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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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Spyridakos D, Mastrodimou N, Vemuri K, Ho TC, Nikas SP, Makriyannis A, Thermos K. Blockade of CB1 or Activation of CB2 Cannabinoid Receptors Is Differentially Efficacious in the Treatment of the Early Pathological Events in Streptozotocin-Induced Diabetic Rats. Int J Mol Sci 2022; 24:240. [PMID: 36613692 PMCID: PMC9820336 DOI: 10.3390/ijms24010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Oxidative stress, neurodegeneration, neuroinflammation, and vascular leakage are believed to play a key role in the early stage of diabetic retinopathy (ESDR). The aim of this study was to investigate the blockade of cannabinoid receptor 1 (CB1R) and activation of cannabinoid receptor 2 (CB2R) as putative therapeutics for the treatment of the early toxic events in DR. Diabetic rats [streptozotocin (STZ)-induced] were treated topically (20 μL, 10 mg/mL), once daily for fourteen days (early stage DR model), with SR141716 (CB1R antagonist), AM1710 (CB2R agonist), and the dual treatment SR141716/AM1710. Immunohistochemical-histological, ELISA, and Evans-Blue analyses were performed to assess the neuroprotective and vasculoprotective properties of the pharmacological treatments on diabetes-induced retinal toxicity. Activation of CB2R or blockade of CB1R, as well as the dual treatment, attenuated the nitrative stress induced by diabetes. Both single treatments protected neural elements (e.g., RGC axons) and reduced vascular leakage. AM1710 alone reversed all toxic insults. These findings provide new knowledge regarding the differential efficacies of the cannabinoids, when administered topically, in the treatment of ESDR. Cannabinoid neuroprotection of the diabetic retina in ESDR may prove therapeutic in delaying the development of the advanced stage of the disease.
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Affiliation(s)
- Dimitris Spyridakos
- Department of Pharmacology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Niki Mastrodimou
- Department of Pharmacology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Kiran Vemuri
- Center for Drug Discovery, Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
| | - Thanh C. Ho
- Center for Drug Discovery, Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
| | - Spyros P. Nikas
- Center for Drug Discovery, Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
| | - Alexandros Makriyannis
- Center for Drug Discovery, Departments of Chemistry and Chemical Biology and Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
| | - Kyriaki Thermos
- Department of Pharmacology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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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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Microvascular and Morphologic Changes of the Macula over Lifetime. Life (Basel) 2022; 12:life12040568. [PMID: 35455059 PMCID: PMC9024868 DOI: 10.3390/life12040568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
In ocular, neurologic, and cardiovascular diseases, macular segmentation data from spectral-domain optical coherence tomography (SD-OCT) provide morphologic, and OCT-angiography (OCTA) results give microvascular information about the macula. Age was shown to influence both methods’ measurements. To further characterize this association, macular SD-OCT and OCTA changes were investigated in a population of juvenile, adult, and older individuals. Macular segment thickness and superficial (SCP) and deep plexus (DCP) vascular density (VD) of 157 healthy individuals aged 10–79 years were analyzed retrospectively. One-way analysis of variance (ANOVA) was used to compare age groups. The association between macular segmentation and OCTA parameters and between these and age was evaluated using linear regression. ANOVA and linear regression analysis showed a thickness decrease in the whole macular and in the ganglion cell and inner plexiform layers with age. While the foveal avascular zone area remained constant between age groups, VD of the SCP and DCP also decreased with age. In multiple linear regression, SCP and DCP VD were associated with inner macular segment thickness in an age-independent way. To conclude, the age-related microvascular and morphological changes in the macula described in this study can contribute to improving the understanding of macular aging processes and better interpreting OCT(A) results in healthy individuals and patients suffering from various retinal diseases.
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Attiku Y, He Y, Nittala MG, Sadda SR. Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries. Indian J Ophthalmol 2021; 69:2968-2976. [PMID: 34708731 PMCID: PMC8725126 DOI: 10.4103/ijo.ijo_1212_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.
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Affiliation(s)
- Yamini Attiku
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California
| | - Ye He
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | | | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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CHANGES IN TOTAL AND INNER RETINAL THICKNESSES IN TYPE 1 DIABETES WITH NO RETINOPATHY AFTER 8 YEARS OF FOLLOW-UP. Retina 2021; 40:1379-1386. [PMID: 31157712 DOI: 10.1097/iae.0000000000002576] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate changes in retinal layer thickness in patients with Type 1 diabetes with no diabetic retinopathy after 8 years of follow-up. METHODS Ninety Type 1 diabetes and 60 control eyes were studied. Changes in the retinal nerve fiber layer, ganglion cell layer, and inner nuclear layer thicknesses in all Early Treatment Diabetic Retinopathy Study areas were evaluated. RESULTS The mean ages were 42.93 ± 13.62 and 41.52 ± 13.05 years in the diabetic and control group, respectively. In 2009, total retinal thickness was higher in diabetic patients; differences were statistically significant in all except the nasal areas. In both groups, the mean foveal thickness remained the same during the 8 years. Among diabetic patients, there was a significant reduction in total retinal thickness in all areas excluding the outer temporal one; controls only in the inferior areas. The thickness loss was due to the thinning of the inner retinal layers (inner nuclear layer, ganglion cell layer, and retinal nerve fiber layer). The controls showed a significant diminution in the retinal nerve fiber layer and in the ganglion cell layer areas. The inner nuclear layer showed a diminution in the diabetes mellitus group. CONCLUSION Before the onset of diabetic retinopathy, Type 1 diabetes patients experience a diminution of their inner retinal layer thicknesses over time, supporting the hypothesis of retinal neurodegeneration.
