Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Abstract

BackgroundTo investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.MethodsWe studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.ResultsWe compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.ConclusionsCardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

Thickness of Intraretinal Layers in Patients with Type 2 Diabetes Mellitus Depending on a Concomitant Diabetic Neuropathy: Results of a Cross-Sectional Study Using Deviation Maps for OCT Data Analysis

“…The thinning of the IMR also seemed to extend into the nasal OMR in TR and RNFL, which was particularly marked in RNFL. Our results are in line with those reported by others [ 3 , 4 , 13 , 16 , 17 , 18 , 19 ] in that the thickness of the inner retinal layers is reduced in patients with T2DM and this thinning is thought to be a marker of the beginning of neurodegenerative changes. While the majority of researchers evaluated the inner retinal layers, a number of studies [ 20 , 21 ] demonstrated morphological alterations in the choroidal and outer retinal layers in diabetes and DR.…”

Risk factors for ocular hypertension after intravitreal dexamethasone implantation in diabetic macular edema

“…Diabetes patients are more susceptible to glaucoma as a result of elevated intraocular pressure (IOP) 16 , 17 . Additionally, recent studies have reported that even eyes with no apparent diabetic retinopathy may develop glaucoma-related changes, including thinning of the retinal nerve fiber layer or macula ganglion cell-inner plexiform layer 18 , 19 . Thus, appropriate management and interventions are needed to prevent irreversible visual impairment in OHTN cases.…”

Exosomes Derived From Mesenchymal Stem Cells Modulate miR-126 to Ameliorate Hyperglycemia-Induced Retinal Inflammation Via Targeting HMGB1

“…D iabetic retinopathy (DR) is one of the main causes of vison loss in the elderly population. Increased inflammatory cytokines in the retina are closely related to retinal pathologies in DR. High glucose levels can affect the retinal neuro-vascular unit, leading to gradual neuro-degeneration, 1 neuro-inflammation, 2 gliosis, 3 vascular abnormalities involving vascular permeability, 4 blood-retinal barrier (BRB) breakdown, 5 inflammation, 6 angiogenesis, 7 and ultimately fibrosis. 8 Vascular endothelial growth factor (VEGF) has been shown to stimulate the proliferation of retinal endothelial cells and lead to vascular leakage.…”