RETINAL NERVE FIBER LAYER THICKNESS IN DIABETIC PATIENTS WITH AND WITHOUT DIABETIC RETINOPATHY (original) (raw)
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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 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.
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.
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.
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.
Journal of the Indian Academy of Geriatrics, 2019
Introduction: Peripapillary retinal nerve fiber layer (RNFL) thinning occurs in the diabetic patients earlier than the detectable diabetic retinopathy. We conducted this study to evaluate the RNFL thickness and macular thickness in elderly diabetic patients using optical coherence tomography in comparison to healthy controls. Material and methods: One fifty study participants were divided in 3 groups (50 each): normal subjects, patients with diabetes with no detectable diabetic retinopathy (NDR) and patients with diabetic retinopathy (DR) of differing severity. The RNFL thickness and macular thickness was measured using spectral-domain optical coherence tomography (SD OCT). Results: The RNFL thickness around the optic disc differed significantly among all the 3 groups and tended to become thinner as the patient develops DR in elderly subjects. The mean, superior-temporal and upper nasal peripapillary RNFL thickness differed among all the 3 groups. We observed that, mean superior, te...
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Diabetes mellitus is one of the major component of metabolic syndrome and a leading cause of ocular morbidity in modern era and India will be considered to be the diabetes capital of the world. Before the onset of diabetic retinopathy, other structural and functional changes may predict the visual diminution of the individual. MATERIALS AND METHODS In this cross-sectional study in a tertiary care hospital, after inclusion and exclusion, the age-gender matched groups (diagnosed type 2 diabetes patients without diabetic retinopathy and controls without diabetes) were thoroughly examined clinically and by noninvasive and invasive examination (after proper counselling of the patient and informed consent). Then, they are tested for functional loss of retina by Humphrey FDT, GDx VCC. Comparison done between cases and controls as well as poorly-controlled and well-controlled diabetic groups. RESULTS It was found that the average RNFL thickness was significantly reduced in diabetics (mean 53.48, SD 2.69) compared to controls (mean 60.21, SD 1.87) (p<0.05). Also, in patients with uncontrolled diabetes (HbA1c >7%), the RNFL thickness was significantly reduced (mean 52.23, SD 1.31) compared to diabetics with good metabolic control (mean 56.38, SD 2.92) (p<0.05). In retinal functional testing, it was found that the Humphrey FDT mean deviation (FDT MD) and pattern standard deviation (FDT PSD) were significantly worse in diabetics (FDT MD-1.478, SD 0.386), (FDT PSD-3.485, SD 0.403) compared to normal controls (FDT MD-0.442, SD 0.536), (FDT PSD-1.438, SD 0.404). The parameters were also found to be significantly worse in uncontrolled diabetics (p<0.05). CONCLUSION To conclude, without diabetic retinopathy, functional and structural loss in retina in diabetes patients compared to age-sex matched individual and especially in poorly-controlled diabetes should be of concern as there are no detectable vasculopathy. So, early diagnosis and control of diabetes is advocated to control this functional loss.
PloS one, 2017
We investigated the relationship between the peripapillary retinal nerve fiber layer and peripapillary retinal thickness in patients with diabetic macular edema. Fifty eyes (group I) with non-proliferative diabetic retinopathy and diabetic macular edema receiving intravitreal anti-VEGF injection, and 90 eyes (group II) without diabetic macular edema were included in this case-control study. The peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, and a new retinal nerve fiber layer index using a modeled relationship between the two parameters were evaluated with spectral-domain optical coherence tomography, at baseline and at the 6-month follow-up. In group I, the peripapillary retinal nerve fiber layer thickness decreased from 126.4 μm at baseline to 117.6 μm at 6 months (p < 0.001), while the peripapillary retinal thickness decreased from 376.0 μm at baseline to 359.6 μm at 6 months (p < 0.001) after intravitreal anti-VEGF injection. In group I...
Clinical Ophthalmology, 2014
The retinal nerve fiber layer (RNFL) thickness in patients with diabetes mellitus type 2 was compared to normal subjects of similar age and sex, having first excluded any risk factors for glaucoma. The correlation between the RNFL thickness and the severity of diabetic retinopathy was investigated at its primary stages and with other ocular and diabetic parameters. Methods: A prospective, case series study was carried out. Twenty-seven diabetic patients without diabetic retinopathy, 24 diabetic patients with mild retinopathy, and 25 normal, agematched subjects underwent a complete ophthalmological examination and imaging with scanning laser polarimetry for the evaluation of the RNFL. Multivariate analysis was applied in order to investigate the correlation between RNFL and diabetic parameters, such as age, duration of diabetes, insulin therapy, levels of glycosylated hemoglobin; and ocular parameters, such as cup to disc ratio, levels of normal intraocular pressure, and central corneal thickness. Results: The mean inferior average of RNFL and the temporal-superior-nasal-inferior-temporal standard deviation were statistically significantly lower in both diabetic groups, and the nerve fiber index was higher (P=0.04) compared to the normal group. There was no statistically significant difference between the diabetic groups. The factor analysis showed no significant correlation between the RNFL and the previously mentioned diabetic and ocular parameters. Conclusion: The existence of diabetes should be seriously considered in evaluating the results of scanning laser polarimetry. Multivariate analysis for RNFL was used for the first time.