impairment of the interdependence of neurovascular units (NVUs) is associated with the pathogenesis of diabetic retinopathy. The NVUs consist of neurons, glial cells, and vascular cells, and the interdependent relationships between these cells are disturbed under diabetic conditions. Clinicians should understand and update the current knowledge of the neurovascular impairments in diabetic retinopathy. Above all, neuronal cell death is an irreversible change, and it is directly related to vision loss in patients with diabetic retinopathy. Thus, neuroprotective and vasoprotective therapies for diabetic retinopathy must be established. Understanding the physiological and pathological interdependence of the NVUs is helpful in establishing neuroprotective and vasoprotective therapies for diabetic retinopathy. This review focuses on the pathogenesis of the neurovascular impairments and introduces possible neurovascular protective therapies for diabetic retinopathy.
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16
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The Pathogenesis and Therapeutic Approaches of Diabetic Neuropathy in the Retina. Int J Mol Sci 2021; 22:ijms22169050. [PMID: 34445756 PMCID: PMC8396448 DOI: 10.3390/ijms22169050] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic retinopathy is a major retinal disease and a leading cause of blindness in the world. Diabetic retinopathy is a neurovascular disease that is associated with disturbances of the interdependent relationship of cells composed of the neurovascular units, i.e., neurons, glial cells, and vascular cells. An impairment of these neurovascular units causes both neuronal and vascular abnormalities in diabetic retinopathy. More specifically, neuronal abnormalities including neuronal cell death and axon degeneration are irreversible changes that are directly related to the vision reduction in diabetic patients. Thus, establishment of neuroprotective and regenerative therapies for diabetic neuropathy in the retina is an emergent task for preventing the blindness of patients with diabetic retinopathy. This review focuses on the pathogenesis of the neuronal abnormalities in diabetic retina including glial abnormalities, neuronal cell death, and axon degeneration. The possible molecular cell death pathways and intrinsic survival and regenerative pathways are also described. In addition, therapeutic approaches for diabetic neuropathy in the retina both in vitro and in vivo are presented. This review should be helpful for providing clues to overcome the barriers for establishing neuroprotection and regeneration of diabetic neuropathy in the retina.
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17
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Zhang M, Jia F, Li N, Song C, Yang J, Yang K, Li Y, Wang S. Quantitative analysis of the RPC vessel density and the RNFL thickness in patients with type 2 diabetes mellitus by using OCT angiography. Ophthalmic Res 2021; 64:951-959. [PMID: 34284394 DOI: 10.1159/000517145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 05/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Weifang Medical University, Weifang, China,
| | - Fan Jia
- Department of Ophthalmology, Weifang Medical University, Weifang, China
| | - Na Li
- Eye Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Chunyuan Song
- Department of Ophthalmology, Weifang Medical University, Weifang, China
| | - Jin Yang
- Department of Ophthalmology, Weifang Medical University, Weifang, China
| | - Kaili Yang
- Eye Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yan Li
- Eye Center, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Shuna Wang
- Eye Center, Affiliated Hospital of Weifang Medical University, Weifang, China
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18
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Correlation Analysis between Nerve Fiber Layer Thickness and Peripapillary Vessel Density and Influencing Factors of Peripapillary Vessel Density in Preclinical Diabetic Retinopathy. J Ophthalmol 2020. [PMID: 31904776 PMCID: PMC7803101 DOI: 10.1155/2020/2758547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose To observe the changes of the retinal nerve fiber layer (RNFL) thickness and the optic disc vessel density (VD) in preclinical diabetic retinopathy (DR) and the relationship between RNFL changes and VD, as well as to investigate the influencing factors on peripapillary vessel density. Methods This was a cross-sectional study. Thirty-four eyes of 34 type 2 diabetes mellitus (T2DM) patients diagnosed with preclinical diabetic retinopathy (DR) were included in our study, with twenty-three eyes of 23 healthy subjects set up as normal controls. History of diabetes, hypertension, and dyslipidemia was recorded in detail. All participants underwent color fundus photography (CFP), RNFL around the optic disc, and OCT angiography (OCTA) over the optic disc. The 4.5 mm × 4.5 mm Angio Disc scan mode was performed with all participants by using the OCTA instrument. The relationship between changes of RNFL in the four quadrants (superior, inferior, temporal, and nasal) and VD changes was analyzed. Results Vessel density was significantly lower in the superior (t = −2.27) and temporal (t = −2.02) peripapillary sectors of diabetic eyes compared to normal eyes (P < 0.05). The retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant (P < 0.001) of diabetic eyes compared to normal eyes. Pearson correlation coefficient analysis showed a significant positive correlation between vessel density and RNFL thickness in the peripapillary region in the temporal (r = 0.468, P < 0.01) and superior (r = 0.612, P < 0.01) sectors. Multiple linear regression analysis showed that glycated hemoglobin (HbA1c) (β = −1.50, P < 0.01) and the duration of diabetes (β = −0.33, P=0.03) were associated with peripapillary vessel density. Conclusions Preclinical DR presented optic disc microcirculation changes. Temporal RNFL thinning is an early sign of retinal neurodegeneration and is associated with temporal peripapillary vessel density reduction. The duration of diabetes and HbA1c are risk factors for peripapillary vessel density reduction in patients with preclinical DR.