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A Real-World Single-Centre Study of Patients with Diabetic Macular Oedema Who Wore a Home-Use Sleep Mask (Noctura 400) for One Year. J Ophthalmol 2021; 2021:6612126. [PMID: 34258049 PMCID: PMC8249224 DOI: 10.1155/2021/6612126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
A “Real-World” single-centre observational study was carried out to analyse the effects of enhanced patient interaction with the use of the Noctura 400 sleep mask on a group of 26 diabetics displaying diabetic retinopathy (DR) and diabetic macular oedema (DMO), of which 24 completed the study. We hoped to find if patient compliance could be maintained and to determine the anatomical and functional consequences of consistent mask wear. While this study was ongoing, COVID-19 impacted on normal eye clinic practice, allowing an unexpected analysis of the effects of this disruption to the clinical system on mask wear and disease progress. Throughout the whole study, outcomes were positive, with a high level of consistent patient use of the mask, above 74% up to and beyond 1 year. Even during the COVID-19 1st lockdown in England, the patients maintained a 65% nightly light mask compliance. Statistically significant improvements in maculopathy, including cyst reduction (56.4% of eyes with cysts exhibited cyst shrinkage), and visual acuity (VA) improvement (42/48 eyes gained 5 letters or more) were observed and maintained to the end of the study. Anatomical improvement or stability was recorded in all but one study eye. This investigation shows that given that there is appropriate interaction with patients who are self-treating in home environment, a high level of patient compliance can be maintained, even while there are disruptions to the normal hospital clinic setup.
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Focal loss volume of ganglion cell complex in diabetic neuropathy. Clin Exp Optom 2021; 99:526-534. [DOI: 10.1111/cxo.12379] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/18/2015] [Accepted: 11/28/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Geoff P Sampson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
- Deakin University, Geelong, Victoria, Australia,
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Anthony W Russell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,
- School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia,
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK,
- Weill Cornell Medical College in Qatar, Doha, Qatar,
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
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Kaur K, Gurnani B. Comment on “Study of peripapillary retinal nerve fiber layer thickness in patients of type 2 diabetes mellitus and its correlation with glycaemic control”. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2021. [DOI: 10.4103/jcor.jcor_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Faraji M, Kangari H, Majidi A, Tabatabaee SM. Stereopsis in Early Diabetic Retinopathy. CLINICAL OPTOMETRY 2020; 12:1-7. [PMID: 32021531 PMCID: PMC6959501 DOI: 10.2147/opto.s232312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The present study was undertaken to compare the stereoacuities measured by TNO and Titmus tests, in diabetic patients with early retinopathies and those without diabetes (control group). METHODS In this study, 139 participants (43 with diabetes mellitus, and 96 age-matched controls) were recruited from a retina subspecialist clinic in Qazvin, Iran, from September 2016 to March 2017. The stereo-acuities were measured following subjective refraction by Titmus and TNO tests at 40 cm. The patients with diabetes whose retinal exam revealed no background retinopathy or only microaneurysms (very mild diabetic retinopathy) in the worse eye were enrolled into this study. RESULTS In the diabetic group, with TNO, the stereoacuity levels in 95.3% of the subjects were in 120, 240, and 480 levels, while in the non-diabetic group, 86.4% of the subjects were in 30, 60, and 120 levels. In the diabetic group, with Titmus, 86.1% of the subjects were in 40, 50, and 60 levels, while in the nondiabetic group 91.7% of the subjects were in 40 levels. The correlation between TNO and Titmus was statistically significant (r = 0.338, P<0.001) for the non-diabetic group, while it was not statistically significant (r = -0.034, P= 0.827) for the diabetic group. CONCLUSION In the early stages of diabetic retinopathy, the global pathway of stereopsis is damaged more than the local. The difference in severity of damage to local and global pathways in patients with diabetes indicates that there may be different underlying mechanisms for these two pathways.
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Affiliation(s)
- Mohadeceh Faraji
- Department of Optometry, School of Rehabilitation, (Student Research Office), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Haleh Kangari
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Morales-Calixto E, Velázquez-Flores MÁ, Sánchez-Chávez G, Ruiz Esparza-Garrido R, Salceda R. Glycine receptor is differentially expressed in the rat retina at early stages of streptozotocin-induced diabetes. Neurosci Lett 2019; 712:134506. [DOI: 10.1016/j.neulet.2019.134506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/21/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
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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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Nawaz IM, Rezzola S, Cancarini A, Russo A, Costagliola C, Semeraro F, Presta M. Human vitreous in proliferative diabetic retinopathy: Characterization and translational implications. Prog Retin Eye Res 2019; 72:100756. [PMID: 30951889 DOI: 10.1016/j.preteyeres.2019.03.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
Diabetic retinopathy (DR) is one of the leading causes of visual impairment in the working-age population. DR is a progressive eye disease caused by long-term accumulation of hyperglycaemia-mediated pathological alterations in the retina of diabetic patients. DR begins with asymptomatic retinal abnormalities and may progress to advanced-stage proliferative diabetic retinopathy (PDR), characterized by neovascularization or preretinal/vitreous haemorrhages. The vitreous, a transparent gel that fills the posterior cavity of the eye, plays a vital role in maintaining ocular function. Structural and molecular alterations of the vitreous, observed during DR progression, are consequences of metabolic and functional modifications of the retinal tissue. Thus, vitreal alterations reflect the pathological events occurring at the vitreoretinal interface. These events are caused by hypoxic, oxidative, inflammatory, neurodegenerative, and leukostatic conditions that occur during diabetes. Conversely, PDR vitreous can exert pathological effects on the diabetic retina, resulting in activation of a vicious cycle that contributes to disease progression. In this review, we recapitulate the major pathological features of DR/PDR, and focus on the structural and molecular changes that characterize the vitreal structure and composition during DR and progression to PDR. In PDR, vitreous represents a reservoir of pathological signalling molecules. Therefore, in this review we discuss how studying the biological activity of the vitreous in different in vitro, ex vivo, and in vivo experimental models can provide insights into the pathogenesis of PDR. In addition, the vitreous from PDR patients can represent a novel tool to obtain preclinical experimental evidences for the development and characterization of new therapeutic drug candidates for PDR therapy.
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Affiliation(s)
- Imtiaz M Nawaz
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Sara Rezzola
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Anna Cancarini
- Department of Ophthalmology, University of Brescia, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Brescia, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Marco Presta
- Department of Molecular and Translational Medicine, University of Brescia, Italy.
