scholarly journals Multimodal Imaging Assessment of Vascular and Neurodegenerative Retinal Alterations in Type 1 Diabetic Patients without Fundoscopic Signs of Diabetic Retinopathy

2019 ◽  
Vol 8 (9) ◽  
pp. 1409 ◽  
Author(s):  
Riccardo Sacconi ◽  
Marco Casaluci ◽  
Enrico Borrelli ◽  
Giacomo Mulinacci ◽  
Francesca Lamanna ◽  
...  

The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 years) were included. Another cohort of 27 eyes (27 healthy control subjects matched with age and sex) was also recruited. All patients underwent multimodal imaging evaluation using structural optical coherence tomography (OCT), OCT-angiography (OCT-A), dynamic vessel analyzer (DVA) and microperimetry. No significant differences were disclosed comparing diabetics and controls for visual acuity, central macular thickness, and subfoveal choroidal thickness. On retinal nerve fiber layer and ganglion cell complex thickness, no significant differences were disclosed comparing each 3-mm-diameter macular and peripapillary subfield between two groups. Using OCT-A, deep capillary plexus perfusion density (PD) of diabetics was significantly lower compared to control group, whereas PD of other retinal/choriocapillaris plexuses and foveal avascular zone area did not show any significant difference. Using DVA, diabetic eyes revealed a significantly decreased vessel response to flicker light in comparison to controls. No differences were disclosed using microperimetry analysis. Taken together, these results suggest that vascular alterations could be the first detectable retinal change in the development of DR.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Enrico Borrelli ◽  
Domenico Grosso ◽  
Mariacristina Parravano ◽  
Eliana Costanzo ◽  
Maria Brambati ◽  
...  

AbstractThe aim of this study was to measure macular perfusion in patients with type 1 diabetes and no signs of diabetic retinopathy (DR) using volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). We collected data from 35 patients with diabetes and no DR who had OCTA obtained. An additional control group of 35 eyes from 35 healthy subjects was included for comparison. OCTA volume data were processed with a previously presented algorithm in order to obtain the 3D vascular volume and 3D perfusion density. In order to weigh the contribution of different plexuses’ impairment to volume rendered vascular perfusion, OCTA en face images were binarized in order to obtain two-dimensional (2D) perfusion density metrics. Mean ± SD age was 27.2 ± 10.2 years [range 19–64 years] in the diabetic group and 31.0 ± 11.4 years [range 19–61 years] in the control group (p = 0.145). The 3D vascular volume was 0.27 ± 0.05 mm3 in the diabetic group and 0.29 ± 0.04 mm3 in the control group (p = 0.020). The 3D perfusion density was 9.3 ± 1.6% and 10.3 ± 1.6% in diabetic patients and controls, respectively (p = 0.005). Using a 2D visualization, the perfusion density was lower in diabetic patients, but only at the deep vascular complex (DVC) level (38.9 ± 3.7% in diabetes and 41.0 ± 3.1% in controls, p = 0.001), while no differences were detected at the superficial capillary plexus (SCP) level (34.4 ± 3.1% and 34.3 ± 3.8% in the diabetic and healthy subjects, respectively, p = 0.899). In conclusion, eyes without signs of DR of patients with diabetes have a reduced volume rendered macular perfusion compared to control healthy eyes.


2021 ◽  
Vol 14 (2) ◽  
pp. 255-262
Author(s):  
Zhong-Qi Wan ◽  
◽  
Min Cui ◽  
Yong-Jie Zhang ◽  
◽  
...  

