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da Silva MO, do Carmo Chaves AEC, Gobbato GC, Lavinsky F, Lavinsky D. Early choroidal and retinal changes detected by swept-source oct in type 2 diabetes and their association with diabetic kidney disease: a longitudinal prospective study. BMC Ophthalmol 2024; 24:85. [PMID: 38395808 PMCID: PMC10885591 DOI: 10.1186/s12886-024-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND To evaluate structural changes in retina and choroid in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD). METHODS T2D patients with mild or no diabetic retinopathy (DR) were followed for 3 years using structural SS-OCT and OCT angiography (OCT-A) taken every 6 months. Parameters were compared longitudinally and according to the DKD status on baseline. RESULTS One hundred and sixty eyes from 80 patients were followed for 3 years, 72 with no DKD (nDKD) at baseline and 88 with DKD. Trend analysis of T2D showed significant thinning in GCL + and circumpapillary retinal fiber neural layer (cRFNL), choroid, and decreased vascular density (VD) in superficial plexus and central choriocapillaris with foveal avascular zone (FAZ) enlargement. Patients with no DKD on baseline presented more significant declines in retinal center and choroidal thickness, increased FAZ and loss of nasal and temporal choriocapillaris volume. In addition, the nDKD group had worse glycemic control and renal parameters at the end of the study. CONCLUSION Our data suggests the potential existence of early and progressive neurovascular damage in the retina and choroid of patients with Type 2 Diabetes (T2D) who have either no or mild Diabetic Retinopathy (DR). The progression of neurovascular damage appears to be correlated with parameters related to glycemic control and renal damage.
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Affiliation(s)
- Monica Oliveira da Silva
- Retina and Vitreous Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Rua Landel de Moura 550/209, Porto Alegre, RS, 91920-150, Brazil.
| | - Anne Elise Cruz do Carmo Chaves
- Retina and Vitreous Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Rua Landel de Moura 550/209, Porto Alegre, RS, 91920-150, Brazil
| | - Glauber Corrêa Gobbato
- Retina and Vitreous Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Lutheran University of Brazil Medical School, Porto Alegre, Brazil
| | - Fabio Lavinsky
- Retina and Vitreous Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Medical School, UNISINOS University, Porto Alegre, Brazil
| | - Daniel Lavinsky
- Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Retina and Vitreous Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Rua Landel de Moura 550/209, Porto Alegre, RS, 91920-150, Brazil
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do Carmo Chaves AEC, Londero TM, da Silva MO, Lavinsky F, Leitão CB, Bauer AC, Lavinsky D. Early retinal neurovascular findings in post-transplant diabetes mellitus patients without clinical signs of diabetic retinopathy. Int J Retina Vitreous 2023; 9:49. [PMID: 37612660 PMCID: PMC10463975 DOI: 10.1186/s40942-023-00487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Post-transplant diabetes mellitus (PTDM) is a specific subtype of diabetes with an uncertain impact on mortality and morbidity in post-transplant patients. Diabetic retinopathy is the most common microvascular complication of diabetes mellitus, but the long-term clinical progression in PTDM is unknown. New technologies are being used to assess pre-clinical signs of retinal changes, such as swept-source optical coherence tomography (OCT) and OCT-angiography. The aim of this study was to detect pre-clinical structural and vascular changes in the retina using swept-source-OCT and OCT-angiography in patients with PTDM. METHODS In this retrospective cohort study, post-kidney transplant patients were divided into PTDM and non-PTDM (control) groups. Both eyes of eligible PTDM patients and controls were included in this study. Inner retinal layer thickness was measured with swept-source-OCT. Retinal capillary density and the foveal avascular zone were measured with OCT-angiography. RESULTS In the PTDM group, reduced thickness was found in the inferior ganglion cell layer plus inner plexiform layer (95% CI -8.76 to -0.68; p = 0.022) and the temporal inferior segment (95% CI -10.23 to -0.76; p = 0.024) of the inner retina, as well as in the retinal nerve fiber layer in the temporal (95% CI -34.78 to -9.28 p = 0.001) and temporal inferior segments (95% CI -33.26 to -5.03 p = 0.008). No significant differences were found in the vascular capillary plexus between groups at all depths, segments, or foveal avascular zone (p = 0.088). CONCLUSIONS According to OCT-angiography, PTDM patients had reduced inner neurosensory retinal layers but no significant change in vascular density, which suggests that early neuroretinal degeneration might occur prior to vascular changes secondary to PTDM. Prospective studies could help elucidate the clinical course of retinal neuropathy and microvascular pathology in PTDM and provide a better understanding of PTDM complications.
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Affiliation(s)
- Anne Elise Cruz do Carmo Chaves
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil.
