Optical coherence tomography (OCT) of the retina and around the optic nerve head and corneal confocal microscopy (CCM) are non-invasive and repeatable techniques that can quantify ocular neurodegenerative changes in individuals with diabetes. We systematically reviewed studies of ocular neurodegenerative changes in adults with type 1 or type 2 diabetes and noted changes in the retina, the optic nerve head, and the cornea. Of the 30 studies that met our inclusion criteria, 14 used OCT and 16 used CCM to assess ocular neurodegenerative changes. Even in the absence of diabetic retinopathy, several layers in the retina and the mean retinal nerve fibre layer around the optic nerve head were significantly thinner (-5·36 μm [95% CI -7·13 to -3·58]) in individuals with type 2 diabetes compared with individuals without diabetes. In individuals with type 1 diabetes without retinopathy none of the intraretinal layer thicknesses were significantly reduced compared with individuals without diabetes. In the absence of diabetic polyneuropathy, individuals with type 2 diabetes had a lower nerve density (nerve branch density: -1·10/mm(2) [95% CI -4·22 to 2·02]), nerve fibre density: -5·80/mm(2) [-8·06 to -3·54], and nerve fibre length: -4·00 mm/mm(2) [-5·93 to -2·07]) in the subbasal nerve plexus of the cornea than individuals without diabetes. Individuals with type 1 diabetes without polyneuropathy also had a lower nerve density (nerve branch density: -7·74/mm(2) [95% CI -14·13 to -1·34], nerve fibre density: -2·68/mm(2) [-5·56 to 0·20]), and nerve fibre length: -2·58 mm/mm(2) [-3·94 to -1·21]). Ocular neurodegenerative changes are more evident when diabetic retinopathy or polyneuropathy is present. OCT and CCM are potentially useful, in addition to conventional clinical methods, to assess diabetic neurodegenerative changes. Additional research is needed to determine their incremental benefit and to standardise procedures before the application of OCT and CCM in daily practice.

Objective: To evaluate the success rate of Bollard miniplate anchorage for bone anchored maxillary protraction (BAMP). Materials and Methods: Twenty-five consecutive patients (mean age, 12.0 6 1.2 years; range, 8.7-14.8 years) with maxillary hypoplasia without congenital or acquired deformation were included in this study. A total of 100 Bollard modified miniplates were placed by the same surgeon. Ninety-nine miniplates were inserted under general anesthesia, and one was placed under local anesthesia because of initially soft bone conditions. Loading of the miniplates with 150 g elastics was initiated at 17.5 6 6.9 days (range, 11-38 days) after surgery. Mean follow-up was provided at 20.8 6 11.1 months (range, 6.5-46.2 months). Results: The overall success rate of miniplate anchorage in terms of stability was 97%. During orthodontic loading, five miniplates showed signs of mobility. After interruption of loading over 2 months, two miniplates became stable again. However, a total of three miniplates needed to be removed and were successfully replaced under local anesthesia after a mean healing period of 3 months. Conclusion: Skeletal anchorage by means of Bollard modified miniplates is effective for BAMP. Success depends on proper presurgical patient counseling, minimal invasive surgery, good postsurgical instructions, and orthodontic follow-up. (Angle Orthod. 2011;81:1010-1013

Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle.

PurposeTo calculate the prevalence of all vitreomacular interface (VMI) disorders and stratify according to age, sex and (pre)diabetes status.MethodsThe presence of VMI disorders was assessed in 2660 participants aged between 40 and 75 years from The Maastricht Study who had a gradable macular spectral‐domain optical coherence tomography (SD‐OCT) volume scan in at least one eye [mean 59.7 ± 8.2 years, 50.2% men, 1531 normal glucose metabolism (NGM), 401 prediabetes, 728 type 2 diabetes (DM2, oversampled)]. A stratified and multivariable logistic regression analysis was used.ResultsThe prevalence of the different VMI disorders for individuals with NGM, prediabetes and DM2 was, respectively, 5.7%, 6% and 6.7% for epiretinal membranes; 6%, 9.6% and 6.8% for vitreomacular traction; 1.1%, 0.7% and 0.3% for lamellar macular holes; 0.1%, 0% and 0% for pseudoholes; 1.1%, 1.9% and 5.5% for macular cysts. None of the participants was diagnosed with a macular hole. The prevalence of epiretinal membranes, vitreomacular traction and macular cysts was higher with age (p < 0.001). Vitreomacular traction and lamellar macular holes were more frequent in women (p < 0.01). DM2 is positively associated [OR = 3.9 (95% CI 2.11–7.22, p < 0.001)] with macular cysts and negatively associated with lamellar macular holes [OR = 0.2 (95% CI 0.04–0.9, p = 0.036)] after adjustment for age and sex. The calculated prevalence of VMI disorders was 15.9%.ConclusionsThe calculated prevalence of VMI disorders in individuals aged between 40 and 75 years is 15.9%. The prevalence depends on age, sex and glucose metabolism status for several types of VMI disorders.

The purpose of this study was to assess thinning of the peripapillary retinal nerve fiber layer (RNFL) in prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DRP) compared with that in individuals with normal glucose metabolism (NGM). METHODS. We measured sectoral and mean RNFL thickness in a 3.45-mm-diameter circular scan centered on the optic nerve head, using spectral domain optical coherence tomography in 1172 participants from The Maastricht Study (a population-based cohort of individuals 59 6 8 years of age, 47% men, 699 NGM, 186 with prediabetes, and 287 with DM2 w/o DRP). Multivariate linear regression was used to assess the association between RNFL thickness and glucose metabolism status, adjusted for age and sex. RESULTS. In individuals with prediabetes, the temporal RNFL was thinner than that in individuals with NGM after adjustment (b ¼ À2.28 lm [95% confidence interval [CI], À4.44 to À0.13], P ¼ 0.04), whereas in individuals with DM2 w/o DRP, the temporal inferior (b ¼ À3.66 lm [95% CI, À6.46 to À0.85], P ¼ 0.01), the temporal superior (b ¼ À2.99 lm [95% CI, À5.95 to À0.02], P ¼ 0.05), the temporal (b ¼ À2.73 lm [95% CI, À4.62 to À0.84], P < 0.01), and the mean RNFL (b ¼ À1.88 lm [95% CI, À3.51 to À0.26], P ¼ 0.02) were thinner than those in individuals with NGM. CONCLUSIONS. Temporal RNFL thinning is already present in individuals with prediabetes. More widespread RNFL thinning occurs in individuals with DM2 w/o DRP, that is before vascular changes are detected. This suggests preferential retinal nerve fiber layer loss in areas related to the papillomacular bundle.