Diyabetik Hastalarda Peripapiller Sinir Lifi Kalınlığını Etkileyen Demografik Faktörlerin Optik Koherens Tomografi ile Değerlendirilmesi

Year 2020, Volume: 12 Issue: 3, 456 - 462, 20.10.2020

Nurdan Arıcan Murat Tunç

https://doi.org/10.18521/ktd.782163

Abstract

Amaç: Diyabetik hastalarda optik koherens tomografi (OKT) ile ölçülen peripapiller sinir lifi kalınlığını (PLSK) etkileyen demografik faktörleri araştırmaktır.
Yöntem: Bu çalışmaya 2009-2013 yılları arasında izlenen 104 diyabetik hastanın (46 erkek hastanın 92 gözü, 58 kadın hastanın 115 gözü) toplam 207 gözü dahil edildi. PLSK, OCT ile üst, alt, temporal ve nazal kadranlarda ölçüldü ve demografik faktörlerle karşılaştırıldı.
Bulgular: 60 yaş ve üzerinde ortalama PSLK, 60 yaş altına göre üst ve alt kadranda daha ince olduğu görüldü(p=0,004, p=0,001). Cinsiyet ile ortalama PSLK arasında sadece alt kadranlarda anlamlı bir ilişki vardır (p = 0,006). Dört kadranda da hipertansiyon(HT) ile ortalama PSLK arasında ilişki yoktur(p>0.05). Glokomlu gözlerde, glokomu olmayanlara göre üst kadranda ortalama PLSK azalmaktadır(p=0.019). 15 yıldan fazla diyabet süresi olan hastalarda üst, alt ve nazal kadranlarda ortalama PLSK, 15 yıl veya daha az olanlara göre azaldığı görüldü(p=0,048, p=0,020, p=0,020). Retinopatisi olmayan gözlerde ortalama temporal PLSK, proliferatif diyabetik retinopatili (PDR) ve non-PDR olan gözlerle karşılaştırıldığında azalmıştı(p=0,025). Temporal PLSK hem diyabetik maküla ödemi (DMÖ) olan hem de panretinal fotokoagülasyon uygulanan hastalarda artmıştı (p=0,001,p=0,001). Fokal lazer tedavisi uygulanan hastalarla dört kadrandaki ortalama PLSK arasında korelasyon bulunmadı (p>0.05).
Sonuç: Yaş, cinsiyet, diyabet süresi, glokom varlığı, DMÖ, PDR-nonPDR gibi faktörlerin PSLK üzerine etkisinin olduğu fakat HT, fokal lazer gibi faktörlerin PSLK üzerine etkisi yoktur. Ayrıca hem glokomu hem de diyabeti bulunan olgularda, retina sinir lifi defektlerinin progresyonunu değerlendirirken diyabet süresi ve diyabetik retinopati mevcudiyetinin dikkate alınması gerekir.

Keywords

Diyabetes mellitus, Peripapiller sinir lifi kalınlığı, Optik koherens tomografi, Demografik faktörler

Evaluation of Demographic Factors Affecting Peripapillary Nerve Fiber Thickness by Optical Coherence Tomography in Diabetic Patients

Abstract

Objective: To investigate the demographic factors affecting the peripapillary nerve fiber thickness(PNFL) measured with optical coherence tomography(OCT) in diabetic patients.
Method: A total of 207 eyes of 104 diabetic patients(92 eyes of 46 male, 115 eyes of 58 female) who were followed-up between 2009-2013 were included. PNFL was measured with OCT in the superior, inferior, temporal and nasal quadrants and compared with demographic factors.
Result: PNFL was found to be thinner in superior and inferior at the age of 60 years and above compared to under 60 years(p=0.004,p=0.001). There is a significant relationship between gender and the average PNFL only in inferior quadrants(p=0.006). There is no relationship between hypertension and the mean PNFL in 4 quadrants(p>0.05). Superior PNFL was decreased in eyes with glaucoma compared to those without glaucoma(p=0.019). The mean PNFL in superior, inferior and nasal patients with diabetes duration of more than 15 years decreased compared to those with 15 years or less(p=0.048,p=0.020,p=0.020). Temporal PNFL was decreased in eyes without retinopathy compared to eyes with proliferative diabetic retinopathy(PDR) and non-PDR(p=0.025). Temporal PNFL was increased both in patients with diabetic macular edema(DME) and the patients treated with panretinal photocoagulation(p=0.001,p=0.001). No correlation was found between the mean PNFL in four quadrants with focal laser treatment(p>0.05).
Conclusion: Age, gender, duration of diabetes, glaucoma, DME, PDR, non-PDR have an effect on PNFL, but HT and focal laser have not. In addition, the duration of diabetes and the presence of diabetic retinopathy(DR) should be taken into account when evaluating the progression of PNFL defects in patients with both glaucoma and diabetes.

