Abstract
Amaç:
İnsülin rezistansı tanısı ile takip edilen prediabetik bireylerde retina sinir
lifi kalınlığının (RSLK) ölçümü ve sağlıklı kontrollerle karşılaştırılması.
Gereç-Yöntem: En
iyi düzeltilmiş görme keskinliği, göz içi basıncı, ön segment ve fundus
muayenelerini içeren tam oftalmolojik inceleme yapıldı. RSLK spectral-domain
optik koherans tomografi (OKT) ile ölçüldü. Açlık plazma glikoz ve insülin
seviyeleri not edildi ve insülin rezistans indexi (HOMA-IR) değeri hesaplandı.
Bulgular:
İnsülin rezistansı tespit edilen 37 birey ile 41 sağlıklı kontrol çalışmaya
dahil edildi. Yaş ortalaması insülin rezistansı ve kontrol grubunda sırasıyla
35,7±9,8 ve 34,9±10,7 yıl idi. İnsülin rezistansı olan grupta ortalama
(95,03±11,38 µm vs 99,2±19,73 µm),
inferior (119,11±18,27 µm vs 127,5±21,03
µm) ve temporal (72,13±12,52 µm vs
79,2±15,97 µm) kadranlarda RSLK değeri kontrol grubuna göre istatistiksel
olarak anlamlı derecede ince tespit edildi (p<0,05).
Superior (121,01±9 µm vs 123,9±01
µm) ve nazal (72,03±13,65 µm vs
74,52±10,52 µm) kadranlarda anlamlı bir değişiklik saptanmadı (p˃0,05).
Sonuç:
Prediabetik hastalarda klinik olarak herhangi bir bulgu vermese de retina sinir
lifi tabakasında nörodejenerasyon insülin rezistansı evresinde
başlayabilmektedir. OKT prediabetik bireylerde erken retinal nörodejenerasyon
tanısı ve takibi için uygun bir araçtır.
References
- 1. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414:813-820.
- 2. Barber AJ, Baccouche B. Neurodegeneration in diabetic retinopathy: Potential for novel therapies. Vision Res. 2017;139:82-92.
- 3. Barber AJ, Gardner TW, Abcouwer SF. The significance of vascular and neural apoptosis to the pathology of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2011;28;52(2):1156-1163.
- 4. Zhu T, Ma J, Li Y, et al. Association between retinal neuronal degeneration and visual function impairment in type 2 diabetic patients without diabetic retinopathy. Sci China Life Sci. 2015;58(6):550-555.
- 5. Tavares Ferreira J, Alves M, Dias-Santos A, et al. Retinal Neurodegeneration in Diabetic Patients Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 2016;1;57(14):6455-6460
- 6. van Dijk HW, Kok PH, Garvin M, et al. Selective loss of inner retinal layer thickness in type 1 diabetic patients with minimal diabetic retinopathy. Invest Ophthalmol Vis Sci. 2009;50(7):3404-3409.
- 7. Dada T. Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4? J Curr Glaucoma Pract. 2017;11(3):77-79.
- 8. Chaturvedi N, Sjoelie AK, Porta M, et al. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. Diabetes Care. 2001;24(2):284-289.
- 9. Weyer C, Bogardus C, Mott DM, et al. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999;104(6):787-794.
- 10. Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci. 2018;11;12:930.
- 11. Karaca C, Karaca Z. Beyond Hyperglycemia, Evidence for Retinal Neurodegeneration in Metabolic Syndrome. Invest Ophthalmol Vis Sci. 2018;1;59(3):1360-1367.
- 12. Arikan S, Ersan I, Eroglu M, et al. Does Retinal Neurodegeneration Seen in Diabetic Patients Begin in the Insulin Resistance Stage? Turk J Ophthalmol. 2016;46(6):264-269.
- 13. Kim K, Kim ES, Rhee SY, et al. Clinical characteristics and risk factors for retinal diabetic neurodegeneration in type 2 diabetes. Acta Diabetol. 2017;54(11):993-999.
- 14. Simo R, Hernandez C. Neurodegeneration in the diabetic eye: new insights and therapeutic perspectives. Trends Endocrinol Metab. 2014;25(1):23-33.
- 15. Pierro L, Iuliano L, Cicinelli MV, Casalino G, Bandello F. Retinal neurovascular changes appear earlier in type 2 diabetic patients. Eur J Ophthalmol. 2017;11;27(3):346-351.
- 16. Toprak I, Yildirim C, Yaylali V. Impaired photoreceptor inner segment ellipsoid layer reflectivity in mild diabetic retinopathy. Can J Ophthalmol. 2015;50(6):438-441.
- 17. Ng DS, Chiang PP, Tan G, et al. Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy. Clin Exp Ophthalmol. 2016;44(4):243-250.
- 18. Schubert M, Gautam D, Surjo D, et al. Role for neuronal insulin resistance in neurodegenerative diseases. Proc Natl Acad Sci U S A. 2004;2;101(9):3100-3105.
- 19. Tumminia A, Vinciguerra F, Parisi M, et al. Type 2 Diabetes Mellitus and Alzheimer's Disease: Role of Insulin Signalling and Therapeutic Implications. Int J Mol Sci. 2018;24;19(11). pii: E3306.
- 20. Kumar P, Raman T, Swain MM, et al. Hyperglycemia-Induced Oxidative-Nitrosative Stress Induces Inflammation and Neurodegeneration via Augmented Tuberous Sclerosis Complex-2 (TSC-2) Activation in Neuronal Cells. Mol Neurobiol. 2017;54(1):238-254.
- 21. Diehl T, Mullins R, Kapogiannis D. Insulin resistance in Alzheimer's disease. Transl Res. 2017;183:26-40.
