Thickness In Diabetic Patients Research Articles

Impact of metabolic control on macular thickness in diabetic macular oedema.

Purpose:To investigate the impact of metabolic control on macular thickness measured using optical coherence tomography in patients with diabetic retinopathy with or without macular oedema.Methods:A total of 124 patients with diabetic retinopathy (n = 70 without macular oedema and n = 54 with macular oedema) were enrolled. Optical coherence tomography parameters measured included central macular thickness and total macular volume. Metabolic factors with correlation to optical coherence tomography parameters were fasting plasma glucose, glycosylated haemoglobin, triglyceride, low-density lipoprotein and estimated glomerular filtration rate. Multiple linear regression models were used to evaluate associations between optical coherence tomography parameters and metabolic factors.Results:Higher glycosylated haemoglobin values were correlated with increased central macular thickness in patients without macular oedema (R = 0.289, p = 0.015), whereas glycosylated haemoglobin values were inversely associated with central macular thickness in patients with macular oedema (R = –0.374, p = 0.005). Both were found to be statistically significant after adjusting for age, sex and diabetic retinopathy severity in addition to other metabolic factors (p = 0.009 and p = 0.002, respectively).Conclusion:Strict metabolic control may not be associated with better macular thickness in diabetic patients with co-existing macular oedema.

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.

Follow-up of the retinal nerve fiber layer thickness of diabetic patients type 2, as a predisposing factor for glaucoma compared to normal subjects.

PurposeTo evaluate and follow-up the retinal nerve fiber layer (RNFL) thickness in patients with diabetes mellitus type 2 compared to a group of healthy individuals with similar demographic characteristics.Patients and methodsThis is a prospective, noninvasive, observational case series study. For the purposes of the study, 27 eyes of diabetic patients without diabetic retinopathy, 24 eyes of patients with mild retinopathy, and 25 normal age-matched subjects (control group [CG]) were examined. All participants underwent complete ophthalmological examination and imaging with GDx variable corneal compensation scanning laser polarimetry. Follow-up was 2 years for all three groups.ResultsThe mean inferior average was statistically significantly lower in both diabetic groups compared to CG at baseline examination and during follow-up. The nerve fiber indicator (NFI) was higher in both diabetic groups compared to CG, both at baseline examination and during follow-up. The NFI was 21.7±11.9 and 22.0±11.8 for the diabetic group without retinopathy, 20.8±9.6 and 21.9±9.8 for the group with mild retinopathy, and 15.3±5.4 and 15.9±5.5 for the normal subjects, at baseline and 24 months, respectively. There was no statistically significant reduction of the RNFL thickness in all three groups compared to baseline examination.ConclusionThis is the first long-term study documenting the RNFL thickness in diabetic patients in comparison with normal controls. Although the lower RNFL was found thinner in diabetics, the 2-year follow-up showed no significant reduction of RNFL thickness in all groups, indicating that RNFL damage may occur early in diabetic patients.

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.

Relation of mean platelet volume with serum paraoxonase-1 activity and brachial artery diameter and intima media thickness in diabetic patients with respect to obesity and diabetic complications

Relation of mean platelet volume with serum paraoxonase-1 activity and brachial artery diameter and intima media thickness in diabetic patients with respect to obesity and diabetic complications

The effect of topical sodium diclofenac on macular thickness in diabetic eyes after phacoemulsification: a randomized controlled trial.

To evaluate the efficacy of prophylactic administration of the topical diclofenac 0.1% on macular thickness in diabetic patients following phacoemulsification and intraocular lens implantation surgery. In a Randomized double-masked clinical trial, 108 eyes of 108 diabetic patients underwent phacoemulsification and intraocular lens implantation surgery were enrolled. Fifty four eyes received the conventional postoperative care with steroid drop, whereas the other group (54 eyes) was given a preoperative diclofenac drop four times daily in addition to steroid drop and continued 6weeks after surgery. All patients were evaluated by optical coherence tomography (OCT) preoperatively and days 1, 30, and 90. The outcome measures including best-corrected visual acuity and OCT findings were compared in and between both groups. Mean CMT changed from 239±16 and 235±17 at baseline to 249±15 and 254±28 at 3months in the case and control groups, respectively(p=0.003). Mean total volume of macula changed from 7.61±0.22 and 7.56±0.3 at baseline to 7.64±0.22 and 7.65±0.31 at 3months in the case and control groups, respectively (p=0.820). In comparison to the quadrants thicknesses and mean of them between groups did not reach the significant level. This study showed that there is a beneficial effect of topical diclofenac for prevention of macular thickness increasing following phacoemulsification in diabetic patients.