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Mukherjee C, Al-Fahad Q, Elsherbiny S. The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review. Ther Adv Ophthalmol 2019; 11:2515841419831155. [PMID: 30923793 PMCID: PMC6431765 DOI: 10.1177/2515841419831155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.
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Affiliation(s)
| | - Qusay Al-Fahad
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
| | - Samer Elsherbiny
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
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Zacharias LC, Azevedo BM, de Araujo RB, Ciongoli MR, Hatanaka M, Preti RC, Monteiro MLR. Effect of panretinal photocoagulation on the peripapillary retinal nerve fiber layer in diabetic retinopathy patients. Clinics (Sao Paulo) 2019; 74:e1163. [PMID: 31778429 PMCID: PMC6844141 DOI: 10.6061/clinics/2019/e1163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the effect of panretinal photocoagulation (PRP) on the peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR). METHODS This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Peripapillary RNFL thickness was measured using scanning laser polarimetry (SLP) with variable corneal compensation (GDx VCC; by Carl Zeiss Meditec, Dublin, CA) and spectral-domain optical coherence tomography (OCT) (Heidelberg Spectralis, Carlsbad, USA) at baseline and 12 months after PRP was performed. RESULTS Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found among all RNFL thickness parameters tested by GDx VCC software (p=0.952, 0.464 and 0.541 for temporal-superior-nasal-inferior-temporal (TSNIT) average, superior average, inferior average, respectively). The nerve fiber indicator (NFI) had a nonsignificant increase (p=0.354). The OCT results showed that the average RNFL thickness (360° measurement) decreased nonsignificantly from 97.2 mm to 96.0 mm at 1 year post-PRP (p=0.469). There was no significant difference when separately analyzing all the peripapillary sectors (nasal superior, temporal superior, temporal, temporal inferior, nasal inferior and nasal thickness). CONCLUSION Our results suggest that PRP, as performed in our study, does not cause significant changes in peripapillary RNFL in diabetic PDR patients after one year of follow-up.
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Affiliation(s)
- Leandro Cabral Zacharias
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Breno M.S. Azevedo
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rafael B. de Araujo
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marina R. Ciongoli
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Hatanaka
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rony C. Preti
- Divisao de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Association between Visual Acuity and Retinal Layer Metrics in Diabetics with and without Macular Edema. J Ophthalmol 2018; 2018:1089043. [PMID: 30402277 PMCID: PMC6192089 DOI: 10.1155/2018/1089043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/26/2018] [Accepted: 08/07/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose Diabetes is known to cause alterations in retinal microvasculature and tissue that progressively lead to visual impairment. Optical coherence tomography (OCT) is useful for assessment of total retinal thickening due to diabetic macular edema (DME). In the current study, we determined associations between visual acuity (VA) and retinal layer thickness, reflectance, and interface disruption derived from enface OCT images in subjects with and without DME. Materials and Methods Best corrected VA was measured and high-density OCT volume scans were acquired in 149 diabetic subjects. A previously established image segmentation method identified retinal layer interfaces and locations of visually indiscernible (disrupted) interfaces. Enface thickness maps and reflectance images of the nerve fiber layer (NFL), combined ganglion cell and inner plexiform layer (GCLIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor outer segment layer (OSL), and retinal pigment epithelium (RPE) were generated in the central macular subfield. The associations among VA and retinal layer metrics were determined by multivariate linear regressions after adjusting for covariates (age, sex, race, HbA1c, diabetes type, and duration) and correcting for multiple comparisons. Results In DME subjects, increased GCLIPL and OPL thickness and decreased OSL thickness were associated with reduced VA. Furthermore, increased NFL reflectance and decreased OSL reflectance were associated with reduced VA. Additionally, increased areas of INL and ONL interface disruptions were associated with reduced VA. In subjects without DME, increased INL thickness was associated with reduced VA, whereas in subjects without DME but with previous antivascular endothelium growth factor treatment, thickening of OPL was associated with reduced VA. Conclusions Alterations in retinal layer thickness and reflectance metrics derived from enface OCT images were associated with reduced VA with and without presence of DME, suggestive of their potential for monitoring development, progression, and treatment of DME.
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17
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Xu Q, Li Y, Cheng Y, Qu Y. Assessment of the effect of age on macular layer thickness in a healthy Chinese cohort using spectral-domain optical coherence tomography. BMC Ophthalmol 2018; 18:169. [PMID: 29996804 PMCID: PMC6042244 DOI: 10.1186/s12886-018-0842-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background To determine the effect of age on the thickness of individual retinal and choroidal vascular layers in the macula in an ophthalmologically healthy Chinese cohort by using spectral-domain optical coherence tomography (SD-OCT). Methods In all, 525 health eyes of 525 subjects were examined with SD-OCT. The instrument automatically obtained the regional retinal thickness of 8 layers. Subfoveal choroidal vascular layers’ thickness was measured using enhanced depth imaging mode. The correlation of age with layer thickness measurements was determined. Results No age-associated variation was found on retinal thickness (RT) in the fovea; however, the foveal thickness of outer nuclear layer (ONL), retinal pigment epithelium (RPE) and vascular sublayers of the choroid decreased significantly with aging in this area (P < 0.05, respectively). Significant age-related reduction was seen in RT in the pericentral and peripheral rings (P < 0.05, respectively). The significant variation in thinning of the ganglion cell layer, inner plexiform layer, and ONL with aging is thought to be the main determinant of these results (P < 0.05, respectively). On the contrary, the RPE layout showed age-related thickening (P < 0.05, respectively) in the pericentral and peripheral regions. Conclusions The thickness of individual layers of the macula may be determinants of the age-related variations observed in the ophthalmologically healthy Chinese cohort, as assessed by SD-OCT examination.
