Quantitatively Evaluating the Relationships between Insulin Resistance and Retinal Neurodegeneration with Optical Coherence Tomography in Early Type 2 Diabetes Mellitus.

INTRODUCTION: The aim of this study was to quantitatively assess retinal neurodegenerative changes with optical coherence tomography (Cirrus HD-OCT) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) and evaluate their relationships with insulin resistance (IR) and associated systemic indicators. METHODS: 102 T2DM patients without DR and 48 healthy controls were included in this observational cross-sectional study. The OCT parameters of macular retinal thickness (MRT) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were evaluated between diabetic and normal eyes. The receiver operating characteristics (ROC) curve was generated to evaluate the discrimination power of early diabetes. Correlation and multiple regression analysis were performed between ophthalmological parameters and T2DM-related demographic and anthropometric variables, and serum biomarkers and homeostasis model assessment of insulin resistance (HOMA-IR) scores. RESULTS: MRT and GCIPL thicknesses showed significant thinning in patients, especially in inferotemporal area. High body mass index (BMI) correlated with decreased GCIPL thicknesses and elevated intraocular pressure (IOP). A negative correlation between waist-to-hip circumference ratio (WHR) and GCIPL thicknesses was also found. High-density lipoprotein (HDL) and fasting C-peptide (CP0) were associated with GCIPL thickness but only in inferotemporal region (r = 0.20, p = 0.04; r = -0.20, p = 0.05, respectively). Multiple regression analysis showed that increased HOMA-IR scores independently predicted both average (ß = -0.30, p = 0.05) and inferotemporal (ß = -0.34, p = 0.03) GCIPL thinning. CONCLUSION: Retinal thinning in early T2DM was associated with obesity-related metabolic disorders. IR as an independent risk factor for retinal neurodegeneration may increase the risk of developing glaucoma.

Correlation analysis of retinal nerve fiber layer and macular retinal thickness in children with anisometropic amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes and correlation of retinal nerve fiber layer(RNFL)and macular retinal thickness in children with anisometropic amblyopia.METHODS: A total of 159 cases(159 eyes)children with anisometropic amblyopia treated in our ophthalmology department from October 2020 to June 2021 were selected as the study group, and 159 cases(159 eyes)children with normal vision who examined in the ophthalmology department of our hospital in the same period and age group were selected as the control group. The study group received traditional comprehensive training combined with 4D visual training for amblyopia based on refractive correction and covering of healthy eyes. The RNFL and macular retinal thickness before and after treatment between the study group and the control group was compared, and the correlation between RNFL and macular retinal thickness before treatment in the study group was analyzed.RESULTS: The RNFL thickness of average, upper, lower, nasal and temporal in the study group before and after 3mo of treatment was higher than those of the control group, and the RNFL thickness of average, upper, lower, nasal and temporal before treatment in the study group was higher than those after 3mo of treatment(P<0.05). The average, inferior, nasal, temporal, nasal, and central retinal thickness of the outer ring of the macular area in the study group before treatment were higher than those in the same group after 3mo of treatment and the control group(P<0.05). Before treatment, there was a negative correlation between the thickness of the upper RNFL in the study group and the retinal thickness in the central macular area(r=-0.330, P<0.05), the thickness of the lower and nasal RNFL was positively correlated with the thickness of the temporal retina in the outer and inner rings of the macular area(all P<0.05), while the thickness of temporal RNFL was negatively correlated with the thickness of the nasal and temporal retina outside the macular area(r=-0.414, -0.462, all P<0.05).CONCLUSION: The changes in RNFL and macular retinal thickness in children with anisometropic amblyopia can hinder normal retinal development, and there is a certain correlation between RNFL and macular retinal thickness.

