Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness?

Somilleda-Ventura, Selma A.; Blanco-Hernández, Dulce M. Razo; Ocampo-Moreno, Itzel; Lima-Gómez, Virgilio

doi:10.5935/0004-2749.20200048

Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Oftalmologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 83 (5) • Sep-Oct 2020 • https://doi.org/10.5935/0004-2749.20200048 copy

Ganglion cell layer thinning in diabetic patients without retinopathy: related or unrelated to total macular thickness?

Afinamento da camada de células ganglionares em pacientes diabéticos sem retinopatia: relacionados ou não à espessura macular total?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Reduction of ganglion cell layer thickness may occur in diabetic patients without retinopathy. The relationships of this preclinical finding with retinal thickness or reduced parafoveal vessel density have not been established. This study investigated the relationships of ganglion cell layer thickness with retinal thickness and parafoveal vessel density in patients with and without diabetes.

Methods:

This was an observational, cross-sectional, prospective study that used optical coherence tomography angiography to compare non-diabetic patients (group 1) with diabetic patients without retinopathy (group 2). Ganglion cell layer thickness, macular thickness, and parafoveal vessel density (central, inner, and complete) medians were compared between groups (Mann-Whitney U test), and their relationships were assessed in each group (Spearman Rho test).

Results:

In total, 68 eyes were included in this study: 34 in group 1 and 34 in group 2. Ganglion cell layer thickness did not differ between groups in any sector. There were strong positive correlations between fields 2 (superior parafoveal), 3 (temporal parafoveal), and 4 (inferior parafoveal) of the optical coherence tomography macular thickness map and the ganglion cell layer thickness in all sectors in both groups. Central vessel density mean was lower in diabetic patients. In group 1 alone, thickness changes in the inferior and nasal inferior ganglion cell layer sectors were partially explained by inner vessel density (r²=0.32 and r²=0.27).

Conclusions:

Mean ganglion cell layer thickness was not lower in diabetic patients without retinopathy than in non-diabetic patients. Moreover, it exhibited a substantial correlation with total macular thickness. Parafoveal vessel density decreased before ganglion cell layer thinning was observed.

Keywords:
Diabetes Mellitus; Retinal ganglion cells; Retinal vessels; Fluorescein angiography; Macula lutea; Tomography, optical coherence; Tonometry, ocular

Variable	Group 1 (n=34)	Group 2 (n=34)	p^* * Mann-Whitney U test
Superior (μm)	79.00, 6.75	82.00, 10.00	0.26
Superior temporal (μm)	79.00, 8.75	80.00, 5.25	0.96
Temporal inferior (μm)	79.00, 10.75	79.00, 8.00	0.90
Inferior (μm)	77.50, 13.50	79.00, 6.25	0.72
Nasal inferior (μm)	79.50, 12.75	81.50, 10.25	0.53
Nasal superior (μm)	80.00, 10.50	84.00, 9.75	0.23
Field 2 (μm)	320.50, 21.50	321.50, 25.75	0.06
Field 3 (μm)	308.00, 21.25	308.00, 25.50	0.43
Field 4 (μm)	317.00, 21.00	316.00, 27.75	0.38
Field 5 (μm)	321.50, 24.50	325.00, 22.50	0.001
RNFL	90.00, 15.25	94.00, 11.25	0.33
FAZ area	0.18, 0.14	0.27, 0.16	0.14
FAZ diameter	0.63, 0.29	0.72, 0.20	0.25
Central vessel density	11.10, 4.52	9.05, 3.73	0.02
Inner vessel density	20.60, 4.75	20.90, 1.40	0.52
Complete vessel density	19.50, 4.15	19.65, 1.35	0.36