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19
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Huru J, Leiviskä I, Saarela V, Liinamaa MJ. Prediabetes influences the structure of the macula: thinning of the macula in the Northern Finland Birth Cohort. Br J Ophthalmol 2020; 105:1731-1737. [PMID: 33028576 DOI: 10.1136/bjophthalmol-2020-317414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the effect of prediabetes and diabetes on macular thickness and retinal vascular calibres in our population-based cohort (Northern Finland Birth Cohort). METHODS The population of 2005 individuals was divided into diabetes (n=57), prediabetes (n=1638) and normal glucose metabolism (NGM) groups (n=310). Total thickness of the macula was measured using Cirrus HD-OCT 4000. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) calibres were measured from the fundus images. The diagnosis of diabetes and prediabetes was made according to WHO 2006 diagnostic standards. RESULTS Significant macular thinning was observed in subjects with prediabetes (-2.69 μm (95% CI -4.29 to -1.09), p<0.05 and -0.10 mm3 (95% CI -0.16 to -0.04), p<0.05 for macular cube average thickness and cube volume, respectively) and it was greatest in the pericentral area. Macular cube average thickness and macular cube volume decreased significantly by worsening glucose metabolism. Furthermore, CRAE was decreased by increases in 2-hour post-load glucose, glucose area under the curve and increase in Matsuda index (p<0.001, 0.019 and <0.001, respectively). In mediation analysis, macular thickness had significant average causal mediation effect (ACME) on CRVE and CRAE in subjects with prediabetes. CONCLUSION We detected significant thinning of the macula in subjects with prediabetes. The diameters of retinal arteries were decreased by impaired glucose metabolism. This study provides a new perspective since it revealed that the early and subtle changes caused by prediabetes as macular thinning had significant ACME on retinal vessels, therefore supporting the neurodegenerative theory of diabetes-induced changes in the retina.
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Affiliation(s)
- JenniMaria Huru
- Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Ilmari Leiviskä
- Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Ville Saarela
- Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - M Johanna Liinamaa
- Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland
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20
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Frizziero L, Parrozzani R, Londei D, Pilotto E, Midena E. Quantification of vascular and neuronal changes in the peripapillary retinal area secondary to diabetic retinopathy. Br J Ophthalmol 2020; 105:1577-1583. [PMID: 32933938 DOI: 10.1136/bjophthalmol-2020-316468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate and quantify peripapillary vascular and neuronal changes secondary to diabetic retinopathy, using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA). DESIGN This was a cross-sectional study. METHODS 51 eyes of 51 patients affected by non-proliferative diabetic retinopathy (NPDR) and 19 age-matched healthy control eyes underwent full ophthalmic examination, including OCT and OCTA in the peripapillary area. Vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI) were quantified in a ring-shaped region of interest of each OCTA image. Capillaries and larger vessels were separately analysed. The thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell complex (GCC) was also analysed. RESULTS VAD and VLF of peripapillary capillaries were significantly reduced in NPDR eyes, along with the progression of NPDR (p<0.05). VDI was significantly reduced in mild (p=0.0093) and moderate (p=0.0190) NPDR eyes, but not in severe NPDR (p=0.0841). Larger peripapillary vessels showed a significant increase of both VAD and VDI in NPDR eyes. pRNFL and GCC thickness decreased in NPDR eyes, reaching statistical significance only for GCC. No statistically significant correlation was found between perfusion parameters and pRNFL and GCC thickness. CONCLUSIONS Retinal capillary remodelling in NPDR involves the peripapillary vascularisation too, as confirmed by OCTA quantitative parameters. The peripapillary macrovasculature and microvasculature need to be separately evaluated. The lack of direct correlation between peripapillary capillaries changes and the loss of retinal nerve fibres suggests that neuronal damage cannot be simply considered secondary to the microvascular one.
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Affiliation(s)
| | | | - Davide Londei
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Edoardo Midena
- IRCCS - Fondazione Bietti, Rome, Italy .,Department of Ophthalmology, University of Padova, Padova, Italy
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21
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Rodrigues TM, Marques JP, Soares M, Dolan MJ, Melo P, Simão S, Teles J, Figueira J, Murta JN, Silva R. PERIPAPILLARY NEUROVASCULAR COUPLING IN THE EARLY STAGES OF DIABETIC RETINOPATHY. Retina 2020; 39:2292-2302. [PMID: 30260919 DOI: 10.1097/iae.0000000000002328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study radial peripapillary capillary (RPC) density in the early stages of diabetic retinopathy (DR), using optical coherence tomography angiography. METHODS A cross-sectional evaluation of RPCs was performed using optical coherence tomography angiography (Avanti RTVue-XR 100, Optovue Inc, Fremont, CA). Annular RPC density was the primary outcome. Global density and retinal nerve fiber layer thickness were secondary outcomes. Diabetic eyes were divided into three groups: no DR, mild nonproliferative DR (mild NPDR), and moderate NPDR. Multilevel mixed-effects univariate and multivariate linear regression models were used. RESULTS We included 155 eyes (n = 42 control; n = 27 no DR; n = 28 mild NPDR; and n = 58 moderate NPDR) from 86 subjects (mean [SD] age 63.39 [10.70] years; 46.45% male). When compared with controls, a significant decrease in annular RPC density was found in all groups of diabetic eyes on multivariate analysis (no DR: β = -2.95, P < 0.001; mild NPDR: β = -1.76, P = 0.017; and moderate NPDR: β = -2.82, P < 0.001). We also detected a significant decrease in retinal nerve fiber layer thickness in diabetic eyes (even in the no DR group). Furthermore, in diabetic eyes, annular RPC density and retinal nerve fiber layer thickness correlated significantly (R = 0.4874, P < 0.001). CONCLUSION Peripapillary neurovascular changes occur early in the course of DR. Their significance in the progression of DR warrants further research.