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Affiliation(s)
- Qian Xu
- Department of Geriatrics, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, Shandong, China.,Department of Ophthalmology, The Central Hospital of Taian, Tai'an, 271000, Shandong, China
| | - Ying Li
- Department of Geriatrics, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Ying Cheng
- Department of Geriatrics, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Yi Qu
- Department of Geriatrics, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, Shandong, China.
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Ma M, Xu Y, Xiong S, Zhang J, Gu Q, Ke B, Xu X. Involvement of ciliary neurotrophic factor in early diabetic retinal neuropathy in streptozotocin-induced diabetic rats. Eye (Lond) 2018; 32:1463-1471. [PMID: 29795129 PMCID: PMC6137181 DOI: 10.1038/s41433-018-0110-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 12/24/2022] Open
Abstract
Objective Ciliary neurotrophic factor (CNTF) has been evaluated as a candidate therapeutic agent for diabetes and its neural complications. However, its role in diabetic retinopathy has not been fully elucidated. Methods This is a randomized unblinded animal experiment. Wistar rats with streptozocin (STZ)-induced diabetes were regularly injected with CNTF or vehicle control in their vitreous bodies beginning at 2 weeks after STZ injection. A total of five injections were used. In diabetic rats, the levels of CNTF and neurotrophin-3 (NT-3) were evaluated by enzyme-linked immunosorbent assays (ELISA) and real-time PCR. The abundance of tyrosine hydroxylase (TH) and β-III tubulin was detected by western blot. Transferase-mediated dUTP nick-end labeling staining (TUNEL) was used to detect cell apoptosis in the retinal tissue. The activation of caspase-3 was also measured. Results The protein and mRNA levels of CNTF in diabetic rat retinas were reduced compared to control rats. In addition, retinal ganglion cells (RGCs) and dopaminergic amacrine cells appeared to undergo degeneration in diabetic rat retinas, as revealed by transferase-mediated dUTP nick-end labeling staining (TUNEL). Tyrosine hydroxylase (TH) and β-III tubulin protein levels also decreased significantly. Intraocular administration of CNTF rescued RGCs and dopaminergic amacrine cells from neurodegeneration and counteracted the downregulation of β-III tubulin and TH expression, thus demonstrating its therapeutic potential. Conclusion Our study suggests that early diabetic retinal neuropathy involves the reduced expression of CNTF and can be ameliorated by an exogenous supply of this neurotrophin.
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Affiliation(s)
- Mingming Ma
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yupeng Xu
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Shuyu Xiong
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jian Zhang
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Qing Gu
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Bilian Ke
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xun Xu
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China. .,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
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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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20
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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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21
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Neurodegeneration in diabetic retinopathy: Potential for novel therapies. Vision Res 2017; 139:82-92. [PMID: 28988945 DOI: 10.1016/j.visres.2017.06.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
The complex pathology of diabetic retinopathy (DR) affects both vascular and neural tissue. The characteristics of neurodegeneration are well-described in animal models but have more recently been confirmed in the clinical setting, mostly by using non-invasive imaging approaches such as spectral domain optical coherence tomography (SD-OCT). The most frequent observations report loss of tissue in the nerve fiber layer and inner plexiform layer, confirming earlier findings from animal models. In several cases the reduction in inner retinal layers is reported in patients with little evidence of vascular lesions or macular edema, suggesting that degenerative loss of neural tissue in the inner retina can occur after relatively short durations of diabetes. Animal studies also suggest that neurodegeneration leading to retinal thinning is not limited to cell death and tissue loss but also includes changes in neuronal morphology, reduced synaptic protein expression and alterations in neurotransmission, including changes in expression of neurotransmitter receptors as well as neurotransmitter release, reuptake and metabolism. The concept of neurodegeneration as an early component of DR introduces the possibility to explore alternative therapies to prevent the onset of vision loss, including neuroprotective therapies and drugs targeting individual neurotransmitter systems, as well as more general neuroprotective approaches to preserve the integrity of the neural retina. In this review we consider some of the evidence for progressive retinal neurodegeneration in diabetes, and explore potential neuroprotective therapies.
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Pekel E, Altıncık SA, Pekel G. Evaluation of optic disc, retinal nerve fiber and macular ganglion cell layers in pediatric diabetes. Int Ophthalmol 2017; 38:1955-1961. [PMID: 28780619 DOI: 10.1007/s10792-017-0683-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/01/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Our aim was to compare optic disc parameters, retinal nerve fiber (RNFL) and macular ganglion cell layers between children and adolescents with diabetes mellitus (type 1) and healthy controls. METHODS Sixty-three eyes of 63 pediatric diabetic patients without diabetic retinopathy and 44 eyes of 44 healthy controls were included in this cross-sectional and comparative study. Diabetic and control groups were similar in the aspect of age, gender and refractive error. Measurements of optic disc parameters (i.e., rim area, disc area, cup-to-disc ratio, cup volume), thickness of RNFL and macular ganglion cell-inner plexiform layers (GCL + IPL) were taken with the spectral domain optical coherence tomography. RESULTS There were not statistically significant differences between the diabetic patients and healthy controls in terms of intraocular pressure (p = 0.14), retinal nerve fiber layer thickness (p = 0.61), rim area (p = 0.92), disc area (p = 0.10), vertical cup-to-disc ratio (p = 0.16), cup volume (p = 0.13), and average macular GCL + IPL thickness (p = 0.43). On the other hand, binocular RNFL thickness symmetry percentage was statistically significantly different in the diabetic and control groups (p = 0.01). CONCLUSION Diabetic children and adolescents without diabetic retinopathy have more binocular RNFL thickness asymmetry compared to healthy controls.
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Affiliation(s)
- Evre Pekel
- Denizli State Hospital, Eye Clinic, Denizli, Turkey
| | | | - Gökhan Pekel
- Ophthalmology Department, Pamukkale University, 20070, Denizli, Turkey.
