Systemic and Ocular Determinants of Choroidal Structures on Optical Coherence Tomography of Eyes with Diabetes and Diabetic Retinopathy

Takamasa Kinoshita,Masanori Iwasaki,Shozo Sonoda,Taiji Sakamoto,Hiroko Imaizumi,Yoshinori Mitamura,Akira Hatanaka,Shuichiro Aoki,Hiroki Sano,Miho Shimizu,Fumiko Murao,Junya Mori,Masanori Niki,Hirotomo Miyamoto

doi:10.1038/s41598-019-52750-0

Takamasa Kinoshita, Masanori Iwasaki + Show 12 more

Open Access

https://doi.org/10.1038/s41598-019-52750-0

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Abstract

Knowledgeof the choroidal structures in eyes with diabetes and diabetic retinopathy (DR) should provide information on the pathogenesis of DR. A prospective study was performed to determine the systemic and ocular factors that affect the choroidal structures in eyes with diabetes. Two-hundred consecutive diabetic subjects consisted of 160 treatment-naïve patients with different stages of DR and 40 patients with proliferative DR with prior panretinal photocoagulation (PRP). All underwent blood and urine tests and enhanced depth imaging optical coherence tomography (EDI-OCT). The cross-sectional EDI-OCT images of the subfoveal choroid were binarized to measure the total choroidal area (TCA), luminal area, and stromal area. Multivariate regression analyses were performed to determine the systemic and ocular factors that were significantly correlated with the choroidal structures. The subfoveal choroidal thickness, TCA, luminal area, and stromal area were larger at more advanced stage of DR, and smaller in eyes with PRP than those without (P < 0.001). The TCA and stromal area were significantly and positively correlated with the degree of albuminuria (P = 0.034, P = 0.025, respectively). The choroidal lumen and stroma may increase as the stages of DR progress and decrease after PRP. Albuminuria may be associated with the choroidal stromal edema.

Highlights

Recent studies have shown that the choroid plays an important role in the physiology of the eye and the pathogenesis of different retinal diseases including diabetic retinopathy (DR)[1,2,3,4,5]
In the group of proliferative DR (PDR) with prior panretinal photocoagulation (PRP), PRPs were performed more than 6 months before enrollment in all eyes
The results showed that the subfoveal choroidal thickness (SFCT), total choroidal area (TCA), luminal area, and stromal area were significantly associated with the age, axial length, and sex in the eyes of diabetic patients with or without DR

Summary

Introduction

Recent studies have shown that the choroid plays an important role in the physiology of the eye and the pathogenesis of different retinal diseases including diabetic retinopathy (DR)[1,2,3,4,5]. One of the reasons for the discrepancies is that there are many potential confounders that can influence the choroidal thickness These include age, refractive error, axial length, diurnal variations, prior ocular treatments including retinal photocoagulation, intravitreal injection of anti-vascular endothelial growth factors, intravitreal or subtenon injection of steroids, and intraocular surgeries[6,7,8,9,10,11,12,13]. The purpose of this study was to prospectively evaluate the choroidal structures in patients with diabetes with and without DR using binarization of EDI-OCT images and to determine the systemic and ocular factors that were significantly correlated with the choroidal structures in consideration of extensive potential confounders

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