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Affiliation(s)
- Tiago M Rodrigues
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, Portugal
| | - João P Marques
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Rua Larga, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Imaging (AIBILI), Azinhaga de Santa Comba, Coimbra, Portugal
| | - Mário Soares
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Michael-John Dolan
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, Virginia
| | - Pedro Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Sílvia Simão
- Association for Innovation and Biomedical Research on Light and Imaging (AIBILI), Azinhaga de Santa Comba, Coimbra, Portugal
| | - João Teles
- Faculty of Medicine, University of Coimbra (FMUC), Rua Larga, Coimbra, Portugal
| | - João Figueira
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Rua Larga, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Imaging (AIBILI), Azinhaga de Santa Comba, Coimbra, Portugal
| | - Joaquim N Murta
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Rua Larga, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Imaging (AIBILI), Azinhaga de Santa Comba, Coimbra, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), E.P.E. Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra (FMUC), Rua Larga, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Imaging (AIBILI), Azinhaga de Santa Comba, Coimbra, Portugal
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Tang Z, Chan MY, Leung WY, Wong HY, Ng CM, Chan VTT, Wong R, Lok J, Szeto S, Chan JCK, Tham CC, Wong TY, Cheung CY. Assessment of retinal neurodegeneration with spectral-domain optical coherence tomography: a systematic review and meta-analysis. Eye (Lond) 2020; 35:1317-1325. [PMID: 32581390 DOI: 10.1038/s41433-020-1020-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To comprehensively assess diabetic retinopathy neurodegeneration (DRN) as quantified by retinal neuronal and axonal layers measured with spectral-domain optical coherence tomography (SD-OCT) in subjects with diabetes mellitus (DM). METHODS Articles on the topic of examining macular ganglion cell-inner plexiform layer (m-GCIPL), macular retinal nerve fibre layer (m-RNFL), macular ganglion cell complex (m-GCC), and peripapillary RNFL (p-RNFL) measured with SD-OCT in DM subjects without DR (NDR) or with non-proliferative DR (NPDR) were searched in PubMed and Embase up to November 31, 2019. Standardized mean difference (SMD) as effect size were pooled using random-effects model. RESULTS Thirty-six studies searched from online databases and the CUHK DM cohort were included in the meta-analysis. In the comparison between NDR and control, macular measures including mean m-GCIPL (SMD = -0.26, p = 0.003), m-RNFL (SMD = -0.26, p = 0.046), and m-GCC (SMD = -0.28; p = 0.009) were significantly thinner in the NDR group. In the comparison between NPDR and NDR, only mean p-RNFL was significantly thinner in the NPDR group (SMD = -0.27; p = 0.03), but not other macular measures. CONCLUSIONS Thinning of retinal neuronal and axonal layers at macula as measured by SD-OCT are presented in eyes with NDR, supporting DRN may be the early pathogenesis in the DM patients without the presence of clinical signs of DR. In the future, these SD-OCT measures may be used as surrogates of DRN to stratify DM patients with a high risk of DR, and may be used as a therapeutic target if neuroprotection treatment for DR is available.
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Affiliation(s)
- Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ming Yan Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wai Yin Leung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ho Yeung Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ching Man Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Raymond Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Eye Hospital, Hong Kong, SAR, China
| | - Jerry Lok
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Eye Hospital, Hong Kong, SAR, China
| | - Simon Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Eye Hospital, Hong Kong, SAR, China
| | - Jason C K Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Eye Hospital, Hong Kong, SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Eye Hospital, Hong Kong, SAR, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China.
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Chua J, Sim R, Tan B, Wong D, Yao X, Liu X, Ting DSW, Schmidl D, Ang M, Garhöfer G, Schmetterer L. Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopathy. J Clin Med 2020; 9:E1723. [PMID: 32503234 PMCID: PMC7357089 DOI: 10.3390/jcm9061723] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Diabetic retinopathy (DR) is a common complication of diabetes mellitus that disrupts the retinal microvasculature and is a leading cause of vision loss globally. Recently, optical coherence tomography angiography (OCTA) has been developed to image the retinal microvasculature, by generating 3-dimensional images based on the motion contrast of circulating blood cells. OCTA offers numerous benefits over traditional fluorescein angiography in visualizing the retinal vasculature in that it is non-invasive and safer; while its depth-resolved ability makes it possible to visualize the finer capillaries of the retinal capillary plexuses and choriocapillaris. High-quality OCTA images have also enabled the visualization of features associated with DR, including microaneurysms and neovascularization and the quantification of alterations in retinal capillary and choriocapillaris, thereby suggesting a promising role for OCTA as an objective technology for accurate DR classification. Of interest is the potential of OCTA to examine the effect of DR on individual retinal layers, and to detect DR even before it is clinically detectable on fundus examination. We will focus the review on the clinical applicability of OCTA derived quantitative metrics that appear to be clinically relevant to the diagnosis, classification, and management of patients with diabetes or DR. Future studies with longitudinal design of multiethnic multicenter populations, as well as the inclusion of pertinent systemic information that may affect vascular changes, will improve our understanding on the benefit of OCTA biomarkers in the detection and progression of DR.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Ralene Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Daniel S. W. Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
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Chung YW, Lee JH, Lee JY, Ju HH, Lee YJ, Jee DH, Ko SH, A Choi J. The Anti-Inflammatory Effects of Glucagon-Like Peptide Receptor Agonist Lixisenatide on the Retinal Nuclear and Nerve Fiber Layers in an Animal Model of Early Type 2 Diabetes. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1080-1094. [PMID: 32354571 DOI: 10.1016/j.ajpath.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 12/30/2022]
Abstract
This study explored the anti-inflammatory effects of a glucagon-like peptide-1 receptor agonist (GLP-1RA), known as lixisenatide, on the eyes of early type 2 diabetic mice. Diabetic (db/db) mice were divided into three groups: GLP-1RA [lixisenatide (LIX)], insulin (INS) with controlled hyperglycemia based on the glucose concentration of lixisenatide, and diabetic control (D-CON). Nondiabetic control mice (db/dm) were also characterized for comparison. After 8 weeks of treatment, mRNA levels of inflammatory markers, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, immunohistochemical staining; Western blot of glial fibrillary acidic protein (GFAP) and thioredoxin-interacting protein; and retinal thickness were assessed in the central and peripheral neurosensory retina. LIX showed decreased immunohistochemical staining for both thioredoxin-interacting protein and GFAP in the central and peripheral neurosensory retina compared with D-CON and INS, and decreased expression of these proteins in the neurosensory retina and immunohistochemical staining in the optic nerve head for GFAP compared with D-CON. The inner nuclear layer in the peripheral retina in LIX was only thinner than those of D-CON and INS. In an early type 2 diabetic mouse model, lixisenatide treatment showed superior anti-inflammatory effects on the retina and optic nerve head independent of hyperglycemia. Thus, the neuroprotective effects of lixisenatide treatment in the peripheral inner nuclear layer should be evaluated in early type 2 diabetic retinopathy.
