July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Low serum vitamin D levels correlate with disorganization of retinal inner layers, ellipsoid zone disruption and retinal pigment epithelium alterations in diabetic retinopathy
Author Affiliations & Notes
  • Sandeep Saxena
    Ophthalmology, KGs Medical University, Lucknow, India
  • Gauhar Nadri
    Ophthalmology, KGs Medical University, Lucknow, India
  • Apjit Kaur
    Ophthalmology, KGs Medical University, Lucknow, India
  • Abbas Mahdi
    Biochemistry, KGs Medical University, Lucknow, U.P., India
  • Kaleem Ahmad
    Biochemistry, KGs Medical University, Lucknow, U.P., India
  • Pragati Garg
    Ophthalmology, Era Medical University, Lucknow, India
  • Footnotes
    Commercial Relationships   Sandeep Saxena, None; Gauhar Nadri, None; Apjit Kaur, None; Abbas Mahdi, None; Kaleem Ahmad, None; Pragati Garg, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5321. doi:https://doi.org/
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      Sandeep Saxena, Gauhar Nadri, Apjit Kaur, Abbas Mahdi, Kaleem Ahmad, Pragati Garg; Low serum vitamin D levels correlate with disorganization of retinal inner layers, ellipsoid zone disruption and retinal pigment epithelium alterations in diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5321. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Vitamin D has anti-angiogenic and anti-inflammatory effects. Vitamin D receptors are expressed in inner retinal layers, photoreceptors and retinal pigment epithelium (RPE). Correlation of serum vitamin D levels with quantitative [central subfield thickness (CST), cube average thickness (CAT)], cross sectional [disorganization of retinal inner layers (DRIL) and ellipsoid zone (EZ)] and topographic parameter (RPE) on spectral domain optical coherence tomography (SD-OCT) was studied in diabetic retinopathy (DR), for the first time.

Methods : A tertiary care center-based cross sectional study was undertaken according to the tenets of the Declaration of Helsinki and institutional review board clearance. Sixty six consecutive cases of type 2 diabetes mellitus [no retinopathy (No DR; n=22); non-proliferative DR (NPDR; n=22); proliferative DR (PDR; n=22)] and healthy controls (n=22) between the ages of 40 and 65 years were included, after sample size calculation. Physician-friendly grading systems were created for DRIL, EZ and RPE abnormalities on SD-OCT. DRIL was graded: grade 0, DRIL absent; grade 1, DRIL present. EZ disruption was graded: grade 0, intact EZ; grade 1, focal EZ disruption; grade 2, global EZ disruption. RPE alterations were graded on segmentation map: grade 0, no RPE alterations; grade 1, RPE alterations in up to two quadrants and grade 2, RPE alterations in more than two quadrants. Serum vitamin D was analyzed using chemiluminescence immunoassay technique. Statistical analysis was done using Pearson correlation, Student’s t test, ANOVA, chi-square (χ2) test and univariate ordinal logistic regression analysis.

Results : Mean serum vitamin D levels (ng/ml) were: No DR=23.36±2.00, NPDR=17.88±1.86, PDR= 14.07± .21, and controls = 25.11±1.59. Low serum vitamin D levels significantly correlated with severity of retinopathy (p<0.001), logMAR visual acuity (r=0.50, p<0.001), CST (r=0.36, p<0.001), CAT (r=0.41, p<0.001), DRIL (r=0.35, p<0.01), EZ disruption (r=0.40, p<0.001) and RPE alterations (r=0.37, p<0.001). Univariate analysis revealed that vitamin D, visual acuity, CST, CAT, DRIL, EZ and RPE are significant predictors of severity of DR .

Conclusions : Low serum vitamin D levels correlate with increased severity of DR and with changes in DRIL, EZ and RPE alterations on SD-OCT.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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