Retinal Nerve Fibre Layer Thinning is Independent of Deranged Serum Lipoprotein Levels in Diabetic Retinopathy
[1]
Khushboo Srivastav, Retina Service, Department of Ophthalmology, King George’s Medical University, Lucknow, India.
[2]
Sandeep Saxena, Retina Service, Department of Ophthalmology, King George’s Medical University, Lucknow, India.
[3]
Surabhi Ruia, Retina Service, Department of Ophthalmology, King George’s Medical University, Lucknow, India.
[4]
Abbas A. Mahdi, Department of Biochemistry, King George’s Medical University, Lucknow, India.
[5]
Vinay Khanna, Indian Institute of Toxicology and Research, Lucknow, India.
Purpose: To correlate retinal nerve fibre layer (RNFL) thinning on spectral domain optical coherence tomography (SD-OCT) with altered levels of serum lipoproteins in diabetic retinopathy. Methods: In a cross sectional observational study, 60 consecutive cases of type 2 diabetes mellitus between the age group of 40-65 years were included. Cases were divided into three groups according to ETDRS classification: diabetes without retinopathy (NO DR; n=20), non-proliferative diabetic retinopathy (NPDR; n=20), and proliferative diabetic retinopathy (PDR; n=20). Twenty healthy controls were included. Serum lipid profile was measured using standard protocol. Average RNFL thickness was measured using SD-OCT. Data was analyzed statistically. Results: Significant increase in serum cholesterol (p<0.001), triglycerides (p=0.001) and low density lipoprotein (p<0.001) was found between the study groups. Significant decrease in average RNFL thickness was also observed (p<0.001) between the study groups. However, no significant correlation was found between RNFL thinning and increase in serum levels of cholesterol (r= 0.09; p= 0.4), low density lipoprotein (r= 0.05; p= 0.6) and triglycerides (r= 0.00; p= 1.0). Conclusion: Increase in serum levels of lipoproteins is associated with progression of diabetic retinopathy, however, RNFL thinning occurs independent of deranged levels of lipoproteins. Serum lipoprotein levels cannot be considered as a surrogate marker for RNFL damage.
Retinopathy, Diabetes Mellitus, Lipid Profile, Retinal Nerve Fibre Layer, Dyslipidemia, Oxidized LDL, Lipoprotein
[1]
Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE: Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research And Clinical Practice 2014;103(2):137-149.
[2]
MeteaMR, Newman EA: Signalling within the neurovascular unit in the mammalian retina. Exp. Physiol 2007;92: 635–640.
[3]
Fletcher EL, Phipps JA, Ward MM, Puthussery T, Wilkinson-BerkaJL: Neuronal and glial cell abnormality as predictors of progression of diabetic retinopathy. Curr. Pharm. Des 2007;13:2699–2712.
[4]
MeteaMR, Newman EA: Signalling within the neurovascular unit in the mammalian retina. Exp. Physiol 2007;92:635–640.
[5]
Chakraborty A, Mondal PR, Kundu SC, Batabyal SK: Serum lipids and lipoproteins in diabetic retinopathy. J Assoc Physicians India 1986; 34:631–632.
[6]
Miccoli R, Odello G, Giampietro O, Marchetti P, Cristofani R, et al: Circulating lipid levels and severity of diabetic retinopathy in type I diabetes mellitus. Ophthalmic Res 1987;19:52–56.
[7]
KostrabaJN, Klein R, Dorman JS, Becker DJ, Drash AL, et al: The epidemiology of diabetes complications study. IV. Correlates of diabetic background and proliferative retinopathy. Am J Epidemiol 1991; 133:381–39.
[8]
Jeremy Y Yu and Timothy J Lyons: Modified Lipoproteins in Diabetic Retinopathy: A Local Action in the Retina. J ClinExpOphthalmol 2014; 4(6).
[9]
CorrêaZMS, Freitas AM, Marcon IM: Risk factors related to the severity of diabetic retinopathy. Arq Bras Oftalmol 2003;66:739-43.
[10]
Lyons TJ, Jenkins AJ, Zheng D, Lackland DT, McGee D, et al: Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort. Invest Ophthalmol Vis Sci 2004;45: 910-918.
