The vascular system is affected by systemic conditions, including diabetes, hypertension, and cardiovascular disease. The choroid is an important vascular tissue surrounding the sensory retina. However, the relationship between the choroid and systemic factors in patients with diabetes has rarely been investigated. Here, we assessed the correlation of renal profiles with choroidal vasculature in eyes with diabetic retinopathy (DR) using a retrospective study design. The study included 131 patients with diabetes who underwent swept-source optical coherence tomography and routine medical work-up within a 4-week period between 1 February 2016 and 30 October 2018. Consecutive patients with treatment-naïve DR who did not receive any subsequent treatment were included. The distribution of patients according to the DR stage was as follows: no DR, 32 patients; mild-to-moderate non-proliferative DR (NPDR), 33 patients; severe NPDR, 34 patients; and treatment-naïve proliferative DR, 32 patients. Multivariate regression analyses showed that the choroidal vascularity index (CVI) of naïve eyes with DR was negatively correlated with age (p = 0.013) and the serum levels of phosphorus (p = 0.002) and positively correlated with subfoveal choroidal thickness (p < 0.001). Taken together, our findings suggest that a lower CVI is associated with phosphorus retention in patients with chronic kidney disease.

Purpose: To describe the clinical findings and prognosis in four eyes with diabetic papillopathy (DP) in three patients with type 2 diabetes. Case summary: Case 1. A 51-year-old female with poor glycemic control presented with macular edema (ME) and optic nerve swelling (ONS) in both eyes at 3 months after insulin treatment. Intravitreal bevacizumab injection with panretinal photocoagulation did not resolve ONS. Following several sub-Tenon injections or intravitreal injections of triamcinolone, the patient's ONS improved at 6 months after presentation. Best corrected visual acuity (BCVA) of the both eyes was 0.06/0.125 (right/left) due to optic disc pallor and macular atrophy at 48 months after initial diagnosis. Case 2. A 64-year-old male with poor glycemic control presented with a 3-month history of decreased visual acuity in his right eye. Retinal examination showed ONS and ME. Although the ME improved after intravitreal bevacizumab injection, the ONS did not. The ONS did improve 1 month after second bevacizumab injection. BCVA was finger counting at 50 cm due to development of ischemic central retinal vein occlusion at 8 months after initial presentation. Case 3. A 71-year-old male who had not taken his diabetes medication for 4-5 weeks due to gastric discomfort presented with a 1-week history of decreased visual acuity in his right eye. DP was diagnosed. Although ONS had not improved at 1 month after sub-Tenon triamcinolone injection, it had improved at 2 months after the injection. BCVA was 0.25 in the right eye at 48 months after initial diagnosis. Conclusions: Ophthalmologists should be aware that optic disc pallor with long-term poor prognosis can develop in eyes with long-standing refractory DP.