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Affiliation(s)
- Yeon Woong Chung
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyung Lee
- Department of Ophthalmology and Visual Science, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Young Lee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Hee Ju
- Clinical Research Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye-Jee Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology & Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin A Choi
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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26
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Jia X, Zhong Z, Bao T, Wang S, Jiang T, Zhang Y, Li Q, Zhu X. Evaluation of Early Retinal Nerve Injury in Type 2 Diabetes Patients Without Diabetic Retinopathy. Front Endocrinol (Lausanne) 2020; 11:475672. [PMID: 33117270 PMCID: PMC7552190 DOI: 10.3389/fendo.2020.475672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/28/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives: To investigate the damage to the retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GCL+) in diabetic patients without retinal microangioma and to determine the kind of nerve damage more likely to indicate early injury. Subjects and Methods: We included 360 patients (360 eyes) with type 2 diabetes mellitus and 168 healthy volunteers (168 eyes). Patients with retinal microangioma were excluded by fundus fluorescein angiography (FFA). The parameters around the optic disc and macular area were measured by optical coherence tomography (OCT). Results: The peripapillary RNFL thickness was thinner in the temporal (72.98 ± 13.76 μm, P < 0.0001) and inferior (120.71 ± 21.43 μm, P = 0.0103) sectors in patients with no diabetic retinopathy (NDR) compared to healthy controls. The reduction of retinal thickness in the macular region was prominent in the inferior sector in patients (34.74 ± 4.92 μm, P < 0.0001) compared to normal controls. Thinning of GCL+ in the second region of the macular area was significant in patients with NDR compared to normal controls (P < 0.05). However, no difference in the GCL+ and retinal thicknesses of the central macular region was observed between the patients with NDR and healthy controls. Using the 5th percentile (P5) of normal controls as the reference value, we found that the parameters with the highest indices in patients with NDR were the inferior and temporal peripapillary RNFL thickness (13.0%), the inferior RNFL thickness in the macular area (20%), the inferior retinal thickness in the outer ring of the macular area (10.8%), and the inferior GCL+ thickness in the macular area (10.6%). The GCL+ and RNFL thicknesses in the central macular area accounted for the smallest proportion in P5 of normal controls (3%). Conclusions: Retinal nerve injury can occur in patients without retinal microangioma. The inferior RNFL in the macular area and the inferior and temporal peripapillary RNFL were most sensitive to glucose damage. These areas might be associated with early detection of diabetic retinopathy (DR) as they are more likely to indicate early damage.
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Affiliation(s)
- Xiuhua Jia
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhijian Zhong
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiancheng Bao
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shasha Wang
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting Jiang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanling Zhang
- Department of Ultrasonography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qigen Li
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Qigen Li
| | - Xiang Zhu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiang Zhu
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Zeng Y, Cao D, Yu H, Yang D, Zhuang X, Hu Y, Li J, Yang J, Wu Q, Liu B, Zhang L. Early retinal neurovascular impairment in patients with diabetes without clinically detectable retinopathy. Br J Ophthalmol 2019; 103:1747-1752. [PMID: 30674454 DOI: 10.1136/bjophthalmol-2018-313582] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the function and the corresponding neurovascular structures in patients with diabetes without clinically detectable retinopathy. METHODS : Sixty-six patients with type 2 diabetes without retinopathy (NDR) and 62 healthy controls were recruited. The 16 and 32 Tds flicker electroretinography (ERG) was performed using a mydriasis-free, full-field flicker ERG recording device (RETeval). The vessel density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP), FD300 and ganglion cell complex (GCC) thickness in the macula were quantified using optical coherence tomography angiography (OCTA). The retinal nerve fibre layer (RNFL) thickness and the radial peripapillary capillary (RPC) density in the peripapillary area were also measured with OCTA. RESULTS Parafoveal and perifoveal VD in both SCP and DCP decreased in NDR group in comparison to control group (all p<0.01). However, macular GCC thickness was comparable between the two groups (p=0.661). Peripapillary RNFL thickness and RPC density were significantly lower in NDR group (p<0.001 and p=0.009, respectively). With regard to ERG parameters, delayed implicit time and decreased amplitude were found in NDR group in comparison to the control group (all p<0.01). In the multiple linear regression analyses, delayed implicit time for 16 and 32 Tds stimuli was significantly correlated with increased HbA1c (β=0.350, p<0.001; β=0.328, p<0.001, respectively) and decreased VD of SCP in the parafoveal region (β=-0.266, p=0.013; β=-0.253, p=0.005, respectively). However, delayed implicit time for 16 and 32 Tds stimuli was not correlated with the thickness of GCC (β=-0.008, p=0.818) in multiple linear regression analyses. CONCLUSION Functional and structural impairments have already started in diabetic retina even in the absence of visible retinal lesions. Subtle microvascular abnormalities rather than ganglion cell loss might be associated with early functional changes in NDR patients. Poor control of blood glucose was associated with delayed implicit time of flicker ERG in preclinical diabetic retinopathy.
