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Delia Cabrera DeBuc, Jing Tian, Wen-Hsiang Lee, Ajay E. Kuriyan, Gabor Mark Somfai, William Feuer, Wei Shi, Ninel Gregori, William E. Smiddy; Potential contribution of the retinal circulation to photoreceptor compromise in individuals with diabetes.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4694. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the microvascular and intraretinal changes occurring during a three-year follow up in patients with Type 2 diabetes mellitus (T2DM)
Longitudinal data were analyzed from T2DM patients (n=71). Patients were divided into two groups: eyes in the DM group (n=58) had no DR while eyes in the MDR group (n=33) had mild non-proliferative DR. Imaging was carried out by Spectralis SD-OCT (Heidelberg Engineering, Germany). Also, the Retinal Function Imager (Optical Imaging Ltd, Israel) was used to measure the retinal blood flow velocity (BFV) and blood flow rate (BFR). The OCT scans were analyzed using OCTRIMA 3D. A total of 7 layers were extracted in all scans, and an average thickness was calculated in the nine ETDRS regions for all layers. We performed a linear regression to analyze the changes observed over time. A mixed model analysis of variance was also conducted for the interaction of time and group, accounting for inter-eye bias. The level of significance was set at 0.5%, with missed significance between 5-0.5%.
Our results did not confirm the previously reported early changes of the inner retina in T2DM patients. There was a significant correlation between the BFR mean values in the arteries and the length of the veins as well as between the BFR mean values in both the arteries and veins located in the superior retina of diabetic subjects with and with no DR that 1) persisted at baseline and follow-up visits and 2) was also significantly different between baseline and follow up visits. It was also found that the superior-inferior BFR difference (maximum values) in the arteries were negatively correlated (r=-0.366, p=0.003) with the photoreceptor segment thickness in the nasal region (outer circle: sector N2 in the ETDRS map).
Our results revealed the typical adaptive response of retinal blood vessels to match metabolic demand and to minimize unnecessary or deficient blood and nutrient delivery. Also, these results suggested that neurodegeneration is accompanied by macular circulatory impairment mediated by increased BFR difference between the inferior and superior sectors which may be a direct consequence of the choroidal circulatory impairment (e.g. hypoperfusion) at the early stage. This trend reveals a possible contribution of the retinal circulation to photoreceptor compromise in diabetic patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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