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Association between retinal nerve fiber layer, ganglion cell layer with inner plexiform layer and diabetic retinopathy in type 2 diabetes

PURPOSE. Aim of this study was to evaluate thickness of retinal nerve fibre layer (RNFL), ganglion cell and inner plexiform layer GCL/IPL) in patients without diabetic retinopathy and mild diabetic retinopathy, which are markers of retinal neurodegeneration, in type 2 diabetic patients using spectral domain optical coherence tomography. METHODS. This was a cross-sectional study including 50 eyes of 25 type 2 diabetic patients (15M/10F) with median age 64 year and median diabetes duration 13 years. Type 2 diabetes was defined according to the ADA classification, and hypertension according to the ESC/ESH classification. Ophthalmologic examination included binocular indirect slit lamp fundoscopy and color fundus photography of two fields (macular field, disc/nasal field) of both eyes according to the EURODIAB retinal photography methodology and optical coherence tomography (SDOCT) with evaluation of optic nerve head (ONH) parameters, thickness of retinal nerve fiber layer (RNFL) macular thickness parameters, ganglion cell and inner plexiform layer (GCL/IPL). Patients with proliferative DR and diabetic macular edema were not included in the study. RESULTS. 50 eyes of 25 patients were divided into two groups: group 1 (no retinopathy ; n=16) and group 2 (nonproliferative DR ; n=34). There was no difference in age between groups. In group 2, there were more men compared to women than in group 1 (87.5% vs. 47.1%, p=0.016) Group 2 had longer diabetes duration (p=0.042), marginally more often hypertension (p=0.058) and significantly lower GCL (p=0.027) than group 1. No difference in RNFL was observed between groups. GCL was positively associated with RNFL (p<0.001), and negatively with diabetes duration (p=0.042) and DR (p=0.024). The best model for predicting GCL (R2=0.176) obtained from backward regression included age, gender and DR. CONCLUSIONS. There was a statistically significant reduction of GLC-IPL in patients with mild diabetic retinopathy, but no ifference in RNFL was observed between groups. Further study on a larger group of patients is needed for evaluating neurodegeneration of retina as marker of preclinical phase of diabetic retinopathy in type 2 diabetic patients.

retinopathy ; type 2 diabetes ; retinal nerve fiber

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