Changes in retinal nerve fiber layer and macular retinal thickness and predictive value of outcome in children with abnormal refractive amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes in retinal nerve fiber layer(RNFL)and macular retinal thickness(MRT)in children with refractive abnormalities and amblyopia, and their predictive value of outcome.METHODS: A total of 168 children with myopic refractive abnormalities and monocular amblyopia admitted to our hospital from January 2020 to October 2022 were selected as the observation group, with 118 cases of mild to moderate amblyopia and 50 cases of severe amblyopia, and 168 children with normal vision were included as the control group in a 1:1 ratio during the same period. The changes of RNFL and MRT in two groups of children were statistically counted, and the correlation between the severity of refractive abnormalities and RNFL and MRT in children with amblyopia was analyzed. Additionally, the observation group was divided into effective subgroup and ineffective subgroup based on the therapeutic effect. The general information, as well as RNFL and MRT of the effective subgroup and the ineffective subgroups before and after treatment were compared. Logistic was used to analyze the factors influencing efficacy, and ROC curves was plotted to analyze the predictive value of RNFL and MRT alone or in combination for efficacy.RESULTS: RNFL and MRT of cases of severe amblyopia were higher than those of the mild to moderate amblyopia and the control groups(all P<0.05); the severity of amblyopia in children with refractive abnormalities is positively correlated with RNFL and MRT(rs=0.745 and0.724, both P<0.001); among patients of mild to moderate and severe, there were statistically significant differences between the effective and ineffective subgroups in terms of initial treatment age, fixation form, treatment compliance, as well as RNFL, MRT, and their differences before and 1mo postoperatively(all P<0.05). Logistic analysis showed that initial treatment age, fixation nature, treatment compliance, RNFL and MRT before and 1mo postoperatively were all factors influencing the therapeutic effect of amblyopia with refractive abnormalities in children(all P<0.05); after 1mo of treatment, the combined prediction of RNFL and MRT was significantly better than that of single prediction in children with mild to severe amblyopia.CONCLUSION:There are differences in RNFL and MRT in children with abnormal refractive amblyopia, and they are closely related to the different degrees and curative effects of children. The combination of RNFL and MRT after 1mo of treatment has certain value in predicting children with different degrees of abnormal refractive amblyopia.

Research progress on related factors of occult myopia / 国际眼科杂志(Guoji Yanke Zazhi)

Occult myopia refers to a special type of myopia, which is caused by the axial length beyond the normal range of children's normal age, and the corneal curvature is lower than the normal range of children with the normal age range of the vision. Because the vision of occult myopia children is within the normal range, it is easy to be ignored in myopia screening. Without timely myopia prevention and control, occult myopia is very easy to develop into dominant myopia, not only the visual development is seriously affected, but visual function will also produce irreversible changes. It is found that the axial length, corneal curvature, retina and chorioid of occult myopia are different from those of ordinary myopia. The change of these indicators can be used to assist the diagnosis and observe their development process. The purpose of this paper is to summarize the research progress at home and abroad on ocular axis length, corneal curvature, macular retinal thickness, macular choroidal thickness and other related factors in children with occult myopia, in order to provide references for related clinical research.

Macular Variability in Children and Adolescents with Metabolic Syndrome: A Cross-sectional Study Examining the Associations with Anthropometric Measurements, Metabolic Parameters and Inflammatory Markers

Objective: Macular damage may be observed in obesity and metabolic syndrome (MetS), a condition which leads to chronic subclinical inflammation and affects most organ systems. To investigate the association between macular variability and anthropometric measurements, metabolic parameters, and inflammatory markers in children and adolescents with MetS. Methods: Two hundred and twenty eyes of 62 obese and 48 healthy children and adolescents were examined. Bilateral macular retinal thickness (MRT) and macular retinal volume (MRV) were measured in all subjects using optical coherence tomography. Associations between mean MRT and mean MRV and age, auxological measurements including body mass index standard deviation scores (BMI-SDS) and waist circumference-SDS (WC-SDS), metabolic parameters and inflammatory parameters including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio and systemic immune-inflammatory index (SIII) were investigated. Results: No statistically significant difference was observed between the groups in terms of age or sex distribution (p>0.05). Mean MRT (r=-0.326, p=0.007) and MRV (r=-0.303, p=0.007) values in the obese group with MetS decreased as homeostasis model assessment-insulin resistance (HOMA-IR) values increased. SIII values were higher in obese groups, but particularly in obese subject with MetS, compared to the control group (p=0.021). The decrease in mean MRT (r=-0.544, p=0.046) and MRV (r=-0.651, p=0.031) in the obese subjects with MetS was negatively correlated with NLR. Mean MRT and MRV decreased in all obese subjects as SIII increased (p<0.05). Conclusion: This is the first study to show that mean MRT and MRV values decrease as BMI-SDS, WC-SDS and HOMA-IR increase in obese children and adolescents with MetS. NLR and SIII may serve as markers of chronic inflammation in obese children with MetS associated with macular damage.