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Affiliation(s)
- Yunkao Zeng
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dawei Yang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Xuenan Zhuang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yunyan Hu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juan Li
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Yang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiaowei Wu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Spaide RF. Measurable Aspects of the Retinal Neurovascular Unit in Diabetes, Glaucoma, and Controls. Am J Ophthalmol 2019; 207:395-409. [PMID: 31078537 DOI: 10.1016/j.ajo.2019.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the structural and angiographic optical coherence tomography (OCT) data of the macula from controls, patients with diabetes, and patients with glaucoma to evaluate neurovascular and structural relationships. METHODS This was a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed. RESULTS The mean GCL volumes were significantly lower than the control group in both the diabetic (P = .016) and glaucoma (P < .001) groups. The difference between the diabetic and glaucoma groups was not significant (P = .052). The mean global vascular density was greater in the control group than the diabetic group (P = .002) and the glaucoma group (P < .001). The mean RNFL thicknesses were lowest in the glaucoma group. Both the diabetic and glaucoma groups had significantly lower radial peripapillary network and deep vascular plexus density values compared to controls. CONCLUSIONS Although there are important differences in disease pathogenesis between diabetes and glaucoma, they share certain similarities in the structural and angiographic abnormalities eventually produced. This suggests that, in addition to canonical pathways of disease, a component of both could represent neurodegenerative disease, offering the possibility for the development of new treatments. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.
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Toprak I, Fenkci SM, Fidan Yaylali G, Martin C, Yaylali V. Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation. Eye (Lond) 2019; 34:1100-1107. [PMID: 31654034 DOI: 10.1038/s41433-019-0646-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/03/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. RESULTS The MA (+), MA (-) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (-) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. CONCLUSIONS In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration.
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Affiliation(s)
- Ibrahim Toprak
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Semin Melahat Fenkci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Guzin Fidan Yaylali
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Cigdem Martin
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Volkan Yaylali
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Sohn EH, Han IC, Abramoff MD. Diabetic Retinal Neurodegeneration—Should We Redefine Retinopathy From Diabetes? JAMA Ophthalmol 2019; 137:1132-1133. [DOI: 10.1001/jamaophthalmol.2019.2536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elliott H. Sohn
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Ian C. Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Michael D. Abramoff
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
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31
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Cao D, Yang D, Yu H, Xie J, Zeng Y, Wang J, Zhang L. Optic nerve head perfusion changes preceding peripapillary retinal nerve fibre layer thinning in preclinical diabetic retinopathy. Clin Exp Ophthalmol 2019; 47:219-225. [PMID: 30203562 DOI: 10.1111/ceo.13390] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Whether neural or vascular defects occur first in the early onset of diabetic retinopathy (DR) is undetermined. BACKGROUND To investigate microcirculation and microstructure differences of optic nerve head (ONH) between diabetic eyes without clinically evident retinopathy and healthy controls using optical coherence tomography angiography (OCTA). DESIGN Cross-sectional observational study. PARTICIPANTS Sixty eyes of 60 patients with type 2 diabetes and without clinically evident retinopathy and 60 eyes of 60 age-matched healthy controls were included in this study. METHODS All participants underwent 4.5 × 4.5-mm rectangle scans centred on the ONH using OCTA (RTVue-XR Avanti; Optovue, Fremont, CA). MAIN OUTCOME MEASURES Peripapillary retinal nerve fibre layer (RNFL) thickness and capillary perfusion density inside the ONH and in the peripapillary region were compared between the two groups. RESULTS Vessel density values in both peripapillary and inside the disc were significantly lower in diabetic patients without DR compared to normal controls. The reduction of vessel density was prominent in all eight peripapillary sectors in diabetic eyes (all P < 0.05). Thinning of RNFL thickness was significant in the nasal superior (P < 0.001), inferior nasal (P = 0.023) and superior nasal quadrant (P < 0.001) in diabetic eyes in comparison to normal controls. CONCLUSIONS AND RELEVANCE ONH perfusion and peripapillary RNFL thickness were significantly decreased in preclinical DR patients compared to normal controls. Microvascular alterations in ONH may occur earlier than peripapillary RNFL defect in the course of DR.
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Affiliation(s)
- Dan Cao
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dawei Yang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianteng Xie
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunkao Zeng
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Jun Wang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Normative Values of Peripapillary Retinal Nerve Fiber Layer Thickness in a Middle Eastern Population. J Ophthalmol 2018; 2018:7238464. [PMID: 30310697 PMCID: PMC6166371 DOI: 10.1155/2018/7238464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Peripapillary retinal nerve fiber layer (pRNFL) thickness is subject to high variability. Normative values of pRNFL thickness remain undocumented in the Middle East. The aim of our study is to assess the normative values of pRNFL thickness in a Middle Eastern population. Methods A retrospective chart review of 74 patients was conducted. Outpatients who had presented to the ophthalmology clinic at the Jordan University Hospital between January 2016 and July 2018 were consecutively sampled. Measurements had been recorded using Fourier-domain optical coherence tomography. Multivariable regression models were developed to generate predicted normative values with adjustments to candidate confounders. Results The mean global pRNFL thickness was 99 ± 11 μm. The mean quadrantic pRNFL thickness increased from the nasal quadrant (75 ± 16 μm) to the temporal (82 ± 20 μm), superior (114 ± 20 μm), and inferior (125 ± 20 μm) quadrants. Gender and eye sidedness did not contribute to the variability in pRNFL thickness. The relationship between aging and pRNFL thinning is independent of diabetes mellitus type 2 and systemic hypertension. Both systemic conditions significantly predicted pRNFL changes despite negative fundoscopic findings. Conclusions Our set of predicted normative data may be used to interpret measurements of pRNFL thickness in Middle Eastern patients. Our findings suggest that systemic conditions with potential ocular manifestations may require consideration in predictive models of pRNFL thickness, even in the absence of gross fundoscopic findings. Normative data from additional Middle Eastern populations are required to appraise our models, which adjust for common clinical confounders.
