OCULAR BLOOD FLOW IN PROLIFERATIVE DIABETIC RETINOPATHY PATIENT’S VS NON-PROLIFERATIVE DIABETIC RETINOPATHY- A COMPARISON STUDY.
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Keywords
Diabetic Retinopathy, Proliferative Diabetic Retinopathy, Non-Proliferative Diabetic Retinopathy, Ocular Blood Flow, Color Doppler Imaging
Abstract
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of vision impairment worldwide, characterized by changes in ocular blood flow that, progress from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR). In the field of ophthalmology, these hemodynamic changes are crucial for early diagnosis and therapeutic interventions. In this background, the present study aims to compare ocular blood flow parameters in patients with PDR and NPDR to identify significant differences that may contribute to disease progression.
METHODOLOGY: In the present study, we received ethical and scientific approval before commencing data collection. Patients visiting ophthalmology outpatient services were screened, and those meeting the inclusion criteria provided informed consent. This prospective study included three groups;10 patients with proliferative diabetic retinopathy (PDR), 10 with non-proliferative diabetic retinopathy (NPDR), and 10 healthy controls. Ocular blood flow velocities in the ophthalmic artery, short posterior ciliary artery, central retinal vessels, and vortex veins were measured, including systolic, end-diastolic, and mean arterial velocities. Each assessment was completed in a single session of 45–60 minutes, confirming strict confidentiality. This data was analyzed using the Statistical Package for Social Studies (SPSS).
RESULTS: In the study of ocular blood flow in diabetic retinopathy, participants with PDR had an average age of 53.27 ± 10.35 years, while those with NPDR averaged 55.18 ± 12.47 years. In the study of maximum diastolic blood flow velocity, patients with PDR exhibited significantly lower velocities compared to those with NPDR in several vessels.
CONCLUSION: Retinal blood flow is significantly altered in diabetic retinopathy, with PDR patients exhibiting reduced velocities in key ocular vessels compared to NPDR, representing impaired circulation. These findings highlighted the role of hemodynamic changes in the progression of diabetic retinopathy and suggest that assessing ocular blood flow may aid in early detection and targeted interventions to prevent vision loss in diabetic patients.
References
2) Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018 Jun 20;19(6):1816. PMID: 29925789; PMCID: PMC6032159. DOI: 10.3390/ijms19061816
3) Ueno Y, Iwase T, Goto K, Tomita R, Ra E, Yamamoto K, Terasaki H. Association of changes of retinal vessels diameter with ocular blood flow in eyes with diabetic retinopathy. Sci Rep. 2021 Feb 25;11(1):4653. PMID: 33633255; PMCID: PMC7907275. doi: 10.1038/s41598-021-84067-2.
4) Thomas RL, Halim S, Gurudas S, Sivaprasad S, Owens DR. IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018. Diabetes Res Clin Pract. 2019 Nov;157:107840. Epub 2019 Nov 14. PMID: 31733978. DOI: 10.1016/j.diabres.2019.107840
5) Raman R, Vasconcelos JC, Rajalakshmi R, Prevost AT, Ramasamy K, Mohan V, Mohan D, Rani PK, Conroy D, Das T, Sivaprasad S. Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban–rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. Lancet Glob Health. 2022;10(12):e1764-73. https://doi.org/10.1016/S2214-109X(22)00411-9.
6) Tilahun M, Gobena T, Dereje D, Welde M, Yideg G. Prevalence of Diabetic Retinopathy and Its Associated Factors among Diabetic Patients at Debre Markos Referral Hospital, Northwest Ethiopia, 2019: Hospital-Based Cross-Sectional Study. Diabetes Metab Syndr Obes. 2020 Jun 24;13:2179-2187. PMID: 32636659; PMCID: PMC7328291. https://doi.org/10.2147 /dmso.s260694.
7) Debele GR, Kanfe SG, Weldesenbet AB, Ayana GM, Jifar WW, Raru TB. Incidence of Diabetic Retinopathy and Its Predictors Among Newly Diagnosed Type 1 and Type 2 Diabetic Patients: A Retrospective Follow-up Study at Tertiary Health-care Setting of Ethiopia. Diabetes Metab Syndr Obes. 2021 Mar 22;14:1305-1313. PMID: 33790598; PMCID: PMC7997545. https://doi.org/10.2147/dmso.s300373.
8) Savage HI, Hendrix JW, Peterson DC, Young H, Wilkinson CP. Differences in pulsatile ocular blood flow among three classifications of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2004 Dec;45(12):4504-9. PMID: 15557461. DOI: 10.1167/iovs.04-0077.
9) Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. DOI: 10.1016/S0161-6420(03)00475-5.