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Wanek J, Blair NP, Chau FY, Lim JI, Leiderman YI, Shahidi M. Alterations in Retinal Layer Thickness and Reflectance at Different Stages of Diabetic Retinopathy by En Face Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2017; 57:OCT341-7. [PMID: 27409491 PMCID: PMC4968784 DOI: 10.1167/iovs.15-18715] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose This article reports a method for en face optical coherence tomography (OCT) imaging and quantitative assessment of alterations in both thickness and reflectance of individual retinal layers at different stages of diabetic retinopathy (DR). Methods High-density OCT raster volume scans were acquired in 29 diabetic subjects divided into no DR (NDR) or non-proliferative DR (NPDR) groups and 22 control subjects (CNTL). A customized image segmentation method identified eight retinal layer interfaces and generated en face thickness maps and reflectance images for nerve fiber layer (NFL), ganglion cell and inner plexiform layers (GCLIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor outer segment layer (OSL), and retinal pigment epithelium (RPE). Mean thickness and intensity values were calculated in nine macular subfields for each retinal layer. Results En face thickness maps and reflectance images of retinal layers in CNTL subjects corresponded to normal retinal anatomy. Total retinal thickness correlated negatively with age in nasal subfields (R ≤−0.31; P ≤ 0.03, N = 51). In NDR subjects, NFL and OPL thickness were decreased (P = 0.05), and ONL thickness was increased (P = 0.04) compared to CNTL. In NPDR subjects, GCLIPL thickness was increased in perifoveal subfields (P< 0.05) and INL intensity was higher in all macular subfields (P = 0.04) compared to CNTL. Conclusions Depth and spatially resolved retinal thickness and reflectance measurements are potential biomarkers for assessment and monitoring of DR.
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Abstract
Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.
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Affiliation(s)
- Brian J Song
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02115, USA
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02215, USA
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25
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Mugdha K, Kaur A, Sinha N, Saxena S. Evaluation of retinal nerve fiber layer thickness profile in thyroid ophthalmopathy without optic nerve dysfunction. Int J Ophthalmol 2016; 9:1634-1637. [PMID: 27990368 DOI: 10.18240/ijo.2016.11.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 08/28/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate retinal nerve fiber layer (RNFL) thickness profile in patients of thyroid ophthalmopathy with no clinical signs of optic nerve dysfunction. METHODS A prospective, case-control, observational study conducted at a tertiary care centre. Inclusion criteria consisted of patients with eyelid retraction in association with any one of: biochemical thyroid dysfunction, exophthalmos, or extraocular muscle involvement; or thyroid dysfunction in association with either exophthalmos or extra-ocular muscle involvement; or a clinical activity score (CAS)>3/7. Two measurements of RNFL thickness were done for each eye, by Cirrus HD-optical coherence tomography 6mo apart. RESULTS Mean age of the sample was 38.75y (range 13-70y) with 18 males and 22 females. Average RNFL thickness at first visit was 92.06±12.44 µm, significantly lower than control group (101.28±6.64 µm) (P=0.0001). Thickness of inferior quadrant decreased from 118.2±21.27 µm to 115.0±22.27 µm after 6mo (P=0.02). There was no correlation between the change in CAS and RNFL thickness. CONCLUSION Decreased RNFL thickness is an important feature of thyroid orbitopathy, which is an inherent outcome of compressive optic neuropathy of any etiology. Subclinical RNFL damage continues in the absence of clinical activity of the disease. RNFL evaluation is essential in Grave's disease and active intervention may be warranted in the presence of significant damage.
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Affiliation(s)
- Kumari Mugdha
- Department of Ophthalmology, King George's Medical University, Lucknow 226003, India
| | - Apjit Kaur
- Department of Ophthalmology, King George's Medical University, Lucknow 226003, India
| | - Neha Sinha
- Sankara Eye Hospital, Kanpur 208001, India
| | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow 226003, India
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Stem MS, Dunbar GE, Jackson GR, Farsiu S, Pop-Busui R, Gardner TW. Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus. Eye (Lond) 2016; 30:825-32. [PMID: 27034201 DOI: 10.1038/eye.2016.48] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/27/2016] [Indexed: 01/05/2023] Open
Abstract
PurposeTo quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.MethodsThirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.ResultsSixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13, P<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8 μm) compared with controls (36.5±2.9 μm) (P=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (R=-0.458, P=0.006) and LGBI (R=-0.473, P=0.004), were negatively correlated with inner temporal INL thickness.ConclusionsPatients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.
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Affiliation(s)
- M S Stem
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - G E Dunbar
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - S Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - R Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - T W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
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Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res 2016; 2016:2156273. [PMID: 27761468 PMCID: PMC5059543 DOI: 10.1155/2016/2156273] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/29/2016] [Accepted: 09/06/2016] [Indexed: 12/15/2022] Open
Abstract
Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.