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.

Diurnal Variations in Intraocular Pressure, Central Corneal Thickness, and Macular and Retinal Nerve Fiber Layer Thickness in Diabetics and Normal Individuals.

Purpose:To evaluate diurnal variations in intraocular pressure (IOP), central corneal thickness (CCT), and macular and retinal nerve fiber layer (RNFL) thickness in diabetic patients and normal individuals.Methods:This study included 11 diabetic patients with macular edema and 11 healthy individuals. IOP, CCT, and macular and RNFL thickness were measured every 3 hours on a single day between 9 AM and 6 PM. Diurnal variations in IOP, CCT, total macular volume (TMV), central macular thickness (CMT), average macular thickness (AMT), and RNFL thickness were measured.Results:None of the parameters showed a significant absolute or relative change over the course of the day. However, the following non-significant changes were observed. In the control group, all parameters demonstrated the highest values at 9 AM. The lowest IOP, TMV and AMT occurred at 12 PM; lowest CCT and RNFL at 6 PM; and the lowest CMT at 3 PM. Diabetic subjects had the highest values of RNFL, CMT and TMV at 9 AM, and that for IOP, CCT and AMT at 6 PM. The lowest RNFL and CMT values occurred at 6 PM; lowest IOP at 12 PM; and the lowest CCT, TMV and AMT were observed at 3 PM. In the diabetic group, TMV, CMT, AMT and CCT were significantly higher and RNFL was significantly lower than the control group at all time points (all P- values < 0.05).Conclusion:While there were slight decreases in IOP, RNFL thickness and CMT during the day, these changes were not significant between 9 AM and 6 PM and probably do not affect the interpretation of measurements.

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.

Retinal Layers Changes in Diabetic Patients without Diabetic Retinopathy

PurposeTo evaluate retinal layers thickness in diabetic patients without diabetic retinopathy (DR) using spectral‐domain optical coherence tomography (SD‐OCT). To correlate retinal layers thickness in diabetic patients with disease duration, systemic blood pressure (BP), glycemia, glycosylate haemoglobin (HbA1c), intraocular pressure (IOP) and ocular pulse amplitude (OPA).MethodsProspective, observational case–control study. A total of 175 eyes from 175 patients (125 diabetic patients without DR; 50 healthy controls) were recruited from the outpatient clinic in a tertiary center. A complete ophthalmological examination was performed (visual acuity, refraction, Goldmann applanation and dynamic contour tonometries, fundoscopy, axial length and SD‐OCT‐Spectralis®). After automated retinal segmentation the thickness of each layer was calculated in the 9 ETDRS areas.ResultsA significant increase of retinal nerve fiber layer (RNFL) thickness in inner and outer rings was found in diabetic eyes vs. controls (p between &lt;0.0001 and 0.02). Thickness was also increased in specific sites of ganglion cell layer (GCL), inner nuclear layer (INL) and retinal pigment epithelium (RPE) in diabetic eyes (p between 0.001 and 0.03). A significant decrease of outer plexiform layer (OPL) was detected in diabetic eyes at two sites of the inner ring (p = 0.04 and p &lt; 0.0001). The different retinal layers weren't correlated with systemic BP, glycemia, HbA1c, IOP and OPA, but the photoreceptor layer was negatively correlated with disease duration at 3 sites (r between −0.18 and −0.21, p &lt; 0.05).ConclusionsIn diabetic patients without DR thickness of the inner retina seems to be increased. This suggests that metabolic and morphological changes of the cells of these inner retinal layers occur early and before the apoptosis and neural degeneration.

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.

Peripapillary retinal nerve fiber layer changes in preclinical diabetic retinopathy: a meta-analysis.

