University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.
Acta Ophthalmol. 2018 Mar;96(2):174-182. doi: 10.1111/aos.13570. Epub 2017 Nov 1.
To assess macular thinning in individuals with prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DR) compared with individuals with normal glucose metabolism (NGM).
Using spectral domain optical coherence tomography (SD-OCT), we measured macular thickness in six subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1838 participants from The Maastricht Study, a population-based cohort study (mean age 59 ± 8 years, 49% men, 1087 NGM, 279 prediabetes, 472 DM2 w/o DR). Multivariable linear regression was used to assess the association between macular thickness and glucose metabolism status.
After adjustment for age, sex and spherical equivalent, individuals with prediabetes showed a significant decrease in pericentral superior macular thickness [β = -2.14 μm (95% confidence interval (CI): -4.24 to -0.03), p < 0.05] compared with individuals with NGM. In individuals with DM2 w/o DR, the fovea [β = -4.05 μm (95% CI: -6.30 to -1.79), p < 0.001] and the four pericentral quadrants (range: β = -4.64 to -5.29 μm, p < 0.001) were significantly thinner compared with individuals with NGM. There was a significant linear trend of macular thinning with severity of glucose metabolism status in five subfields (p < 0.001).
Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle.
评估无糖尿病视网膜病变（DM2 w/o DR）的糖尿病前期或 2 型糖尿病（T2DM）患者与葡萄糖代谢正常（NGM）个体之间的黄斑变薄情况。
利用频域光学相干断层扫描（SD-OCT），我们在马斯特里赫特研究的一个基于人群的队列研究中，对 1838 名参与者的六个亚区进行了黄斑厚度测量，该研究由早期糖尿病视网膜病变治疗研究（ETDRS）定义（平均年龄 59±8 岁，49%为男性，1087 名 NGM，279 名糖尿病前期，472 名 DM2 w/o DR）。多变量线性回归用于评估黄斑厚度与葡萄糖代谢状态之间的关系。
在校正年龄、性别和等效球镜后，与 NGM 个体相比，糖尿病前期个体的中心旁上方黄斑厚度明显下降[β=-2.14μm（95%置信区间（CI）：-4.24 至-0.03），p<0.05]。在 DM2 w/o DR 个体中，黄斑中心凹[β=-4.05μm（95% CI：-6.30 至-1.79），p<0.001]和四个中心旁象限（范围：β=-4.64 至-5.29μm，p<0.001）与 NGM 个体相比明显变薄。在五个亚区中，黄斑变薄程度与葡萄糖代谢状态严重程度呈显著线性趋势（p<0.001）。
在糖尿病前期和 DM2 中，黄斑厚度变薄，且在 DR 临床出现之前，DM2 的变薄程度更大。在 DM2 w/o DR 中观察到的变薄的一半以上已经存在于糖尿病前期中。黄斑的普遍变薄可能与通过连接视乳头-黄斑束的视神经颞侧变薄有关。