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Rio Grande do Sul, Brazil.
| | - Thizá Massaia Londero
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil
- Clinical Medicine Department, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Monica Oliveira da Silva
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil
| | - Fábio Lavinsky
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Rio Grande do Sul, Brazil
| | - Cristiane Bauermann Leitão
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, 90035-903, Rio Grande do Sul, Brazil
| | - Andrea Carla Bauer
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil
- Nephrology Division, Hospital de Clínicas de Porto Alegre (HCPA), Port Alegre, 90035-903, Rio Grande do Sul, Brazil
| | - Daniel Lavinsky
- Post-Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, 97105-900, Rio Grande do Sul, Brazil
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Rio Grande do Sul, Brazil
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da Silva MO, do Carmo Chaves AEC, Gobbato GC, Dos Reis MA, Lavinsky F, Schaan BD, Lavinsky D. Early neurovascular retinal changes detected by swept-source OCT in type 2 diabetes and association with diabetic kidney disease. Int J Retina Vitreous 2021; 7:73. [PMID: 34865654 PMCID: PMC8647413 DOI: 10.1186/s40942-021-00347-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/21/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate retinal thickness and capillary density in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD) using swept-source optical coherence tomography (SS-OCT). Methods A cross-sectional study was conducted with T2D patients with mild or no diabetic retinopathy (DR) and nondiabetic controls. Inner retinal layer thickness was measured with SS-OCT. Retinal capillary density and the foveal avascular zone (FAZ) were measured with SS-OCT angiography (OCTA). SS-OCT parameters were compared in patients with and without diabetic kidney disease (DKD) and nondiabetic controls. Results 131 DKD eyes showed decreased ganglion cell layer plus (GCL+) (p = 0.005 TI; p = 0.022 I), retinal nerve fiber layer (RNFL) (p = 0.003), and central retinal thickness (CRT) (p = 0.032), as well as foveal avascular zone (FAZ) enlargement (p = 0.003) and lower capillary density in the superficial vascular plexus (p = 0.016, central quadrant), compared to controls. No statistically significant changes were found between diabetic patients without significant DKD and controls. Conclusion Our findings suggest early neurovascular damage in patients with T2D; these changes were more significant in patients with DKD. Larger longitudinal studies are warranted to determine the role of early neurovascular damage in the pathophysiology of severe DR.
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Affiliation(s)
- Monica Oliveira da Silva
- Retina and Vitreous Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. .,Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.
| | - Anne Elise Cruz do Carmo Chaves
- Retina and Vitreous Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Glauber Corrêa Gobbato
- Retina and Vitreous Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Lutheran University of Brazil Medical School, Porto Alegre, Brazil
| | - Mateus Augusto Dos Reis
- Department of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Fabio Lavinsky
- Retina and Vitreous Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Medical School, UNISINOS University, Porto Alegre, Brazil
| | - Beatriz D'Agord Schaan
- Department of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Daniel Lavinsky
- Department of Ophthalmology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Retina and Vitreous Research Center, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Endocrinology, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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Farias LB, Lavinsky D, Benfica CZ, da Silva MO, Lavisnky J, Canani LH. Changes in choroidal thickness and volume are related to urinary albumin excretion in type 2 diabetic patients without retinopathy. Clin Ophthalmol 2018; 12:1405-1411. [PMID: 30127589 PMCID: PMC6089603 DOI: 10.2147/opth.s164195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate choroidal thickness and volume in patients with type 2 diabetes and microalbuminuria using spectral-domain optical coherence tomography. Methods We recruited 37 diabetic patients without diabetic retinopathy (18 normoalbuminuric and 19 microalbuminuric) and 21 healthy controls. Choroidal thickness and volume were mapped using the automated Early Treatment Diabetic Retinopathy Study grid and a topographic map of thickness was generated manually. Choroid was also measured at 10 locations under the fovea, temporally and nasally. Results Mean choroidal thickness and volume among patients with diabetes and microalbuminuria was reduced in all locations compared to controls (P<0.05). A sectoral decrease of choroidal thickness and volume was shown between microalbuminuric and normoalbuminuric groups. Conclusion Choroidal changes were present in type 2 diabetic patients before clinical development of retinopathy. Microalbuminuria was associated with a decrease in choroidal thickness and volume in diabetic patients without diabetic retinopathy.
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Affiliation(s)
- Lucas Brandolt Farias
- Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, .,Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
| | - Daniel Lavinsky
- Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, .,Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
| | - Camila Zanella Benfica
- Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, .,Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
| | - Monica Oliveira da Silva
- Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, .,Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
| | - Jacó Lavisnky
- Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, .,Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
| | - Luis Henrique Canani
- Ophthalmology Section, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, .,Department of Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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