Abstract
Purpose: The aim of this study was to evaluate whether perivascular space (PVS) severity and retinal ganglion cell layer (GCL) thickness differed based on the stage of diabetic retinopathy (DR) and the cognitive status in patients with DR.Methods: A total of 81 patients with DR (51 in the non-proliferative group and 30 in the proliferative group) were included in this retrospective, cross-sectional study. PVS severity was assessed in the basal ganglia (BG) and centrum semiovale using MRI. The total cerebral small vessel disease (SVD) score was determined based on the numbers of lacunes and microbleeds and the severity of white matter hyperintensity. Optical coherence tomography was used to measure foveal and perifoveal GCL thicknesses. Cerebral SVD markers and cognitive function were compared between the groups, and correlations between the BG-PVS severity and the Mini-Mental Status Examination (MMSE) scores and GCL parameters were evaluated.Results: Patients with proliferative DR had higher BG-PVS severity (P = 0.012), higher total cerebral SVD scores (P = 0.035), reduced GCL thicknesses in the inferior (P = 0.027), superior (P = 0.046), and temporal (P = 0.038) subfields compared to patients with non-proliferative DR. In addition, the BG-PVS severity was negatively correlated with the MMSE score (P = 0.007), and the GCL thickness was negatively correlated with the BG-PVS severity (P-values < 0.05 for inferior, superior, and temporal subfields).Conclusion: BG-PVS severity and retinal GCL thickness may represent novel imaging biomarkers reflecting the stage of DR and cognitive decline in diabetic patients. Furthermore, these results suggest a possible link between cerebral and retinal neurodegeneration at the clinical level.
Highlights
Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes mellitus (T2DM) and a predictor of other end-organ complications (Aminian et al, 2020), with a global prevalence of 27% in patients with T2DM (Thomas et al, 2019)
In this study, we investigated whether MRI-visible perivascular space (PVS), other cerebral small vessel disease (SVD) markers, and retinal ganglion cell layer (GCL) thickness differed based on the DR stage and the cognitive status of patients with DR
The inter-rater reliabilities were good for both basal ganglia (BG)-PVS (κ = 0.76) and centrum semiovale (CSO)-PVS (κ = 0.73)
Summary
Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes mellitus (T2DM) and a predictor of other end-organ complications (Aminian et al, 2020), with a global prevalence of 27% in patients with T2DM (Thomas et al, 2019). While the retina is the classic target organ for diabetic microangiopathy, the brain has recently been identified as another target organ for diabetic microvascular complications (Woerdeman et al, 2014). Similar to the retinal microvasculature, an increasing body of evidence indicates that hyperglycemia can induce dysfunction in the cerebral microvasculature, causing pathological neurovascular remodeling, blood-brain barrier disruption, and cell damage to neurons and glial cells (Ergul et al, 2012). The retinal glymphatic system, a network between the superficial capillary plexus and the inner nuclear layers, has been reported to reflect the state of neurodegenerative and inflammatory disorders in the brain (Petzold, 2016)
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