Co-Evaluation of Peripapillary RNFL Thickness and Retinal Thickness in Patients with Diabetic Macular Edema: RNFL Misinterpretation and Its Adjustment (original) (raw)
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RETINAL NERVE FIBER LAYER THICKNESS IN DIABETIC PATIENTS WITH AND WITHOUT DIABETIC RETINOPATHY
Transstellar Journal , 2019
Study aims to evaluate the retinal nerve fiber layer thickness in diabetic patients with and without retinopathy and to assess the correlation of retinal nerve fiber layer thickness among the cases diabetic retinopathy. A cross-sectional observational study was conducted at Department of Ophthalmology, PESIMSR, Kuppam during 2016–2019. Total 200 consecutive cataract known patients were selected based on SOP. Inclusion and exclusion criteria were employed to conduct the research work inclusion; all the patients with diabetes mellitus willing to give consent to clinical examination and evaluation. Exclusion; secondary glaucoma, patients who are mentally challenged, corneal and lenticular opacity, diabetic retinopathy with vitreous haemorrhage or retinal detachment and post retinal surgery. A total of 200 (400 eyes) cases were considered for the study group (G1:G2 = 100). Of which male comprises (61%) and females (39.0%), sex ratio 2:1. Diabetic status was recorded and it revealed that a total of 150 (75%) cases were subjected to diabetes and 50(25%) cases were subjected to non diabetes and it was found that the DM status is found to be statistically significant (p < 0.01). As per the findings, the average RNFL in the case of RE was 95.58 ± 6.96 in DM with DR and 98.08 ± 1.44 in DM without DR. It was found to be statistically significant (p < 0.01). In case of RNFL of LE was 95.80 ± 6.93 in DM with DR and 98.18 ± 1.48 in DM without DR, it was also found that there is a statistically significant (p < 0.001) with and without DR. The superior retinal nerve fibre layer thickness (p < 0.001), nasal retinal fiber layer thickness (p < 0.001), inferior retinal nerve layer thickness (p < 0.001), temporal nerve fibre layer thickness, macular thickness (p < 0.001), HBa1C (p < 0.001), serum creatine and serum cholestrol (p < 0.001) were found to be statistically significant. The present study concludes that the optical coherence tomography is an important non invasive tool for the assessment and quantification of the RNFL thickness in diabetes patients, while on evaluating for DR.
2018
Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes and one of the leading causes of blindness. Retinal function loss in diabetic patients is not only caused by microvascular abnormality but also retinal neurodegeneration. Optical coherence tomography (OCT) can detect retinal neural tissue loss caused by diabetes by measuring the retinal nerve fiber layer (RNFL) thickness on the cross-sectional imaging of the retina. This study is to evaluate the changes of peripapillary retinal nerve fiber layer (RNFL) thickness in diabetic retinopathy patients using OCT and compare it to age matched healthy controls. Methods: A cross-sectional study of 16 eyes from 11 diabetic retinopathy patients and 10 eyes from 7 aged matched healthy subjects for control. Patients underwent optic nerve OCT imaging, RNFL thickness was recorded globally (average thickness) and segmented for superior, inferior, nasal, and temporal quadrants Result: There were no significant differe...
Effect of diabetic retinopathy on retinal nerve fiber layer thickness
Delta Journal of Ophthalmology, 2016
Background: Diabetic retinopathy is one of the most common causes of vision loss in developed countries. Objective: The objective of this study was to assess the effect of diabetic retinopathy (DR) on the retinal nerve fiber layer (RNFL) thickness. Patients and methods: This study was carried out on 55 eyes of 35 patients designed as a prospective, interventional case series at Sohag Hospital from January, 2016 to December, 2016. A complete ophthalmologic examination was performed including best-corrected visual acuity (BCVA) using the ETDRS charts, intraocular pressure (IOP) measurement, slit-lamp biomicroscopic examination, fundus examination and fluorescein angiography. Results: The RNFL (inferior and total) thickness at each follow-up was increased significantly from baseline to 1 month and 6 months post-PRP then decreased significantly from 1 month to 6 months follow up (p < 0.001). The superior RNFL was increased significantly from baseline to 1 month post-PRP and then decreased at 6 month follow up (p < 0.001). While no significant change from 1 month to 6 months follow up (p > 0.05). Conclusion: Increase in the macular Ganglion cell (GC) thickness and RNFL at 1 month of follow-up that may be related to laser induced intraretinal inflammation which triggers increased capillary permeability and ensuing axonal edema due to the cytokine release.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Diabetic retinopathy is one of the leading causes of blindness according to vision 2020 protocol. There is evidence of structural changes prior to clinically detectable vascular complications. With newer technologies, like optical coherence tomography (OCT) it is possible to obtain optical section biopsies and it aids in quantifying the effects of diabetic retinopathy on the retinal nerve fibre layer thickness. Objectives: To establish the role of OCT in evaluating the RNFL thickness in diabetics without clinically evident diabetic retinopathy. Materials and Methods: This study presents a total of 60 eyes of 60 patients attending the OPD at Bapuji hospital and Chigateri general hospital attached to J.J.M medical college, Davangere from September 2014 to September 2016. All patients were subjected to RNFL analysis using OCT. Results: In our study, we found a tendency towards thinning in RNFL thickness globally and significant RNFL thinning in the superior quadrant with increasing duration of diabetes (<5 years-120.24±17.54 and > 5 years-112.88±19.63). No significant change was observed with other variables. Conclusion: OCT may be used to detect earlier signs and structural changes of DR, leading to earlier diagnosis and intervention. The RNFL loss in diabetics without retinopathy could be an indicator of likely neuronal loss in early DR. Further clarifications are required in this regard, we believe that OCT measurements may be one of the useful methods to elucidate the characterization of early structural changes of DR.