A study of retinal thickness in macular region of diabetic patients without obvious visual impairment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the difference of macular retinal thickness between diabetic patients without apparent visual loss and normal subjects.<p>METHODS: Totally 40 cases(79 eyes)with type 2 diabetes without significant decrease of visual acuity(best corrected visual acuity, BCVA ≥0.8)in our hospital from April, 2018 to June, 2019 were enrolled as observation group and 64 cases(119 eyes)normal persons were enrolled as control group. The average retinal thickness in nine areas of macula, central retinal thickness(CRT), average retinal thickness(ART)and total volume(TV)of all patients were determined by optical coherence tomography(OCT), and the difference of average retinal thickness in nine areas of macula, CRT, ART and TV among them were compared.<p>RESULTS: The CRT, ART and TV(193.99±14.58μm, 291.07±12.24μm, 8.22±0.35mm3)in the observation group were significantly higher than those in the control group(187.38±12.24μm, 280.54±8.71μm, 7.92±0.25mm3), and the average retinal thickness in nine areas of macula in the observation group was significantly higher than that in the control group(<i>P</i><0.05).<p>CONCLUSION: Compared with normal persons, macular retinal thickness and TV are significantly thickened in early stage of type 2 diabetes.

Macular retinal thickness and flow density change by optical coherence tomography angiography after posterior scleral reinforcement.

Optical coherence tomography angiography (Angio-OCT) has introduced a new non-invasive, quantitative method to assess superficial and deep capillary networks of the retina. In this study, we investigated macular retinal thickness and flow density change following posterior scleral reinforcement (PSR) surgery, using an RTVue XR Avanti Angio-OCT (A2016.2.0.35, Optovue, Fremont, CA), in patients with pathological myopia. A total of 13 patients with pathological myopia were recruited and all patients completed the 6 months follow-up visit. Data from 22 eyes were used in this study. The mean age was 36.23±15.29 years, and 43% (n=6) were men. Spherical equivalent refractive error (SE) ranged from -8.0 to -24.0 D. Post-operative axial length, best-corrected visual acuity and SE did not change significantly at each follow-up, compared with preoperative measure (all P>0.05). Postoperative flow density of superficial and deep retinal layers at each sector did not change significantly at each follow-up, compared to pre-operative measure (all P>0.05). However, we found significant decrease in retinal thickness of parafovea-inferior sector after PSR surgery (P<0.01), indicating potential relaxation of vitreofoveal traction after PSR surgery.

Clinical observation of corneal plastic mirror in the treatment of adolescent myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical effect and safety of orthokeratology for minor to moderate myopia in adolescents.<p>METHODS:Sixty-three adolescent patients with mild to moderate myopia were selected in our hospital from January 2016 to January 2018. Visual acuity, corneal curvature, central corneal thickness, diopter, macular retinal thickness, axial length, intraocular pressure, tear film rupture time, corneal staining and complications were observed before and after wearing glasses for 1wk, 1, 6mo and 1a respectively.<p>RESULTS: There were significant differences in naked vision, diopter, corneal curvature and tear film rupture time before and after wearing glasses in this group(<i>P</i><0.001). And there were no differences in axial length, central corneal thickness, macular retinal thickness and intraocular pressure(<i>P</i>>0.05).<p>CONCLUSION: Corneal plastic lens is a safe and effective non-surgical method for myopia correction in adolescents at the stage of growth and development.

Macular Thickness in Moderate to Severe Amblyopia.

PURPOSE: To compare the macular retinal thickness of moderately to severely amblyopic eyes with non-amblyopic eyes as controls. METHODS: This case control study was conducted on 56 children aged 4 to 10 years old (64.3% female subjects). Twenty-eight children had unilateral amblyopia (28 amblyopic eyes as cases and 28 normal fellow eyes as internal controls) and 28 children had normal visual acuity in both eyes and were considered as external controls (n = 56 eyes). Among our cases, 14 had strabismic amblyopia and 14 had anisometropic amblyopia. Macular retinal thickness was measured using optical coherence tomography at the center and in 1-, 3-, and 6-mm rings. RESULTS: Best-corrected visual acuity of the amblyopic eyes was less than that of the internal and external controls, and the best-corrected visual acuity of their fellow eyes was also less than that of the external controls. Thickness of the central macula and a 1-mm ring area in the amblyopic eyes was higher than that of both internal and external controls. Difference of central macular thickness ≥20 µm between two eyes of the amblyopic children was significantly more than non-amblyopic subjects. CONCLUSIONS: Based on the results of this study, the macular retinal thickness was significantly higher in moderate to severe amblyopic eyes compared to their fellow eyes and external controls. This might be due to macular developmental disorders in amblyopic eyes. Therefore, optical coherence tomography imaging is recommended if subtle macular abnormalities are suspected in moderate to severe amblyopic eyes.