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Fahmy RM, Bhat RS, Al-Mutairi M, Aljaser FS, El-Ansary A. Correlation between glycemic control and peripapillary retinal nerve fiber layer thickness in Saudi type II diabetics. Clin Ophthalmol 2018. [PMID: 29535499 PMCID: PMC5840186 DOI: 10.2147/opth.s151564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the effect of diabetes mellitus (DM), diabetic retinopathy, and degree of glycemic control (glycosylated hemoglobin [HbA1c]) on peripapillary retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography. Methods The study included 126 eyes of healthy controls (n=32) and diabetics patients (n=31), whose ages ranged from 40 to 70 years. The diabetic group was divided into: Subgroup 1: with HbA1c <7% and Subgroup 2: with HbA1c ≥7%. All patients underwent full ophthalmic examination. HbA1c level was obtained with the A1cNow+ system and the peripapillary RNFLT was measured using 3D-OCT 2000 Topcon (360-degree circular scan with 3.4 mm diameter centered on optic disc). Results The obtained data demonstrates significant decrease in peripapillary RNFLT in superior and inferior quadrants of the right eye (p=0.000 and p=0.039, respectively), and in superior quadrant of the left eye (p=0.002) with impairment of glycemic control. Pearson's correlation test showed significant negative correlation of RNFLT with HbA1c in the superior quadrant in both eyes. Conclusion Impairment of glycemic control affects the peripapillary RNFLT mainly in the superior quadrant. This thickness also tends to decrease with long-standing DM, use of DM medications, and development of diabetic retinopathy. The measurement of peripapillary RNFLT may become a useful method to monitor early retinal changes in diabetic patients.
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Affiliation(s)
- Rania M Fahmy
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ramesa S Bhat
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Manar Al-Mutairi
- Central Laboratory, Female Center for Medical Studies and Scientific Section, King Saud University, Riyadh, Saudi Arabia
| | - Feda S Aljaser
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Afaf El-Ansary
- Central Laboratory, Female Center for Medical Studies and Scientific Section, King Saud University, Riyadh, Saudi Arabia
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Şahin M, Şahin A, Kılınç F, Karaalp Ü, Yüksel H, Özkurt ZG, Türkcü FM, Çaça İ. Early detection of macular and peripapillary changes with spectralis optical coherence tomography in patients with prediabetes. Arch Physiol Biochem 2018; 124:75-79. [PMID: 28780883 DOI: 10.1080/13813455.2017.1361450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the retina ganglion cell complex (GCC) layer and peripapillary nerve fibre layer thickness (pRNFL) in patients with prediabetes and healthy subjects analysed by spectral domain optical coherence tomography (SD-OCT). METHODS This cross-sectional and comparative study included prediabetic patients and healthy subjects. All participants underwent SD-OCT measurement of pRNFL thickness, and GCC thickness. RESULTS A total of 30 eyes of the 30 patients with prediabetes and 30 eyes of 30 controls were included. The overall calculated pRNFL thicknesses were similar between the prediabetic and control subjects. The GCC thickness was significantly lower in all quadrants of the inner macula, and outer nasal quadrant in the prediabetes group when compared to the control group. CONCLUSION Our study demonstrated that inner macular GCC thickness was significantly thinner in prediabetic subjects. As a result neurodegeneration may play role in the thinning of GCC.
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Affiliation(s)
- Muhammed Şahin
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - Alparslan Şahin
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - Faruk Kılınç
- b Department of Internal Medicine , Elazığ Training and Research Hospital , Elazığ , Turkey
| | - Ümit Karaalp
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - Harun Yüksel
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - Zeynep Gürsel Özkurt
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - Fatih Mehmet Türkcü
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
| | - İhsan Çaça
- a Department of Ophthalmology, School of Medicine , Dicle University , Diyarbakir , Turkey
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Simonett JM, Scarinci F, Picconi F, Giorno P, De Geronimo D, Di Renzo A, Varano M, Frontoni S, Parravano M. Early microvascular retinal changes in optical coherence tomography angiography in patients with type 1 diabetes mellitus. Acta Ophthalmol 2017; 95:e751-e755. [PMID: 28211261 DOI: 10.1111/aos.13404] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Diabetic retinopathy (DR) can lead to significant vision loss and blindness and has a particularly high prevalence in patients with type 1 diabetes (DM1). In this study, we investigate quantitative differences in optical coherence tomography angiography (OCTA) data between DM1 patients with no or mild signs of retinopathy and non-diabetic subjects. METHODS Optical coherence tomography angiography (OCTA) imaging was performed on DM1 patients with no or mild nonproliferative diabetic retinopathy and healthy, age-matched controls. Parafoveal vessel density and foveal avascular zone (FAZ) area in the deep capillary plexus (DCP) and superficial capillary plexus (SCP) were calculated with automated quantification software and compared between patient cohorts. RESULTS A significant decrease in parafoveal vessel density was seen in the DCP of DM1 patients compared to non-diabetic controls (57.0 ± 3.3% versus 60.7 ± 2.4%, p < 0.001). There was no significant difference in SCP parafoveal vessel density, DCP FAZ area, or SCP FAZ area between cohorts. CONCLUSION M1 patients with no or mild signs of retinopathy have reduced parafoveal vessel density in the DCP on OCTA when compared to non-diabetic controls. These OCTA findings suggest that parafoveal capillary nonperfusion is an early process in DM1-related retinal changes and occurs initially at the level of the DCP. Further investigation is needed to understand the prognostic role of these vascular changes.
