Neriyanuri Srividya, Pardhan Shahina, Gella Laxmi, Pal Sakshyar Saumya, Ganesan Suganeswari, Sharma Tarun, Raman Rajiv
Vision Research Foundation, Sankara Nethralaya Eye Hospital, Chennai, India.
Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
Br J Ophthalmol. 2017 Sep;101(9):1174-1178. doi: 10.1136/bjophthalmol-2016-309641. Epub 2017 Jan 20.
To explore any relationship between the markers of early retinal neuronal damage and peripheral diabetic neuropathy in subjects with no diabetic retinopathy (DR).
A cross-sectional study in which type 2 diabetic subjects (n=743) without DR were studied. Visual functions including visual acuity, contrast sensitivity, colour vision, retinal sensitivity using microperimeter and retinal thicknesses by spectral domain optical coherence tomography were measured. Vibration perception thresholds of greater than or equal to 20 µV, measured by sensitometer using a biothesiometer probe, were defined as having peripheral diabetic neuropathy. Statistical analyses were performed using independent t-test, multivariate logistic regression and Pearson's correlation.
Of 743 subjects who had no DR, 24.9% had diabetic neuropathy. Independent comparisons among subjects who had diabetic neuropathy compared with those who did not showed statistically significant retinal nerve fibre layer thinning (p=0.01), reduced contrast sensitivity (p=0.0001), reduced retinal sensitivity (p=0.03), impaired colour vision (p=0.04) and reduced visual acuity (p=0.0001). Multivariate analysis showed significant association between the mean retinal sensitivity (measured using a microperimeter) and diabetic neuropathy (adjusted OR (95% CI): 0.76 (0.60 to 0.95), p=0.01).
Significant association of neuroretinal dysfunction with the presence of diabetic neuropathy was noted among subjects with no DR.
探讨无糖尿病视网膜病变（DR）患者早期视网膜神经元损伤标志物与周围性糖尿病神经病变之间的关系。
对743例无DR的2型糖尿病患者进行横断面研究。测量了包括视力、对比敏感度、色觉、使用微视野计测量的视网膜敏感度以及通过光谱域光学相干断层扫描测量的视网膜厚度等视觉功能。使用生物感觉阈值测定仪探头通过感觉阈值测定仪测量的振动感觉阈值大于或等于20 µV被定义为患有周围性糖尿病神经病变。采用独立样本t检验、多因素逻辑回归和Pearson相关性分析进行统计分析。
在743例无DR的患者中，24.9%患有糖尿病神经病变。患有糖尿病神经病变的患者与未患糖尿病神经病变的患者进行独立比较，结果显示视网膜神经纤维层明显变薄（p = 0.01）、对比敏感度降低（p = 0.0001）、视网膜敏感度降低（p = 0.03）、色觉受损（p = 0.04）和视力下降（p = 0.0001）。多因素分析显示平均视网膜敏感度（使用微视野计测量）与糖尿病神经病变之间存在显著关联（调整后的比值比（95%可信区间）：0.76（0.60至0.95），p = 0.01）。
在无DR的患者中，神经视网膜功能障碍与糖尿病神经病变的存在之间存在显著关联。