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Affiliation(s)
- Pedro Romero-Aroca
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira & Virgili, Reus, Spain
- *Pedro Romero-Aroca:
| | - Marc Baget-Bernaldiz
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira & Virgili, Reus, Spain
| | - Alicia Pareja-Rios
- Department of Ophthalmology, Retina Section, Hospital Universitario de Canarias, Tenerife, Spain
| | - Maribel Lopez-Galvez
- Department of Ophthalmology, University Hospital Valladolid, Ocular Diabetes Unit of IOBA, Valladolid, Spain
| | - Raul Navarro-Gil
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira & Virgili, Reus, Spain
| | - Raquel Verges
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira & Virgili, Reus, Spain
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Retinal thickness profile of individuals with diabetes. Ophthalmic Physiol Opt 2015; 36:158-66. [DOI: 10.1111/opo.12263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Geoff P. Sampson
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Anthony W. Russell
- Princess Alexandra Hospital; Woolloongabba Australia
- School of Medicine; University of Queensland; Woolloongabba Australia
| | - Rayaz A. Malik
- Centre for Endocrinology and Diabetes; Institute of Human Development; University of Manchester; Manchester UK
- Weill Cornell Medical College in Qatar; Doha Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
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Peripapillary retinal nerve fiber layer changes in preclinical diabetic retinopathy: a meta-analysis. PLoS One 2015; 10:e0125919. [PMID: 25965421 PMCID: PMC4429076 DOI: 10.1371/journal.pone.0125919] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 01/11/2023] Open
Abstract
Background Diabetic retinopathy is a microvascular neurodegenerative disorder in diabetic patients. Peripapillary retinal nerve fiber layer changes have been described in patients with preclinical diabetic retinopathy, but study results have been inconsistent. Objective To assess changes in peripapillary retinal nerve fiber layer thickness in diabetic patients with preclinical diabetic retinopathy. Methods A literature search was conducted through PubMed, EMBASE, Web of Science and Cochrane Library. Case-control studies on RNFL thickness in preclinical diabetic retinopathy patients and healthy controls were retrieved. A meta-analysis of weighted mean difference and a sensitivity analysis were performed using RevMan 5.2 software. Results Thirteen case-control studies containing 668 diabetic patients and 556 healthy controls were selected. Peripapillary RNFL thickness was significantly reduced in patients with preclinical diabetic retinopathy compared to healthy controls in studies applying Optical Coherence Tomography (-2.88μm, 95%CI: -4.44 to -1.32, P = 0.0003) and in studies applying Scanning Laser Polarimeter (-4.21μm, 95%CI: -6.45 to -1.97, P = 0.0002). Reduction of RNFL thickness was significant in the superior quadrant (-3.79μm, 95%CI: -7.08 to -0.50, P = 0.02), the inferior quadrant (-2.99μm, 95%CI: -5.44 to -0.54, P = 0.02) and the nasal quadrant (-2.88μm, 95%CI: -4.93 to -0.82, P = 0.006), but was not significant in the temporal quadrant (-1.22μm, 95%CI: -3.21 to 0.76, P = 0.23), in diabetic patients. Conclusion Peripapillary RNFL thickness was significantly decreased in preclinical diabetic retinopathy patients compared to healthy control. Neurodegenerative changes due to preclinical diabetic retinopathy need more attention.
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Zhu T, Ma J, Li Y, Zhang Z. Association between retinal neuronal degeneration and visual function impairment in type 2 diabetic patients without diabetic retinopathy. SCIENCE CHINA-LIFE SCIENCES 2015; 58:550-5. [PMID: 25951931 DOI: 10.1007/s11427-015-4858-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/08/2015] [Indexed: 11/30/2022]
Abstract
The changes in retinal thickness and visual function in type 2 diabetic patients without clinical evidence of diabetic retinopathy were evaluated. A total of 141 diabetic subjects without retinopathy and 158 healthy subjects were enrolled in this study. Superior macular ganglion cell complex thicknesses were significantly decreased in diabetic cases, and no significant peripapillary retinal nerve fiber layer thickness changes were observed. The contrast sensitivities at all space frequencies were significantly different between diabetic patients and controls. The mean P50 amplitude from pattern electroretinogram results was reduced significantly in the diabetic group. In the diabetic group, average superior ganglion cell complex thicknesses positively correlated with both contrast sensitivities at high spatial frequencies and P50 amplitudes. The results indicated that ganglion cell complex thickness and visual function changes could be observed in diabetic subjects before the onset of any significant diabetic retinopathy. Macular ganglion cell complex reduction occurred much earlier than peripapillary retinal nerve fiber layer thinning in diabetic patients without retinopathy.
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Affiliation(s)
- TiePei Zhu
- Eye Hospital of Wenzhou Medical University, Hangzhou, 310020, China
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Diabetic retinopathy: recent advances towards understanding neurodegeneration and vision loss. SCIENCE CHINA-LIFE SCIENCES 2015; 58:541-9. [DOI: 10.1007/s11427-015-4856-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/02/2015] [Indexed: 12/22/2022]
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Evaluation of the Effect of Pan Retinal Photocoagulation on Optic Nerve Head Parameters Using HRT3. J Glaucoma 2014; 23:467-70. [DOI: 10.1097/ijg.0b013e3182946536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jindal V. Neurodegeneration as a primary change and role of neuroprotection in diabetic retinopathy. Mol Neurobiol 2014; 51:878-84. [PMID: 24826918 DOI: 10.1007/s12035-014-8732-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023]
Abstract
Diabetic retinopathy (DR) was earlier recognized as a vascular disease, but nowadays, it is considered as a neurovascular disorder. Neuronal death is the primary change which leads to various vascular changes which are visible to an ophthalmologist. But these changes are feature of an advanced disease and can affect vision at any moment of time. There are various evidences which suggests that glutamate excitotoxicity, hyperhomocysteinemia, kynurenic acid, and erythro-poietin plays important role in causation of retinal ganglionic cell apoptosis in diabetic patients. Adaptive optics, a new imaging technique, also showed that loss of photoreceptors (specialized neurons) is the early change in diabetic retinopathy. These changes suggest DR as a neurovascular disorder. Neuroprotective agents also showed good results in delaying progression of DR especially memantine, insulin receptor activation, and neurotrophic factors. More research in this field will help us to find novel therapeutic measures for DR, which can delay or even stop progression of DR at a very early stage.
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Affiliation(s)
- Vishal Jindal
- , H. No. 102 GHS 51 sector 20, Panchkula, Haryana, India,
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Ola MS. Effect of hyperglycemia on insulin receptor signaling in the cultured retinal Müller glial cells. Biochem Biophys Res Commun 2014; 444:264-9. [DOI: 10.1016/j.bbrc.2014.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/15/2014] [Indexed: 12/16/2022]
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Marozas LM, Fort PE. Diabetic Retinopathy-Update on Prevention Techniques, Present Therapies, and New Leads. ACTA ACUST UNITED AC 2014; 7:54-58. [PMID: 25419235 DOI: 10.17925/usor.2014.07.01.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetic retinopathy is the major ocular complication associated with diabetes, and represents the leading cause of legal blindness in the working-age population of developed countries. Although classically diagnosed based on abnormalities of the retinal microvasculature, diabetic retinopathy is now widely recognized as a neurovascular disease. While all patients with diabetes are at increased risk for eye disease including diabetic retinopathy, proactive measures, and timely intervention can prevent or delay subsequent vision loss. Systemic management of diabetes by combined control of glycemia, blood pressure, and serum lipid levels remains the most important method of preventing diabetic retinopathy onset and progression. Once detected, surgical and medical interventions including photocoagulation, vitrectomy, and intravitral drug injection can help preserve vision. However, the need for improved detection methods and therapies that will allow earlier diagnosis and treatment remains apparent. This review summarizes current techniques for the prevention and intervention for diabetic retinopathy, and examines ongoing developments in the search for new endpoints and therapies as they apply to preventing vision loss associated with diabetes.
