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비증식당뇨망막병증을 가진 제2형 당뇨환자에서 망막 각 층의 두께 변화

Changes of the Individual Retinal Layer Thickness in Non-proliferative Diabetic Retinopathy in Type 2 Diabetes

정일원|최창욱|양연식|김상엽
대한안과학회 (The Korean Ophthalmological Society)|2017.12|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제58권 제12호|pp. 1376-1387

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키워드

Diabetic retinopathyOptical coherence tomographyGanglion cell layerInner plexiform layerInner retinal layer
주제분류안과학

초록

목적: 제2형 당뇨병을 가진 비증식당뇨망막병증 환자에서 빛간섭단층촬영을 이용한 망막 각 층의 두께 변화를 비교하고자 하였다. 대상과 방법: 2015년 1월부터 2016년 7월까지 정상군 39안, 비증식당뇨망막병증이 없는 당뇨군 38안, 비증식당뇨망막병증군 31안으로 총 108안을 대상으로 빛간섭단층촬영을 이용한 망막 각 층의 두께를 후향적으로 비교하였다. 각 층은 망막신경섬유층, 신경절세포층, 내망상층, 내핵층, 외망상층, 외핵층, 망막색소상피, 내망막층, 외망막층, 전체망막층으로 총 10개의 층을 대상으로 하였다. 중심와로부터 1-3 mm 직경 사이의 상측, 하측, 비측, 이측 4개의 구역을 대상으로 각 층을 비교하였다. 결과: 망막신경섬유층은 상측 구역에서만 비증식당뇨망막병증군이 정상군에 비해 두께가 얇았으며 이는 통계적으로 유의하였다(p=0.016). 신경절세포층과 내망상층, 내망막층은 모든 구역에서 정상군, 당뇨망막병증이 없는 당뇨군, 비증식당뇨망막병증군 순으로 두께가 감소하는 경향을 보였으며 모든 구역에서 정상군과 비증식당뇨망막병증군 사이의 통계학적 유의성이 관찰되었다. 또한 신경절세포층과 내망상층, 내망막층의 상측 구역에서 정상군과 당뇨망막병증이 없는 당뇨군 간의 두께에 의미 있는 차이를 보였다(p=0.026, 0.003, 0.003). 내핵층과 외망상층과 외핵층의 합, 망막색소상피층, 외망막층의 두께는 세 군 간에 통계학적으로 유의미한 변화를 보이지 않았다. 또한 내망막층에 나타난 두께 감소 차이가 전체망막층의 두께 감소와 거의 일치하였다. 결론: 결론적으로 미세혈관 손상이 나타나기 전 초기 제2형 당뇨에서 망막신경섬유층, 신경절세포층, 내망상층을 포함한 내망막층의 망막신경변성을 확인할 수 있었다. 당뇨 초기 때부터 철저한 혈당 조절에 대한 교육이 필요하며 망막 신경변성을 늦출 수 있는 다른 치료법에 대해 더 많은 연구가 필요할 것으로 사료된다. 또한 빛간섭단층촬영이 초기 당뇨망막병증을 진단하는 데 도움을 주고 추적관찰하는 도구로서 역할을 할 것으로 생각된다.

Abstract

Purpose: To compare retinal layer thickness in non-proliferative diabetic retinopathy in type 2 diabetic patients as measured by optical coherence tomography. Methods: A total of 108 eyes from 71 patients, between January 2015 and July 2016, were included in this study. Of these, 39 eyes were included in the control group, 38 eyes in the diabetic group without non-proliferative diabetic retinopathy, and 31 eyes in the non-proliferative diabetic retinopathy group (NPDR). We measured the thickness of each retinal layer by optical coherence tomography (OCT). A total of ten layers were evaluated including the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retinal layer (IRL), outer retinal layer (ORL), and the total retinal layer (TRL). We compared the superior, inferior, nasal, and temporal regions at 1-3mm from the central fovea. Results: RNFL was thinner in the superior region of the NPDR, as compared with that of the control group, showing statistical significance (p = 0.016). The thickness of all regions in the GCL, IPL, and IRL were decreased in NPDR, as compared to the control group with statistical significance. In addition, the thickness of the superior region in the GCL, IPL, and IRL showed statistically significant differences between controls and the no diabetic retinopathy (DR) group (p = 0.026, 0.003, 0.003). The thickness of the INL, OPL plus ONL, RPE, and ORL in all three groups showed no significant difference. The differences in the decreased thickness in the IRL were similar to that of TRL. Conclusions: Retinal neurodegeneration was observed in the IRL, which included changes to the RNFL, GCL, and IPL in early type 2 diabetes before microvascular injury was apparent. Thorough control of blood glucose is required in early diabetes, and further studies to delay retinal neurodegeneration are required. OCT might have an important role in early diagnosis and follow up of diabetic retinopathy.