Variable	S	TS	TI	I	NI	NS	Field 2	Field 3	Field 4	Field 5
Field 2	0.61^ p<0.01, Spearman Rsho Test.	0.68^ p<0.01, Spearman Rsho Test.	0.60^ p<0.01, Spearman Rsho Test.	0.47^ p<0.01, Spearman Rsho Test.	0.48^ p<0.01, Spearman Rsho Test.	0.57^ p<0.01, Spearman Rsho Test.	1	0.71^ p<0.01, Spearman Rsho Test.	0.63^ p<0.01, Spearman Rsho Test.	0.57^ p<0.01, Spearman Rsho Test.
Field 3	0.68^ p<0.01, Spearman Rsho Test.	0.69^ p<0.01, Spearman Rsho Test.	0.68^ p<0.01, Spearman Rsho Test.	0.58^ p<0.01, Spearman Rsho Test.	0.62^ p<0.01, Spearman Rsho Test.	0.60^* * p<0.05, Spearman Rho Test;	---	1	0.79^ p<0.01, Spearman Rsho Test.	0.02
Field 4	0.57^* * p<0.05, Spearman Rho Test;	0.50^* * p<0.05, Spearman Rho Test;	0.58^ p<0.01, Spearman Rsho Test.	0.47^* * p<0.05, Spearman Rho Test;	0.57^ p<0.01, Spearman Rsho Test.	0.54^* * p<0.05, Spearman Rho Test;	---	---	1	0.19
Field 5	0.09	0.19	0.12	0.02	0.01	0.10	---	---	---	1
S	1	0.80^ p<0.01, Spearman Rsho Test.	0.88^ p<0.01, Spearman Rsho Test.	0.85^ p<0.01, Spearman Rsho Test.	0.82^ p<0.01, Spearman Rsho Test.	0.90^ p<0.01, Spearman Rsho Test.	---	---	---	---
TS	---	1	0.78^ p<0.01, Spearman Rsho Test.	0.66^ p<0.01, Spearman Rsho Test.	0.66^ p<0.01, Spearman Rsho Test.	0.73^ p<0.01, Spearman Rsho Test.	---	---	---	---
TI	---	---	1	0.93^ p<0.01, Spearman Rsho Test.	0.81^ p<0.01, Spearman Rsho Test.	0.78^ p<0.01, Spearman Rsho Test.	---	---	---	---
I	---	---	---	1	0.87^ p<0.01, Spearman Rsho Test.	0.78^ p<0.01, Spearman Rsho Test.	---	---	---	---
NI	---	---	---	---	1	0.90^ p<0.01, Spearman Rsho Test.	---	---	---	---
NS	---	---	---	---	---	1	---	---	---	---

Variable	S	TS	TI	I	NI	NS	Field 2	Field 3	Field 4	Field 5
Field 2	0.65^ p<0.01, Spearman Rho Test.	0.77^ p<0.01, Spearman Rho Test.	0.72^ p<0.01, Spearman Rho Test.	0.67^ p<0.01, Spearman Rho Test.	0.67^ p<0.01, Spearman Rho Test.	0.63^ p<0.01, Spearman Rho Test.	1	0.96^ p<0.01, Spearman Rho Test.	0.93^ p<0.01, Spearman Rho Test.	0.97^ p<0.01, Spearman Rho Test.
Field 3	0.58^ p<0.01, Spearman Rho Test.	0.74^ p<0.01, Spearman Rho Test.	0.74^ p<0.01, Spearman Rho Test.	0.69^ p<0.01, Spearman Rho Test.	0.66^ p<0.01, Spearman Rho Test.	0.57^* * p<0.05, Spearman Rho Test;	---	1	0.96^ p<0.01, Spearman Rho Test.	0.94^ p<0.01, Spearman Rho Test.
Field 4	0.59^ p<0.01, Spearman Rho Test.	0.71^* * p<0.05, Spearman Rho Test;	0.77^ p<0.01, Spearman Rho Test.	0.77^* * p<0.05, Spearman Rho Test;	0.70^ p<0.01, Spearman Rho Test.	0.58^ p<0.01, Spearman Rho Test.	---	---	1	0.92^ p<0.01, Spearman Rho Test.
Field 5	0.65^ p<0.01, Spearman Rho Test.	0.71^* * p<0.05, Spearman Rho Test;	0.71^ p<0.01, Spearman Rho Test.	0.71^* * p<0.05, Spearman Rho Test;	0.68^ p<0.01, Spearman Rho Test.	0.63^ p<0.01, Spearman Rho Test.	---	---	---	1
S	1	0.83^ p<0.01, Spearman Rho Test.	0.81^ p<0.01, Spearman Rho Test.	079^ p<0.01, Spearman Rho Test.	0.80^ p<0.01, Spearman Rho Test.	0.94^ p<0.01, Spearman Rho Test.	---	---	---	---
TS	---	1	0.87^ p<0.01, Spearman Rho Test.	0.76^ p<0.01, Spearman Rho Test.	0.72^ p<0.01, Spearman Rho Test.	0.78^ p<0.01, Spearman Rho Test.	---	---	---	---
TI	---	---	1	0.88^ p<0.01, Spearman Rho Test.	0.80^ p<0.01, Spearman Rho Test.	0.81^ p<0.01, Spearman Rho Test.	---	---	---	---
I	---	---	---	1	0.92^ p<0.01, Spearman Rho Test.	0.84^ p<0.01, Spearman Rho Test.	---	---	---	---
NI	---	---	---	---	1	0.89^ p<0.01, Spearman Rho Test.	---	---	---	---
NS	---	---	---	---	---	1	---	---	---	---

