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PLoS One ; 16(10): e0258479, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34648529


OBJECTIVE: To investigate the effects of axial length (AL) on the peripapillary microvascular density acquired from optical coherence tomography angiography (OCTA). METHODS: Retrospective observational study. A total of 111 eyes from 111 normal healthy subjects were examined. The subjects were divided into three groups according to the AL: Group 1 (AL: < 24.0 mm; 35 eyes), Group 2 (AL: 24.0-25.99 mm; 37 eyes), and Group 3 (AL: ≥ 26 mm; 39 eyes). Peripapillary OCTA images were acquired using 6× 6 mm angiography scans, and vessel density (VD) and perfusion density (PD) of the superficial capillary plexus were calculated automatically. VD and PD were compared among the three groups according to the distance from the optic disc (inner and outer rings). Linear regression analyses were also performed to identify clinical factors associated with average VD. RESULTS: The average ALs of Groups 1-3 were 23.33± 0.57, 25.05± 0.60, and 27.42± 0.82, respectively. Average VD (P = 0.009) and PD (P = 0.029) in the inner ring increased with increasing AL. However, average VD (P < 0.001) and PD (P < 0.001) in the outer ring decreased with AL increased; the same trends were found for the full areas (VD, p<0.001; PD, p = 0.001). Average VDs in the inner and outer rings were not associated (P = 0.938). CONCLUSIONS: Peripapillary VD and PD were significantly associated with AL. Depending on the distance from the disc, peripapillary VDs and PDs of the inner and outer rings were differentially affected by AL. Physicians should therefore consider the effects of AL in the analyses of peripapillary microvasculature.

Microvasos/fisiologia , Tomografia de Coerência Óptica/métodos , Adulto , Estudos de Casos e Controles , Feminino , Angiofluoresceinografia , Humanos , Modelos Lineares , Masculino , Microvasos/diagnóstico por imagem , Pessoa de Meia-Idade , Disco Óptico/fisiologia , Estudos Retrospectivos
Diabetes ; 70(11): 2663-2667, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34475099


Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are both relatively common systemic diseases and cause damage to the retina, such as inner retina reduction and microvascular impairment. The purpose of this study was to identify peripapillary retinal nerve fiber layer (pRNFL) damage by diabetic neurodegeneration and the effects of HTN on the pRNFL thickness in patients with T2DM without clinical diabetic retinopathy. Subjects were divided into three groups: healthy control subjects (group 1), patients with T2DM (group 2), and patients with both diabetes and HTN (group 3). The pRNFL thickness was measured using optical coherence tomography and compared among each group. Linear regression analyses were performed to identify factors associated with pRNFL thickness. A total of 325 eyes were included: 143 eyes in the group 1, 126 eyes in group 2, and 56 eyes in group 3. The mean pRNFL thicknesses of each group were 96.1 ± 7.7, 94.4 ± 8.6, and 91.6 ± 9.6 µm, respectively (P = 0.003). In multivariate linear analyses, diabetes duration (ß = -0.236; P = 0.018) and HTN (ß = -3.766; P = 0.008) were significant factors affecting the pRNFL thickness in groups 2 and 3. Additionally, the HTN duration was significantly correlated with pRNFL thickness in group 3 (R 2 = 0.121; P = 0.008). In conclusion, patients with T2DM with HTN showed thinner pRNFL thickness than those with T2DM only. Additionally, the duration of HTN was significantly correlated with pRNFL thickness in patients with both diabetes and HTN.

Diabetes Mellitus Tipo 2/patologia , Retinopatia Diabética/patologia , Hipertensão/patologia , Neurônios Retinianos/patologia , Idoso , Estudos Transversais , Feminino , Hemoglobina A Glicada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
Sci Rep ; 11(1): 6813, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762673


To identify the effects of prolonged type 2 diabetes (T2DM) on changes in peripapillary retinal nerve fiber layer (pRNFL) thickness in patients without clinical diabetic retinopathy. Subjects were divided into two groups: controls and patients with T2DM (DM group). After the initial visits, the pRNFL thicknesses were measured three more times at 1-year intervals. Subgroup analyses were performed in patients with T2DM duration ≥ 10 years. The mean pRNFL thickness at each visit was 95.8 ± 8.1, 95.4 ± 8.3, 94.9 ± 8.1, and 94.5 ± 8.3 µm in the control group (P = 0.138) (n = 55); and 93.4 ± 9.1, 92.1 ± 9.3, 90.9 ± 9.3, and 89.5 ± 9.2 µm in the DM group (P < 0.001) (n = 85). The estimated rate of reduction in mean pRNFL thickness was - 0.45 µm/year in the control group and - 1.34 µm/year in the DM group, respectively. In the DM group, the BCVA and HbA1c (both P = 0.001) were significant factors associated with pRNFL reduction. In patients with T2DM duration ≥ 10 years, the estimated pRNFL reduction rate was - 1.61 µm/year, and hypertension was a significant factor affecting the pRNFL reduction (P = 0.046). We confirmed rapid pRNFL reduction over time in T2DM, and the reduction rate was higher in patients with T2DM ≥ 10 years. Additionally, BCVA and HbA1c levels were significantly associated with the change in pRNFL thickness in T2DM patients.