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Affiliation(s)
- Lauren M Marozas
- Undergraduate Student, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, US
| | - Patrice E Fort
- Assistant Professor, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, US
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Identifying cell class specific losses from serially generated electroretinogram components. BIOMED RESEARCH INTERNATIONAL 2013; 2013:796362. [PMID: 24089688 PMCID: PMC3781995 DOI: 10.1155/2013/796362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022]
Abstract
Purpose. Processing of information through the cellular layers of the retina occurs in a serial manner. In the electroretinogram (ERG), this complicates interpretation of inner retinal changes as dysfunction may arise from “upstream” neurons or may indicate a direct loss to that neural generator. We propose an approach that addresses this issue by defining ERG gain relationships. Methods. Regression analyses between two serial ERG parameters in a control cohort of rats are used to define gain relationships. These gains are then applied to two models of retinal disease. Results. The PIIIamp to PIIamp gain is unity whereas the PIIamp to pSTRamp and PIIamp to nSTRamp gains are greater than unity, indicating “amplification” (P < 0.05). Timing relationships show amplification between PIIIit to PIIit and compression for PIIit to pSTRit and PIIit to nSTRit, (P < 0.05). Application of these gains to ω-3-deficiency indicates that all timing changes are downstream of photoreceptor changes, but a direct pSTR amplitude loss occurs (P < 0.05). Application to diabetes indicates widespread inner retinal dysfunction which cannot be attributed to outer retinal changes (P < 0.05). Conclusions. This simple approach aids in the interpretation of inner retinal ERG changes by taking into account gain characteristics found between successive ERG components of normal animals.
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Ola MS, Nawaz MI, Khan HA, Alhomida AS. Neurodegeneration and neuroprotection in diabetic retinopathy. Int J Mol Sci 2013; 14:2559-72. [PMID: 23358247 PMCID: PMC3588002 DOI: 10.3390/ijms14022559] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 02/06/2023] Open
Abstract
Diabetic retinopathy is widely considered to be a neurovascular disease. This is in contrast to its previous identity as solely a vascular disease. Early in the disease progression of diabetes, the major cells in the neuronal component of the retina consist of retinal ganglion cells and glial cells, both of which have been found to be compromised. A number of retinal function tests also indicated a functional deficit in diabetic retina, which further supports dysfunction of neuronal cells. As an endocrinological disorder, diabetes alters metabolism both systemically and locally in several body organs, including the retina. A growing body of evidences indicates increased levels of excitotoxic metabolites, including glutamate, branched chain amino acids and homocysteine in cases of diabetic retinopathy. Also present, early in the disease, are decreased levels of folic acid and vitamin-B12, which are potential metabolites capable of damaging neurons. These altered levels of metabolites are found to activate several metabolic pathways, leading to increases in oxidative stress and decreases in the level of neurotrophic factors. As a consequence, they may damage retinal neurons in diabetic patients. In this review, we have discussed those potential excitotoxic metabolites and their implications in neuronal damage. Possible therapeutic targets to protect neurons are also discussed. However, further research is needed to understand the exact molecular mechanism of neurodegeneration so that effective neuroprotection strategies can be developed. By protecting retinal neurons early in diabetic retinopathy cases, damage of retinal vessels can be protected, thereby helping to ameliorate the progression of diabetic retinopathy, a leading cause of blindness worldwide.
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Affiliation(s)
- Mohammad Shamsul Ola
- Department of Biochemistry, Faculty of Science, King Saud University, Riyadh 11415, Saudi Arabia.
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Vujosevic S, Midena E. Retinal layers changes in human preclinical and early clinical diabetic retinopathy support early retinal neuronal and Müller cells alterations. J Diabetes Res 2013; 2013:905058. [PMID: 23841106 PMCID: PMC3694491 DOI: 10.1155/2013/905058] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the changes in thickness of individual inner and outer macular and peripapillary retinal layers in diabetes. METHODS 124 subjects (124 eyes) were enrolled: 74 diabetics and 50 controls. Macular edema, proliferative diabetic retinopathy (DR), any intraocular treatment and refractive error >6 diopters were the main exclusion criteria. Full ophthalmic examination, stereoscopic fundus photography, and spectral domain-OCT were performed. After automatic retinal segmentation (layering) in 5 layers, the thickness of each layer was calculated, and values compared among groups. RESULTS Thirty patients had no DR, 44 patients had non proliferative DR. A significant increase of inner plexiform and nuclear layers was found in DR eyes versus controls (P < 0.001). A significant decrease (P < 0.01) of retinal nerve fiber layer (RNFL) and at specific sites of retinal ganglion cell layer (P = 0.02) was documented in the macula. In the peripapillary area there were no differences between diabetics and controls. CONCLUSIONS Decreased RNFL thickness and increased INL/OPL thickness in diabetics without DR or with initial DR suggest early alterations in the inner retina. On the contrary, the outer retina seems not to be affected at early stages of DM. Automatic intraretinal layering by SD-OCT may be a useful tool to diagnose and monitor early intraretinal changes in DR.
