Abstract
In this retrospective cross-sectional study, we quantitatively analyzed the tomographic features in the neural tissues around the optic disc in patients with diabetic retinopathy with and without panretinal photocoagulation. We analyzed 206 eyes, comprising 33 normal eyes in subjects without diabetes (group I), 30 eyes without diabetic retinopathy (group II), 66 eyes with non-proliferative diabetic retinopathy (group III), 45 eyes with panretinal photocoagulation (group IV), and 32 eyes with normal tension glaucoma (group V). Sequential images acquired using swept-source optical coherence tomography in three-dimensional mode were used to measure peripapillary retinal nerve fiber layer thickness, neuro-retinal rim thickness, anterior lamina cribrosa depth, prelaminar thickness, and thickness of the lamina cribrosa. The peripapillary retinal nerve fiber layer thickness and lamina cribrosa thickness were significantly thinner in group IV than in group III (p = 0.019 and p < 0.001). However, there was no significant difference in rim thickness, anterior lamina cribrosa depth, or prelaminar thickness between groups III and IV (p = 0.307, p = 0.877, and p = 0.212). Multivariate analysis revealed that time since panretinal photocoagulation and thickness of the lamina cribrosa had a significant effect on peripapillary retinal nerve fiber layer thickness (p < 0.001 and p = 0.014). In group IV, there was a negative correlation between time elapsed since panretinal photocoagulation and peripapillary retinal nerve fiber layer thickness, rim thickness, and thickness of the lamina cribrosa (r = -0.765, r = -0.490, and r = -0.419), but no correlation with prelaminar thickness or anterior lamina cribrosa depth (r = 0.104 and r = -0.171). Panretinal photocoagulation may be related to thinning of the peripapillary retinal nerve fiber layer, rim thickness, and lamina cribrosa, but not prelaminar thickness or anterior lamina cribrosa depth. These features are different from the peripapillary features of eyes with typical normal tension glaucoma.
Highlights
Diabetes mellitus is a systemic disease with well-known micro-vascular and macro-vascular complications [1]
In a recent cross-sectional study, Lim et al reported that changes in the optic disc indicating optic neuropathy were different from those in patients with glaucoma and that those changes became prominent after panretinal photocoagulation (PRP) [3,12]
Dijk et al argued that diabetes is associated with changes in the vasculature and with neurodegeneration, given that the functional reduction in patients with early-stage diabetic retinopathy is accompanied by significant thinning of the ganglion cell layer and the retinal nerve fiber layer (RNFL) [24]
Summary
Diabetes mellitus is a systemic disease with well-known micro-vascular and macro-vascular complications [1]. Diabetic retinopathy is one of the most common micro-vascular complications and a leading cause of blindness in both developed and developing countries [2]. Population-based studies [5,6,7] have indicated that the prevalence of open-angle glaucoma in the diabetic patient population is at least twice that in the non-diabetic general population. Studies on the progression of glaucoma have reported inconsistent results. The Collaborative Initial Glaucoma Treatment Study (CIGTS) and Advanced Glaucoma Intervention Study (AGIS) suggested that diabetes may be a risk factor for progression of glaucoma, while the CNTGS (Collaborative Normal Tension Glaucoma Study) and EMGT (Early Manifest Glaucoma Trial) failed to show this correlation [9]
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