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      The effect of acute hyperglycemia on retinal thickness and ocular refraction in healthy subjects

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          Abstract

          Purpose

          To quantify the retinal thickness and the refractive error of the healthy human eye during hyperglycemia by means of optical coherence tomography (OCT) and Hartmann–Shack aberrometry.

          Methods

          Hyperglycemia was induced in five healthy subjects who were given a standard oral glucose tolerance test (OGTT) after a subcutaneous injection of somatostatin. Main outcome parameters were the central, pericentral and peripheral thickness of the fovea, measured by means of optical coherence tomography (OCT3). Ocular refractive error was determined with Hartmann-Shack aberrometry. Measurements at baseline and during maximal hyperglycemia were analyzed, and a change was considered clinically significant if the difference between the measurements exceeded the threshold of 50 μm for retinal thickness and 0.2 D for refractive error.

          Results

          During hyperglycemia (mean blood glucose level at baseline: 4.0 mmol/l; mean maximal blood glucose level: 18.4 mmol/l) no significant changes could be found in the central, pericentral, or peripheral foveal thickness in any of the five subjects. One of the subjects had a hyperopic shift of 0.4 D, but no significant change in refractive error was found in any of the other subjects.

          Conclusions

          The present study shows that in healthy subjects induced hyperglycemia does not affect retinal thickness, but it can cause a small hyperopic shift of refraction.

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          Most cited references 37

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          Optical coherence tomography.

          A technique called optical coherence tomography (OCT) has been developed for noninvasive cross-sectional imaging in biological systems. OCT uses low-coherence interferometry to produce a two-dimensional image of optical scattering from internal tissue microstructures in a way that is analogous to ultrasonic pulse-echo imaging. OCT has longitudinal and lateral spatial resolutions of a few micrometers and can detect reflected signals as small as approximately 10(-10) of the incident optical power. Tomographic imaging is demonstrated in vitro in the peripapillary area of the retina and in the coronary artery, two clinically relevant examples that are representative of transparent and turbid media, respectively.
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            Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.

            (1985)
            Data from the Early Treatment Diabetic Retinopathy Study (ETDRS) show that focal photocoagulation of "clinically significant" diabetic macular edema substantially reduces the risk of visual loss. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. In this randomized clinical trial, which was supported by the National Eye Institute, 754 eyes that had macular edema and mild to moderate diabetic retinopathy were randomly assigned to focal argon laser photocoagulation, while 1,490 such eyes were randomly assigned to deferral of photocoagulation. The beneficial effects of treatment demonstrated in this trial suggest that all eyes with clinically significant diabetic macular edema should be considered for focal photocoagulation. Clinically significant macular edema is defined as retinal thickening that involves or threatens the center of the macula (even if visual acuity is not yet reduced) and is assessed by stereo contact lens biomicroscopy or stereo photography. Follow-up of all ETDRS patients continues without other modifications in the study protocol.
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              Optical coherence tomography of the human retina.

              To demonstrate optical coherence tomography for high-resolution, noninvasive imaging of the human retina. Optical coherence tomography is a new imaging technique analogous to ultrasound B scan that can provide cross-sectional images of the retina with micrometer-scale resolution. Survey optical coherence tomographic examination of the retina, including the macula and optic nerve head in normal human subjects. Research laboratory. Convenience sample of normal human subjects. Correlation of optical coherence retinal tomographs with known normal retinal anatomy. Optical coherence tomographs can discriminate the cross-sectional morphologic features of the fovea and optic disc, the layered structure of the retina, and normal anatomic variations in retinal and retinal nerve fiber layer thicknesses with 10-microns depth resolution. Optical coherence tomography is a potentially useful technique for high depth resolution, cross-sectional examination of the fundus.
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                Author and article information

                Contributors
                +31-20-4440234 , +31-20-4441015 , ngm.wiemer@vumc.nl
                Journal
                Graefes Arch Clin Exp Ophthalmol
                Graefe's Archive for Clinical and Experimental Ophthalmology
                Springer-Verlag (Berlin/Heidelberg )
                0721-832X
                1435-702X
                25 January 2008
                May 2008
                : 246
                : 5
                : 703-708
                Affiliations
                [1 ]Department of Ophthalmology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
                [2 ]Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
                [3 ]Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
                [4 ]Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
                Article
                729
                10.1007/s00417-007-0729-8
                2292474
                18219490
                © The Author(s) 2007
                Categories
                Basic Science
                Custom metadata
                © Springer-Verlag 2008

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