Keywords

Diabetes mellitus, peripapillary nerve fiber thickness, Optical coherence tomography, Demographic factors

References

• 1. Zeng Y, Cao D, Yu H, et al. Early retinal neurovascular impairment in patients with diabetes without clinically detectable retinopathy. Br J Ophthalmol. 2019;103(12):1747-52.
• 2. Lim HB, Shin YI, Lee MW, et al. Longitudinal Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness of Patients With Type 2 Diabetes. JAMA Ophthalmol. 2019;137(10):1125-32.
• 3. Shin YI, Nam KY, Lee SE, et al. Peripapillary microvasculature in patients with diabetes mellitus: An optical coherence tomography angiography study. Sci Rep. 2019;9(1):15814
• 4. Mendivil A, Cuartero V, Mendivil MP. Ocular blood flow velocities in patients with proliferative diabetic retinopathy and healhy volunteers: a prospective study. Br J Ophthalmol 1995;79: 413-6.
• 5. Kohner EM, Hamilton AM, Saunders SJ, et al: The retinal blood flow in diabetes. Diabetologia 1975;1: 22-33. 6. Erşanlı D, Ünal M, Çiftçi F, et al. Diabetik retinopatide oküler hemodinami. T Oft Gaz 1997;27: 342-46.
• 7. Mendivil A, Cuartero V. Ocular blood flow velocities in patients with proliferative diabetic retinopathy after scatter photocoagulation. Retina 1996;16: 222-27.
• 8. Lim HB, Lee MW, Park JH, et al. Changes in Ganglion Cell-Inner Plexiform Layer Thickness and Retinal Microvasculature in Hypertension: An Optical Coherence Tomography Angiography Study. Am J Ophthalmol. 2019;199:167-76.
• 9. Lopes JM, Russ H, Costa VP. Retinal nerve fiber layer loss in patients with type 1 diabetes mellitus without retinopathy. Br J Ophthalmol 2002; 86: 725-28.
• 10. Chiara H, Matsuoka T, Ogura Y,et al. Retinal nerve fiber layer defects as an early manifestation of diabetic retinopathy. Ophthalmology 1993; 100: 1147-51.
• 11. Conceiçao LL, Bernardes RC, Abreu RF, et al. One-year followup of blood-retinal barrier and retinal thickness alterations in patients with type 2 diabetes mellitus and mild nonproliferative retinopathy. Arch Ophthalmol 2001; 119: 1469-74.
• 12. Lopes de Faria JM, Russ H, Costa VP. Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy Br J Ophthalmol 2002; 86: 725-28.
• 13. Jong Yeon Lee, Young Hoon Hwang, Sun Min Lee, et al. Age and Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography. Korean J Ophthalmol 2012;26(3):163-68
• 14. Yusuke Nakatani, MD, Tomomi Higashide, MD, PhD, Shinji Ohkubo, MD, et al. Evaluation of Macular Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness for Detection of Early Glaucoma Using Spectral Domain Optical Coherence Tomography.J Glaucoma 2011;20:252–59.
• 15. Tielsch JM, Katz J, Sommer A, et al. Hypertension, Perfusion Pressure and open-angle glaucoma: A population base assessment. Arch. Ophthalmol 1995; 113:216-21
• 16. Carol Y. Cheung , David Chen, Tien Y. Wong , et al. Determinants of Quantitative Optic Nerve Measurements Using Spectral Domain Optical Coherence Tomography in a Population-Based Sample of Non-glaucomatous Subjects.Invest Ophthalmol Vis Sci. 2011 Dec 20;52(13):9629-35.
