Enhanced depth imaging optical coherence tomography in type 2 diabetes.

PURPOSE To investigate the changes in macular choroidal thickness in eyes with various stages of diabetic retinopathy, using enhanced depth imaging optical coherence tomography (EDI OCT). METHODS Sixty-three consecutive diabetic patients--who presented without diabetic retinopathy (NDR); with diabetic retinopathy (nonproliferative diabetic retinopathy [NPDR]) and no clinically significant macular edema (CSME-); or with NDPR and clinically significant macular edema (CSME+)--underwent EDI OCT. Twenty-one age- and sex-matched healthy subjects (21 eyes) also underwent EDI OCT. RESULTS A total of 63 eyes of 63 consecutive diabetic patients (26 female [41.2%]; mean age 65 ± 9 years, range 48-83 years) were included in the analysis. Mean best-corrected visual acuity was 0.13 ± 0.25 LogMAR (range 0-1). Mean CMT was 272.5 ± 16.2 μm in 21 NDR eyes, 294.5 ± 23.5 μm in 21 NPDR/CSME- eyes, and 385.6 ± 75.1 μm in 21 NPDR/CSME+ eyes. There was no difference in mean subfoveal choroidal thickness among each diabetic group (238.4 ± 47.9 μm [NDR], 207.0 ± 55.9 μm [NPDR/CSME-], 190.8 ± 48.4 μm [NPDR/CSME+]; P = 0.23). The mean subfoveal choroidal thickness was significantly reduced in each diabetic group compared with the control group (309.8 ± 58.5 μm, P < 0.001). CONCLUSIONS In diabetic eyes, there is an overall thinning of the choroid on EDI OCT. A decreased choroidal thickness may lead to tissue hypoxia and consequently increase the level of VEGF, resulting in the breakdown of the blood-retinal barrier and development of macular edema.

[1]  P. Campochiaro,et al.  Upregulation of vascular endothelial growth factor in ischemic and non-ischemic human and experimental retinal disease. , 1997, Histology and histopathology.

[2]  Matthew D. Davis,et al.  Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. , 2003, Ophthalmology.

[3]  C. Vygantas,et al.  Early detection of retinal involvement in diabetes by vitreous fluorophotometry. , 1979, Ophthalmology.

[4]  M. Langham,et al.  Choroidal blood flow in diabetic retinopathy. , 1991, Experimental eye research.

[5]  Boris Hermann,et al.  Mapping choroidal and retinal thickness variation in type 2 diabetes using three-dimensional 1060-nm optical coherence tomography. , 2011, Investigative ophthalmology & visual science.

[6]  L. Aiello,et al.  Hypoxic regulation of vascular endothelial growth factor in retinal cells. , 1995, Archives of ophthalmology.

[7]  E Reichel,et al.  Topography of diabetic macular edema with optical coherence tomography. , 1998, Ophthalmology.

[8]  B. S. Fine,et al.  Macular edema and cystoid macular edema. , 1981, American journal of ophthalmology.

[9]  G. Lutty,et al.  Relationship of polymorphonuclear leukocytes to capillary dropout in the human diabetic choroid. , 1997, The American journal of pathology.

[10]  Soon-Sun Kwon,et al.  COMPARISON OF CHOROIDAL THICKNESS AMONG PATIENTS WITH HEALTHY EYES, EARLY AGE-RELATED MACULOPATHY, NEOVASCULAR AGE-RELATED MACULAR DEGENERATION, CENTRAL SEROUS CHORIORETINOPATHY, AND POLYPOIDAL CHOROIDAL VASCULOPATHY , 2011, Retina.

[11]  S. Wu,et al.  Adler's Physiology of the Eye , 2002 .

[12]  J. Cunha-Vaz,et al.  Early breakdown of the blood-retinal barrier in diabetes. , 1975, The British journal of ophthalmology.

[13]  R. Spaide,et al.  Enhanced depth imaging spectral-domain optical coherence tomography. , 2008, American journal of ophthalmology.

[14]  G. Bresnick,et al.  DIABETIC MACULAR EDEMA: A REVIEW , 1986 .

[15]  Paul Latkany,et al.  Ocular perfusion abnormalities in diabetes. , 2002, Acta ophthalmologica Scandinavica.

[16]  T. Hikichi,et al.  Dysfunction of active transport of blood-retinal barrier in patients with clinically significant macular edema in type 2 diabetes. , 2002, Diabetes care.

[17]  M. Neudorfer,et al.  Pulsatile ocular blood flow in diabetic retinopathy. , 1999, Acta ophthalmologica Scandinavica.

[18]  B. S. Fine,et al.  Diabetic choroidopathy. Light and electron microscopic observations of seven cases. , 1985, Ophthalmology.

[19]  Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. ETDRS report number 7. , 1991, Ophthalmology.

[20]  D. S. Mcleod,et al.  High-resolution histologic analysis of the human choroidal vasculature. , 1994, Investigative ophthalmology & visual science.

[21]  T. Hikichi,et al.  Alteration of choroidal circulation in the foveal region in patients with type 2 diabetes , 2004, British Journal of Ophthalmology.

[22]  Angus M'Gillivray,et al.  The Ocular Circulation , 1904, Edinburgh Medical Journal.