Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Vista Klinik Binningen, Binningen, Switzerland.
Acta Ophthalmol. 2020 May;98(3):e292-e300. doi: 10.1111/aos.14273. Epub 2019 Oct 25.
To evaluate early changes in retinal layers using optical coherence tomography (OCT) in patients with long-standing type 1 diabetes (DM1) receiving intensified insulin therapy.
In a cross-sectional case-control study 150 patients with DM1 and 150 age- and sex-matched healthy control participants underwent OCT imaging. Scans of both eyes were analysed for different layers (NFL, GCL (+IPL), INL, outer layer complex (OLC, including OPL, ONL and ELM) and photoreceptors (PR)) in all subfields of an ETDRS grid. All analyses were performed semi-automatically using custom software by certified graders of the Vienna Reading Center. ANOVA models were used to compare the mean thickness of the layers between patients and controls.
Six hundred eyes with 512 datapoints in 49 b-scans in each OCT were analysed. Mean thickness in patients/controls was 31.35 μm/30.65 μm (NFL, p = 0.0347), 76.7 μm/73.15 μm (GCL, p ≤ 0.0001), 36.29 μm/37.13 μm (INL, p = 0.0116), 114.34 μm/112.02 μm (OLC, p < 0.0001) and 44.71 μm/44.69 μm (PR, p = 0.9401). When evaluating the ETDRS subfields separately for clinically meaningful hypotheses, a significant swelling of the GCL in patients could be found uniformly and a central swelling for the OLC, whereas the distribution of NFL and INL thickening suggests that their statistical significance was not clinically relevant.
These preliminary results demonstrate that preclinical retinal changes in patients with long-standing DM1 can be found by retinal layer evaluation. However, the changes are layer-specific, with significant thickening of the GCL and less so of the OLC suggesting a role as an early sign for diffuse swelling and the evolution of DME even in well-controlled diabetes.
利用光学相干断层扫描（OCT）评估长期 1 型糖尿病（DM1）患者接受强化胰岛素治疗后的视网膜各层早期变化。
在一项横断面病例对照研究中，150 例 DM1 患者和 150 名年龄和性别匹配的健康对照参与者接受了 OCT 成像。对所有眼的各层（NFL、GCL（+IPL）、INL、外核层复合体（OLC，包括 OPL、ONL 和 ELM）和光感受器（PR））进行了分析。所有分析均使用维也纳阅读中心认证分级器的定制软件进行半自动分析。方差分析模型用于比较患者和对照组各层的平均厚度。
共分析了 600 只眼的 49 个 ETDRS 网格中 49 个 b 扫描的 512 个数据点。患者/对照组的平均厚度分别为 31.35μm/30.65μm（NFL，p=0.0347）、76.7μm/73.15μm（GCL，p≤0.0001）、36.29μm/37.13μm（INL，p=0.0116）、114.34μm/112.02μm（OLC，p<0.0001）和 44.71μm/44.69μm（PR，p=0.9401）。当分别评估 ETDRS 子场以获得具有临床意义的假设时，可以发现患者的 GCL 均匀肿胀，而 OLC 则出现中心肿胀，而 NFL 和 INL 增厚的分布表明，它们的统计学意义在临床上并不相关。
这些初步结果表明，通过视网膜层评估可以发现长期 1 型糖尿病患者的临床前视网膜变化。然而，这些变化是特定于层的，GCL 明显增厚，而 OLC 增厚较少，这表明 GCL 和 OLC 的弥漫性肿胀和 DME 的演变即使在控制良好的糖尿病中也可能作为早期标志。