• 17. Schuman JS, Hee MR, Puliafito CA, et al. Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol. 1995;113:586- 96.
• 18. Townsend KA, Wollstein G, Schuman JS. Imaging of the retinal nerve fiber layer for glaucoma. Br J Ophthalmol, 2009; Vol. 93 (2), pp. 139-43.
• 19. Leung CK, Chan WM, Hui YL, et al. Analysis of retinal nerve fiber layer and optic nerve head in glaucoma with different reference plane offsets, using optical coherence tomography. Invest Ophthalmol Vis Sci 2005; 46 (3), 891-9
• 20. Chihara E, Zhang S. Analysis of diabetic optic neuropathy with a topographic laser scanning system. Nippon Ganka Gakkas Zasshi 1998; 102: 431-35
• 21. Klein BEK, Moss SE, Magli YL, et al. Optic disc cupping: four year follow-up from the WESDR. Invest Ophthalmol Vis Sci 1989; 30: 310-15.
• 22. Hirokazu Takahashi and Etsuo Chihara. Impact of Diabetic Retinopathy on Quantitative Retinal Nerve Fiber Layer Measurement and Glaucoma Screening. Investigative Ophthalmology & Visual Science, 2008;49: 2
• 23. Weinreb RN, Shakiba S, Zangwill L. Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes. Am J Ophthalmol 1995; 119: 627-36.
• 24. Airaksinen PJ, Drance SM, Doulas GR, et al. Diffuse and localized nerve fiber loss in glaucoma. Am J Ophthalmol 1984; 98: 566-71.
• 25. Yoshida Y, Hagura R, Hana Y, et al. Risk factors for the development of diabetic retinopathy in Japanese type 2 diabetic patients. Diabetes Res ClinPract 2001; 51: 195-203
• 26. Dowse GK, Humphrey ARG, Colins VR, et al. Prevalance and risk factors for diabetic retinopathy in the multiethnic population of Mauritius. Am J Epidemiol 1998; 147: 448-57.
• 27. Sugimoto M, Wakitani Y, Takahashi C, et al. Detection of early diabetic change with optical coherence tomography in type 2 diabetes mellitus patients without retinopathy. Ophthalmologica 2005; 219: 379-85.
• 28. Chihara E, Matsuoka T, Ogura Y, et al. Retinal nerve fiber layer defect as an early manifestation of diabetic retinopathy. Ophthalmol 1993; 100: 1147-151.
• 29. Ido T, Inauzmi K, Chi Q, et al. Diabetic change in retinal nerve fiber layer thickness evaluated by scanning laser polarimetry. Invest Ophthalmol Vis Sci Annual(ARVO Suppl) 1995; 36: 482.
• 30. Konigsreuther KA, Jonas JB. Optic disc morphology in diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 1995; 233: 200-04.
• 31. Barber AJ, Lieth E, Khin SA, et al. Neural apoptosis in the retina during experimental and human diabetes; early onset and effect of insulin. J Clin Invest 1998; 102: 783-91.
• 32. Ho Young Kim, MD, Ho Kyun Cho, MD, PhD. Peripapillary Retinal Nerve Fiber Layer Thickness Change After Panretinal Photocoagulation in Patients With Diabetic Retinopathy. Korean Journal of Ophthalmology 2009;23:23-6
• 33. Apple DJ, Wyhinny GJ, Goldberg MF et al: Experimental argon laser photocoagulation. III. Relative dangers of immediate vs delayed retreatment. Arch Ophthalmol. 1976; 94: 309-12.
• 34. Takahashi H, Goto T, Shoji T, et al. Diabetes-associated retinal nerve fiber damage evaluated with scanning laser polarimetry. Am J Ophthalmol 2006; 142: 88-94.