Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, #1643 Gwanjeo-dong, Seo-gu, Daejeon, Republic of Korea.
Acta Diabetol. 2024 Apr;61(4):495-504. doi: 10.1007/s00592-023-02226-5. Epub 2024 Jan 12.
To identify the impact of hypertension (HTN) on inner retinal layer thickness in patients with diabetic retinopathy (DR).
In this retrospective cross-sectional study, participants were divided into three groups: type 2 diabetes patients without DR (DM group), patients with DR (DR group), and patients with both DR and HTN (DR+HTN group). The peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses, measured using optical coherence tomography, were compared among the groups.
A total of 470 eyes were enrolled: 224 eyes in the DM group, 131 eyes in the DR group, and 115 eyes in the DR+HTN group. The mean RNFL thicknesses were 95.0 ± 7.7, 92.5 ± 10.1, and 89.2 ± 11.2 μm, and the mean GC-IPL thicknesses were 84.0 ± 5.7, 82.0 ± 7.6, and 79.2 ± 8.1 μm in each group, respectively (all P < 0.001). In the DR+HTN group, the DR stage showed a significant association with pRNFL (B = - 5.38, P = 0.014) and GC-IPL (B = - 5.18, P = 0.001) thicknesses in multivariate analyses. Subgroup analyses revealed that pRNFL (P = 0.007) and GC-IPL (P = 0.005) thicknesses decreased significantly as DR progressed only in the DR+HTN group.
Patients with both DR and HTN exhibited much thinner pRNFL and GC-IPL, compared with patients with DR only. These results may have been related to the amplified diabetic retinal neurodegeneration and synergistic impact of ischemia in DR patients with concurrent HTN. Additionally, the progression of DR resulted in more severe inner retinal damage when combined with HTN.
探讨高血压（HTN）对糖尿病视网膜病变（DR）患者内层视网膜厚度的影响。
本回顾性横断面研究将参与者分为三组：无 DR 的 2 型糖尿病患者（DM 组）、DR 患者（DR 组）和同时患有 DR 和 HTN 的患者（DR+HTN 组）。使用光学相干断层扫描（OCT）比较各组的视盘周围视网膜神经纤维层（pRNFL）和节细胞-内丛状层（GC-IPL）厚度。
共纳入 470 只眼：DM 组 224 只眼，DR 组 131 只眼，DR+HTN 组 115 只眼。各组平均 RNFL 厚度分别为 95.0±7.7、92.5±10.1 和 89.2±11.2μm，平均 GC-IPL 厚度分别为 84.0±5.7、82.0±7.6 和 79.2±8.1μm（均 P<0.001）。在 DR+HTN 组中，多变量分析显示 DR 分期与 pRNFL（B=-5.38，P=0.014）和 GC-IPL（B=-5.18，P=0.001）厚度显著相关。亚组分析显示，仅在 DR+HTN 组中，随着 DR 的进展，pRNFL（P=0.007）和 GC-IPL（P=0.005）厚度显著降低。
与单纯 DR 患者相比，同时患有 DR 和 HTN 的患者的 pRNFL 和 GC-IPL 更薄。这些结果可能与糖尿病视网膜神经退行性变的放大和同时患有 HTN 的 DR 患者缺血的协同影响有关。此外，当与 HTN 同时发生时，DR 的进展会导致更严重的内层视网膜损伤。
