Retinal microvascular parameters are not associated with diabetes in the Northern Ireland Cohort for the Longitudinal Study of Ageing.

BACKGROUND: The retinal microvasculature offers unique non-invasive evaluation of systemic microvascular abnormalities. Previous studies reported associations between retinal microvascular parameters (RMPs) and diabetes. The aim of this study was to assess associations between RMPs and diabetes in a cross-sectional analysis of older persons from the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA). METHODS: RMPs (central retinal arteriolar/venular equivalents, arteriolar to venular ratio, fractal dimension, and tortuosity) were measured from optic disc-centred fundus images using semi-automated software. Associations were assessed between RMPs and diabetes status with adjustment for potential confounders. RESULTS: Data were included for 1762 participants with 209 classified as having diabetes. Participants had a mean age of 62.1 ± 8.5 years, and 54% were female. As expected, participants with diabetes had significantly higher mean glycated haemoglobin A1c compared to participants without diabetes (57.4 ± 17.6 mmol/mol versus 37.0 ± 4.2 mmol/mol, respectively). In unadjusted and minimally adjusted regression, arteriolar to venular ratio, arteriolar tortuosity and venular tortuosity were significantly associated with diabetes (minimally adjusted odds ratio [OR] = 0.85; 95% confidence intervals [CIs] 0.73, 0.99; P = 0.04, OR = 1.18; 95% CI 1.02, 1.37; P = 0.03 and OR = 1.20; 95% CI 1.04, 1.38; P = 0.01, respectively), although all failed to remain significant following adjustment for potential confounders. No additional associations between other RMPs and diabetes were detected. CONCLUSION: Despite previously reported associations between diabetes and RMPs, our study failed to corroborate these associations in an older community-based cohort.

Evaluation of long-term intravitreal anti-vascular endothelial growth factor injections on renal function in patients with and without diabetic kidney disease.

BACKGROUND: Administering anti-vascular endothelial growth factor (anti-VEGF) by intraocular injection has been shown to have a safe systemic profile. Nevertheless, incidents of acute kidney injury following anti-VEGF injection have been reported. We assessed the long-term effect of multiple intravitreal anti-VEGF injections on measures of renal function in patients with diabetes including rate of change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR). METHODS: A retrospective review of patients receiving diabetic macular oedema (DMO) treatment was undertaken. Serum creatinine, ACR, number of intravitreal anti-VEGF injections and clinical characteristics were collected from electronic healthcare records (EHR). A co-efficient of eGFR and ACR change with time was calculated over a mean duration of 2.6 years. Regression modelling was used to assess variation in the number of anti-VEGF injections and change in eGFR and ACR. RESULTS: The EHR of 85 patients with DMO (59% male, 78% type 2 diabetes mellitus [T2DM]) were reviewed. On average, 26.8 intravitreal anti-VEGF injections were given per patient over a mean duration of 31 months. No association between increasing number of anti-VEGF injections and rate of eGFR decline (beta = 0.04, 95% confidence intervals [CI]: - 0.02, 0.09; p = 0.22) or ACR change over time (beta = 0.02, CI: - 0.19, 0.23; p = 0.86) was detected, following adjustment for hypertension, cerebrovascular disease, T2DM, and medications taken. CONCLUSION: Our data suggests regular long-term intravitreal VEGF inhibition does not significantly alter the rate of change in eGFR and/or ACR with increasing number of treatment injections.