참고문헌 (49)

  1. Group ETDRSR, "Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10", Ophthalmology, 98(5 Suppl), pp.786~806 (1991)
  2. Cogan DG, "Retinal vascular patterns. IV. Diabetic retinopathy", Arch Ophthalmol, 66, pp.366~378 (1961)
  3. Gastinger MJ, "Loss of cholinergic and dopaminergic amacrine cells in streptozotocin-diabetic rat and Ins2Akitadiabetic mouse retinas", Invest Ophthalmol Vis Sci, 47, pp.3143~3150 (2006)
  4. Ly A, "Early inner retinal astrocyte dysfunction during diabetes and development of hypoxia, retinal stress, and neuronal functional loss", Invest Ophthalmol Vis Sci, 52, pp.9316~9326 (2011)
  5. Barber AJ, "The significance of vascular and neural apoptosis to the pathology of diabetic retinopathy", Invest Ophthalmol Vis Sci, 52, pp.1156~1163 (2011)
  6. Fletcher EL, "Dysfunction of retinal neurons and glia during diabetes", Clin Exp Optom, 88, pp.132~145 (2005)
  7. Villarroel M, "Neurodegeneration:an early event of diabetic retinopathy", World J Diabetes, 1, pp.57~64 (2010)
  8. Chhablani J, "Retinal ganglion cells thinning in eyes with nonproliferative idiopathic macular telangiectasia type 2A", Invest Ophthalmol Vis Sci, 56, pp.1416~1422 (2015)
  9. Araie M, "Relationship between macular inner retinal layer thickness and corresponding retinal sensitivity in normal eyes inner retinal layer thickness effect on sensitivity", Invest Ophthalmol Vis Sci, 55, pp.7199~7205 (2014)
  10. Sabater AL, "Evaluation of macular retinal ganglion cell-inner plexiform layer thickness after vitrectomy with internal limiting membrane peeling for idiopathic macular holes", Biomed Res Int, 2014, pp.458631~ (2014)
  11. Yang JY, "Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008–2009 Korea National Health and Nutrition Examination Survey", Diabetes Res Clin Pract, 102, pp.218~224 (2013)
  12. Park CY, "Prevalence of and risk factors for diabetic retinopathy in Koreans with type II diabetes: baseline characteristics of Seoul Metropolitan City-Diabetes Prevention Program (SMC-DPP) participants", Br J Ophthalmol, 96, pp.151~155 (2012)
  13. Qin Y, "Dendritic abnormalities in retinal ganglion cells of three-month diabetic rats", Curr Eye Res, 31, pp.967~974 (2006)
  14. Kadłubowska J, "Neurodegeneration and neuroinflammation in diabetic retinopathy: potential approaches to delay neuronal loss", Curr Neuropharmacol, 14, pp.831~839 (2016)
  15. van Dijk HW, "Association of visual function and ganglion cell layer thickness in patients with diabetes mellitus type 1 and no or minimal diabetic retinopathy", Vision Res, 51, pp.224~228 (2011)
  16. Vujosevic S, "Aqueous humor biomarkers of Müller cell activation in diabetic eyesMüller cell activation in diabetics", Invest Ophthalmol Vis Sci, 56, pp.3913~3918 (2015)
  17. Matteucci A, "Neuroprotection by rat Müller glia against high glucose-induced neurodegeneration through a mechanism involving ERK1", 2 activation, 2014, pp.125, 20~29
  18. Faghihi H, "Agreement of two different spectral domain optical coherence tomography instruments for retinal nerve fiber layer measurements", J Ophthalmic Vis Res, 9, pp.31~37 (2014)
  19. Liu X, "Repeatability and reproducibility of eight macular intra-retinal layer thicknesses determined by an automated segmentation algorithm using two SD-OCT instruments", PLoS One, 9, pp.e87996~ (2014)
  20. Lee HJ, "Ganglion cell–inner plexiform layer thickness in retinal diseases: Repeatability study of spectral-domain optical coherence tomography", Am J Ophthalmol, 160, pp.283~289 (2015)
  21. Chen Y, "Diabetic macular morphology changes may occur in the early stage of diabetes", BMC Ophthalmol, 16, pp.12~ (2016)
  22. Appukuttan B, "Normative spectral domain optical coherence tomography data on macular and retinal nerve fiber layer thickness in Indians", Indian J Ophthalmol, 62, pp.316~321 (2014)
  23. 강재훈, "OCT를 이용하여 측정한 정상인의 나이에 따른 황반두께의 변화", 대한안과학회지, 45(4), pp.10~10 (2004), 대한안과학회
