Choroidal Thickness In Diabetic Patients Research Articles

Choroidal Changes in Patients with Diabetic Retinopathy: A Retrospective Study.

This study aimed to investigate the characteristic choroidal changes in patients with diabetic retinopathy and identify factors affecting choroidal thickness (CTh), choroidal vascular index (CVI), and choriocapillaris flow. We retrospectively analyzed 79 eyes of 48 patients with diabetes between August 2021 and February 2022. We collected laboratory data, including HbA1c, serum creatinine, blood urea nitrogen, triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein (LDL) levels. Optical coherence tomography images of the foveal avascular zone, retinal vascular density, choroidal flow, retinal thickness, CTh, and CVI were analyzed. Possible determining factors affecting CTh, CVI, and choriocapillaris flow were analyzed using nonparametric multivariate analysis. LDL (p < 0.001) positively correlated with CTh, whereas CVI (p = 0.007) was negatively correlated with CTh in diabetic patients with diabetes. We also identified a negative correlation between choriocapillaris flow and deep parafoveal retinal vessel density in patients with low-grade diabetic retinopathy (DR), which diminished in those with more advanced DR. Our study provides further information on the changes in choroidal structure and blood flow in patients with diabetes.

Rates of Choroidal and Neurodegenerative Changes Over Time in Diabetic Patients Without Retinopathy: A 3-Year Prospective Study

To evaluate the longitudinal changes of retinal neurodegeneration and choroidal thickness in diabetic patients with and without diabetic retinopathy (DR). Prospective observational cohort study. This prospective observational cohort study recruited type 2 diabetic patients from a community registry in Guangzhou. All participants underwent annual ocular examinations via swept-source optical coherence tomography that obtained choroid thickness (CT), retinal thickness (RT), and ganglion cell-inner plexiform layer (GC-IPL) thickness. The changes in GC-IPL, CT, and RT between patients who developed incident DR (IDR) or remained non-DR (NDR) were compared during a 3-year follow-up. Among 924 patients, 159 (17.2%) patients developed IDR within the 3-year follow-up. A reduction in GC-IPL, RT, and CT was observed in NDR and IDR; however, CT thinning in patients with IDR was significantly accelerated, with an average CT reduction of -6.98 (95% CI: -8.26, -5.71) μm/y in patients with IDR and -3.98 (95% CI: -4.60, -3.36) μm/y in NDR patients (P < .001). Reductions in average GC-IPL thickness over 3 years were -0.97 (95% CI: -1.24, -0.70) μm/y in patients with IDR and -0.76 (95% CI: -0.82, -0.70) μm/y in NDR patients (P=.025). After adjusting for confounding factors, the average CT and GC-IPL thinning were significantly faster in patients with IDR compared with those who remained NDR by 2.09 μm/y (95% CI: 1.01, 3.16; P=.004) and -0.29 μm/y (95% CI: -0.49, -0.09; P=.004), respectively. The RT in the IDR group increased, whereas the RT in the NDR group decreased over time, with the adjusted difference of 2.09 μm/y (95% CI: 1.01, 3.16; P < .001) for central field RT. The rate of retinal neurodegeneration and CT thinning were significantly different between the eyes that developed IDR and remained NDR during the 3-year follow-up, but both groups observed thickness reduction. This indicates that GC-IPL and CTs may decrease before the clinical manifestations of DR.

Comparison of Central Subfoveal Choroidal Thickness in Diabetic Patients with and without Diabetic Retinopathy

