Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil,
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA,
Ophthalmic Res. 2020;63(5):474-482. doi: 10.1159/000506381. Epub 2020 Feb 10.
The purpose of this study was to evaluate the influence of renal and glycemic parameters on choroidal thickness (CT) in patients with diabetes with and without diabetic retinopathy (DR).
This cross-sectional study included patients with and without diabetes. Patients underwent comprehensive ocular examination. CT was obtained using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode. Clinical parameters were body mass index, mean arterial pressure, glycated hemoglobin, fasting plasma glucose, estimated glomerular filtration rate, and capillary plasma glucose (CPG) a few minutes before EDI-SD-OCT.
The study included 275 participants: 42 with diabetes and no DR, 43 with mild nonproliferative diabetic retinopathy (NPDR), 46 with moderate NPDR, 39 with severe NPDR, 24 with proliferative diabetic retinopathy (PDR), 40 with previous panretinal photocoagulation (PRP) treatment for DR, and 41 without diabetes. The diabetic patients had thinner subfoveal CT than the nondiabetic participants (280.5 ± 83.4 vs. 327.1 ± 48.8 µm, p < 0.001). After multivariable adjustment, CT was significantly correlated with age, DR stage, and CPG. In patients with mild and moderate NPDR, a higher level of CPG was associated with thicker CT. This relationship was not found in patients with PDR.
CPG had the strongest correlation with CT in patients with NPDR (mild, moderate, and severe), but not in PDR and PRP PDR patients. Our study suggests that the glucose level at the time of the test should be aggregated to other systemic and ocular parameters, such as age and axial length, when studying the choroid using SD-OCT.
本研究旨在评估肾功能和血糖参数对糖尿病患者（伴或不伴糖尿病视网膜病变）脉络膜厚度（CT）的影响。
本横断面研究纳入了糖尿病患者和非糖尿病患者。所有患者均接受了全面的眼部检查。使用频域光学相干断层扫描（SD-OCT）结合增强深度成像（EDI）模式获取 CT。临床参数包括体重指数、平均动脉压、糖化血红蛋白、空腹血糖、估算肾小球滤过率和 EDI-SD-OCT 前几分钟的毛细血管血浆葡萄糖（CPG）。
本研究共纳入 275 名参与者：42 名糖尿病无 DR 患者、43 名轻度非增生性糖尿病视网膜病变（NPDR）患者、46 名中度 NPDR 患者、39 名重度 NPDR 患者、24 名增生性糖尿病视网膜病变（PDR）患者、40 名因 DR 接受过全视网膜光凝（PRP）治疗的患者和 41 名非糖尿病患者。糖尿病患者的黄斑中心凹下 CT 厚度比非糖尿病患者薄（280.5±83.4μm 比 327.1±48.8μm，p＜0.001）。校正多变量后，CT 与年龄、DR 分期和 CPG 显著相关。在轻度和中度 NPDR 患者中，较高的 CPG 水平与较厚的 CT 相关。但在 PDR 患者中未发现这种关系。
在 NPDR（轻度、中度和重度）患者中，CPG 与 CT 的相关性最强，但在 PDR 和 PRP 患者中则没有。本研究提示，在使用 SD-OCT 研究脉络膜时，应将测试时的血糖水平与其他全身和眼部参数（如年龄和眼轴长度）相结合。
