Faculty of Medicine, Department of Ophthalmology, UKM Medical Center, Cheras, Kuala Lumpur, Malaysia.
Department of Ophthalmology, Hospital Sultanah Aminah Johor Bahru, Ministry of Health Malaysia, Johor, Malaysia.
PLoS One. 2021 Feb 25;16(2):e0246830. doi: 10.1371/journal.pone.0246830. eCollection 2021.
To evaluate the retinal nerve fiber layer (RNFL) and macular thicknesses and identify systemic risk factors for thinning of these layers in patients with metabolic syndrome (MetS).
A cross-sectional observational study was performed on patients diagnosed with MetS and compared to normal controls. All patients underwent ophthalmic and anthropometric examination, serological and biochemical blood investigations; and ocular imaging using spectral-domain optical coherence tomography. Patients with ocular pathology were excluded. Unpaired t-test was used to compare mean thickness between the two groups. One-way ANOVA with Bonferroni correction for multiple comparisons was used to compare mean thickness between different tertiles of MetS parameters, and a generalized estimating equation was used to correct for inter-eye correlation and to assess association between mean thickness and covariates.
Two hundred and forty-eight eyes from 124 participants (1:1 ratio of MetS patients to controls) were included. Age ranged between 30 to 50 years old, and mean age was 40 ± 6.6 years. RNFL thickness was lower globally (93.6 ± 9.9 μm vs 99.0 ± 9.3, p<0.001) and in the inferior (124.5 ± 17.5 μm vs 131.0 ± 16.4 μm, p = 0.002), superior (117.2 ± 16.0 μm vs 126.3 ± 14.4 μm, p<0.001) and temporal (65.5 ± 10.2 μm vs 69.5 ± 9.8, p = 0.002) sectors in MetS patients compared to controls. Only the central (237.0 ± 14.0 μm vs 243.6 ± 18.0 μm, p = 0.002) and inferior parafoveal (307.8 ± 20.9 vs 314.6 ± 14.6, p = 0.004) area of the macula was significantly thinner. The inferior RNFL sector had the most difference (mean difference = 9.1 μm). The Generalized Estimating Equation found that, after adjusting for age, diastolic blood pressure, BMI, HDL and obesity; the number of MetS components and elevated triglyceride levels were independent risk factors for reduced thickness in global RNFL (β = -4.4, 95% CI = -7.29 to -1.5, p = 0.003) and inferior parafovea (β = -6.85, 95% CI = -11.58 to -2.13, p = 0.004) thickness respectively.
RNFL thinning was seen more than macula thinning in MetS patients, suggesting RNFL susceptibility to neurodegeneration than the macula. A higher number of metabolic components and elevated triglyceride levels were independent risk factors for retinal thinning in this group of patients.
评估代谢综合征（MetS）患者的视网膜神经纤维层（RNFL）和黄斑厚度，并确定这些层变薄的系统危险因素。
对诊断为 MetS 的患者进行横断面观察性研究，并与正常对照组进行比较。所有患者均接受眼科和人体测量检查、血清学和生化血液检查；并使用谱域光相干断层扫描进行眼部成像。排除有眼部疾病的患者。使用独立样本 t 检验比较两组之间的平均厚度。使用单因素方差分析（ANOVA）和 Bonferroni 校正进行多重比较，以比较 MetS 参数不同三分位数之间的平均厚度，并使用广义估计方程校正眼间相关性，并评估平均厚度与协变量之间的关联。
纳入了 124 名参与者的 248 只眼睛（MetS 患者与对照组比例为 1:1）。年龄在 30 至 50 岁之间，平均年龄为 40±6.6 岁。与对照组相比，RNFL 厚度整体（93.6±9.9μm 与 99.0±9.3μm，p<0.001）和下方（124.5±17.5μm 与 131.0±16.4μm，p=0.002）、上方（117.2±16.0μm 与 126.3±14.4μm，p<0.001）和颞侧（65.5±10.2μm 与 69.5±9.8μm，p=0.002）节段变薄。只有中央（237.0±14.0μm 与 243.6±18.0μm，p=0.002）和下方黄斑中心凹旁（307.8±20.9μm 与 314.6±14.6μm，p=0.004）区域变薄更明显。下方 RNFL 节段差异最大（平均差异=9.1μm）。广义估计方程发现，在校正年龄、舒张压、BMI、HDL 和肥胖后；MetS 成分数量和甘油三酯水平升高是全球 RNFL（β=-4.4，95%CI=-7.29 至-1.5，p=0.003）和下方黄斑中心凹旁（β=-6.85，95%CI=-11.58 至-2.13，p=0.004）厚度变薄的独立危险因素。
与黄斑相比，MetS 患者的 RNFL 变薄更明显，表明 RNFL 对神经退行性变的敏感性高于黄斑。在这组患者中，更多的代谢成分和升高的甘油三酯水平是视网膜变薄的独立危险因素。
