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Gabor Mark Somfai, Jing Tian, Wen-Hsiang Lee, Richard K Lee, Ajay E. Kuriyan, Ninel Gregori, William J Feuer, Wei Shi, Sandra Pineda, Heinrich Gerding, William Smiddy, Delia Cabrera DeBuc; Outer retinal changes in patients with diabetes and no or mild non-proliferative diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):101.
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There are controversial data available on retinal changes in diabetes. We aimed to assess the intraretinal changes occurring during a three-year follow up in patients with Type 1 diabetes mellitus (T1DM).
After informed consent 91 patients with T1DM were enrolled in our study. Routine ophthalmic examination was carried out with dilated fundoscopy and patients were divided into two groups based on the severity of diabetic retinopathy (DR). Eyes in the DM group (n=58) had no DR while eyes in the MDR group (n=33) had mild non-proliferative DR. Any eyes with more severe DR were excluded from the study. Imaging was carried out by Spectralis SD-OCT. Patients were followed yearly for three years. The scans were segmented using our custom-built OCTRIMA 3D tool. A total of seven layers were extracted in all scans and an average thickness was calculated in the nine ETDRS regions for all layers and the inner retina (IR), outer retina (OR) and total retina (TR). Linear regression was performed along with a mixed model analysis of variance (ANOVA) for the interaction of time and group, accounting for inter-eye correlation. The level of significance was set at 5%.
In the DM group the significant changes were predominantly in the ETDRS regions of the inner segment and outer segment layers (number of regions, thickening +, thinning -): RNFL 2-, GCL-IPL 0, INL 1+, OPL 3+, ONL 1+, IS 7+, OS 9-, IR 0, OR 0, TR 0. In the MDR group the observed changes were predominantly in the ONL and OR: RNFL 2-, GCL-IPL 1+, INL 4+, OPL 4-, ONL 5+, IS 0, OS 0, IR 2+, OR 6+, TR 3+. The mixed-model ANOVA analysis showed statistically significant results in one region in the OPL, one region in the ONL, three regions in the IS and three regions in the OS layers. Significant results were observed in the central subfield of both the IS and OS.
Our results did not confirm the previously reported early changes of the ganglion cells and retinal nerve fibers in patients with T1DM. On the contrary, our data show evidence for the differentiated involvement of the outer retina, with changes in the photoreceptor inner-outer segments in patients without apparent DR and changes in the ONL and OR in mild non-proliferative DR. Further studies are warranted to elucidate the background of our observations related to diabetes-induced alterations in photoreceptor structure and function.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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