Kiyoung Kim1, Eung Suk Kim1, Seung-Young Yu2. 1. Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea. 2. Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea. Electronic address: syyu@khu.ac.kr.
Abstract
PURPOSE: To investigate the longitudinal relationship between diabetic retinal neurodegeneration and the progression of diabetic retinopathy (DR) by measuring macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with type 2 diabetes (T2DM). DESIGN: Retrospective cohort study. METHODS: T2DM patients with no DR or mild nonproliferative DR (NPDR) followed up for ≥4 years were included in this study. DR was graded according to retinal photography, and mean parafoveal mGCIPL thickness was measured using optical coherence tomography with at least a 6-month interval from baseline. Hazard ratios (HR) for predicting 2-step progression and development of proliferative DR (PDR) were calculated using Cox proportional hazard modeling using baseline clinical factors. RESULTS: Of 87 eyes of T2DM patients, 39 (44.8%) exhibited 2-step DR progression and 6 (6.9%) experienced progression to PDR. Patients with DR progression exhibited longer T2DM duration, thinner mGCIPL, greater mGCIPL thinning rate, severe cardiac autonomic neuropathy (CAN), lower peripheral nerve-conduction velocity, and higher glycated hemoglobin A1c level. Multivariate regression modeling revealed that baseline mGCIPL thickness (HR = 0.94), mGCIPL thinning rate (HR = 1.924), CAN score (HR = 1.248), and conduction velocity of peripheral nerves (HR = 0.894) were significant predictive factors for DR progression (area under the curve = 0.92). CONCLUSION: Progressive loss of mGCIPL is an independent risk factor for progression in early-stage DR. Further assessment of autonomic and peripheral nerve functions can increase sensitivity in predicting aggravation of DR in patients with T2DM.
PURPOSE: To investigate the longitudinal relationship between diabetic retinal neurodegeneration and the progression of diabetic retinopathy (DR) by measuring macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with type 2 diabetes (T2DM). DESIGN: Retrospective cohort study. METHODS: T2DM patients with no DR or mild nonproliferative DR (NPDR) followed up for ≥4 years were included in this study. DR was graded according to retinal photography, and mean parafoveal mGCIPL thickness was measured using optical coherence tomography with at least a 6-month interval from baseline. Hazard ratios (HR) for predicting 2-step progression and development of proliferative DR (PDR) were calculated using Cox proportional hazard modeling using baseline clinical factors. RESULTS: Of 87 eyes of T2DM patients, 39 (44.8%) exhibited 2-step DR progression and 6 (6.9%) experienced progression to PDR. Patients with DR progression exhibited longer T2DM duration, thinner mGCIPL, greater mGCIPL thinning rate, severe cardiac autonomic neuropathy (CAN), lower peripheral nerve-conduction velocity, and higher glycated hemoglobin A1c level. Multivariate regression modeling revealed that baseline mGCIPL thickness (HR = 0.94), mGCIPL thinning rate (HR = 1.924), CAN score (HR = 1.248), and conduction velocity of peripheral nerves (HR = 0.894) were significant predictive factors for DR progression (area under the curve = 0.92). CONCLUSION: Progressive loss of mGCIPL is an independent risk factor for progression in early-stage DR. Further assessment of autonomic and peripheral nerve functions can increase sensitivity in predicting aggravation of DR in patients with T2DM.
Authors: Ziqi Tang; Ming Yan Chan; Wai Yin Leung; Ho Yeung Wong; Ching Man Ng; Victor T T Chan; Raymond Wong; Jerry Lok; Simon Szeto; Jason C K Chan; Clement C Tham; Tien Y Wong; Carol Y Cheung Journal: Eye (Lond) Date: 2020-06-24 Impact factor: 3.775
Authors: Bright Asare-Bediako; Sunil K Noothi; Sergio Li Calzi; Baskaran Athmanathan; Cristiano P Vieira; Yvonne Adu-Agyeiwaah; Mariana Dupont; Bryce A Jones; Xiaoxin X Wang; Dibyendu Chakraborty; Moshe Levi; Prabhakara R Nagareddy; Maria B Grant Journal: Cells Date: 2020-02-18 Impact factor: 6.600