Abstract
Purpose: To measure the retinal nerve fiber layer
thickness (RNFLT) in prediabetic subjects who were diagnosed with insulin
resistance and to compare with healthy controls.
Materials
and methods: Each
subject was underwent a standard ophthalmological examination including measurement
of best corrected visual acuity and intraocular pressure, anterior segment
biomicroscopy and funduscopy. Average and four quadrant (superior, temporal,
inferior, nasal) RNFLT measurements were performed using spectral domain
optical coherence tomography (OCT). Plasma fasting insulin and glucose levels
were noted and homeostasis model assessment of insulin resistance index
(HOMA-IR) was calculated.
Results: A
total of 37 patients with insulin resistance and 41 healthy controls were
included in the study. Mean age of the insulin resistant group and healthy
controls were 35.7±9.8 and 34.9±10.7 years, respectively. The average (95.03±11.38 µm vs 99.2±19.73 µm), inferior (119.11±18.27 µm vs 127.5±21.03 µm) and temporal (72.13±12.52 µm vs 79.2±15.97 µm) quadrant
RNFL were significantly thinner in subjects with insulin resistance as compared
with healthy controls (p<0.05). No significant difference was observed
between the groups in the superior (121.01±9 µm vs 123.9±01 µm) and nasal (72.03±13.65 µm vs 74.52±10.52 µm) quadrants (p˃0.05).
Conclusion: Neurodegeneration
of the retina which is seen in diabetic patients may begin in the insulin
resistance stage. OCT is a useful tool both in the early diagnosis and
follow-up of retinal neurodegeneration.
References
- 1. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414:813-820.
- 2. Barber AJ, Baccouche B. Neurodegeneration in diabetic retinopathy: Potential for novel therapies. Vision Res. 2017;139:82-92.
- 3. Barber AJ, Gardner TW, Abcouwer SF. The significance of vascular and neural apoptosis to the pathology of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2011;28;52(2):1156-1163.
- 4. Zhu T, Ma J, Li Y, et al. Association between retinal neuronal degeneration and visual function impairment in type 2 diabetic patients without diabetic retinopathy. Sci China Life Sci. 2015;58(6):550-555.
- 5. Tavares Ferreira J, Alves M, Dias-Santos A, et al. Retinal Neurodegeneration in Diabetic Patients Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 2016;1;57(14):6455-6460
- 6. van Dijk HW, Kok PH, Garvin M, et al. Selective loss of inner retinal layer thickness in type 1 diabetic patients with minimal diabetic retinopathy. Invest Ophthalmol Vis Sci. 2009;50(7):3404-3409.
- 7. Dada T. Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4? J Curr Glaucoma Pract. 2017;11(3):77-79.
- 8. Chaturvedi N, Sjoelie AK, Porta M, et al. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. Diabetes Care. 2001;24(2):284-289.
- 9. Weyer C, Bogardus C, Mott DM, et al. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999;104(6):787-794.
- 10. Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci. 2018;11;12:930.
- 11. Karaca C, Karaca Z. Beyond Hyperglycemia, Evidence for Retinal Neurodegeneration in Metabolic Syndrome. Invest Ophthalmol Vis Sci. 2018;1;59(3):1360-1367.
- 12. Arikan S, Ersan I, Eroglu M, et al. Does Retinal Neurodegeneration Seen in Diabetic Patients Begin in the Insulin Resistance Stage? Turk J Ophthalmol. 2016;46(6):264-269.
- 13. Kim K, Kim ES, Rhee SY, et al. Clinical characteristics and risk factors for retinal diabetic neurodegeneration in type 2 diabetes. Acta Diabetol. 2017;54(11):993-999.
- 14. Simo R, Hernandez C. Neurodegeneration in the diabetic eye: new insights and therapeutic perspectives. Trends Endocrinol Metab. 2014;25(1):23-33.
- 15. Pierro L, Iuliano L, Cicinelli MV, Casalino G, Bandello F. Retinal neurovascular changes appear earlier in type 2 diabetic patients. Eur J Ophthalmol. 2017;11;27(3):346-351.
- 16. Toprak I, Yildirim C, Yaylali V. Impaired photoreceptor inner segment ellipsoid layer reflectivity in mild diabetic retinopathy. Can J Ophthalmol. 2015;50(6):438-441.
- 17. Ng DS, Chiang PP, Tan G, et al. Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy. Clin Exp Ophthalmol. 2016;44(4):243-250.
- 18. Schubert M, Gautam D, Surjo D, et al. Role for neuronal insulin resistance in neurodegenerative diseases. Proc Natl Acad Sci U S A. 2004;2;101(9):3100-3105.
- 19. Tumminia A, Vinciguerra F, Parisi M, et al. Type 2 Diabetes Mellitus and Alzheimer's Disease: Role of Insulin Signalling and Therapeutic Implications. Int J Mol Sci. 2018;24;19(11). pii: E3306.
- 20. Kumar P, Raman T, Swain MM, et al. Hyperglycemia-Induced Oxidative-Nitrosative Stress Induces Inflammation and Neurodegeneration via Augmented Tuberous Sclerosis Complex-2 (TSC-2) Activation in Neuronal Cells. Mol Neurobiol. 2017;54(1):238-254.
- 21. Diehl T, Mullins R, Kapogiannis D. Insulin resistance in Alzheimer's disease. Transl Res. 2017;183:26-40.
Details
| Primary Language | English |
|---|---|
| Subjects | Ophthalmology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 30, 2019 |
| Submission Date | March 25, 2019 |
| Acceptance Date | August 6, 2019 |
| Published in Issue | Year 2019 Volume: 12 Issue: 3 |
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