Frydkjaer-Olsen Ulrik, Hansen Rasmus Soegaard, Peto Tunde, Grauslund Jakob
Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Int Ophthalmol. 2018 Aug;38(4):1621-1626. doi: 10.1007/s10792-017-0632-1. Epub 2017 Jul 21.
To examine differences in structural and functional neurodegenerative measurements between patients with no and early diabetic retinopathy (DR).
In this cross-sectional study, we examined 103 patients with type 2 diabetes mellitus. In 7-field fundus photographs acquired with Topcon TRC-NW6S, a single, certified grader determined the presence of DR according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Retinal neurodegeneration was evaluated by Topcon 3D OCT-2000 spectral domain optical coherence tomography (OCT) and by a RETI-scan multifocal electroretinography (mf-ERG) system in rings 1-6.
Median age and duration of diabetes were 63.6 and 10 years, respectively, and 46% were men. Median HbA1c was 50 mmol/mol (6.7%), and ETDRS levels were 10 (41.7%, n = 43), 20 (35.0%, n = 36), and 35 (23.3%, n = 24). The duration of diabetes increased with higher levels of DR (p = 0.04), but patients with different level of DR did not differ according to age, sex, blood pressure, HbA1c, and mf-ERG or OCT parameters. In a multiple logistic regression model, macular ganglion cell layer thickness was associated with the presence of DR (OR 1.73 per 5 μm increase, 95% CI 1.06-2.85, p = 0.03). Conversely, retinal nerve fibre layer thickness at optic disc was inversely related to DR (OR 0.69 per 5 μm increase, 95% CI 0.51-0.95, p = 0.02). There were no associations between DR and mf-ERG outcomes.
In patients with type 2 diabetes, structural neurogenic characteristics were associated with DR. If confirmed by larger prospective studies, these results may indicate that a complex neurovascular interaction is an early event in the pathogenesis of DR.
研究无糖尿病视网膜病变（DR）和早期糖尿病视网膜病变患者在神经退行性变的结构和功能测量方面的差异。
在这项横断面研究中，我们检查了103例2型糖尿病患者。使用Topcon TRC-NW6S获取7视野眼底照片，由一名经过认证的分级人员根据早期糖尿病视网膜病变研究（ETDRS）量表确定DR的存在情况。通过Topcon 3D OCT-2000光谱域光学相干断层扫描（OCT）和RETI-scan多焦视网膜电图（mf-ERG）系统在1-6环评估视网膜神经退行性变。
糖尿病患者的中位年龄和病程分别为63.6岁和10年，男性占46%。HbA1c中位数为50 mmol/mol（6.7%），ETDRS水平为10（41.7%，n = 43）、20（35.0%，n = 36）和35（23.3%，n = 24）。糖尿病病程随DR水平升高而增加（p = 0.04），但不同DR水平的患者在年龄、性别、血压、HbA1c以及mf-ERG或OCT参数方面无差异。在多因素逻辑回归模型中，黄斑神经节细胞层厚度与DR的存在相关（每增加5μm，OR为1.73，95%CI为1.06 - 2.85，p = 0.03）。相反，视盘处视网膜神经纤维层厚度与DR呈负相关（每增加5μm，OR为0.69，95%CI为0.51 - 0.95，p = 0.02）。DR与mf-ERG结果之间无关联。
在2型糖尿病患者中，结构神经源性特征与DR相关。如果更大规模的前瞻性研究证实这些结果，可能表明复杂的神经血管相互作用是DR发病机制中的早期事件。
