Peripapillary Retinal Nerve Fiber Layer Changes in Patients with Diabetes Mellitus: A Case-control Study
Peripapillary Retinal Nerve Fiber Layer Changes in Patients with Diabetes Mellitus: A Case-control Study
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DOI：
10.1080/08820538.2020.1810289
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发表时间：
2020-08-24
影响因子：
1.7
通讯作者：
Theodossiadis, Panagiotis
中科院分区：
文献类型：
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作者：
Chatziralli, Irini;Karamaounas, Aristotelis;Theodossiadis, Panagiotis
目的探讨糖尿病（DM）患者乳头周围视网膜神经纤维层（RNFL）的变化，并与正常人群进行比较。此外，本研究旨在确定影响DM患者RNFL变化的潜在因素。方法本研究的参与者为107例DM患者（211眼）和100例健康对照（200眼）。根据糖尿病视网膜病变的严重程度将糖尿病患者进一步分为四组（无视网膜病变、轻度、中度、重度非增殖性糖尿病视网膜病变和增殖性糖尿病视网膜病变），同时评估黄斑水肿的存在。所有参与者都接受了光谱域光学相干断层扫描（SD-OCT）来测量RNFL厚度，同时记录了参与者的人口统计学和临床特征。结果DM合并或不合并DR的患者在所有象限的乳头周围RNFL厚度均显著降低。在糖尿病组，多因素分析显示RNFL平均厚度下降与HbA1c升高（p< 0.001）、DM病程延长（p= 0.007）、糖尿病视网膜病变严重程度加重（p= 0.016）有显著相关性，而DME、年龄、性别、高血压、高脂血症的存在与RNFL厚度下降无相关性。结论糖尿病可能影响RNFL厚度，提示早期神经退行性改变可能发生在微血管改变之前。由于疾病持续时间、DR严重程度和HbA1c水平与RNFL变薄相关，因此改善血糖控制似乎对潜在地预防DM并发症的发生很重要。
Purpose To evaluate peripapillary retinal nerve fiber layer (RNFL) changes in patients with diabetes mellitus (DM) and compare them with those of normal population. In addition, this study aims to determine potential factors, affecting RNFL changes in patients with DM. Methods Participants in this study were 107 patients (211 eyes) with DM and 100 healthy controls (200 eyes). Diabetic patients were further classified into four groups depending on severity of diabetic retinopathy (no retinopathy, mild, moderate, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy, while presence of macular edema was also assessed. All participants underwent spectral-domain optical coherence tomography (SD-OCT) to measure RNFL thickness, while demographic and clinical characteristics of the participants were also recorded. Results Patients with DM with or without DR presented significantly decreased peripapillary RNFL thickness in all quadrants. In the diabetic group, the multivariate analysis showed a significant association between decreased average RNFL thickness and increased HbA1c (p< 0.001), longer DM duration (p= 0.007), and more severe diabetic retinopathy status (p= 0.016), while presence of DME, age, gender, hypertension, and hyperlipidemia were not found to be associated with RNFL thickness decrease. Conclusion Diabetes mellitus seems to affect RNFL thickness, suggesting that early neurodegenerative changes may occur, potentially before microvascular alterations. Since duration of disease, DR severity, and HbA1c levels were associated with RNFL thinning, modifying glycemic control seems to be important to potentially prevent the development of DM complications.