Variable	S	TS	TI	I	NI	NS	Central VD	Inner VD	Complete VD	FAZ d
Central VD	0.17	0.18	0.09	0.02	0.01	0.11	1	0.37	0.50^* * p<0.05, Spearman Rho Test;	-0.68^ p<0.01, Spearman Rho Test.
Inner VD	0.53^* * p<0.05, Spearman Rho Test;	0.36	0.44^* * p<0.05, Spearman Rho Test;	0.60^ p<0.01, Spearman Rho Test.	0.58^ p<0.01, Spearman Rho Test.	0.49^* * p<0.05, Spearman Rho Test;	---	1	0.97^ p<0.01, Spearman Rho Test.	0.27
Complete VD	0.47^* * p<0.05, Spearman Rho Test;	0.31	0.40	0.53^* * p<0.05, Spearman Rho Test;	0.50^* * p<0.05, Spearman Rho Test;	0.44	---	---	1	0.17
FAZ d	0.011	0.009	0.16	0.28	0.27	0.12	---	---	---	1
S	1	0.80^ p<0.01, Spearman Rho Test.	0.88^ p<0.01, Spearman Rho Test.	0.85^ p<0.01, Spearman Rho Test.	0.82^ p<0.01, Spearman Rho Test.	0.90^ p<0.01, Spearman Rho Test.	---	---	---	---
TS	---	1	0.78^ p<0.01, Spearman Rho Test.	0.66^ p<0.01, Spearman Rho Test.	0.66^ p<0.01, Spearman Rho Test.	0.73^ p<0.01, Spearman Rho Test.	---	---	---	---
TI	---	---	1	0.93^ p<0.01, Spearman Rho Test.	0.81^ p<0.01, Spearman Rho Test.	0.78^ p<0.01, Spearman Rho Test.	---	---	---	---
I	---	---	---	1	0.87^ p<0.01, Spearman Rho Test.	0.78^ p<0.01, Spearman Rho Test.	---	---	---	---
NI	---	---	---	---	1	0.90^ p<0.01, Spearman Rho Test.	---	---	---	---
NS	---	---	---	---	---	1	---	---	---	---

Variable	S	TS	TI	I	NI	NS	Central VD	Inner VD	Complete VD	FAZ d
Central VD	-0.002	-0.20	-0.24	-0.17	-0.14	-0.13	1	0.57^ p<0.01, Spearman Rho Test.	0.71^ p<0.01, Spearman Rho Test.	-0.68^ p<0.01, Spearman Rho Test.
Inner VD	-0.05	-0.15	-0.03	-0.01	-0.02	-0.06	---	1	0.97^ p<0.01, Spearman Rho Test.	-0.42
Complete VD	-0.05	-0.21	-0.10	-0.06	-0.06	-0.08	---	---	1	-0.21
FAZ d	-0.12	-0.05	0.56^ p<0.01, Spearman Rho Test.	-0.10	-0.06	-0.003	---	---	---	1
S	1	0.77^ p<0.01, Spearman Rho Test.	0.85^ p<0.01, Spearman Rho Test.	0.83^ p<0.01, Spearman Rho Test.	0.92^ p<0.01, Spearman Rho Test.	0.91^ p<0.01, Spearman Rho Test.	---	---	---	---
TS	---	1	0.75^ p<0.01, Spearman Rho Test.	0.62^ p<0.01, Spearman Rho Test.	0.65^ p<0.01, Spearman Rho Test.	0.58^ p<0.01, Spearman Rho Test.	---	---	---	---
TI	---	---	1	0.90^ p<0.01, Spearman Rho Test.	0.85^ p<0.01, Spearman Rho Test.	0.70^ p<0.01, Spearman Rho Test.	---	---	---	---
I	---	---	---	1	0.89^ p<0.01, Spearman Rho Test.	0.71^ p<0.01, Spearman Rho Test.	---	---	---	---
NI	---	---	---	---	1	0.91^ p<0.01, Spearman Rho Test.	---	---	---	---
NS	---	---	---	---	---	1	---	---	---	---

Conselho Brasileiro de Oftalmologia Rua Casa do Ator, 1117 - cj.21, 04546-004 São Paulo SP Brazil, Tel: 55 11 - 3266-4000, Fax: 55 11- 3171-0953 - São Paulo - SP - Brazil
E-mail: abo@cbo.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Virgilio Lima Gómez. E-mail: forscher7@gmail.com