Peripapillary Retinal Nerve Fiber Layer Changes in Preclinical Diabetic Retinopathy: A Meta-Analysis

Abstract

BackgroundDiabetic retinopathy is a microvascular neurodegenerative disorder in diabetic patients. Peripapillary retinal nerve fiber layer changes have been described in patients with preclinical diabetic retinopathy, but study results have been inconsistent.ObjectiveTo assess changes in peripapillary retinal nerve fiber layer thickness in diabetic patients with preclinical diabetic retinopathy.MethodsA literature search was conducted through PubMed, EMBASE, Web of Science and Cochrane Library. Case-control studies on RNFL thickness in preclinical diabetic retinopathy patients and healthy controls were retrieved. A meta-analysis of weighted mean difference and a sensitivity analysis were performed using RevMan 5.2 software.ResultsThirteen case-control studies containing 668 diabetic patients and 556 healthy controls were selected. Peripapillary RNFL thickness was significantly reduced in patients with preclinical diabetic retinopathy compared to healthy controls in studies applying Optical Coherence Tomography (-2.88μm, 95%CI: -4.44 to -1.32, P = 0.0003) and in studies applying Scanning Laser Polarimeter (-4.21μm, 95%CI: -6.45 to -1.97, P = 0.0002). Reduction of RNFL thickness was significant in the superior quadrant (-3.79μm, 95%CI: -7.08 to -0.50, P = 0.02), the inferior quadrant (-2.99μm, 95%CI: -5.44 to -0.54, P = 0.02) and the nasal quadrant (-2.88μm, 95%CI: -4.93 to -0.82, P = 0.006), but was not significant in the temporal quadrant (-1.22μm, 95%CI: -3.21 to 0.76, P = 0.23), in diabetic patients.ConclusionPeripapillary RNFL thickness was significantly decreased in preclinical diabetic retinopathy patients compared to healthy control. Neurodegenerative changes due to preclinical diabetic retinopathy need more attention.

Optic nerve head perfusion changes preceding peripapillary retinal nerve fibre layer thinning in preclinical diabetic retinopathy

“…In addition, significant retinal ganglion cell complex thinning has been reported in patients at early stages of diabetes, predating their retinal vasculpathy . And there is a well‐documented evidence to indicate that even in the absence of vascular changes, RNFL thickness around the optic disc become significantly thinner in eyes with type 2 diabetes compared with those without diabetes, and that the most frequent location of RNFL loss in diabetes was the superior hemisphere . However, it was still uncertain whether neural or vascular defects occurs first in the early onset of DR. Our study showed that average RNFL thickness and sector RNFL thickness in NS, SN and IN quadrants in diabetes were significantly thinner than those of normal controls, which was consistent with previous researches.…”

“…However, growing evidences suggest that retinal neurodegeneration is present before the development of clinically detectable microvascular damage. A decrease in retinal nerve fibre layer (RNFL) thickness has been reported in patients with DM without clinical DR. 5 Recent studies have showed positive correlation between peripapillary vessel density and RNFL thickness at 3.45-mm circle diameter around the optic nerve head (ONH). Since peripapillary RNFL thinning is significant in preclinical DR, it is of interest to investigate the blood flow of ONH in diabetic patients.…”

Thickening of inner retinal layers in the parafovea after bariatric surgery in patients with type 2 diabetes

“…, ; Cabrera DeBuc & Somfai ; Vujosevic & Midena ) and in the peripapillary region (Chen et al. ). However, in our preoperative analysis, the association was only borderline significant, which could be due to study size.…”

Особливості Перипапілярних Нейрональних Змін У Хворих З Аксіальною Діабетичною Оптичною Нейропатією Залежно Від стадії Захворювання

“…При проведенні метааналізу секторальної товщини шару перипапілярних нервових волокон сітківки у хворих на ЦД без діабетичної ретинопатії виявили витончення у верхньому нижньому та назальному секторах, але у темпоральному зміни не були вірогідними [7]. Згідно з даними А. Araszkiewicz зі співавторами, при ЦД I типу загальне витончення шару нервових волокон сітківки спостерігалось за рахунок верхнього та носового сегментів [4].…”