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Affiliation(s)
- Joseph M. Simonett
- Department of Ophthalmology; Feinberg School of Medicine; Northwestern University; Chicago IL USA
- Fondazione G.B.Bietti-IRCCS; Rome Italy
| | | | - Fabiana Picconi
- Endocrinology, Diabetes and Metabolism; S. Giovanni Calibita Fatebenefratelli Hospital; University of Rome Tor Vergata; Rome Italy
| | | | | | | | | | - Simona Frontoni
- Endocrinology, Diabetes and Metabolism; S. Giovanni Calibita Fatebenefratelli Hospital; University of Rome Tor Vergata; Rome Italy
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Shi R, Guo Z, Wang F, Li R, Zhao L, Lin R. Alterations in retinal nerve fiber layer thickness in early stages of diabetic retinopathy and potential risk factors. Curr Eye Res 2017; 43:244-253. [PMID: 29111833 DOI: 10.1080/02713683.2017.1387669] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS To investigate the loss of retinal nerve fiber layer (RNFL) in type-2 diabetic patients with early-stage diabetic retinopathy (DR) and to identify potential risk factors accounting for these alterations. METHODS In this cross-sectional study, 158 type-2 diabetic patients were divided into three groups based on their DR status. RNFL thickness and other optic disc parameters were obtained by optical coherence tomography (OCT) and then compared among different groups. We investigated the potential association between RNFL loss and systemic risk factors for DR, including diabetes duration, body mass index (BMI), serum lipids, hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR). One-way ANOVA was carried out to compare RNFL thickness among different groups, Pearson correlation and multivariate linear regression analysis were performed to determine potential risk factors related to RNFL thickness in these patients. RESULTS There were significant differences in the average (F = 8.872, P = 0.003), superior (F = 8.769, P = 0.004), and inferior (F = 8.857, P = 0.003) RNFL thickness of both eyes among the groups, but no obvious difference in optic disc parameters was found. Diabetic duration, BMI, TG, High density lipoprotein cholesterol (HDL), HbA1c, and ACR were found negatively related to the RNFL thickness in both or single eye according to Pearson correlation analysis. After controlling for age, gender, and axis length (AL) in multivariate linear regression analysis, the diabetic duration was associated significantly with RNFL thickness of superior in both eye (right eye: p = 0.016, left eye: p = 0.024), BMI was related to the nasal quadrant of the right eye (p = 0.034), and TG was related to the inferior of the right eye (p = 0.037), HbA1c (p = 0.026) was associated significantly with the average RNFL thickness of the right eye. In addition, ACR was found negatively related to average (p = 0.042) and inferior quadrant (p = 0.014) of the left eye, respectively. CONCLUSIONS RNFL loss might be the earliest structural change of retina in diabetic patients, and associated with diabetic duration, BMI, TG, HbA1c, and ACR. The conclusions of this study need to be proved by other well-matched and large-scale prospective clinical trials in the future, because the correlations discovered in our study were weak.
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Affiliation(s)
- Rui Shi
- a Department of Pharmacology , School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center , Xi'an , Shaanxi , P.R. China.,b Department of Ophthalmology , Shaanxi Provincial People's Hospital , Xi'an , China
| | - Zhonglan Guo
- b Department of Ophthalmology , Shaanxi Provincial People's Hospital , Xi'an , China
| | - Feng Wang
- c Department of Ophthalmology , the Second Affiliated Hospital of Xi'an Jiaotong University (Xibei hospital) , Xi'an , China
| | - Rong Li
- d the First Affiliated Hospital , Xi'an Medical University , Xi'an , China
| | - Lei Zhao
- e Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center , University of Iowa Carver College of Medicine , Iowa City , USA
| | - Rong Lin
- f Department of Pharmacology , School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center , Xi'an , P. R. China
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Zarei R, Anvari P, Eslami Y, Fakhraie G, Mohammadi M, Jamali A, Afarideh M, Ghajar A, Heydarzade S, Esteghamati A, Moghimi S. Retinal nerve fibre layer thickness is reduced in metabolic syndrome. Diabet Med 2017; 34:1061-1066. [PMID: 28430372 DOI: 10.1111/dme.13369] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
AIMS To investigate retinal nerve fibre layer (RNFL) thickness in people with metabolic syndrome (MetS) and healthy controls. METHODS A cross-sectional study was performed from March 2014 to January 2016. All participants underwent anthropometric and serological biochemical measurements, ophthalmological examination, and spectral-domain optical coherence tomography (SD-OCT). Individuals with elevated intraocular pressure, glaucoma, diabetic retinopathy and other ocular disorders were excluded. T-test, Chi square and general linear models were used to analyse the data. RESULTS In total, 278 eyes from 139 participants were investigated [median (interquartile range) age: 37 (32-43) years]. RNFL thickness was lower in the nasal superior (107.8 ± 19.5μm) and temporal superior (135.7 ± 18.9μm) sectors in MetS group compared with the control group (114.6 ± 22.4 μm, P = 0.013 and 140.7 ± 18.2 μm, P = 0.027, respectively). After multiple adjustments for age, gender and the side of the examined [right (OD)/left (OS)] eye, MetS was independently associated with a lower RFNL thickness in the nasal superior (β = 0.20, P = 0.009) and temporal superior (β = 0.14, P = 0.048) sectors. RNFL thickness was significantly reduced in participants with higher numbers of metabolic abnormalities, independent of age, gender and the side of the examined eye (P = 0.043). CONCLUSION Our findings demonstrate that MetS is independently associated with reduced RNFL thickness, suggesting that neurodegeneration is implicated in pathogenesis of MetS.