Purpose: To compare the Central subfoveal choroidal thickness (CCT) in diabetic patients with and without diabetic retinopathy.&#x0D; Study Design: Cross sectional observational study.&#x0D; Place and Duration of Study: Al-Ehsan Welfare Eye Hospital, Lahore, from June 2019 to May 2020.&#x0D; Methods: One hundred and twenty patients with type II diabetes were included with a mean age of57±0.9. Patients were divided into two groups (60 in each group) based on presence or absence of diabetic retinopathy after ophthalmic examination. Group A comprised of patients showing signs of retinopathy and group B with no signs of diabetic retinopathy. After detailed ophthalmic examination, spectral–domain OCT was performed for the measurement of central subfoveal choroidal thickness. The differences in measurements were analyzed and measured by using SPSS version 22.&#x0D; Results: Out of 120 patients, 69 (57.5%) were males and 51 were females (42.5%). Mean age of patients was 58.8 ± 10 years with minimum 28 years and maximum 94 years. Central choroidal thickness in group A showed a mean value of 239 ± 41 µm with standard error of mean 3.76. While diabetic patients having no signs of diabetic retinopathy (Group B) showed mean subfoveal choroidal thickness of 240 ± 42 µm with standard error of mean 3.89. The difference in central subfoveal choroidal thickness in both groups was 1.337 which is statistically insignificant with p value of 0.250.&#x0D; Conclusion: Central choroidal thickness amongst diabetic patients with and without signs of retinopathy does not have any significant changes.&#x0D; Key Words: Choroid, Diabetic retinopathy, Optical Coherence Tomography.

Effects of Femtosecond Laser-Assisted Cataract Surgery on Macular and Choroidal Thickness in Diabetic Patients.

IntroductionThis study aimed to compare the short-term changes in retinal and choroid thickness in diabetic patients after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (PE) surgery.MethodsA total of 47 eyes in the PE group and 44 eyes in the FLACS group were included. All patients underwent measurement of central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) before and after surgery using optical coherence tomography (OCT).ResultsThe effective phaco time (EPT) in the FLACS group was significantly reduced. The BCVA differed significantly between the two groups at 1 week and 1 month after surgery. The CMT in both groups increased at 1 week after the operation. It did not return to the preoperative level until month 12 in the PE group. In the FLACS group, the CMT began to decrease at month 3 and recovered to the preoperative level at month 12. The SFCT of the two groups increased at week 1; it began to decrease at month 6 in the PE group but did not recover to the preoperative level until month 12. The SFCT in the FLACS group recovered to preoperative levels at month 6. In the PE group, baseline CMT values predicted CMT change at week 1 and months 1, 3 and 12 after surgery. In the FLACS group, baseline CMT predicted CMT changes at week 1, month 1 and month 3. In the FLACS group, EPT predicted SFCT change at month 3.ConclusionFLACS is safe and effective in patients with no fundus change or mild diabetic retinopathy. It has advantages in effectively reducing EPT, achieving good vision earlier and promoting faster recovery of the retinal and choroidal thickness. Preoperative CMT is a significant predictor of CMT changes in the early period after FLACS.

Choroidal Thickness in Diabetic Patients Without Diabetic Retinopathy: A Meta-analysis

To evaluate the relationship between diabetic eyes without diabetic retinopathy and healthy eyes in subfoveal choroidal thickness. Systematic review and meta-analysis. An independent retrospective or prospective clinical study comparing diabetic eyes without diabetic retinopathy and healthy control eyes in the subfoveal choroidal thickness was selected. This study compiled data from publications in PubMed and Web of Science between January 1, 2008, and November 15, 2019. Heterogeneity was statistically quantified by I2 statistics, and meta-analysis was performed using a random-effects model. Seventeen related studies were identified, including a total of 4,213 eyes, which consisted of 1,197 diabetic eyes without diabetic retinopathy and 3,016 healthy eyes. Meta-analysis clearly showed that the subfoveal choroidal thickness of diabetic eyes without retinopathy was significantly thinner than that of healthy control eyes (weighted mean difference=-14.34μm; 95% confidence interval:-24.37 to-4.32μm; P < .005). Similar results were obtained in sub-analysis based on the adjustment of the axial length. This study suggests that the subfoveal choroidal thickness was thin in diabetic eyes without retinopathy compared to healthy eyes. Subfoveal choroidal thickness might be an important parameter for the development of diabetic retinopathy in diabetic eyes without retinopathy.

Choroidal Thickness and Hemoglobin A1c Levels in Patients with Type 2 Diabetes Mellitus.

