Retina and Choroid of Diabetic Patients Without Observed Retinal Vascular Changes: A Longitudinal Study

Ferreira, Joana Tavares; Proença, Rita Pinto; Alves, Marta; Dias‐Santos, Arnaldo; Santos, Bruno Oliveira; Cunha, João Paulo; Papoila, Ana Luísa; Pinto, Luís Abegão

doi:10.1016/j.ajo.2016.12.023

Cited by 36 publications

(18 citation statements)

References 31 publications

(33 reference statements)

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“…For eyes with these characteristics, a high-penetration OCT with a longer wavelength would be more accurate. Tavares et al [26] observed in their one-year follow-up study that the CT of diabetic patients without DR increased, while the thickness of the inner retinal layers and the total retina decreased, similar to the findings in our research. Several studies have analyzed CT in diabetic patients without DR, although the results have been contradictory.…”

Section: Discussionsupporting

confidence: 92%

“…In the study by Tavares et al looking at choroidal thickening at one-year follow-up, they discuss that the increase in CT observed in DM patients without DR could correspond to the presence of a choroidal vasculopathy, so DME or vascular dilatation with greater rigidity of the blood vessels may be responsible for the increased CT. We found similar results [26]. The autoregulation of the choroid is controversial [31].…”

Section: Discussionsupporting

confidence: 73%

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Choroidal Changes of Long-Term Type 1 Diabetic Patients without Retinopathy

et al. 2020

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The aim of the study is to assess choroidal thickness (CT) and choroidal volume (CV) in 90 type 1 diabetes mellitus (DM1) patients with no diabetic retinopathy (DR) and 60 control eyes using spectral domain optical coherence tomography (SD-OCT) and swept source (SS)-OCT in the areas of the Early Treatment Diabetic Retinopathy Study (ETDRS). Mean ages were 42.93 ± 13.62 and 41.52 ± 13.05 years in the diabetic and control groups, respectively. Significant differences were obtained between both groups with Spectralis SD-OCT in all ETDRS areas and in the total CV, excluding the temporal perifoveal one. With Triton SS-OCT, statistically significant differences were obtained in the subfoveal CT and in the vertical areas. CT showed the same tendency with both OCTs, with greater CT and CV in the DM1 group than the mean values of the control group. To assess the influence of DM1 evolution in the CT modifications, DM1 patients were divided into Group 1, with less than 24 years of diagnosis, and Group 2, with ≥24 years of DM1 evolution. Using both OCTs, seven of the nine ETDRS areas and the CV had lower values in Group 2. CT and CV measured by OCT were higher in DM1 without DR. There is a choroidal thinning related to disease evolution in DM1. In patients with DM evolution greater than 24 years, the CT is statistically lower than in patients with less evolution of the disease.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 73%

Choroidal Changes of Long-Term Type 1 Diabetic Patients without Retinopathy

et al. 2020

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“…Other studies have examined changes in the retinal layers. Tavares Ferreira et al analyzed the outermost layers of the retina in the macular area and found a significant reduction in the photoreceptor layer of DM patients compared to healthy subjects [ 31 ]. Salvi et al [ 9 ] analyzed the GCC in patients with DM2 and healthy individuals and found no differences between the groups.…”

Section: Discussionmentioning

confidence: 99%

Structural and functional findings in patients with moderate diabetic retinopathy

Boned‐Murillo

Barreda

Ferreras

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate structural and functional ocular changes in patients with type 2 diabetes mellitus (DM2) and moderate diabetic retinopathy (DR) without apparent diabetic macular edema (DME) assessed by optical coherence tomography (OCT) and microperimetry. Methods This was a single-center cross-sectional descriptive study for which 75 healthy controls and 48 DM2 patients with moderate DR were included after applying exclusion criteria (one eye per patient was included). All eyes underwent a complete ophthalmic examination (axial length, macular imaging with swept-source OCT, and MAIA microperimetry). Macular thicknesses, ganglion cell complex (GCC) thicknesses, and central retinal sensitivity were compared between groups, and the relationships between the OCT and microperimetry parameters were evaluated. Results Macular thickness was similar in both groups (242.17 ± 35.0 in the DM2 group vs 260.64 ± 73.9 in the control group). There was a diminution in the parafoveal area thickness in the DM2 group in the GCC complex. Retinal sensitivity was reduced in all sectors in the DM2 group. The central global value was 24.01 ± 5.7 in the DM2 group and 27.31 ± 2.7 in the control group (p < 0.001). Macular integrity was 80.89 ± 26.4 vs 64.70 ± 28.3 (p < 0.001) and total mean threshold was 23.90 ± 4.9 vs 26.48 ± 2.6 (p < 0.001) in the DM2 and control group, respectively. Moderate correlations were detected between the central sector of MAIA microperimetry and retina total central thickness (− 0.347; p = 0.0035). Age, visual acuity, and hemoglobin A1c levels also correlated with retinal sensitivity. Conclusion Macular GCC thickness and central retinal sensitivity were reduced in patients with moderate DR without DME, suggesting the presence of macular neurodegeneration.

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“…Several studies have identified alterations in the inner retinal layers of patients without or with minimal DR using structural OCT, suggesting that detectable damage arising from diabetic neuroretinopathy could precede microvascular changes [6,12,13]. On the other hand, other authors reported microvascular changes using OCT-A in patients without DR [6,7,8,9,14,15]. OCT-A represents a relatively new noninvasive way to investigate retinal and choroidal vasculature in details.…”

Section: Introductionmentioning

confidence: 99%

Multimodal Imaging Assessment of Vascular and Neurodegenerative Retinal Alterations in Type 1 Diabetic Patients without Fundoscopic Signs of Diabetic Retinopathy

Sacconi

Casaluci

Borrelli

et al. 2019

JCM

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The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 years) were included. Another cohort of 27 eyes (27 healthy control subjects matched with age and sex) was also recruited. All patients underwent multimodal imaging evaluation using structural optical coherence tomography (OCT), OCT-angiography (OCT-A), dynamic vessel analyzer (DVA) and microperimetry. No significant differences were disclosed comparing diabetics and controls for visual acuity, central macular thickness, and subfoveal choroidal thickness. On retinal nerve fiber layer and ganglion cell complex thickness, no significant differences were disclosed comparing each 3-mm-diameter macular and peripapillary subfield between two groups. Using OCT-A, deep capillary plexus perfusion density (PD) of diabetics was significantly lower compared to control group, whereas PD of other retinal/choriocapillaris plexuses and foveal avascular zone area did not show any significant difference. Using DVA, diabetic eyes revealed a significantly decreased vessel response to flicker light in comparison to controls. No differences were disclosed using microperimetry analysis. Taken together, these results suggest that vascular alterations could be the first detectable retinal change in the development of DR.

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Retina and Choroid of Diabetic Patients Without Observed Retinal Vascular Changes: A Longitudinal Study

Cited by 36 publications

References 31 publications

Choroidal Changes of Long-Term Type 1 Diabetic Patients without Retinopathy

Choroidal Changes of Long-Term Type 1 Diabetic Patients without Retinopathy

Structural and functional findings in patients with moderate diabetic retinopathy

Multimodal Imaging Assessment of Vascular and Neurodegenerative Retinal Alterations in Type 1 Diabetic Patients without Fundoscopic Signs of Diabetic Retinopathy

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