Department of Ophthalmology, Students' Hospital, Cairo University, Cairo, Egypt.
Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Cairo, Egypt.
Int Ophthalmol. 2021 Feb;41(2):409-420. doi: 10.1007/s10792-020-01590-3. Epub 2020 Sep 18.
To evaluate optical coherence tomography (OCT) parameters in patients with concomitant type-2 diabetes mellitus (DM) and primary open angle glaucoma (POAG) compared with patients with either of these diseases.
Sixty eyes (52 patients) were divided into three groups. The first group included nonglaucomatous diabetic patients, the second included patients with POAG without DM, and the third included patients with both POAG and DM. Spectral domain OCT evaluation of the retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and optic disc parameters was performed. Visual field (VF) was measured for structural and functional correlation.
Significant differences were found in average RNFL, inferior RNFL, average GCC, inferior GCC, rim area, focal loss volume (FLV%), and global loss volume (GLV%) (P = 0.014, 0.001, 0.027, 0.006, 0.009, 0.043, and 0.001, respectively). The concomitant presence of DM and glaucoma was a risk factor for decreased average RNFL, inferior RNFL, rim area, and inferior GCC, and for increased GLV% (P = 0.034, 0.002, 0.014, 0.015, and 0.003, respectively). The inferior RNFL thickness had the largest significant area under the curve (P = 0.726; 90% sensitivity) at a specificity greater than 80% with a cutoff value of 105.38 μm (P = 0.005) compared with average RNFL, inferior GCC, rim area, and GLV% (P = 0.073, 0.25, 0.23, and 0.1, respectively). VF demonstrated the predominance of nasal scotomata in the diabetic group and arcuate scotoma in the glaucoma group (P < 0.001 and 0.03, respectively).
OCT could be a valuable tool for the detection and follow-up of POAG in diabetic patients. The inferior RNFL thickness could be a sensitive and a specific predictor for glaucoma diagnosis and progression in diabetic patients without retinopathy.
评估同时患有 2 型糖尿病（DM）和原发性开角型青光眼（POAG）的患者与仅患有其中一种疾病的患者的光学相干断层扫描（OCT）参数。
将 60 只眼（52 例患者）分为三组。第一组为非糖尿病性青光眼患者，第二组为无 DM 的 POAG 患者，第三组为 POAG 合并 DM 患者。对视网膜神经纤维层（RNFL）、节细胞复合体（GCC）和视盘参数进行光谱域 OCT 评估。进行视野（VF）测量以进行结构和功能相关性分析。
平均 RNFL、下方 RNFL、平均 GCC、下方 GCC、边缘面积、局灶性损失体积（FLV%）和整体损失体积（GLV%）存在显著差异（P=0.014、0.001、0.027、0.006、0.009、0.043 和 0.001）。DM 和青光眼同时存在是平均 RNFL、下方 RNFL、边缘面积和下方 GCC 降低以及 GLV%增加的危险因素（P=0.034、0.002、0.014、0.015 和 0.003）。下方 RNFL 厚度的曲线下面积最大（P=0.726；80%以上的特异性具有 90%的敏感性），其截断值为 105.38μm（P=0.005），优于平均 RNFL、下方 GCC、边缘面积和 GLV%（P=0.073、0.25、0.23 和 0.1）。VF 显示糖尿病组以鼻侧缺损为主，青光眼组以弓形缺损为主（P<0.001 和 0.03）。
OCT 可能是检测和随访糖尿病患者 POAG 的有用工具。在无视网膜病变的糖尿病患者中，下方 RNFL 厚度可能是青光眼诊断和进展的敏感且特异的预测指标。
