Análise das alterações em coroide e retina em pacientes com diabetes mellitus tipo 2 e microalbuminúria utilizando tomografia de coerência óptica de domínio espectral

Objetivo: Avaliar as alterações na coroide e na retina em pacientes com diabetes mellitus tipo 2 (DM2) e microalbuminúria usando tomografia de coerência óptica de domínio espectral (SD-OCT). Métodos: Estudo transversal realizado com SD-OCT Spectralis (Heidelberg Engineering, Alemanha) em pacientes divididos em 3 grupos: pacientes com diabetes e microalbuminúria, pacientes com diabetes e excreção urinária normal de albumina, e controles saudáveis. As medidas da espessura das camadas da retina na grade do ETDRS com segmentação automática foram realizadas em um grupo de 60 pacientes. A espessura e o volume da coroide foram medidas na grade do ETDRS após segmentação manual em 10 localidades abaixo da mácula, nasal e temporalmente, em um grupo de 58 pacientes. Resultados: A espessura macular média da camada de células ganglionares apresentou um significativo afinamento localizado nos pacientes com microalbuminúria. A excreção urinária de albumina foi o único fator relacionado com essa redução em uma análise de regressão linear múltipla. A espessura e o volume médios da coroide entre pacientes com diabetes e microalbuminúria estavam reduzidos em todas as localidades medidas quando comparados aos controles. Uma redução setorizada da espessura e do volume da coroide foi demonstrada entre os grupos com microalbuminúria e com excreção urinária normal de albumina. Conclusões: Houve uma perda seletiva das camadas da retina interna, e uma redução da espessura e do volume da coroide nos olhos com DM2 e microalbuminúria antes do aparecimento dos primeiros sinais clínicos da retinopatia diabética. A excreção urinária de albumina foi o único fator associado de maneira independente com o afinamento das camadas internas da retina.Purpose: To evaluate choroidal and retinal changes in patients with type 2 diabetes and microalbuminuria using spectral-domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was performed using the SD-OCT Spectralis (Heidelberg Engineering, Germany) in patients divided in three groups: diabetic patients with microalbuminuria, diabetic patients with normal urinary albumin excretion, and controls. Retinal thickness was evaluated by ETDRS grid automatic segmentation in 60 patients. Choroidal thickness and volume were mapped using the automated ETDRS grid with manual segmentation, and also measured at 10 locations under the macula, temporally and nasally, in 58 patients. Results: The average and sectoral macular thicknesses of the ganglion cell layer were significantly thinner in the microalbuminuria group. Urinary albumin excretion was the only factor related to this reduction in a multiple linear regression analysis. Mean choroidal thickness and volume among patients with diabetes and microalbuminuria were reduced in all locations compared to controls. A sectoral decrease of choroidal thickness and volume was shown between microalbuminuric and normoalbuminuric groups. Conclusions: A selective loss of inner retina and a reduction of the choroidal thickness and volume were present in type 2 diabetic patients before clinical development of retinopathy. Inner retinal thinning was independently associated with abnormal urinary albumin excretion

Changes in choroidal thickness and volume are related to urinary albumin excretion in type 2 diabetic patients without retinopathy

Purpose: To evaluate choroidal thickness and volume in patients with type 2 diabetes and microalbuminuria using spectral-domain optical coherence tomography. Methods: We recruited 37 diabetic patients without diabetic retinopathy (18 normoalbuminuric and 19 microalbuminuric) and 21 healthy controls. Choroidal thickness and volume were mapped using the automated Early Treatment Diabetic Retinopathy Study grid and a topographic map of thickness was generated manually. Choroid was also measured at 10 locations under the fovea, temporally and nasally. Results: Mean choroidal thickness and volume among patients with diabetes and microalbuminuria was reduced in all locations compared to controls (P,0.05). A sectoral decrease of choroidal thickness and volume was shown between microalbuminuric and normoalbuminuric groups. Conclusion: Choroidal changes were present in type 2 diabetic patients before clinical development of retinopathy. Microalbuminuria was associated with a decrease in choroidal thickness and volume in diabetic patients without diabetic retinopathy

Análise das alterações em coroide e retina em pacientes com diabetes mellitus tipo 2 e microalbuminúria utilizando tomografia de coerência óptica de domínio espectral

