Structural analysis of the choroid and the optic nerve in diabetes mellitus

Aim: The aim of this study was to determine the choroidal and peri-optic nerve head retinal nerve fiber layer (RNFL) changes indiabetes mellitus (DM) patients without retinopathy.Material and Methods: Four groups of 70 eyes were defined: control group (healthy subjects); group 1 - DM patients with glycatedhemoglobin (HbA1c) level of 6.5–7.9%; group 2 (DM patients, HbA1c 8–9.5%); and group 3 (DM patients, HbA1c > 9.5%). Opticalcoherence tomography measurements of choroidal thickness (CT) and RNFL changes and were compared within groups.Results: CT was thinner in diabetic groups compared with control, but this decrease was not directly proportional to the HbA1cincrease. CT loss in the subfovea was only seen in group 1. In temporal quadrant, all diabetic groups had RNFL loss compared withcontrol, with no difference between them. RNFL in groups 2 and 3 had significant loss in the inferior temporal area compared withthe control group, whereas in the inferior nasal quadrant, only group 3 had significant loss.Conclusion: CT changes were consistently seen in the lower HbA1c group compared with healthy subjects. This could be the resultof the combined effect of low blood flow - which leads to CT decrease- that is then rivaled by the choroidal thickening due toincreased vessel rigidity that is observed because of diabetic inflammation and high glycation end-product accumulation. RNFL wasaffected in temporal quadrants regardless to glycemic control. However, inferior RNFL damage was correlated with higher HbA1clevels, showing that optic nerve changes differ by diabetic control.

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