Macular Thickness in Moderate to Severe Amblyopia

PURPOSE: To compare the macular retinal thickness of moderately to severely amblyopic eyes with non-amblyopic eyes as controls. METHODS: This case control study was conducted on 56 children aged 4 to 10 years old (64.3% female subjects). Twenty-eight children had unilateral amblyopia (28 amblyopic eyes as cases and 28 normal fellow eyes as internal controls) and 28 children had normal visual acuity in both eyes and were considered as external controls (n = 56 eyes). Among our cases, 14 had strabismic amblyopia and 14 had anisometropic amblyopia. Macular retinal thickness was measured using optical coherence tomography at the center and in 1-, 3-, and 6-mm rings. RESULTS: Best-corrected visual acuity of the amblyopic eyes was less than that of the internal and external controls, and the best-corrected visual acuity of their fellow eyes was also less than that of the external controls. Thickness of the central macula and a 1-mm ring area in the amblyopic eyes was higher than that of both internal and external controls. Difference of central macular thickness ≥20 µm between two eyes of the amblyopic children was significantly more than non-amblyopic subjects. CONCLUSIONS: Based on the results of this study, the macular retinal thickness was significantly higher in moderate to severe amblyopic eyes compared to their fellow eyes and external controls. This might be due to macular developmental disorders in amblyopic eyes. Therefore, optical coherence tomography imaging is recommended if subtle macular abnormalities are suspected in moderate to severe amblyopic eyes.

Application of optical coherence tomography in the laser treatment for diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the application of optical coherence tomography(OCT)in the laser treatment for diabetic macular edema.<p>METHODS: This was a retrospective case study. We reviewed 188 patients(376 eyes)with diabetic macular edema(DME)treating by simple grid pattern laser photocoagulation in Haigang Hospital from January 2015 to June 2016. We measured retinal thickness of macular area within 6 mm scope by OCT at 1mo after laser treatment, analyzed the data using SPSS19.0 statistical software.<p>RESULTS: At 1mo after laser treatment, average macular retinal thickness with macular center fovea to 1mm at diameter, 1mm to 3mm, 3mm to 6mm is respectively 332.02±18.07, 393.40±19.71, 372.00±20.01μm. The average macular retinal thickness is respectively 404.70±16.37, 445.17±18.25, 410.87±18.14μm before treatment. Compared with before treatment, the difference is statistically significant(<i>P</i>< 0.05). The thickness change with macular center fovea to 1mm, 1mm to 3mm, 3mm to 6mm is respectively 72.68±14.74, 51.77±9.48, 38.87±17.94μm, the difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION: Macular area retinal thickness is reduced at 1mo after simple grid pattern laser photocoagulation, the effect is more obvious when closer to macular center fovea.

Quantitative analysis of macular retinal thickness and macular volume in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To evaluate and characterize the macular thickness and macular volume in patients of different stages of diabetic retinopathy with special - domain optical coherence tomography( SD-OCT) .·METHODS: Totally 40 patients ( 78 eyes ) with diabetic retinopathy were recruited in the study from January 2016 to January 2017 in our hospital. According to the international clinical classification of diabetic retinopathy, 20 cases (40 eyes) were categorized as non-proliferative diabetic retinopathy ( NPDR ) group and 20 cases proliferative diabetic retinopathy (PDR) group (38 eyes). All subjects were examined and analyzed with Early Treatment Diabetic Retinopathy Study ( ETDRS ) subfields, which were embedded in HS ( Haag-Streit ) with diameter of 1, 3 and 6mm. The changes of retinal thickness and volume of the macular center were measured.·RESULTS: The thickness of macular foveolar in NPDR group and PDR group were 252. 57 ± 31. 36μm, 362. 47 ± 20. 81μm. The retinal thickness of inner superior subfield (ISM) and inner nasal subfield(INM) were the thickest;that of inner inferior subfield ( IIM ) was next to ISM and INM, and that of inner temporal subfield was the thinnest. Of the outer subfields, the retinal thickness of outer superior subfield ( OSM ) was the thickest;that of outer nasal subfield( ONM) was next to OSM, and that of outer temporal subfield(OTM)and outer inferior subfield ( OIM ) was the thinnest. The value of macular central concave thickness and retinal thickness in each quadrant of the NPDR group were less than those of the PDR group, the difference was statistically significant ( P <0. 05). The volume (V) of macular center in NPDR group and PDR group were 0. 20±0. 02mm3, 0. 28±0. 16mm3, the upper and nasal sides of the middle part of the partition were the largest, the inferior and the temporal side were the smallest. The nasal side of the outer loop was the largest, the upper was the second, the temporal side and the inferior were the smallest. The volume of macular central fovea and the retinal volume in each quadrant of the NPDR group were smaller than those of the PDR group, the difference was statistically significant (P<0. 05).·CONCLUSION: The changes of retinal thickness and volume in macular central fovea were related with the progression of diabetic retinopathy. Using OCT to analyze the macular thickness and macular volume in different stages of diabetic retinopathy, helps physicians to understand the morphological changes of macular region and its surrounding macular degeneration with the severity of diabetic retinopathy, and provide a basis for better analysis of the changes of the structure of macular in different severity diabetic retinopathy.