  24. 김청환, "스펙트럼 영역 빛간섭단층촬영을 이용한 한국인의 연령과 성별에 따른 황반부 층별 두께 연구", 대한안과학회지, 57(2), pp.264~275 (2016), 대한안과학회
  25. Jonas JB, "Parapapillary retinal vessel diameter in normal and glaucoma eyes. II. Correlations", Invest Ophthalmol Vis Sci, 30, pp.1604~1611 (1989)
  26. Kern TS, "Vascular lesions in diabetes are distributed non-uniformly within the retina", Exp Eye Res, 60, pp.545~549 (1995)
  27. Anand-Apte B, "Developmental anatomy of the retinal and choroidal vasculature", pp.9~15 (2010), Elsevier Ltd.
  28. Savastano MC, "In vivo characterization of retinal vascularization morphology using optical coherence tomography angiography", Retina, 35, pp.2196~2203 (2015)
  29. Couturier A, "Capillary plexus anomalies in diabetic retinopathy on optical coherence tomography angiography", Retina, 35, pp.2384~2391 (2015)
  30. Talisa E, "Detection of microvascular changes in eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography", Retina, 35, pp.2364~2370 (2015)
  31. Garcia-Ramírez M, "Interphotoreceptor retinoid-binding protein (IRBP) is downregulated at early stages of diabetic retinopathy", Diabetologia, 52, pp.2633~2641 (2009)
  32. Valverde AM, "Proapoptotic and survival signaling in the neuroretina at early stages of diabetic retinopathy", Mol Vis, 19, pp.47~53 (2013)
  33. Simó R, "Ocular anti-VEGF therapy for diabetic retinopathy: the role of VEGF in the pathogenesis of diabetic retinopathy", Diabetes Care, 37, pp.893~899 (2014)
  34. Kern TS, "Retinal ganglion cells in diabetes", J Physiol, 586, pp.4401~4408 (2008)
  35. Padhy D, "Macular ganglion cell", inner plexiform layer measurements by spectral domain optical coherence tomography for detection of early glaucoma and comparison to retinal nerve fiber layer measurements, 2014, pp.158, 211~
  36. Abu El-Asrar AM, "Expression of antiapoptotic and proapoptotic molecules in diabetic retinas", Eye (Lond), 21, pp.238~245 (2007)
  37. Abu-El-Asrar AM, "Expression of apoptosis markers in the retinas of human subjects with diabetes", Invest Ophthalmol Vis Sci, 45, pp.2760~2766 (2004)
  38. Carpineto P, "Neuroretinal alterations in the early stages of diabetic retinopathy in patients with type 2 diabetes mellitus", Eye (Lond), 30, pp.673~679 (2016)
  39. Barber AJ, "Insulin rescues retinal neurons from apoptosis by a phosphatidylinositol 3-kinase", Aktmediated mechanism that reduces the activation of caspase-3, 2001, pp.276, 32814~32821
  40. Fine BS, "Macular edema and cystoid macular edema", Am J Ophthalmol, 92, pp.466~481 (1981)
  41. Murakami T, "Optical coherence tomographic reflectivity of photoreceptors beneath cystoid spaces in diabetic macular edema", Invest Ophthalmol Vis Sci, 53, pp.1506~1511 (2012)
  42. Bandello F, "Retinal layer location of increased retinal thickness in eyes with subclinical and clinical macular edema in diabetes type 2", Ophthalmic Res, 54, pp.112~117 (2015)
  43. Picconi F, "Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability", Acta Diabetol, 54, pp.489~497 (2017)
  44. Matsumoto H, "Outer nuclear layer thickness at the fovea determines visual outcomes in resolved central serous chorioretinopathy", Am J Ophthalmol, 148, pp.105~110 (2009)
  45. Curcio CA, "Human chorioretinal layer thicknesses measured in macula-wide, high-resolution histologic sections", Invest Ophthalmol Vis Sci, 52, pp.3943~3954 (2011)
  46. Otani T, "Improved visualization of Henle fiber layer by changing the measurement beam angle on optical coherence tomography", Retina, 31, pp.497~501 (2011)
  47. Lujan BJ, "Revealing Henle's fiber layer using spectral domain optical coherence tomography", Invest Ophthalmol Vis Sci, 52, pp.1486~1492 (2011)
  48. Ouyang Y, "Different phenotypes of the appearance of the outer plexiform layer on optical coherence tomography", Graefes Arch Clin Exp Ophthalmol, 251, pp.2311~2317 (2013)
  49. Sohn EH, "Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus", Proc Nati Acad Sci U S A, 113, pp.E2655~E2664 (2016)

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