10) Eisma JH, Dulle JE, Fort PE. Current knowledge on diabetic retinopathy from human donor tissues. World J Diabetes. 2015 Mar 15;6(2):312-20. PMID: 25789112; PMCID: PMC4360424. DOI: 10.4239/wjd.v6.i2.312
11) Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory. J Diabetes Res. 2016;2016:2156273. Epub 2016 Sep 28. PMID: 27761468; PMCID: PMC5059543. https://doi.org/10.1155/2016/2156273.
12) Nittala MG, Keane PA, Zhang K, Sadda SR. Risk factors for proliferative diabetic retinopathy in a Latino American population. Retina. 2014 Aug;34(8):1594-9. PMID: 24662751; PMCID: PMC4110161. https://doi.org/10.1097/iae.0000000000000117.
13) Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. Diabetic retinopathy: an update. Indian J Ophthalmol. 2008 May-Jun;56(3):178-88. PMID: 18417817; PMCID: PMC2636123. https://pmc.ncbi.nlm.nih.gov/articles/PMC2636123/pdf/IndianJOphthalmol-56-179.pdf.
14) Buus NH, Mathiassen ON, Fenger-Grøn M, Præstholm MN, Sihm I, Thybo NK, Schroeder AP, Thygesen K, Aalkjær C, Pedersen OL, Mulvany MJ, Christensen KL. Small artery structure during antihypertensive therapy is an independent predictor of cardiovascular events in essential hypertension. J Hypertens. 2013 Apr;31(4):791-7 PMID: 23325394. https://doi.org/10.1097/hjh.0b013e32835e215e.
15) Lombardo M, Serrao S, Devaney N, Parravano M, Lombardo G. Adaptive optics technology for high-resolution retinal imaging. Sensors (Basel). 2012 Dec 27;13(1):334-66. PMID: 23271600; PMCID: PMC3574679. https://doi.org/10.3390/s130100334.
16) Arichika S, Uji A, Murakami T, Suzuma K, Gotoh N, Yoshimura N. Correlation of retinal arterial wall thickness with atherosclerosis predictors in type 2 diabetes without clinical retinopathy. Br J Ophthalmol. 2017 Jan;101(1):69-74. Epub 2016 Dec 2. PMID: 27913444. https://doi.org/10.1136/bjophthalmol-2016-309612.
17) Zaleska-Żmijewska A, Wawrzyniak ZM, Dąbrowska A, Szaflik JP. Adaptive Optics (rtx1) High-Resolution Imaging of Photoreceptors and Retinal Arteries in Patients with Diabetic Retinopathy. J Diabetes Res. 2019 Mar 17;2019:9548324. PMID: 31008115; PMCID: PMC6441527. https://doi.org/10.1155/2019/9548324.
18) Iwase T, Ra E, Yamamoto K, Kaneko H, Ito Y, Terasaki H. Differences of Retinal Blood Flow Between Arteries and Veins Determined by Laser Speckle Flowgraphy in Healthy Subjects. Medicine (Baltimore). 2015 Aug;94(33):e1256. PMID: 26287409; PMCID: PMC4616433. https://doi.org/10.1097/MD.0000000000001256. References for discussion:-
19) Zaghloul H, Pallayova M, Al-Nuaimi O, Hovis KR, Taheri S. Association between diabetes mellitus and olfactory dysfunction: current perspectives and future directions. Diabet Med. 2018;35(1):41–52. doi: 10.1111/dme.13542.
20) Jin PY, Peng JJ, Zou HD, Wang WW, Fu J, Shen BJ, Bai XL, Xu X, Zhang X. A five-year prospective study of diabetic retinopathy progression in Chinese type 2 diabetes patients with “well-controlled” blood glucose. PLoS One. 2015;10(4):e0123449. doi: 10.1371/journal. pone.0123449.
21) Maroufizadeh S, Almasi-Hashiani A, Hosseini M, Sepidarkish M, Omani Samani R. Prevalence of diabetic retinopathy in Iran: a systematic review and Meta-analysis. Int J Ophthalmol. 2017;10(5):782–789. doi: 10.18240/ijo.2017.05.21.
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Dr. Karen Josephine Rayen
PG at Department of Ophthalmology, ACS Medical College and Hospital, Chennai
Dr. Sheela M
Senior resident at Department of Ophthalmology, ACS Medical College and Hospital, Chennai
Dr. Prof. K Kanmani
Professor and HOD at Department of Ophthalmology, ACS Medical College and Hospital, Chennai
Dr. Ajay A
PG at Department of Radiology, ACS Medical College and Hospital, Chennai
Dr. Atchaya Sivanandam
PG at Department of Ophthalmology, ACS Medical College and Hospital, Chennai