AIM: To investigate the changes of retinal nerve fiber layer (RNFL) among normal individuals, diabetic patients without diabetic retinopathy (NDR) and non-proliferative diabetic retinopathy (NPDR), and explore the possible risk factors of early diabetic retinopathy (DR). METHODS: In this cross-sectional study, 107 participants were divided in three groups. Totally 31 normal individuals (control group), 40 diabetic patients without DR (NDR group) and 36 patients with NPDR (NPDR group) were included. Optical coherence tomography (OCT) was used to detect RNFL thickness and other optic disc parameters among different groups. The potential association between RNFL loss and systemic risk factors were assessed for DR, including diabetes duration, body mass index (BMI), hemoglobin A1c (HbA1c), serum lipids, and blood pressure. RESULTS: The average and each quadrant RNFL thickness were thinner in NPDR group compared to control group of the right (P=0.00, P=0.01, P=0.01, P=0.02, P=0.04) and left eyes (P=0.00, P=0.00, P=0.00, P=0.03, P=0.04). The average, superior and inferior RNFL thickness were thinner in NDR group compared to the NPDR group of the right (P=0.00, P=0.02, P=0.03) and left eyes (P=0.00, P=0.00, P=0.01). Diabetic duration was negatively correlated with the superior, inferior, and average RNFL thickness of the right (r=-0.385, P=0.001; r=-0.366, P=0.001; r=-0.503, P=0.000) and left eyes (r=-0.271, P=0.018; r=0.278, P=0.015; r=-0.260, P=0.023). HbA1c was negatively correlated with the superior, inferior, and average RNFL thickness of the right (r=-0.316 P=0.005; r=-0.414, P=0.000; r=-0.418, P=0.000) and left eyes (r= -0.367, P=0.001; r=-0.250, P=0.030; r=-0.393, P=0.000). Systolic pressure was negatively correlated with the inferior and average RNFL thickness of the right eye (r=-0.402, P=0.000; r=-0.371, P=0.001) and was negatively correlated with the superior and average RNFL thickness of the left eye (r=-0.264, P=0.021; r=-0.233, P=0.043). CONCLUSION: RNFL loss, especially in the superior and inferior quadrants, may be the earliest structural change of the retina in diabetic patients, and is also associated with diabetic duration, HbA1c, and systolic pressure.


2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Ali Afzal Bodla ◽  
Syeda Minahil Kazmi ◽  
Noor Tariq ◽  
Ayema Moazzam ◽  
Muhammad Muneeb Aman

Purpose:  To study the effects of Intra-vitreal injection of Bevacizumab as an adjunct during phacoemulsification in patients with diabetic retinopathy. Study Design:  Quasi experimental study. Methods:  Hundred diabetic patients who were scheduled to undergo phacoemulsification were included in the study. They were equally divided into two groups; Bevacizumab and control group. Complete ocular examination and macular thickness and volume were determined using an OPTOVUE-OCT machine. The patients in the Bevacizumab group were given intra-vitreal injection of 1.25 mg/0.05ml of Bevacizumab at the time of Phacoemulsification. A written ethical approval was obtained and the study was conducted according to principles of declaration of Helsinki. Results:  The bevacizumab group manifested low value of CMT one month post-surgery as compared to the control group (262.2 ± 32.2 and 288.5 ± 54.1, respectively) with P = 0.01. The Total Macular volume, and Best-corrected visual acuity in the two groups showed no significant difference one month after surgery. Amongst the patients who developed postsurgical macular edema, four patients did not possess a positive history for diabetic retinopathy and 3 of them had Non Proliferative Diabetic Retinopathy. We found no significant relationship between the post-surgical macula edema with the presence of mild Non Proliferative Diabetic Retinopathy. (Fisher's test, P = 0.321). Conclusion:  The ocular anti-VEGF therapy substantially reduces macular edema secondary to post-surgical inflammation in diabetic patients. It effectively reduces the central macular thickness although the results are not found to be statistically significant when compared with the control group. Key Words:  Diabetes mellitus; diabetic macular edema; diabetic retinopathy: Bevacizumab.


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Fariba Ghassemi ◽  
Sahar Berijani ◽  
Ameneh Babeli ◽  
Houshang Faghihi ◽  
Alireza Gholizadeh ◽  
...  