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Affiliation(s)
- R Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - P Anvari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Y Eslami
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - G Fakhraie
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Jamali
- Schepens Eye Research Institute/Mass Eye and Ear, Harvard Medical School, Boston, USA
| | - M Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - A Ghajar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Heydarzade
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Moghimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Vinuthinee-Naidu MN, Zunaina E, Azreen-Redzal A, Nyi-Nyi N. Correlation of retinal nerve fibre layer and macular thickness with serum uric acid among type 2 diabetes mellitus. BMC Ophthalmol 2017; 17:91. [PMID: 28615022 PMCID: PMC5471720 DOI: 10.1186/s12886-017-0486-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 06/08/2017] [Indexed: 12/17/2022] Open
Abstract
Background Uric acid is a final breakdown product of purine catabolism in humans. It’s a potent antioxidant and can also act as a pro-oxidant that induces oxidative stress on the vascular endothelial cells, thus mediating progression of diabetic related diseases. Various epidemiological and experimental evidence suggest that uric acid has a role in the etiology of type 2 diabetes mellitus. We conducted a cross-sectional study to evaluate the correlation of retinal nerve fibre layer (RNFL) and macular thickness with serum uric acid in type 2 diabetic patients. Methods A cross-sectional study was conducted in the Eye Clinic, Hospital Universiti Sains Malaysia, Kelantan between the period of August 2013 till July 2015 involving type 2 diabetes mellitus patients with no diabetic retinopathy and with non-proliferative diabetic retinopathy (NPDR). An evaluation for RNFL and macular thickness was measured using Spectralis Heidelberg optical coherence tomography. Six ml of venous blood was taken for the measurement of serum uric acid and glycosylated haemoglobin (HbA1C). Results A total of 180 diabetic patients were recruited (90 patients with no diabetic retinopathy and 90 patients with NPDR) into the study. The mean level of serum uric acid for both the groups was within normal range and there was no significance difference between the two groups. Based on gender, both male and female gender showed significantly higher level of mean serum uric acid in no diabetic retinopathy group (p = 0.004 respectively). The mean serum uric acid was significantly higher in patient with HbA1C < 6.5% (p < 0.031). Patients with NPDR have thicker RNFL and macular thickness compared to patients with no diabetic retinopathy. However, only the RNFL thickness of the temporal quadrant and the macular thickness of the superior outer, inferior outer and temporal outer subfields were statistically significant (p = 0.038, p = 0.004, 0.033 and <0.001 respectively). There was poor correlation between RNFL and macular thickness with serum uric acid in both the groups. Conclusion Serum uric acid showed a poor correlation with RNFL and macular thickness among type 2 diabetic patients.
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Affiliation(s)
- Munisamy-Naidu Vinuthinee-Naidu
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Ophthalmology, Hospital Sultanah Bahiyah, 05460, Alor Setar, Kedah, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. .,Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Anuar Azreen-Redzal
- Department of Ophthalmology, Hospital Sultanah Bahiyah, 05460, Alor Setar, Kedah, Malaysia
| | - Naing Nyi-Nyi
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.,Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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Brynskov T, Laugesen CS, Floyd AK, Sørensen TL. Thickening of inner retinal layers in the parafovea after bariatric surgery in patients with type 2 diabetes. Acta Ophthalmol 2016; 94:668-674. [PMID: 27226121 DOI: 10.1111/aos.13087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/11/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE Bariatric surgery dramatically improves the metabolic profile in patients with type 2 diabetes (T2D). We have previously reported a thickening of the retina after bariatric surgery and aimed to investigate these subclinical changes in retinal thickness and vessel calibres in more detail. METHODS We examined 51 patients with T2D 2 weeks before and 1, 3, 6 and 12 months after bariatric surgery. Retinal thickness was measured with optical coherence tomography and automated segmentation in the fovea, parafovea and perifovea in each retinal layer. Retinal vessels were semiautomatically measured in a zone 0.5-1 disc diameters from the optic disc. RESULTS The total macula thickened with a peak after 6 months in both univariate (2.7 ± 0.4 μm, p < 0.001) and multivariate analysis (2.2 ± 0.7 μm, p = 0.001). The thickening was most prominent in the parafoveal ring 1-3 mm from the centre and in the retinal nerve fibre layer and outer nuclear layer. A fall in HbA1c (p = 0.01) and longer duration of diabetes (p = 0.01) were associated with more thickening. The central retinal artery equivalent widened 22.1 μm (±8.9, p = 0.01) in the multivariate analysis 12 months postoperatively. A reduction in blood pressure was associated with less widening of the arterioles (p = 0.01). CONCLUSION Patients with T2D had thickening of the retina after gastric bypass surgery with a peak 6 months postoperatively. The thickening was most pronounced in the retinal nerve fibre layer and the outer nuclear layer of the parafovea. In multivariate analysis, the central retinal artery equivalent increased at 12 months.
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Affiliation(s)
- Troels Brynskov
- Department of Ophthalmology; Copenhagen University Hospital Roskilde; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Caroline S. Laugesen
- Department of Ophthalmology; Copenhagen University Hospital Roskilde; Roskilde Denmark
| | - Andrea K. Floyd
- Department of Bariatric Surgery; Copenhagen University Hospital Køge; Køge Denmark
| | - Torben L. Sørensen
- Department of Ophthalmology; Copenhagen University Hospital Roskilde; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Abstract
INTRODUCTION Mitochondria, essential to multicellular life, convert food into ATP to satisfy cellular energy demands. Since different tissues have different energy requirements, mitochondrial density is high in tissues with high metabolic needs, such as the visual system, which is therefore highly susceptible to limited energy supply as a result of mitochondrial dysfunction. AREAS COVERED Vision impairment is a common feature of most mitochondrial diseases. At the same time, there is mounting evidence that mitochondrial impairment contributes to the pathogenesis of major eye diseases such as glaucoma and might also be involved in the reported vision impairment in neurodegenerative disorders such as Alzheimer's disease. EXPERT OPINION Rather than relying on symptomatic treatment, acknowledging the mitochondrial origin of visual disorders in mitochondrial, neurodegenerative and ocular diseases could lead to novel therapeutics that aim to modulate mitochondrial function in order to protect against vision loss. This approach has already shown some promising clinical results in inherited retinal disorders, which supports the idea that targeting mitochondria could also be a treatment option for other optic neuropathies.
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Affiliation(s)
- Jamuna Chhetri
- a Division of Pharmacy, School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - Nuri Gueven
- a Division of Pharmacy, School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
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