PurposeThe aim of this study was to assess the correlation of hemoglobin A1c (HbA1c) levels with choroidal thickness in patients with type 2 diabetes mellitus (DM) using spectral domain optical coherence tomography (SD-OCT).MethodsIn this prospective case series, 180 eyes from 90 patients with type 2 DM were classified into three study groups based on HbA1c values: group 1 included patients with good glycemic control (HbA1c 7%), group 2 included patients with moderate glycemic control (HbA1c between 7% and 8%), and group 3 included patients with poor glycemic control (HbA1c 8%). Additionally, 50 eyes from 25 non-diabetic subjects were enrolled to group 4 as a control group. Sub-foveal, nasal, and temporal choroidal thickness were measured and compared.ResultsMean central, nasal, and temporal choroidal thicknesses in diabetic patients (247.80, 238.63, and 239.30 m) were significantly less than non-diabetic healthy subjects (277.56, 262.92, and 266.32 m). Additionally, mean central, nasal, and temporal choroidal thickness values in group 4 (277.56, 262.92, and 266.32 m) were significantly greater than the corresponding values in group 2 (248.34, 237.55, and 236.45 m) and group 3 (239.81, 234.62, and 233.94 m), but was not significantly different from corresponding values in group 1 (259.46, 246.12, and 251.00 m).Conclusion HbA1c values have a significant correlation with choroidal thickness in diabetic patients, and better glycemic control with HbA1c 7% may prevent choroidal thinning.

Choroidal thickness changes following cataract surgery in patients with type 2 diabetes mellitus

PurposeTo evaluate the choroidal thickness changes after cataract surgery in type 2 diabetic patients. MethodsThree groups of patients were enrolled into this prospective study. Group A included diabetic patients without diabetic retinopathy (DR) or with mild non-proliferative diabetic retinopathy (NPDR) who underwent phacoemulsification, Group B included non-diabetic patients with significant cataract who underwent phacoemulsification, and Group C included diabetic patients without DR or with mild NPDR who followed up without surgical procedure. Choroidal thickness in 5 points (subfoveal and 500 μ temporal, nasal, superior and inferior to the fovea) and central macular thickness were measured before surgery using enhanced depth spectral domain optical coherence tomography. Patients were re-evaluated 1 week, 1 month, and 3 months after operation and compared with the baseline values. ResultsIn total, 63 eyes from 63 patients were enrolled to this study, including 21 eyes in Group A, 22 eyes in Group B, and 20 eyes in Group C. After three months of follow-up of the patients, choroidal thickness in all measured points was decreased significantly, and central macular thickness was increased significantly following cataract surgery in diabetic eyes (Ggroup A); meanwhile, both choroidal thickness and central macular thickness were increased significantly in non-diabetic eyes (Group B). In Group C, choroidal thickness and central macular thickness had no significant changes, after three months. ConclusionUnlike in non-diabetic eyes, choroidal thickness in diabetic patients decreased following cataract surgery.

Influence of glycosylated hemoglobin on the choroidal thickness.

The aim of the study reported here was to assess the influence of serum HbA1c levels on foveal choroidal thickness in diabetic patients. A total of 122 eyes from 122 patients who had type 2 DM were studied in this prospective, cross-sectional study. Patients were divided into three groups: 43 patients (43 eyes) without diabetic retinopathy (NDR), 39 patients (39 eyes) with diabetic retinopathy and no macular edema (DR/ME-), 40 patients (40 eyes) with diabetic retinopathy and macular edema (DR/ME+). Central foveal thicknesses and subfoveal choroidal thicknesses were noted. Subfoveal choroidal thickness measurement was taken perpendicularly from the outer part of the retinal pigment epithelial layer to the line corresponding to the choroidal-scleral junction. Serum glycosylated hemoglobin (HbA1c) levels were evaluated. No significant differences in age, gender, pseudophakia were observed between the groups. There was no significant difference in HbA1c value among the three diabetic groups. Mean foveal choroidal thickness was 270.09±42.41 in NDR group, 243.18±30.21 in DR/ME- group and 250.90±40.06 in DR/ME+ group. Mean foveal choroidal thickness in NDR group was significantly different from DR/ME- group. There was no statistically significant difference between the other groups among foveal choroidal thicknesses. There was no correlation between HbA1c and foveal choroidal thickness. Multiple regression analyses of two diabetic retinopathy groups showed no significant correlation between foveal choroidal thickness and HbA1c and also no significant correlation between foveal choroidal thickness and duration of diabetes. Serum HbA1c levels were not correlated with foveal choroidal thickness. Choroidal thickness is effected by several factors as axial length, age and systemic diseases.