[11]
Klein R, Sharrett AR, Klein BE, Moss SE, Folsom AR, et al: The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes : the atherosclerosis risk in communities study. Ophthalmology 2002;109: 225-1234.
[12]
Jain A, Saxena S, Ruia S, Srivastav K, Natu SM: Altered Lipid Profile is Associated with External Limiting Membrane and Inner Segment Ellipsoid Band Disruption in Type 2 Diabetes Mellitus: A Preliminary Study. Open Science Journal of Clinical Medicine 2015;3(2):37-41.
[13]
Chihara E, Matsuoka T, Ogura Y, Matsumura M: Retinal nerve fiber layer defect as an early manifestation of diabetic retinopathy. Ophthalmology 1993;100:1147-1151.
[14]
Lopes de FariaJM, Russ H, Costa VP. Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy. Br J Ophthalmol 2002;86:725-728.
[15]
Takahashi H, Goto T, Shoji T, Tanito M, Park M, et al: Diabetes-associated retinal nerve fiber damage evaluated with scanning laser polarimetry. Am J Ophthalmol 2006;142: 88-94.
[16]
Sugimoto M, Sasoh M, Ido M, Wakitani Y, Takahashi C, et al: Detection of early diabetic change with optical coherence tomography in type 2 diabetes mellitus patients without retinopathy. Ophthalmologica 2005;219: 379-385.
[17]
Verma A, Raman R, Vaitheeswaran K, Pal SS, Laxmi G, et al: Does neuronal damage precede vascular damage in subjects with type 2 diabetes mellitus and having no clinical diabetic retinopathy? Ophthalmic Res 2012;47: 202- 207.
[18]
MeteaMR, Newman EA: Signalling within the neurovascular unit in the mammalian retina. Exp. Physiol 2007;92:635–640.
[19]
Kern TS, Du Y, Miller CM, Hatala DA, Levin LA. Overexpression of Bcl-2 in vascular endothelium inhibits the microvascular lesions of diabetic retinopathy. Am. J. Pathol 2010;176:2550–2558.
[20]
Martin PM, Roon P, Van Ells TK, Ganapathy V, Smith SB: Death of retinal neurons in streptozotocin-induced diabetic mice. Invest. Ophthalmol. Vis. Sci. 2004;45:3330–3336.
[21]
Nor-Sharina Y, Zunaina E, Shatriah I, Win-Mar K, Azriani AR:Correlation of Retinal Nerve Fibre Layer Thickness with HbA1c and Oxidised LDL in Non-proliferative Diabetic Retinopathy. J Diabetes Metab 2013;4: 298.
[22]
Levitan I, Volkov S, Subbaiah PV: Oxidized LDL: diversity, patterns of recognition, and pathophysiology. Antioxid Redox Signal 2010;13:39–75.
[23]
Wu M, Chen Y, Wilson K, Chirindel A, Ihnat MA, et al: Intraretinal leakage and oxidation of LDL in diabetic retinopathy. Invest Ophthalmol Vis Sci 2008;49: 2679-2685.
[24]
Wu M, Chen Y, Wilson K, Chirindel A, Ihnat MA, et al. Intraretinal leakage and oxidation of LDL in diabetic retinopathy. Invest Ophthalmol Vis Sci. 2008; 49:2679–2685.
[25]
Hammes HP: Pericytes and the pathogenesis of diabetic retinopathy.HormMetab Res 2005;37: 39-43.
[26]
Garner A: Histopathology of diabetic retinopathy in man. Eye (Lond) 1993;7: 250-253.
[27]
Jeremy Y Yu and Timothy J Lyons: Modified Lipoproteins in Diabetic Retinopathy: A Local Action in the Retina. J ClinExpOphthalmo2013 ; 4(6).
[28]
ACCORD Study Group, ACCORD Eye Study Group. Chew EY, AmbrosiusWT, Davis MD, et al: Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 2010;363:233–244.
[29]
Keech A, Simes RJ, Barter P, Best J, Scott R, et al: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366:1849–1861.