Abstract Background To represent choroidal thickness (CT) and choroidal volume (CV) databases in diabetic retinopathy (DR) patients and healthy control participants using optical coherence tomography (OCT) and enhanced depth imaging OCT (EDI-OCT). No study had evaluated CT at all main stages of diabetic retinopathy in a single study. Methods The study included 176 eyes from 93 patients (39–80 years old; 42% females) who were divided into three groups based on DR severity and normal control group: 39 eyes no DR, 64 eyes NPDR, 33 eyes PDR, and 40 eyes normal control. The CT and CV were measured and statistically analyzed. Intra-observer and inter-observer coefficients of repeatability were calculated. Results Subfoveal CT showed persistent thinning from normal group (322.50 ± 69.24) to no-diabetic retinopathy (NDR, 308.33 ± 74.45) to nonproliferative diabetic retinopathy (NPDR, 283.45 ± 56.50) group and then thickening as the patient progressed to proliferative diabetic retinopathy (PDR, 295.17 ± 95.69) (P = 0.087). A significant difference was found between the control group and the NDR, NPDR, and PDR groups in nearly all CT and CV of Early Treatment Diabetic Retinopathy Study macular subfields. Fasting blood sugar (FBS = 189.08 ± 51.3 mg/dl) and diabetes mellitus (DM) duration (13.6 ± 6.5 years) had no noticeable effect on CT. In patients with diabetes, the best-corrected visual acuity (BCVA), diabetic macular edema (DME), and foveal avascular zone (FAZ) were not affected by CT and CV. Conclusions The choroidal thickness decreases from the early stages of diabetic retinopathy up to the NPDR stage, with a subsequent modest rise in CT during the PDR stage. There was no correlation between FBS, diabetes duration, BCVA, DME, and FAZ, and CT.


2014 ◽  
Vol 142 (9-10) ◽  
pp. 529-534 ◽  
Author(s):  
Ivan Sencanic ◽  
Miroslav Stamenkovic ◽  
Vesna Jovanovic ◽  
Sinisa Babovic ◽  
Vesna Jaksic ◽  
...  

Introduction. Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described. Objective. The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopathy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects. Methods. The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study. Results. The mean CDR value was significantly higher in the diabetic group (570.52?31.81 ?m) compared with the control group (541.42?27.82 ?m). The difference between the two groups was statistically significant (p<0.0001). The highest mean CDR value was recorded in the PDR group (585.97?28.58 ?m), followed by the NPDR group (570.84?30.27 ?m), whereas the lowest mean CDR value was recorded in the NDR group (559.80?31.55 ?m). There was a statistically significant difference in CDR between the NDR and PDR groups, as well as between the NPDR and PDR groups (p<0.001, p<0.05 respectively). No significant difference was recorded between the NDR and NPDR groups (p>0.05). Conclusion. CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups.


Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 235 ◽  
Author(s):  
Elvira Orduna-Hospital ◽  
Lorena Perdices ◽  
Ana Sanchez-Cano ◽  
Javier Acha ◽  
Nicolás Cuenca ◽  
...  

The aim of the study is to assess choroidal thickness (CT) and choroidal volume (CV) in 90 type 1 diabetes mellitus (DM1) patients with no diabetic retinopathy (DR) and 60 control eyes using spectral domain optical coherence tomography (SD-OCT) and swept source (SS)-OCT in the areas of the Early Treatment Diabetic Retinopathy Study (ETDRS). Mean ages were 42.93 ± 13.62 and 41.52 ± 13.05 years in the diabetic and control groups, respectively. Significant differences were obtained between both groups with Spectralis SD-OCT in all ETDRS areas and in the total CV, excluding the temporal perifoveal one. With Triton SS-OCT, statistically significant differences were obtained in the subfoveal CT and in the vertical areas. CT showed the same tendency with both OCTs, with greater CT and CV in the DM1 group than the mean values of the control group. To assess the influence of DM1 evolution in the CT modifications, DM1 patients were divided into Group 1, with less than 24 years of diagnosis, and Group 2, with ≥24 years of DM1 evolution. Using both OCTs, seven of the nine ETDRS areas and the CV had lower values in Group 2. CT and CV measured by OCT were higher in DM1 without DR. There is a choroidal thinning related to disease evolution in DM1. In patients with DM evolution greater than 24 years, the CT is statistically lower than in patients with less evolution of the disease.