Evaluation of the effect of intracameral cefuroxime on macular and subfoveal choroidal thickness and macular sensitivity in diabetic patients after cataract surgery

To evaluate the macular and subfoveal choroidal thickness variation and macular sensitivity changes in diabetic patients after intracameral cefuroxime in cataract surgery. Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai, China. Prospective case series. Diabetic patients with visually significant cataract were divided into a treatment group, which received an intracameral injection of 1mg/0.1mL cefuroxime, and a control group, which received an equal volume of 0.9% saline solution. The macular thickness and subfoveal choroidal thickness were measured by optical coherence tomography. The macular sensitivity was assessed by microperimetry using the MP-1. The study comprised 46 eyes of 38 patients. The macular thickness increased significantly both in the treatment group (P<.01) and the control group (P<.05) postoperatively. The mean variation was 8.27±μm 3.22 (SD) in the treatment eyes and 11.38±7.75μm in the control eyes. The mean preoperative subfoveal choroidal thickness was 262.86±37.02μm and 279.70±54.68μm, respectively (P=.497). No statistical difference was found in the macular thickness variation (P=.338) orsubfoveal choroidal thickness variation (P=.491) between the 2 groups. For macular sensitivity, there was no significant differencein the variation between the treatment group and the control group (6.05±2.37dB versus 5.52±4.17dB) (P=.772). Intracameral cefuroxime did not significantly influence the thickening of macula or the subfoveal choroidal thickness in diabetic patients after uneventful cataract surgery. The functional improvement in macular sensitivity was also not affected.

Correlation between choroidal and retinal thickness in diabetic patients without diabetic retinopathy

PurposeThis study was design to examine the correlation between retinal and choroidal thickness in diabetic patients without diabetic retinopathy.Methods125 type 2 diabetic patients without diabetic retinopathy underwent a complete ophthalmological examination. Retinal total thickness and retinal layer automatic segmentation were assessed by using spectral domain optic coherence tomography (Spectralis Heidelberg Engineering). Retinal measures were made at fovea and at 3 mm temporal (T3), nasal (N3), superior (S3) and inferior (I3) to the fovea. Choroidal Thickness (CT) was assessed with enhanced depth mode (EDI) software (subfoveal and at 1,000 μm temporal, nasal, superior and inferior to the fovea). Pearson correlations were analyzed between CT and RT (total and by layer) at the five locations of study: subfoveal CT with central RT; and CT at the 1,000 μm temporal, nasal, superior and inferior to fovea's center with RT at the T3, N3, S3 and I3, respectively.ResultsDiabetic patients were in average 66.9 ± 9.33 years old with an average disease duration of 93.50 ± 81.74 months. Except for the pigmented epithelium retinal layer, which showed a positive, but weak correlation with CT at N3, S3 and I3 (r between 0.25 and 0.32, p &lt; 0.05), the analyze didn't showed a statistical significant correlation between CT and the thickness of the other retinal layers.ConclusionsRecent studies empathize the role of a choroidal vasculopathy in diabetic retinopathy pathogenesis. The absence of correlation between CT and RT may be related to changes in the choroid occur in earlier stages of the disease. Future longitudinal studies are needed in patients at different stages of diabetic retinopathy.