BackgroundDiabetic retinopathy is a microvascular neurodegenerative disorder in diabetic patients. Peripapillary retinal nerve fiber layer changes have been described in patients with preclinical diabetic retinopathy, but study results have been inconsistent.ObjectiveTo assess changes in peripapillary retinal nerve fiber layer thickness in diabetic patients with preclinical diabetic retinopathy.MethodsA literature search was conducted through PubMed, EMBASE, Web of Science and Cochrane Library. Case-control studies on RNFL thickness in preclinical diabetic retinopathy patients and healthy controls were retrieved. A meta-analysis of weighted mean difference and a sensitivity analysis were performed using RevMan 5.2 software.ResultsThirteen case-control studies containing 668 diabetic patients and 556 healthy controls were selected. Peripapillary RNFL thickness was significantly reduced in patients with preclinical diabetic retinopathy compared to healthy controls in studies applying Optical Coherence Tomography (-2.88μm, 95%CI: -4.44 to -1.32, P = 0.0003) and in studies applying Scanning Laser Polarimeter (-4.21μm, 95%CI: -6.45 to -1.97, P = 0.0002). Reduction of RNFL thickness was significant in the superior quadrant (-3.79μm, 95%CI: -7.08 to -0.50, P = 0.02), the inferior quadrant (-2.99μm, 95%CI: -5.44 to -0.54, P = 0.02) and the nasal quadrant (-2.88μm, 95%CI: -4.93 to -0.82, P = 0.006), but was not significant in the temporal quadrant (-1.22μm, 95%CI: -3.21 to 0.76, P = 0.23), in diabetic patients.ConclusionPeripapillary RNFL thickness was significantly decreased in preclinical diabetic retinopathy patients compared to healthy control. Neurodegenerative changes due to preclinical diabetic retinopathy need more attention.

Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis.

ObjectiveTo evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT) and best corrected visual acuity (BCVA) in both diabetic patients without diabetic retinopathy (DR) and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR).MethodsPotential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD) and 95% confidence interval (CI) for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model.ResultsA total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95%CI, -1.230 to -0.399), 3 months (SMD, -0.565; 95%CI, -0.927 to -0.202) and 6 months (SMD, -0.458; 95%CI, -0.739 to -0.177) in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95%CI, -2.433 to 0.021)and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95%CI, -1.252 to 0.182) and 6 months (SMD, -1.181; 95%CI, -2.625 to 0.263) in diabetic patients without DR.BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95%CI, 0.251 to 2.047; and SMD,1.349; 95%CI, 0.264 to 2.434, respectively) and 6 months (SMD, 1.295; 95%CI, 0.494 to 2.096; and SMD, 2.146; 95%CI, 0.172 to 4.120, respectively) in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable.ConclusionUncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR. BCVA was significantly improved in both diabetic patients without DR and diabetic patients with mild to moderate NPDR.

Is the central corneal thickness of diabetic patients thicker than that of non-diabetics’ eyes?

The purpose of the study was to evaluate central corneal thickness in diabetic patients and to compare the results with controls without diabetes mellitus. Sixty-five diabetic patients (65 eyes) constituted the study group, and 50 eyes were from the healthy control group (50 non-diabetic patients). The study group was subdivided into group 1 (no diabetic retinopathy, n = 35), group 2 (mild to moderate nonproliferative diabetic retinopathy, n = 20), and group 3 (proliferative diabetic retinopathy, n = 10). Central corneal thickness measurements in microns were determined using ultrasound pachymetry. The mean central corneal thickness was significantly greater in the study group (567.14 μm ± 14.63 μm) than in the control group (531.14 μm ± 5 μm). In addition, the mean central corneal thickness was found to be greater in group 3 (577 μm ± 12 μm) than in groups 1 (562 μm ± 13 μm) and 2 (566.86 μm ± 15 μm), but the difference did not reach statistical significance. We found that the mean central corneal thickness for diabetic patients was thicker than that of the healthy controls. Thicker central corneas associated with diabetes mellitus should be taken into consideration when obtaining accurate intraocular pressure measurements in diabetics.

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.

