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      Comparison of retinal nerve fiber layer thickness between normal population and patients with diabetes mellitus using optical coherence tomography

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          Abstract

          Objective:

          To compare the difference in peripapillary Retinal Nerve Fibre Layer (RNFL) thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography (SD OCT).

          Methods:

          This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups.

          Results:

          Mean age of study population was 44.63 ± 4.30 years. Mean axial length was 23.46 ± 0.59 mm. Mean peripapillary RNFL thickness was 126.98 ± 10.07 µm in Group-A (normal individuals), and 120.77 ± 5.41 µm in Group-B (Type-II diabetics). Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically significant between both groups (p-value < 0.001).

          Conclusion:

          Diabetic patients have thin RNFL as compared to normal individuals, and must be taken in account while making diagnosis of any disease based on thinning of RNFL.

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          Most cited references18

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          Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus.

          Diabetic retinopathy (DR) has long been recognized as a microvasculopathy, but retinal diabetic neuropathy (RDN), characterized by inner retinal neurodegeneration, also occurs in people with diabetes mellitus (DM). We report that in 45 people with DM and no to minimal DR there was significant, progressive loss of the nerve fiber layer (NFL) (0.25 μm/y) and the ganglion cell (GC)/inner plexiform layer (0.29 μm/y) on optical coherence tomography analysis (OCT) over a 4-y period, independent of glycated hemoglobin, age, and sex. The NFL was significantly thinner (17.3 μm) in the eyes of six donors with DM than in the eyes of six similarly aged control donors (30.4 μm), although retinal capillary density did not differ in the two groups. We confirmed significant, progressive inner retinal thinning in streptozotocin-induced "type 1" and B6.BKS(D)-Lepr(db)/J "type 2" diabetic mouse models on OCT; immunohistochemistry in type 1 mice showed GC loss but no difference in pericyte density or acellular capillaries. The results suggest that RDN may precede the established clinical and morphometric vascular changes caused by DM and represent a paradigm shift in our understanding of ocular diabetic complications.
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            The Role of Microglia in Diabetic Retinopathy: Inflammation, Microvasculature Defects and Neurodegeneration

            Diabetic retinopathy is a common complication of diabetes mellitus, which appears in one third of all diabetic patients and is a prominent cause of vision loss. First discovered as a microvascular disease, intensive research in the field identified inflammation and neurodegeneration to be part of diabetic retinopathy. Microglia, the resident monocytes of the retina, are activated due to a complex interplay between the different cell types of the retina and diverse pathological pathways. The trigger for developing diabetic retinopathy is diabetes-induced hyperglycemia, accompanied by leukostasis and vascular leakages. Transcriptional changes in activated microglia, mediated via the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) and extracellular signal–regulated kinase (ERK) signaling pathways, results in release of various pro-inflammatory mediators, including cytokines, chemokines, caspases and glutamate. Activated microglia additionally increased proliferation and migration. Among other consequences, these changes in microglia severely affected retinal neurons, causing increased apoptosis and subsequent thinning of the nerve fiber layer, resulting in visual loss. New potential therapeutics need to interfere with these diabetic complications even before changes in the retina are diagnosed, to prevent neuronal apoptosis and blindness in patients.
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              Choroidal thinning as a new finding in Alzheimer's disease: evidence from enhanced depth imaging spectral domain optical coherence tomography.

              The involvement of retina and its vasculature has been recently described in Alzheimer's disease (AD). However, none of the previous works have yet investigated the choroid in vivo.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Jan-Feb 2019
                : 35
                : 1
                : 29-33
                Affiliations
                [1 ]Dr. Mohammad Asim Mehboob, FCPS (Ophth), FICO, MRCSEd (Ophth), Combined Military Hospital (CMH) Gujranwala, Gujranwala, Pakistan
                [2 ]Dr. Zulfiqar Ali Amin, FCPS(Med), FCPS (Oncology), Associate Professor, PNS Shifa Naval Hospital, Karachi, Pakistan
                [3 ]Dr. Qamar Ul Islam, FCPS (Ophthalmology), FCPS (Vitreo-retinal Ophthalmology), Associate Professor, PNS Shifa Naval Hospital, Karachi, Pakistan
                Author notes
                Correspondence: Dr. Mohammad Asim Mehboob, FCPS(Ophth), FICO, MRCSEd (Ophth), Graded Eye Specialist, Combined Military Hospital (CMH) Gujranwala, Gujranwala, Pakistan. Email: asimmehboob@ 123456gmail.com
                Article
                PJMS-35-29
                10.12669/pjms.35.1.65
                6408645
                30881391
                9bd5c6d3-dc7f-4b6a-b3cc-3e4d77b3b389
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 October 2018
                : 05 January 2019
                Categories
                Original Article

                diabetic neuropathy,optical coherence tomography,retinal nerve fibre layer thickness

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