Choroidal thickness in diabetic patients without diabetic retinopathy

PurposeCompare choroidal thickness (CT) between diabetic patients without diabetic retinopathy (DR) and a non‐diabetic group. Explore how CT relates to disease duration, mean arterial pressure (MAP), glycaemia, glycosylated haemoglobin (HbA1c), intraocular pressure and ocular pulse amplitude (OPA).MethodsIn this cross‐sectional study, CT was assessed using SD‐OCT (Spectral Domain Optical Coherence Tomography) and enhanced depth mode at 13 different locations (subfoveal and 3 measurements 500 μm apart in all 4 directions – nasal, temporal, superior and inferior). Linear regression models were used to analyse the data.Results175 patients were recruited (125 diabetic patients without DR and 50 non‐diabetics patients). In diabetic patients, CT was significantly thicker than in non‐diabetic group in two locations: 1,500 μm nasal (p = 0.036) and 1,500 μm superior to the fovea (p = 0.021). CT was negatively associated with age (p &lt; 0.001) in both groups, but only in the diabetic group was it positively associated to OPA (with a mean increase in thickness between 8.5 and 11.6 μm for each increase of one OPA's unit). CT values seem to stabilize after 150 months of diabetes, with patients presenting higher glycaemia levels (&gt;160 mg/dl) while showing no fluctuation in neither HbA1c nor MAP.ConclusionsThere appears to be a thickening of the choroid in diabetic patients without DR. Moreover, this tissue may be functionally different in diabetic patients, as the pattern of associations seems to differ between groups.

Macular Choroidal Thickness Measurement by Enhanced Depth Imaging Optical Coherence Tomography in Type (II) Diabetes Mellitus Patients

PURPOSE: To evaluate the central (macular) choroidal thickness in diabetic patients with type (II) diabetes mellitus (DM) using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: A prospective clinical interventional study included 100 eyes of 100 subjects divided into two groups: Group (A) included 50 eyes of 50 diabetic patients with type (II) DM and Group (B) included 50 eyes of 50 age-matched normal healthy controls with no gender or laterality specification. The central choroidal thickness (CCT) was measured from the posterior edge of RPE to the choroid-scleral junction at 1500µm intervals up to 3000µm from the fovea using EDI-OCT in 11 quadrants and regions. RESULTS: Mean age in group (A) was 42±7 years (range, 26-50 years), and 39±9 years (range, 25-50 years) in group (B). Mean duration of DM was 7.96±3.9 years in group (A). Subfoveal CCT was found to be 291±42µm in group (A) (275.31±31µm for no apparent retinopathy (No DR), 298±42µm for non-proliferative diabetic retinopathy (NPDR), 309±58µm for proliferative diabetic retinopathy (PDR), 277±29µm for diabetic macular edema (DME) absent and 306±47µm for DME present) while it was 284±54µm in group (B). There was a statistically significant positive correlation between CCT and DM duration (P≤0.05). CONCLUSION: Choroidal thickness was found to be correlated with the stage of diabetic retinopathy (DR). Progressive thickening of the choroid with the progression of DR and/or the development of DME may reflect the concurrent progression of diabetic choroidopathy.

Choroidal Thickness in Diabetic Patients without Diabetic Retinopathy

PurposeTo evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) using enhanced depth imaging spectral‐domain optical coherence tomography (EDI SD‐OCT). To correlate CT with disease duration, systemic blood pressure (BP), glycemia, intraocular pressure (IOP) and ocular pulse amplitude (OPA).MethodsProspective, observational case‐control study. A complete ophthalmological examination was performed (visual acuity, refraction, Goldmann applanation and dynamic contour tonometries, fundoscopy and axial length). CT was assessed by a non‐invasive procedure using an EDI‐OCT (Spectralis Heidelberg) at 13 locations (subfoveal and 3 measurements 500 μm apart in all 4 directions – nasal, temporal, superior and inferior).Results180 patients were recruited: 130 diabetic patients with no DR and 50 healthy controls; one eye per patient included in the study. CT at 1500 μm above the fovea was significantly thicker in the diabetic group (239.9 ± 56 μm vs 268.2 ± 67.7 μm, p = 0.001). None of the other topographic region comparisons were statistically different (p &gt; 0.05). In diabetic patients CT was not correlated with disease duration, BP, glycemia or IOP. CT was positively correlated with OPA in 12 points in diabetic patients (r between 0.19 and 0.27, p &lt; 0.05) but not in the control group. CT variation coefficients in the diabetic group were statistically lower than in the control group (p &lt; 0.01).ConclusionsThe thickening of the choroid at 1500 μm superior of the fovea in diabetic patients without DR may correspond to the diabetic choroidopathy in mid‐periphery presented before DR. Moreover, this tissue may be functionally different, as the pattern of correlations seems to differ between groups. Further studies are needed to explore these differences and the potential of the CT in the clinical setting.

