Purpose To elucidate changes in the neurosensory retina in the macular area, using spectral domain OCT and correlate with functional loss on fundus-related microperimetry, in patients with diabetes and no diabetic retinopathy compared with age-matched healthy volunteers. Methods This was a prospective study enroling 39 patients in each group. All patients underwent comprehensive dilated eye examination. The foveal thickness and the photoreceptor layer thickness at the foveal centre were measured using spectral domain OCT, and the mean retinal sensitivity of central 20 degrees was measured using microperimetry. Results The mean age of the patients with diabetes was 50.92 ± 4.75 years, and of controls, 49.87±5.50 years. SD-OCT measured photoreceptor layer thickness (PLT) to be 61.62±4.48 lm in cases, and 68.79±7.84 lm in controls (Po0.0001); foveal thickness (FT) was 168.64 ± 16.46 lm in cases and 177.74 ± 14.58 lm in controls (P ¼ 0.012). The mean retinal sensitivity (MRS) of the central 20 degrees, measured on microperimetry was 15.74±3.74 db in cases and 17.70±1.5 db in controls (Po0.003). In cases compared with controls (aged under 50 years) statistically significant differences were noted in all the three outcome variables: FT, P ¼ 0.030; PLT, P ¼ 0.015; and MRS, P ¼ 0.020. The duration of diabetes influenced only the PLT (P ¼ 0.017). Statistical analysis was performed with Student's t-test and v 2 test. Conclusion Neuronal damage was observed in those eyes that did not have clinical evidence of diabetic retinopathy.

Aim: To investigate the occurrence of neuronal damage, as the earliest change occurring, before the clinical evidence of diabetic retinopathy. Methods: 70 eyes of subjects with type 2 diabetes mellitus and with no evidence of diabetic retinopathy (cases) and 40 eyes of subjects with no diabetes mellitus (controls) were studied using spectral-domain OCT and microperimetry. The influence of age and gender on the outcome measures was also analyzed. Results: Age- and gender-matched subjects showed a decreased mean retinal nerve fiber layer thickness in cases when compared to the controls (27 vs. 33 µm; p = 0.018). Among the cases, subjects between 40 and 45 years of age showed a reduced mean central foveal thickness (175.1 vs. 198.1 µm; p = 0.05), mean retinal thickness in the central 6-mm fundus (260.5 vs. 275.3 µm; p = 0.006) and mean retinal nerve fiber layer thickness (29 vs. 39 µm; p = 0.036) when compared to the controls. However, no differences were noted in the microperimetry outcomes in cases when compared to the controls. The duration of diabetes and the glycemic control did not show any significant changes on the outcome measures in cases, except for a significantly lower mean retinal sensitivity in diabetics with glycosylated hemoglobin values <7% as compared to those with glycosylated hemoglobin ≥7% (14.1 ± 2.9 vs. 15.4 ± 1.7 dB; p = 0.027). Conclusion: The results suggest that there is some evidence of early neuronal damage particularly on spectral-domain OCT, before the clinical evidence of diabetic retinopathy, in subjects with type 2 diabetes mellitus.

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Background:While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease.Purpose:To assess the functional and visual outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 ROP.Materials and Methods:In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity. Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months after the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light.Results:At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63%. The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation.Conclusions:Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP.