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Decrease in Inner Retinal Thickness at Para- and Perifoveal Areas Before Vascular Retinopathy in Patients with Metabolic Risk Factors

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Decrease in Inner Retinal Thickness at Para- and Perifoveal Areas Before Vascular Retinopathy in Patients with Metabolic Risk Factors View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Taiwan Journal of Ophthalmology 3 (2013) 108e115 Contents lists available at SciVerse ScienceDirect Taiwan Journal of Ophthalmology journal homepage: www.e-tjo.com Original article Decrease in inner retinal thickness at para- and perifoveal areas before vascular retinopathy in patients with metabolic risk factors Ko-Jo Lin a, Mei-Xue Loi a, Shao-Yu Lei a, Chao-Chun Shiau a, Chien-Liang Wu a,b,*, Jennifer Hui-Chun Ho a,b,c,* a Department of Ophthalmology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan b Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan c Center for Stem Cell Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan article info abstract Article history: Background: Hypertension, dyslipidemia, and hyperglycemia are major risk factors for vascular reti- Received 1 April 2013 nopathy. The relationship between retinal thickness at the macular area and metabolic risk factors, as Received in revised form well as visual impairment, in elderly patients before developing vascular occlusion needs to be 13 May 2013 investigated. Accepted 22 May 2013 Methods: In this prospective, case-control study, patients >60 years old, without objective visual Available online 12 July 2013 threatened ocular diseases or systemic abnormalities, except for hypertension, dyslipidemia or/and hy- perglycemia, were included for measurement of retinal thickness at the macular area by optical coher- Keywords: inner retina ence tomography (OCT). macular thickness Results: Fifty-four patients were analyzed; 11 patients had no metabolic risk factors, 16 had one, 17 had metabolic risk factors two, and 10 had three. There was no significant difference in age, and full and outer retinal thickness, but parafovea there was a significantly lower inner retinal thickness at the parafoveal (p ¼ 0.0013) and perifoveal perifovea (p ¼ 0.018) areas in patients with at least one metabolic risk factor. The superior (p ¼ 0.040) and inferior (p ¼ 0.046) inner retina at the perifovea and superior (p ¼ 0.013) inner retinal thickness at the parafovea were sensitive to metabolic abnormalities. Only patients with three factors had significantly reduced best corrected visual acuity (BCVA). Conclusion: Elderly patients with metabolic risk factors had decreased inner retinal thickness at the para- and perifoveal areas before retinal vascular diseases. Accelerated inner retinal degeneration occurred prior to visual impairment. Copyright Ó 2013, The Ophthalmologic Society of Taiwan. Published by Elsevier Taiwan LLC. All rights reserved. 1. Introduction visual disturbance. Hypertension, dyslipidemia, and hyperglyce- mia, are the most common risk factors for retinal vascular dis- e Metabolic syndrome is a constellation of abnormalities in eases.8 10 Moreover, more metabolic risks are associated with the metabolic homeostasis, including glucose intolerance, insulin higher incidence of diabetic complications,11 and diabetic patients e resistance, dyslipidemia, central obesity, and hypertension.1 3 The with concomitant metabolic syndrome suffer from a higher prev- worldwide increased prevalence of metabolic syndrome contrib- alence of macro- and microvascular diseases, including retinop- uting to the mortality of cardiovascular diseases, has been a athy.11,12 The above findings implicated the possible role of e major public health problem.4 7 It is known that retinal vascular metabolic risks in visual outcome. diseases, such as retinal artery occlusion, retinal vein occlusion, Diabetes- or retinal vascular occlusion-related macular edema diabetic retinopathy with vascular leakage, hemorrhage or neo- leads to severe visual disturbance,13,14 and optical coherence to- vascularization, attack visual acuity complicated with irreversible mography (OCT) provides a noninvasive approach to accurately measure retinal thickness at macular areas.15,16 Increase in macular thickness due to macular edema diagnosed by OCT has been widely * Corresponding authors. Department of Ophthalmology, Wan Fang Hospital, used in clinical ophthalmology.17,18 However, only a handful of in- Taipei Medical University, 111, Section 3, Hsing-Long Road, Taipei 116, Taiwan. E-mail addresses: [email protected] (C.-L. Wu), [email protected] vestigations of the macular thickness in diabetic or vascular reti- 19e22 (J.H.-C. Ho). nopathy without macular edema have been reported. In 2211-5056/$ e see front matter Copyright Ó 2013, The Ophthalmologic Society of Taiwan. Published by Elsevier Taiwan LLC. All rights reserved. http://dx.doi.org/10.1016/j.tjo.2013.05.006 K.-J. Lin et al. / Taiwan Journal of Ophthalmology 3 (2013) 108e115 109 animal experiments, neuroglial tissue loss could be observed before Wan Fang Hospital, were included for the measurement of macular any sign of vasculopathy at the early stage of diabetic retinop- thickness by OCT and complete ophthalmic evaluation, including e athy.19 21 It has been reported that a significant decrease in peri- BCVA measurement by an auto Ref/Keratometer (Nidek ARK-710A; central retinal thickness could be detected by OCT in patients of Nidek Co. Ltd, Gamagori-shi, Aichi, Japan), pneumotonometer type 1 diabetes mellitus with early diabetic retinopathy,22 indi- measurement of intraocular pressure (Nidek NT-2000, Nidek Co. cating that progressive loss of thickness at the macular area Ltd), corneal, anterior segment and lens evaluation under slit lamp occurred before advanced retinopathy induced by hyperglycemia. microscopy (Nidek SL-1600, Nidek Co. Ltd), and vitreous and eye In fact, the relationship among retinal thickness, visual acuity ground examination under pupil dilation by indirect microscopy and metabolic risk factors has not been clearly established. The (Welch Allyn 12500; Welch Allyn Inc., Skaneateles Falls, NY, USA). purpose of this study is to investigate the effect of hypertension, The metabolic risk factors were confirmed by three independent dyslipidemia and hyperglycemia on macular thickness in elderly blood pressure measurements (Omron HEM-1000, Omron, Taipei, patients without retinal vascular diseases. In this study, patients Taiwan), blood tests, including fasting blood sugar (Beckman were divided into four groups according to their cumulative Coulter, Inc., Brea, CA, USA), glycated hemoglobin (Tosoh, Tokyo, metabolic risks. Full, inner and outer retinal thickness at the central Japan), triglyceride, total cholesterol, low-density lipoprotein and foveal, parafoveal and perifoveal areas, respectively, were high-density lipoprotein (Beckman Coulter) within 6 months. measured by OCT. Best corrected visual acuity (BCVA) in each group Among these patients, anyone who suffered from a visual threat- was also analyzed. ened ocular disease, such as opaque cornea and vitreous, glaucoma, cataract (nuclear color > grade 2 according to the lens opacities 2. Methods classification system III23 or any grade of cortical cataract and posterior subcapsular cataract), uveitis, or any kind of choroidop- 2.1. Inclusion and exclusion criteria athy, retinopathy (including diabetic retinopathy, age-related macular degeneration, myopic retinopathy), retinal vascular oc- An Institutional Review Board approval from Wan Fang Hospital, clusion, retinal hemorrhage, vascular leakage, neovascularization, Taipei Medical University was obtained prior to the commence- optic neuropathy, as well as abnormality detectable on OCT, such as ment of this study. Patients >60 years old, with or without meta- macular/retinal edema, cystic lesion, neovascular lesions, and bolic risk factors (hypertension, dyslipidemia, or hyperglycemia), macular hole, were excluded. Furthermore, patients with a history from the outpatient clinic of the department of ophthalmology at of any kind of acute visual loss, or with a systemic abnormality Fig. 1. Illustration of retinal thickness measurement. The full sensory retina was divided into the outer retina and inner retina. Retinal thickness at the macular area was divided into the fovea (0e1 mm diameter from central fovea), parafovea (1e3 mm diameter from central fovea), and perifovea (3e5 mm diameter from central fovea). The superior and inferior hemispheres were divided by the horizontal line crossing the central fovea, while the nasal and temporal hemispheres were divided by the vertical line crossing the central fovea. 110 K.-J. Lin et al. / Taiwan Journal of Ophthalmology 3 (2013) 108e115 Table 1 2.3. Definition of metabolic risks The definition of metabolic risk factors in our study. Risk factor (IDFa 2005) Hypertension, hyperglycemia and dyslipidemia were identified fi Dyslipidemia Raised triglycerides 150 mg/dL (1.7 mmol/L) or specific on the basis of the new de nition of International Diabetes Feder- 2 treatment for this lipid abnormality ation (IDF) in 2005, which is summarized in Table 1. In this study, Reduced HDLb <40 mg/dL (1.03 mmol/L) in males patients were divided into four groups according to the number of cholesterol <50 mg/dL (1.29 mmol/L) in females metabolic risk factors (0, 1, 2 and 3). Patients with no metabolic risk fi or speci c treatment for this lipid factor (0) served as controls. abnormality Hypertension Systolic BPc 130 or diastolic BP 85 mmHg or treatment of 2.4. Statistical analyses previously diagnosed hypertension Statistical analysis was performed using the Statistical Package d Hyperglycemia FPG 100 mg/dL (5.6 mmol/L), or previously diagnosed
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