A study on change of macular retinal thickness and its relationship with vision before and after operation to idiopathic macular epiretinal membranes.

OBJECTIVE: To evaluate the change of macular retinal thickness and vision before and after 23G minimally invasive vitrectomy to idiopathic macular epiretinal membranes. METHODS: Clinical data of 40 patients who were confirmed as idiopathic epiretinal membrane and accept vitrectomy combined with internal limiting membrane peeling was retrospectively analyzed. In regular follow-up before and after operation, OCT (optical coherence tomography) inspection was conducted for the best corrected visual acuity, intraocular pressure, eye-ground photography, and fundus oculi. In addition, the follow eye which has no relevant ophthalmological disease was treated as the control group. RESULTS: The vision greatly improves after operation, and the thickness in central fovea of macula significantly decreases. Postoperative vision shows obvious linear correlation with postoperative thickness in central fovea of macula. The thickness in division 9 of macula sharply decreases after operation, while the retina in central macula and nasal sides significantly thickens compared with normal group. CONCLUSION: Internal limiting membrane peeling can enhance the vision of patients and improve macula morphology, while the status in central macula and nasal side has not completely recovered.

A comparison between amblyopic and fellow eyes in unilateral amblyopia using spectral-domain optical coherence tomography.

PURPOSE: To compare the macular retinal thickness and characteristics of optic nerve head (ONH) parameters in amblyopic and fellow eyes in patients with unilateral amblyopia. PATIENTS AND METHODS: A total of 21 patients with unilateral amblyopia (14 patients with anisometropic amblyopia, four patients with strabismic amblyopia, and three patients with both) were examined using spectral-domain optical coherence tomography. The mean age of the patients was 8.5±3.5 years. The examined parameters included the mean macular (full, inner, and outer), ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) thicknesses, and ONH parameters (rim volume, nerve head volume, cup volume, rim area, optic disc area, cup area, and cup-to-disc area ratio). RESULTS: The amblyopic eyes were significantly more hyperopic than the fellow eyes (P<0.001). Among the macular retinal thickness parameters, the cpRNFL thickness (P<0.01), macular full retinal thickness (3 mm region) (P<0.01), and macular outer retinal thickness (1 and 3 mm regions) (P<0.05) were significantly thicker in the amblyopic eyes than in the fellow eyes, while the ganglion cell complex thickness, macular full retinal thickness (1 mm region), and macular inner retinal thickness (1 and 3 mm regions) were not significantly different. Among the ONH parameters, the rim area was significantly larger and the cup-to-disc area ratio was smaller in the amblyopic eyes than in the fellow eyes (P<0.05). None of the other ONH parameters were significantly different between the investigated eyes. The differences in the cpRNFL thickness and macular outer retinal thickness in the 1 mm region were significantly correlated with the difference in axial length (P<0.05, r=-0.48; P<0.01, r=-0.59, respectively) and refractive error (P<0.05, r=0.50; P<0.01, r=0.60, respectively). The other parameters were not significantly related to the difference in axial length, refractive error, or best corrected visual acuity. CONCLUSION: We found significant differences in some of the morphological measurements between amblyopic and fellow eyes that appear to be independent of abnormalities in the visual cortex.