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Affiliation(s)
- Stela Vujosevic
- Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
- Fondazione G. B. Bietti, Via Livenza 3, 00198 Roma, Italy
- *Edoardo Midena:
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Reduced Levels of Brain Derived Neurotrophic Factor (BDNF) in the Serum of Diabetic Retinopathy Patients and in the Retina of Diabetic Rats. Cell Mol Neurobiol 2012; 33:359-67. [DOI: 10.1007/s10571-012-9901-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/13/2012] [Indexed: 01/18/2023]
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Kara N, Bozkurt E. Reply. Am J Ophthalmol 2012. [DOI: 10.1016/j.ajo.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shoji T, Sakurai Y, Sato H, Chihara E, Takeuchi M. Do type 2 diabetes patients without diabetic retinopathy or subjects with impaired fasting glucose have impaired colour vision? The Okubo Color Study Report. Diabet Med 2011; 28:865-71. [PMID: 21418090 DOI: 10.1111/j.1464-5491.2011.03290.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate associations between fasting plasma glucose level and the prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy. METHODS Participants in this cross-sectional study of male officials aged 20-60 yr in the Japanese Self Defence Force, underwent colour vision testing, ophthalmic examination, a standardized interview and examination of venous blood samples. Ishihara plates, a Lanthony 15-hue desaturated panel and Standard Pseudoisochromatic Plates Part 2 were used to examine colour vision. The Farnsworth-Munsell 100-hue test was performed to define acquired colour vision impairment. Cardiovascular disease risk factors were determined from serum blood samples, physical records and an interview. We performed logistic regression analysis adjusted for age, diagnosed hypertension, dyslipidaemia, cataract, glaucoma, being overweight, smoking status and alcohol intake. Crude and adjusted odds ratios were calculated for three glucose levels, which included normal fasting glucose, impaired fasting glucose and diabetes. RESULTS Out of a total of 1042 men enrolled, 872 were eligible for the study, and 31 were diagnosed with acquired colour vision impairment. As compared with the subjects with normal fasting glucose (< 5.6 mmol/l), the crude odds ratio for acquired colour vision impairment was 0.93 (95% CI 0.32-2.74) for the subjects with impaired fasting glucose (5.6-6.9 mmol/l) and 8.07 (95% CI 2.48-26.22) for the patients with type 2 diabetes. The multiple-adjusted odds ratios were 0.77 (95% CI 0.25-2.34) for the subjects with impaired fasting glucose and 5.89 (95% CI 1.55-22.40) for the patients with type 2 diabetes. CONCLUSIONS Our findings suggest that there is a dramatically increased prevalence of acquired colour vision impairment in type 2 diabetes patients without diabetic retinopathy which might be attributable to another pathogenesis associated with diabetic retinopathy.
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Affiliation(s)
- T Shoji
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan.
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Cankaya AB, Ozdamar Y, Ozalp S, Ozkan SS. Impact of panretinal photocoagulation on optic nerve head parameters. Ophthalmologica 2011; 225:193-9. [PMID: 21293162 DOI: 10.1159/000323573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/10/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND To investigate the impact of panretinal photocoagulation (PRP) on quantitative optic nerve head (ONH) assessment in patients with diabetic retinopathy. METHODS Eighty eyes of 80 diabetic patients who did not undergo PRP and 45 eyes of 45 subjects with diabetes who underwent PRP were enrolled in the prospective, cross-sectional study. Participants were evaluated by confocal scanning laser ophthalmoscopy (CSLO). The global values of ONH parameters were compared among the groups. RESULTS The eyes that had been treated with PRP had a significantly greater rim area (1.84 ± 0.45 vs. 1.68 ± 0.30 mm(2)), smaller cup/disc area ratio (0.14 ± 0.12 vs. 0.19 ± 0.12), smaller linear cup/disc ratio (0.34 ± 0.17 vs. 0.42 ± 0.14) and shallower cup depth (0.15 ± 0.09 vs. 0.18 ± 0.07 mm) than controls (p = 0.021, p = 0.019, p = 0.007, p = 0.04, respectively). On the other hand, PRP-treated eyes were found to have a significantly thinner mean peripapillary retinal nerve fibre layer compared with the eyes in the control group (0.21 ± 0.08 vs. 0.25 ± 0.09 mm; p = 0.029). CONCLUSIONS These results suggest that the ONH morphology in eyes treated with PRP may be altered to mask glaucomatous cupping due to PRP itself. Therefore caution must be taken to interpret the CSLO parameters obtained from eyes that have been treated with PRP.
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Reznicek L, Kernt M, Haritoglou C, Kampik A, Ulbig M, Neubauer AS. In vivo characterization of ischemic retina in diabetic retinopathy. Clin Ophthalmol 2010; 5:31-5. [PMID: 21311655 PMCID: PMC3033002 DOI: 10.2147/opth.s13850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective The aim of this article is to characterize pathomorphologic changes within particular layers of fluorescein angiographically ‘ischemic’ compared to ‘nonischemic’ retina in patients with diabetic retinopathy. Methods Cross-sectional images of ischemic retinal areas were obtained using Heidelberg Spectralis optical coherence tomography (OCT). Presumed retinal ischemia was defined as focal hypofluorescence in early or early and late phase fluorescein angiography. Pathomorphologic changes on OCT were evaluated and the thickness of retinal layers measured and compared with nonischemic retina at corresponding topographic locations in a matched-pairs design based on 22 eyes (mean age 64 ± 14). Results In all eyes, based on spectral domain-OCT cross-section images, the retina layers in ischemic retinal areas could be segmented. Total retinal thickness was significantly increased in ischemic compared to nonischemic areas (381 ± 94 μm versus 323 ± 89 μm, P = 0.005). Middle retinal layers (inner nuclear layer, outer plexiform layer, and outer nuclear layer) were significantly thickened in retinal ischemic areas (215 ± 82 μm versus 168 ± 62 μm, P = 0.002). The inner retinal layers (retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer) showed a nonsignificant change (117 ± 53 μm versus 98 ± 30 μm), while the outer layers were slightly thinned (photoreceptors plus retinal pigment epithelium layer; 51 ± 9 μm versus 57 ± 8 μm, P = 0.02) in ischemic versus nonischemic retina. Conclusions Ischemic diabetic retina seems to be thickened due to thickening of, in particular, middle retinal layers, which can be measured with high-resolution OCT.
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Affiliation(s)
- Lukas Reznicek
- Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
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