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N A H Omran ◽  
A G Salman ◽  
Y A T Farweez ◽  
P S Saif

Abstract Background Diabetic retinopathy (DR) is one of the most common diabetic complications, which has become a leading cause for vision loss, mainly because of macular edema and vitreous hemorrhage. Objective Using Optical Coherence Tomography(OCT) and Optical Coherence Tomography Angiography (OCT-A) for qualitative and quantitative assessment of retinal vascular density in superficial capillary plexus, quantitative assessment of foveal avascular zone, choroidal vascular density map, assessment of retinal thickness and choroidal thickness in normal individuals and diabetic patients with and without diabetic retinopathy (DR). Patients and Methods This study included 64 eyes. Diabetics and control group were recruited from internal medicine clinic in Misr University for science and Technology Hospital and asked to participate in this study. This study was designed as an observational and cross sectional study in the period from 8/2018 to 2/2019. Results There is decrease in Choroidal vascular density in diabetic patients. There is decrease in retinal thickness in diabetic patients and there is no significant differences in the retinal thickness between control subjects and patients with NDR. Conclusion Our study suggested that OCTA can identify preclinical DR before the manifestation of clinically apparent retinopathy. Our findings highlight the potential role of OCT-A in monitoring and quantifying retinal vascular alterations in diabetes


2021 ◽  
Vol 8 ◽  
Author(s):  
Li Chen ◽  
Jing Feng ◽  
Yanhong Shi ◽  
Fuxiao Luan ◽  
Fang Ma ◽  
...  

Purpose: To evaluate the expressions of erythropoietin (EPO) and vascular endothelial growth factor (VEGF) in the vitreous and fibrovascular membranes (FVMs) of proliferative diabetic retinopathy (PDR) after the intravitreal injection of ranibizumab (IVR) and further explore the relationship between EPO and VEGF.Method: The concentrations of EPO and VEGF levels in the vitreous fluid were measured in 35 patients (24 PDR and 11 non-diabetic patients) using enzyme-linked immunosorbent assay. The patients were divided into three groups: PDR with IVR (IVR group) before par plana vitrectomy (n = 10), PDR without IVR (Non-IVR group) (n = 14) and a control group [macular holes (MHs) or epiretinal membranes (ERM), n = 11]. Fluorescence immunostaining was performed to examine the expressions of VEGF, EPO and CD 105 in the excised epiretinal membranes.Result: The PDR eyes of Non-IVR group had the highest vitreous VEGF and EPO levels (836.30 ± 899.50 pg/ml, 99.29 ± 27.77 mIU/ml, respectively) compared to the control group (10.98 ± 0.98 pg/ml and 18.96 ± 13.30 mIU/ml/ml). Both the VEGF and EPO levels in the IVR group (13.22 ± 2.72 pg/ml and 68.57 ± 41.47 mIU/ml) were significantly lower than the Non-IVR group (P = 0.004 and P = 0.04, respectively). Furthermore, no significant difference was observed for VEGF levels between the control and IVR groups (10.9 ± 0.98 pg/ml and 13.22 ± 2.72 pg/ml, respectively, P = 0.9). Yet the EPO level in the IVR group was significantly higher than that in the Non-diabetic group (68.57 ± 41.47 pg/ml and 18.96 ± 13.30 pg/ml, respectively, P = 0.001). The expressions of EPO, VEGF, and CD105 were significantly reduced in fluorescence immunostaining of FVMs in the IVR group compared with the Non-IVR group. The receiver operating characteristic (ROC) curve of the EPO and VEGF levels were 0.951 and 0.938 in the PDR group.Conclusion: Both of the VEGF and EPO level were significantly increased in PDR patients, which have equal diagnostic value in the prediction of PDR. IVR could reduce the EPO level, but not enough to the normal level.