Diabetes Mellitus Tipo 2/fisiopatologia , Fibras Nervosas/fisiologia , Retina/fisiologia , Idoso , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia , Tomografia de Coerência Óptica , Acuidade Visual
Invest Ophthalmol Vis Sci ; 60(12): 3914-3919, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31546252


Purpose: To determine longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with hypertension (HTN). Methods: Participants without any ophthalmic disease were divided into two groups: an HTN group (50 eyes) that included patients with HTN for ≥5 years and a control group. After the initial visit, pRNFL thicknesses were measured four more times at 1-year intervals using spectral-domain optical coherence tomography. The pRNFL thickness was fitted using linear mixed models. Univariate and multivariate generalized linear mixed models were used to determine factors associated with pRNFL reductions over time. Results: The mean ages of the HTN and control groups were 62.9 ± 6.2 and 60.7 ± 6.1 years, respectively, and they were not significantly different (P = 0.089). The baseline mean pRNFL thicknesses were 90.50 ± 8.31 and 93.90 ± 8.77 µm; they were significantly different (P = 0.049). The mean pRNFL reduction rate was -0.99 and -0.40 µm/y in the HTN and control groups, respectively; the interaction between group and duration was significant (P < 0.001). In the linear mixed model determination of factors associated with pRNFL reduction, there was no significant factor in the control group. In the HTN group, age, and axial length showed significant results in both univariate and multivariate analyses (estimate: -0.362 and -2.618; P = 0.042 and 0.026, respectively). Conclusions: Patients with HTN had a significantly greater decrease in pRNFL than normal individuals. Additionally, age and axial length significantly affected the reduction in pRNFL in HTN patients.

Hipertensão/patologia , Fibras Nervosas/patologia , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Anti-Hipertensivos/uso terapêutico , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia
JAMA Ophthalmol ; 137(10): 1125-1132, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31343674


Importance: Type 2 diabetes is expected to accelerate age-related peripapillary retinal nerve fiber layer (pRNFL) loss, but limited information on the rate of reduction in pRNFL thicknesses in patients with type 2 diabetes is available. Objective: To investigate longitudinal changes in pRNFL thickness in patients with type 2 diabetes, with or without diabetic retinopathy (DR). Design, Setting, and Participants: A total of 164 eyes of 63 healthy individuals and 101 patients with type 2 diabetes (49 patients without DR [non-DR group] and 52 patients with mild to moderate nonproliferative DR [NPDR group]) were enrolled in this prospective, longitudinal, observational study from January 2, 2013, through February 27, 2015. Participants were followed up for 3 years, and the peripapillary mean and sector RNFL thicknesses were measured at 1-year intervals. The mean rate of pRNFL loss was estimated using a linear mixed model and compared among the 3 groups. Follow-up was completed on March 16, 2018, and data were analyzed from April 2 through July 27, 2018. Exposure: Type 2 diabetes. Main Outcomes and Measures: The rate of reduction in pRNFL thickness in patients with type 2 diabetes. Results: A total of 164 participants (88 women [53.7%]; mean [SD] age, 58.2 [8.7] years) were included in the study analysis. The mean (SD) age of the control group was 56.5 (9.3) years (39 women [61.9%]); the non-DR group, 59.1 (9.4) years (26 women [53.1%]); and the NPDR group, 59.4 (11.0) years (23 women [44.2%]). Mean (SD) duration of type 2 diabetes was 7.1 (4.4) years in the non-DR group and 13.2 (8.4) years in the NPDR group. The baseline mean (SD) pRNFL thickness was 96.2 (11.0) µm in the control group, 93.5 (6.4) µm in the non-DR group, and 90.4 (7.9) µm in the NPDR group. During 3 years of follow-up, these values decreased to 95.0 (9.2) µm in the control group, 90.3 (6.4) in the non-DR group, and 86.6 (7.9) µm in the NPDR group. In a linear mixed model, the estimated mean pRNFL loss was -0.92 µm/y in the non-DR group (P < .001) and -1.16 µm/y in the NPDR group (P < .001), which was 2.9-fold (95% CI, 1.1-14.8; P = .003) and 3.3-fold (95% CI, 1.4-18.0; P < .001) greater, respectively, than that of the control group (-0.35 µm/y; P = .01). Conclusions and Relevance: Progressive reduction of pRNFL thickness was observed in healthy controls and patients with type 2 diabetes without and with DR; however, type 2 diabetes was associated with a greater loss of pRNFL regardless of whether DR was present. These findings suggest that pRNFL loss may occur in people with type 2 diabetes even in the absence of DR progression.