Objetivo: Avaliar as alterações na coroide e na retina em pacientes com diabetes mellitus tipo 2 (DM2) e microalbuminúria usando tomografia de coerência óptica de domínio espectral (SD-OCT). Métodos: Estudo transversal realizado com SD-OCT Spectralis (Heidelberg Engineering, Alemanha) em pacientes divididos em 3 grupos: pacientes com diabetes e microalbuminúria, pacientes com diabetes e excreção urinária normal de albumina, e controles saudáveis. As medidas da espessura das camadas da retina na grade do ETDRS com segmentação automática foram realizadas em um grupo de 60 pacientes. A espessura e o volume da coroide foram medidas na grade do ETDRS após segmentação manual em 10 localidades abaixo da mácula, nasal e temporalmente, em um grupo de 58 pacientes. Resultados: A espessura macular média da camada de células ganglionares apresentou um significativo afinamento localizado nos pacientes com microalbuminúria. A excreção urinária de albumina foi o único fator relacionado com essa redução em uma análise de regressão linear múltipla. A espessura e o volume médios da coroide entre pacientes com diabetes e microalbuminúria estavam reduzidos em todas as localidades medidas quando comparados aos controles. Uma redução setorizada da espessura e do volume da coroide foi demonstrada entre os grupos com microalbuminúria e com excreção urinária normal de albumina. Conclusões: Houve uma perda seletiva das camadas da retina interna, e uma redução da espessura e do volume da coroide nos olhos com DM2 e microalbuminúria antes do aparecimento dos primeiros sinais clínicos da retinopatia diabética. A excreção urinária de albumina foi o único fator associado de maneira independente com o afinamento das camadas internas da retina.Purpose: To evaluate choroidal and retinal changes in patients with type 2 diabetes and microalbuminuria using spectral-domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was performed using the SD-OCT Spectralis (Heidelberg Engineering, Germany) in patients divided in three groups: diabetic patients with microalbuminuria, diabetic patients with normal urinary albumin excretion, and controls. Retinal thickness was evaluated by ETDRS grid automatic segmentation in 60 patients. Choroidal thickness and volume were mapped using the automated ETDRS grid with manual segmentation, and also measured at 10 locations under the macula, temporally and nasally, in 58 patients. Results: The average and sectoral macular thicknesses of the ganglion cell layer were significantly thinner in the microalbuminuria group. Urinary albumin excretion was the only factor related to this reduction in a multiple linear regression analysis. Mean choroidal thickness and volume among patients with diabetes and microalbuminuria were reduced in all locations compared to controls. A sectoral decrease of choroidal thickness and volume was shown between microalbuminuric and normoalbuminuric groups. Conclusions: A selective loss of inner retina and a reduction of the choroidal thickness and volume were present in type 2 diabetic patients before clinical development of retinopathy. Inner retinal thinning was independently associated with abnormal urinary albumin excretion

Macular choroidal thickness in pregnant women with type 1, type 2 and gestational diabetes mellitus measured by spectral-domain optical coherence tomography

Purpose: To analyze choroidal thickness (CT) of pregnant women with type 1 diabetes mellitus (DM), type 2 DM and gestational diabetes mellitus (GDM) using spectral-domain optical coherence tomography. Patients and methods: This cross-sectional study included 144 eyes of 72 pregnant women in the third trimester divided into four groups: 27 non-diabetic pregnant women; 15 pregnant women with GDM; 16 with type 2 DM and 14 with type 1 DM. CT was measured using optical coherence tomography at ten different locations. We also analyzed possible confounding factors, such as gestational age, glycosylated hemoglobin, time from DM diagnosis, hypertension and severity of diabetic retinopathy. Results: The comparison between the four groups showed a thinner choroid in patients with type 1 DM in all locations, with statistical significance in subfoveal and temporal measurements. When comparing only patients with type 1 and type 2 DM, adjusting for confounding factors, the choroid of patients with type 1 DM remained thinner at all macular points, also with statistical significance in subfoveal and temporal measurements. Conclusion: Pregnant women with type 1 DM had significantly thinner CT measurements on subfoveal and temporal locations. No differences were found in CT between the control group and pregnant women with GDM and type 2 DM

Comparative analysis of choroidal thickness in third trimester pregnant women

Background: The impact of pregnancy on the choroid is still under investigation. The aim of this study is to compare choroidal thickness measurements of healthy pregnant women in the third trimester and healthy non-pregnant women using spectral-domain optical coherence tomography (OCT). Methods: This cross-sectional study included 122 eyes of 61 women, divided into two groups: 27 healthy pregnant women in the third trimester and 34 age-matched healthy non-pregnant women. Choroidal thickness was measured using Enhanced Depth Imaging OCT at ten different locations: at the fovea and every 500 μm from the fovea up to 2500 μm temporally and up to 2000 μm nasally. Results: There were no significant differences in the ten measurements of choroidal thickness comparing both groups. Mean subfoveal choroidal thickness was 304.1 + 9.6 μm in the control group and 318.1 + 15.6 μm in the pregnant women group (p = 0.446). There was also no statistically significant association between gestational age and choroidal thickness measurements in the healthy pregnant women group. Conclusions: Our study showed no statistically difference in choroidal thickness between healthy non-pregnant women and healthy pregnant women in the third trimester