2016 ◽  
Vol 27 (3) ◽  
pp. 346-351 ◽  
Author(s):  
Luisa Pierro ◽  
Lorenzo Iuliano ◽  
Maria Vittoria Cicinelli ◽  
Giuseppe Casalino ◽  
Francesco Bandello

Purpose To investigate the early neurodegenerative changes of inner retina and choroid in type 1 and type 2 diabetic patients without retinopathy and with early-stage retinopathy. Methods In this observational cross-sectional study, 90 right eyes of 90 naive type 1 and 2 diabetic patients without diabetic retinopathy (DR) and with mild to moderate nonproliferative DR (NPDR) were analyzed. Forty healthy eyes were included as controls. We used spectral-domain optical coherence tomography to evaluate the ganglion cell complex (GCC) thickness, the retinal nerve fiber layer (RNFL) thickness, the choroid thickness, and the central foveal thickness (CFT) of patients and controls. Results Average GCC thickness turned out to be thinner in type 2 diabetic patients with no DR and with NPDR compared to controls ( p = 0.046 and p = 0.041, respectively). The RNFL thickness and CFT were similar among the studied groups and compared to controls ( p = 0.78 and p = 0.104, respectively). Average choroid thicknesses (both in the subfoveal area and in a 1-mm radius circular area) were significantly thinner in type 2 diabetic patients with no DR and NPDR, compared to DMT1 groups and controls (both p<0.0001). The GCC and choroid thickness changes were not correlated in any of the investigational groups. Conclusions Type 2 diabetic patients without retinopathy and with early-stage retinopathy have inferior thickness values of GCC and choroid compared to controls. Insulin resistance might be a possible adjunctive pathogenetic aspect of neurodegeneration.


2020 ◽  
Vol 76 (3) ◽  
pp. 111-117
Author(s):  
Lukáš Magera ◽  
Jan Krásný ◽  
Patrik Pluhovský ◽  
Lucie Holubová

Aim: Learn about the development and changes in foveal avascular zone (FAZ) and vascularity of retina in the surrounding zone, depending on the duration in young diabetic patients type 1 (T1DM). Methods: As part of regular one-year examinations of young T1DM patients at the Eye Clinic of the University Hospital Královské Vinohrady in Prague (Czech Republic, EU) from January to December 2019, OCT angiography using the device Spectralis (Heidelberg Engineering) was included. Forty patients aged 18 to 30 years were examined, median 21 years. T1DM was diagnosed in childhood and lasted for more than 10 years. At the same time, a control group of forty individuals of similar age, without metabolic and other general disease was examined, normal visual acuity and physiological fundoscopic finding were obligatory. The FAZ size was evaluated in both groups (using built-in function "Draw Region"), also its shape, density decrease and change in character of vascularity of the retina was assessed. Results: In the control group, the FAZ area ranged from 0.06 to 0.4 mm², with an average of 0.253 ± 0.092 mm² and a median of 0.27 mm². It was not affected by a fundamental change in its round shape and the surrounding capillary netting was regular and reasonably dense. In T1DM patients, the FAZ area was in a wider range, from 0.05 to 0.64 mm², an average of 0.300 ± 0.132 mm², and a median of 0.31 mm². The difference in FAZ across-the-board evaluation was statistically significant (p = 0, 009). Diabetic preretinopathy (DpR) was defined by the irregularity of the capillary density up to the manifestation of non-perfusion, in 61% of cases the size of the FAZ was changed. In diabetic retinopathy (DR) there was always an irregularity of the FAZ shape with its enlargement, manifestation of non-perfusion, capillary dilatation and rare microaneurysms. Conclusion: Changes in FAZ size corresponded to the stage of T1DM on the fundoscopic finding of the eye depending on its duration. The initial increased amount of foveal capillaries, which resulted in decreased FAZ area, was followed by a gradual decrease in capillaries and increased FAZ area, consistent with the manifestations of DpR. It was accompanied by a change in capillary density in macula to eventual non-perfusion. On the contrary, the increase in the FAZ area and its irregularity accompanied by non-perfusion of the capillary net and microaneurysms corresponded to the development of DR already.


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