Purpose

To evaluate the longitudinal changes of retinal neurodegeneration and choroidal thickness in diabetic patients with and without diabetic retinopathy (DR).

Design

Prospective observational cohort study.

Methods

This prospective observational cohort study recruited type 2 diabetic patients from a community registry in Guangzhou. All participants underwent annual ocular examinations via swept-source optical coherence tomography that obtained choroid thickness (CT), retinal thickness (RT), and ganglion cell–inner plexiform layer (GC-IPL) thickness. The changes in GC-IPL, CT, and RT between patients who developed incident DR (IDR) or remained non-DR (NDR) were compared during a 3-year follow-up.

Results

Among 924 patients, 159 (17.2%) patients developed IDR within the 3-year follow-up. A reduction in GC-IPL, RT, and CT was observed in NDR and IDR; however, CT thinning in patients with IDR was significantly accelerated, with an average CT reduction of −6.98 (95% CI: −8.26, −5.71) μm/y in patients with IDR and −3.98 (95% CI: −4.60, −3.36) μm/y in NDR patients (P < .001). Reductions in average GC-IPL thickness over 3 years were −0.97 (95% CI: −1.24, −0.70) μm/y in patients with IDR and −0.76 (95% CI: −0.82, −0.70) μm/y in NDR patients (P = .025). After adjusting for confounding factors, the average CT and GC-IPL thinning were significantly faster in patients with IDR compared with those who remained NDR by 2.09 μm/y (95% CI: 1.01, 3.16; P = .004) and −0.29 μm/y (95% CI: −0.49, −0.09; P = .004), respectively. The RT in the IDR group increased, whereas the RT in the NDR group decreased over time, with the adjusted difference of 2.09 μm/y (95% CI: 1.01, 3.16; P < .001) for central field RT.

Conclusions

The rate of retinal neurodegeneration and CT thinning were significantly different between the eyes that developed IDR and remained NDR during the 3-year follow-up, but both groups observed thickness reduction. This indicates that GC-IPL and CTs may decrease before the clinical manifestations of DR.

中文翻译：

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无视网膜病变的糖尿病患者的脉络膜和神经退行性变化率随时间变化：一项为期 3 年的前瞻性研究

目的

评估伴有和不伴有糖尿病视网膜病变 (DR) 的糖尿病患者视网膜神经变性和脉络膜厚度的纵向变化。

设计

前瞻性观察队列研究。

方法

这项前瞻性观察性队列研究从广州的一个社区登记处招募了 2 型糖尿病患者。所有参与者都通过扫描源光学相干断层扫描进行年度眼部检查，获得脉络膜厚度 (CT)、视网膜厚度 (RT) 和神经节细胞-内丛状层 (GC-IPL) 厚度。在 3 年的随访期间比较发生事件 DR (IDR) 或保持非 DR (NDR) 的患者之间 GC-IPL、CT 和 RT 的变化。

结果

在 924 名患者中，159 名 (17.2%) 患者在 3 年随访期间发生了 IDR。在 NDR 和 IDR 中观察到 GC-IPL、RT 和 CT 的减少；然而，IDR 患者的 CT 变薄明显加速，IDR 患者的平均 CT 减少 -6.98 (95% CI: -8.26, -5.71) μm/y 和 -3.98 (95% CI: -4.60, - NDR 患者为 3.36) μm/y ( P < .001)。IDR 患者 3 年内平均 GC-IPL 厚度减少为 -0.97（95% CI：-1.24，-0.70）μm/年，NDR 患者为 -0.76（95% CI：-0.82，-0.70）μm/年患者 ( P  = .025)。调整混杂因素后，与保持 NDR 的患者相比，IDR 患者的平均 CT 和 GC-IPL 变薄速度显着加快 2.09 μm/y（95% CI：1.01，3.16；P = .004) 和 −0.29 μm/y (95% CI: −0.49, −0.09; P  = .004)。随着时间的推移，IDR 组的 RT 增加，而 NDR 组的 RT 减少，中心区域 RT 的调整差异为 2.09 μm/y（95% CI：1.01，3.16；P < .001）。

结论

在 3 年的随访期间，发生 IDR 和保持 NDR 的眼睛之间的视网膜神经变性和 CT 变薄率有显着差异，但两组都观察到厚度减少。这表明 GC-IPL 和 CTs 可能在 DR 的临床表现之前降低。