Vaspin in type 2 diabetes in relation to atherosclerosis

Vaspin is a novel adipocytokine with insulin-sensitizing effects. However, it is not known whether a correlation exists between human vaspin serum levels and markers of insulin sensitivity and glucose or lipid metabolism. To determine whether there is an association between serum vaspin levels (a novel adipocytokine with insulin-sensitizing effects), type 2 diabetes mellitus (T2D) and atherosclerosis. The study included 40 patients with T2D divided into 20 without hypertension (group 1), 20 with hypertension (group 2) and 15 age-matched and sex-matched healthy control participants (group 3). The serum vaspin level was determined by enzyme-linked immunosorbent assay. Its level was compared between both diabetic patients and controls, and between diabetic patients without hypertension and those with hypertension. All participants were subjected to an imaging procedure in the form of carotid Doppler to measure the intima — media thickness as an early marker of atherosclerosis. The serum vaspin level was significantly higher in diabetic patients compared with control participants. There was significant increase in the left carotid intima–media thickness in diabetic patients with hypertension and without hypertension compared with control participants. There was a significant positive correlation between the serum vaspin level and the BMI in diabetic patients with hypertension, a significant negative correlation between the serum vaspin level and the duration of diabetes and a significant negative correlation between the serum vaspin level and HDL in diabetic patients without hypertension. There was a significantly high level of serum vaspin in T2D patients. Serum vaspin was shown to be significantly lower in T2D patients with a longer duration of illness. An increased carotid intima–media thickness in diabetic patients was not related to the vaspin level, denoting an underlying combining factor for atherosclerosis in diabetic patients other than vaspin.

Comparison of postoperative macular thickness in diabetic patients after phacoemulsification or manual small-incision cataract surgery

Objective To compare the macular central foveal thickness in cataract patients with type Ⅱ diabetes after phacoemulsification or manual small incision cataract surgery.Methods Fifty-six eyes of 56 cataract patients with type Ⅱ diabetes were randomly divided into two groups.Patients were treated by phacoemulsificaiton or manual small incision cataract surgery,respectively.All patients underwent fundus examination and fundus photography before operation.The foveal thickness measurement by OCT was performed on 1 month before surgery and 1 week,4 weeks,6 weeks and 3 months after operation.The correlation between foveal thickness and postoperative best corrected visual acuity was analyzed.Results The manual small incision cataract surgery was performed on 26 eyes and phacoemulsification cataract surgery was performed on 30 eyes.No significant difference in postoperative macular edema was found between the two groups.One week after operation,compared with the phacoemulsification group,the retinal neuroepithelial thickness in central fovea of macula in manual small incision surgery group was significantly higher (t =4.602,P =0.006),the best corrected visual acuity was significantly lower (x2 =9.753,P =0.009).Four weeks after operation,neither the retinal neuroepithelial thickness nor the best corrected visual acuity between two groups was significantly different.A negative correlation was found between the postoperative retinal neuroepithelial thickness and the best corrected visual acuity.Conclusion Although the incidence of postoperative macular edema in the two groups was not significantly different from each other,the postoperative retinal neuroepithelial thickness and the best corrected visual acuity were obviously infected by manual small incision surgery in short term after operation. Key words: Diabetics, type Ⅱ ; Surgery, cataract, small incision, manual; Phacoemulsificaiton; Thickness, foveal

Evaluation of central macular thickness in diabetic patients with primary open angle glaucoma on topical latanoprost

Purpose The aim of the study was to evaluate the changes in central macular thickness (CMT) in the eyes of diabetic patients with primary open angle glaucoma (POAG) on topical latanoprost. Design This study was designed as a prospective, interventional, comparative trial. Place The study was conducted at Ain Shams University Hospitals and at private practices. Patients and methods Twenty eyes of 12 diabetic patients with uncontrolled POAG who required topical latanoprost either as first or as additive glaucoma medication were prospectively enrolled in this study. Twenty nonglaucomatous eyes of 10 diabetic patients were included as controls. After a complete ophthalmic examination, spectral-domain optical coherence tomography and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 3 months, and clinical examinations were repeated 1, 2 and 3 months later; optical coherence tomography and FA were repeated after 3 months. Outcome measures were intraocular pressure (IOP), CMT and best-corrected visual acuity (BCVA). Results The mean patient age was 49 ± 11 (range 43-56) years. The mean BCVA in logMAR was 0.1 ± 0.1 (range 6/6-6/12), IOP was 24 ± 4.2 (range 19-30) mmHg, and mean CMT was 239.7 ± 26.8 (range 157-288) μm before administration of latanoprost. At 3 months' follow-up, IOP was 14.1 ± 2.9 mmHg ( P Conclusion Topical use of latanoprost for 3 months does not seem to predispose to increased CMT in diabetic patients with POAG. However, individual variations should be considered. Close observation is recommended by spectral-domain optical coherence tomography for diabetic patients on topical latanoprost.