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Rashmi Akshikar, Mathew Richardson, Roxanne Crosby-Nwaobi, Ahmed Abdelhay, Sobha Sivaprasad, Sharon Heng; Retinal Neuronal Changes In People With Diabetes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2852.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effects of diabetes on different neuronal layers of the retina.
The thickness of various layers of the neural retina were compared in 3 groups of 20 age-matched subjects: 40 eyes with no diabetes (control); 40 eyes with diabetes but no clinical evidence of diabetic retinopathy (no-DR) and 40 eyes with minimal diabetic retinopathy with no maculopathy (DR). Spectralis SD-OCT 20 x 20 volume cube with 60 scans with a spatial separation of 150µm were obtained for each eye. All measurements were taken manually by 2 experts at 12 points on the intersecting lines of the ETDRS grid at diameters 1, 3 and 6mm centred at the fovea. This method standardises the sampling pattern for retinal reference points thus allowing for meaningful comparisons. The presumed retinal layers measured were nerve fibre layer (NFL); ganglion cell layer & inner plexiform layer (GCL-IPL); inner nuclear layer (INL) and the outer retinal complex (ORC) consisting of all layers from the outer plexiform layer to the retinal pigment epithelium. The data was analyzed by one-way analysis of variance (ANOVA), Tukey HSD and Dunnett t-tests for multiple comparisons.
The GCL-IPL layers were significantly thinned in eyes with DR at 3mm (p= 0.025) and showed a trend at 6mm (p=0.055) compared to the other groups. Similarly, the ORC complex was significantly thinned at 3 mm (p=0.027) and 6mm (p=0.008). None of the other neuronal changes showed any significant differences between groups. It was notable that there were no differences in any of the neuronal layers between controls and eyes with no DR.
This study supports the retinal neurodegenerative concept in early diabetic retinopathy. It also suggests that changes in neuronal layers occur in parallel to vascular changes. The heterogenecity in local measurements at comparable points between the 3 groups indicates a complex pathology of diabetic retinopathy at the cellular level. Thinning of the outer retina needs to be further explored.
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