Amaç: Bu çalışmada, diyabetik retinopati (DR) şiddetinin makular ödemi olmayan ve tedavi almamış diyabetik hastalarda, retina sinir lifi tabakası (RSLT) ve ganglion hücre tabakası (GHT) kalınlıkları üzerine etkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada, DR'si olmayan 30 diabetes mellitus (DM) hastası, 20 hafif nonproliferatif DR (NPDR) hastası, 17 orta NPDR hastası, 16 ağır NPDR hastası, 29 proliferatif DR (PDR) hastası ile 33 sağlıklı kontrol incelendi. Optik koherens tomografi ile iç retinal katmanların kalınlık analizi yapıldı. Diyabetik hastaların serum hemoglobin A1c (HbA1c) düzeyleri ile DM hastalık süreleri kaydedildi. Bulgular: GHT kalınlıkları açısından çalışma grupları arasında istatistiksel anlamlı bir fark saptanmadı (p˃0,05). PDR grubunda foveal, parafoveal ve perifoveal RSLT kalınlığı kontrol, DM ve hafif NPDR grubuna göre artmış saptandı (tümü için p˂0,01). Hastaların görme keskinliği düzeyleri ile foveal RSLT (β=-0,356, p=0,004) ve perifoveal RSLT (β=-0,498, p=0,001) kalınlıkları arasında istatistiksel olarak anlamlı negatif korelasyonlar saptandı. Ayrıca serum HbA1c düzeyleri ile parafoveal ve perifoveal RSLT kalınlıkları arasında istatistiksel olarak anlamlı pozitif korelasyonlar saptandı (sırası ile β=0,308, p=0,002 ve β=0,332, p=0,001). Sonuç: PDR hastalarında istatistiksel olarak anlamlı düzeyde artış gösteren makular RSLT kalınlığının, retinal iskemi ile indüklenen retinal inflamasyon ile ilişkili olabileceği düşünülmektedir. Ayrıca artmış makular RSLT kalınlığının, diyabetik hastalarda görme keskinliği kaybı ile korele olduğu saptanmıştır.
Anahtar Kelimeler: Diyabetik retinopati; ganglion hücre tabakası; optik koherens tomografi; retina sinir lifi tabakası; Tip 2 diabetes mellitus
Objective: To investigate the effect of diabetic retinopathy (DR) severity on retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thicknesses in treatment-naive diabetic patients who do not have any sign of macular edema. Material and Methods: This study enrolled 30 diabetic patients without DR, 20 patients with mild non-proliferative DR (NPDR), 17 patients with moderate NPDR, 16 patients with severe NPDR, 29 patients with proliferative DR (PDR), and 33 healthy control subjects. Optical coherence tomography was performed to analyze inner retinal layer thicknesses. Serum hemoglobin A1c (HbA1c) levels and diabetes mellitus (DM) duration of diabetic patients were recorded. Results: There was no statistically significant difference in GCL thicknesses between the study groups (p˃0.05). The thicknesses of foveal, parafoveal, and perifoveal RNFL were statistically significantly higher in the PDR group compared to the control, DM, and mild NPDR groups (p˂0.01 for all). There were statistically significant negative correlations between the foveal RNFL (β=-0.356, p=0.004) and perifoveal RNFL (β=-0.498, p=0.001) thicknesses with the visual acuity of patients. Additionally, there were statistically significant positive correlations between the serum HbA1c levels with parafoveal and perifoveal RNFL thicknesses (β=0.308, p=0.002 and β=0.332, p=0.001; respectively). Conclusion: Increased macular RNFL thickness in patients with PDR which was statistically significant may be associated with retinal inflammation induced by retinal ischemia. Additionally, a correlation between increased macular RNFL thickness and visual acuity loss was detected in diabetic patients.
Keywords: Diabetic retinopathy; ganglion cell layer; optical coherence tomography; retinal nerve fiber layer; Type 2 diabetes mellitus
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