Heterogeneous choroidal thickness pattern in diabetic patients without diabetic retinopathy

PurposeThe authors intend to present an analysis and comparison of the choroidal thickness in more distant superior regions. Choroidal thickness is increased in a heterogeneous pattern superiorly to the fovea in diabetic patients without diabetic retinopathy.MethodsObservational case‐control study of 60 eyes of 60 patients with diabetes mellitus type 2 without diabetic retinopathy. A control group of 31 eyes of 31 patients without diabetes with similar demographic features was also created. All the patients were recruited from the same outpatient clinic. Enhanced depth imaging spectral‐domain optical coherence tomography (EDI SD‐OCT SPECTRALIS®) was performed and high‐resolution macular scans were obtained. Choroidal thickness was evaluated 2000 μm superiorly to the fovea by manual layer segmentation. Previous studies have validated the validity of using a manual layer segmentation procedure in OCT. Statistical analysis was done with SPSS Statistics. A p value &lt;0.05 was considered statistically significant.ResultsDiabetic patients were in average 67.0 ± 9.6 years old and 56.7% were male. Average choroidal thickness 2000 μm superiorly to the fovea was 287.77 ± 74.32 μm in diabetic patients and 249.81 ± 53.96 μm in non‐diabetic patients. There was a significant increase in choroidal thickness in diabetic patients when compared to non‐diabetic patients (T‐student, p = 0.014).ConclusionsChoroidal thickness can be accurately measured using high‐definition macular OCT scans. This study documented structural differences in the choroid associated with diabetes mellitus type 2 that are not only present in the central foveal area as reported in previous studies. Diabetes Mellitus is associated with multiple microvascular dysfunctions that are probably coupled with choroidal vascular modifications that induce changes in thickness.

Choroidal thickness in diabetic patients of Indian ethnicity.

Purpose:To evaluate choroidal thickness (CT) change in various grades of diabetic retinopathy (DR) in comparison to age-matched healthy subjects.Methods:This prospective observational study included 227 eyes of 125 subjects with diabetes (study group: 58 females) and 197 eyes of 110 age-matched healthy subjects (control group: 66 females). Collected data included age, gender, duration of diabetes, glycemic control, comprehensive ocular examination, fundus photography, and CT measurement on spectral domain ocular coherence tomography using enhanced depth imaging.Results:Mean age in the study group was 57.0 ± 9.37 years (43–73 years). The mean age was 41.48 ± 5.43 years in the control group. Subjects with diabetes with (252.8 ± 55.6 microns) and without (261.71 ± 51.8 microns) retinopathy had significantly thinner choroids when compared to the control group (281.7 ± 47.7 microns; P = 0.032). Seventy-four of 227 eyes did not have any evidence of DR, 89 eyes had features of nonproliferative diabetic retinopathy (NPDR), and 33 eyes had treatment naïve proliferative diabetic retinopathy (PDR). Thirty-one PDR eyes had received previous laser photocoagulation. Subjects with diabetes without retinopathy had a greater subfoveal choroidal thickness (SFCT) than subjects with diabetes with retinopathy (P < 0.001). Eyes with PDR (243.9 ± 56.2 microns) had thinner SFCT than those with NPDR (238.98 ± 111.23 microns). There was no difference in the SFCT between treated (laser photocoagulation done; 251.784 ± 103.72 microns) and treatment naïve PDR (258.405 ± 89.47 microns, P = 0.23).Conclusions:Control eyes had greater SFCT compared to subjects with diabetes, with and without retinopathy. The thinning progressed with increasing severity of DR. Choroidal thinning may contribute to DR pathogenesis.

Effects of Diabetic Retinopathy and Intravitreal Bevacizumab Injection on Choroidal Thickness in Diabetic Patients

Effects of Diabetic Retinopathy and Intravitreal Bevacizumab Injection on Choroidal Thickness in Diabetic Patients