Pakistan Journal of Medical Sciences
Objective: To compare the difference in peripapillary Retinal Nerve Fibre Layer (RNFL) thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography (SD OCT). Methods: This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups. Results: Mean age of study population was 44.63 ± 4.30 years. Mean axial length was 23.46 ± 0.59 mm. Mean peripapillary RNFL thickness was 126.98 ± 10.07 µm in Group-A (normal individuals), and 120.77 ± 5.41 µm in Group-B (Type-II diabetics). Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically ...
International Journal of Retina, 2021
Introduction: Impaired blood flow is an early sign of retinal dysfunction in diabetes. Impaired blood flow of the radial peripapillary capillaries can affect the Retinal Nerve Fiber Layer (RNFL) or ganglion cell function. Methods: This was an analytic cross-sectional study in February-April 2019 at Bandung. The subjects of this study were 41 people (79 eyes) divided into two groups, group A (healthy subjects) 19 people (37 eyes) and group B (DM type 2 without diabetic retinopathy) 22 people (42 eyes). Peripapillary retinal perfusion was assesed using OCT Angiography and RNFL thickness was assesed using OCT. Pearson or Spearman correlation statistics test was used to analyze the result. P value ≤0.05 was consiedered significant. Results: There was a decrease in peripapillary retinal perfusion density in the inferior quadrant (P = 0.003) and flux index throughout the peripapillary retinal quadrant (P = 0.0001) but an increase in RNFL thickness in the peripapillary temporal quadrant (P...
Clinical Ophthalmology, 2018
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.
International Journal of Research in Medical Sciences, 2018
INTRODUCTION Diabetic retinopathy (DR) is the leading cause of visual impairment in the working age population. 1 The prevalence of diabetes mellitus is attaining epidemic proportion worldwide with number expected to rise to 592 million by 2035. 2 A widely accepted pathogenesis of DR consists of abnormalities and microvasculopathy and the early clinical signs of DR include microaneurysms and retinal microhemorrhages. 2-5 However, research on the pathogenesis of DR found that neuronal dysfunction and neurodegeneration are closely correlated with ABSTRACT Background: A widely accepted pathogenesis of DR consists of microvascular abnormalities. However recent investigations have demonstrated neurodegenerative alterations before the appearance of microvascular changes in patients with DM. Aim of the study was to evaluate thickness of retinal nerve fiber layer and ganglion cell layer with inner plexiform layer in patent without diabetic retinopathy and mild diabetic retinopathy in type 2 diabetic patients using spectral domain optical coherence tomography. Methods: Thirty patients with type 2 diabetes mellitus without diabetic retinopathy, 30 with mild diabetic retinopathy and 30 healthy controls are taken considering inclusion and exclusion criteria. GCL-ILM and RNFL thickness was measured in each individual and measurements were compared using one way ANOVA test and Pearson's correlation was performed to evaluate the linear correlation between variables and calculated p value <0.05 was regarded as significant. Results: The average RNFL thickness was 86.18±8.44μm and 91.79±4.77μm in diabetic patients and controls respectively (p=0.002). Furthermore, for two different groups of diabetic patients, the average RNFL thickness was 86.74±11.18μm in the no DR group and 85.62±11.10μm in the mild DR group (p=0.697). The average GCL-IPL thickness was 79.95±4.32μm and 84.66±3.26μm in diabetic patients and controls, respectively (p=<0.001). Furthermore, for two different groups of diabetic patients, the average GCL-IPL thickness was 80.15±5.78μm in the no DR group and 79.75±5.70μm in the mild DR group (p=0.788). Conclusions: There was a statistically significant reduction of the mean GCL-IPL and RNFL thickness in type 2 diabetic patients with no or mild DR compared with a homogenous control group indicating neuroretinal changes occur before vascular changes of diabetic retinopathy. But the correlation of average RNFL thickness and GCL-IPL thickness was not statistically significant with the duration of diabetes and HbA1c value.
Clinics, 2019
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 o 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.
Journal of Surgical Academia, 2016
Diabetic retinopathy is a disease involving microangiopathic changes in response to chronic hyperglycaemia and pan retinal photocoagulation (PRP) is currently the mainstay of treatment for proliferative retinopathy. In the present study, we evaluated the effect of pan retinal photocoagulation (PRP) on retinal nerve fibre layer (RNFL) thickness in patients with diabetic retinopathy using optical coherence tomography (OCT). This was a prospective longitudinal study. Patients with Type 2 diabetes mellitus with proliferative diabetic retinopathy (PDR) or very severe non-(N)PDR requiring laser treatment were included in the study. PRP was performed by a single trained personnel. Peripapillary RNFL located 3.4 mm around the optic disc was evaluated using time-domain OCT. Examination was performed before treatment, and 2 and 4 months after laser treatment. In total, 39 subjects (39 eyes) were recruited into this study. Twenty-nine patients had PDR and 10 had very severe NPDR. Mean age was 54.97 ± 8.38 years. Male and female genders were almost equally distributed with 18 males and 21 females. Median thickness of average RNFL at baseline was 108.8 um (interquartile range [IQR] 35.3). At two months post-procedure, average RNFL thickness significantly increased to 117.4 (IQR 28.6; P = 0.006). Although, other quadrants revealed a similar trend of increasing thickness at two months but it was not significant. At 4 months post-laser treatment, RNFL thickness in all quadrants reduced to baseline levels with insignificant changes of thickness compared to prior to laser treatment. There was also no significant association between changes in RNFL thickness and HbA1c levels (P = 0.77). In conclusion, PRP causes transient thickening of the RNFL which recovers within 4 months post-laser treatment. At the same time, poor sugar control has no direct influence on the RNFL changes after PRP.