Feyzahan UZUN, Hüseyin FINDIK, Hatice Beyazal POLAT

İnsülin rezistansı bulunan bireylerde retina sinir lifi tabakası kalınlığının değerlendirilmesi

Amaç: İnsülin rezistansı tanısı ile takip edilen prediabetik bireylerde retina sinir lifi kalınlığının (RSLK) ölçümü ve sağlıklı kontrollerle karşılaştırılması.Gereç-Yöntem: En iyi düzeltilmiş görme keskinliği, göz içi basıncı, ön segment ve fundus muayenelerini içeren tam oftalmolojik inceleme yapıldı. RSLK spectral-domain optik koherans tomografi (OKT) ile ölçüldü. Açlık plazma glikoz ve insülin seviyeleri not edildi ve insülin rezistans indexi (HOMA-IR) değeri hesaplandı.Bulgular: İnsülin rezistansı tespit edilen 37 birey ile 41 sağlıklı kontrol çalışmaya dahil edildi. Yaş ortalaması insülin rezistansı ve kontrol grubunda sırasıyla 35,7±9,8 ve 34,9±10,7 yıl idi. İnsülin rezistansı olan grupta ortalama (95,03±11,38 µm vs 99,2±19,73 µm), inferior (119,11±18,27 µm vs 127,5±21,03 µm) ve temporal (72,13±12,52 µm vs 79,2±15,97 µm) kadranlarda RSLK değeri kontrol grubuna göre istatistiksel olarak anlamlı derecede ince tespit edildi (p<0,05). Superior (121,01±9 µm vs 123,9±01 µm) ve nazal (72,03±13,65 µm vs 74,52±10,52 µm) kadranlarda anlamlı bir değişiklik saptanmadı (p˃0,05). Sonuç: Prediabetik hastalarda klinik olarak herhangi bir bulgu vermese de retina sinir lifi tabakasında nörodejenerasyon insülin rezistansı evresinde başlayabilmektedir. OKT prediabetik bireylerde erken retinal nörodejenerasyon tanısı ve takibi için uygun bir araçtır.

Anahtar Kelimeler:

Diabetes mellitus, insülin direnci, optik koherans tomografi

The evaluation of retinal nerve fiber layer thickness in subjects with insulin resistance

Purpose: To measure the retinal nerve fiber layer thickness (RNFLT) in prediabetic subjects who were diagnosed with insulin resistance and to compare with healthy controls. Materials and methods: Each subject was underwent a standard ophthalmological examination including measurement of best corrected visual acuity and intraocular pressure, anterior segment biomicroscopy and funduscopy. Average and four quadrant (superior, temporal, inferior, nasal) RNFLT measurements were performed using spectral domain optical coherence tomography (OCT). Plasma fasting insulin and glucose levels were noted and homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated.Results: A total of 37 patients with insulin resistance and 41 healthy controls were included in the study. Mean age of the insulin resistant group and healthy controls were 35.7±9.8 and 34.9±10.7 years, respectively. The average (95.03±11.38 µm vs 99.2±19.73 µm), inferior (119.11±18.27 µm vs 127.5±21.03 µm) and temporal (72.13±12.52 µm vs 79.2±15.97 µm) quadrant RNFL were significantly thinner in subjects with insulin resistance as compared with healthy controls (p<0.05). No significant difference was observed between the groups in the superior (121.01±9 µm vs 123.9±01 µm) and nasal (72.03±13.65 µm vs 74.52±10.52 µm) quadrants (p˃0.05). Conclusion: Neurodegeneration of the retina which is seen in diabetic patients may begin in the insulin resistance stage. OCT is a useful tool both in the early diagnosis and follow-up of retinal neurodegeneration.

Keywords:

Diabetes mellitus, insulin resistance, optical coherence tomography,

PDF

___

1. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414:813-820.
2. Barber AJ, Baccouche B. Neurodegeneration in diabetic retinopathy: Potential for novel therapies. Vision Res. 2017;139:82-92.
3. Barber AJ, Gardner TW, Abcouwer SF. The significance of vascular and neural apoptosis to the pathology of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2011;28;52(2):1156-1163.
4. Zhu T, Ma J, Li Y, et al. Association between retinal neuronal degeneration and visual function impairment in type 2 diabetic patients without diabetic retinopathy. Sci China Life Sci. 2015;58(6):550-555.
5. Tavares Ferreira J, Alves M, Dias-Santos A, et al. Retinal Neurodegeneration in Diabetic Patients Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 2016;1;57(14):6455-6460
6. van Dijk HW, Kok PH, Garvin M, et al. Selective loss of inner retinal layer thickness in type 1 diabetic patients with minimal diabetic retinopathy. Invest Ophthalmol Vis Sci. 2009;50(7):3404-3409.
7. Dada T. Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4? J Curr Glaucoma Pract. 2017;11(3):77-79.
8. Chaturvedi N, Sjoelie AK, Porta M, et al. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. Diabetes Care. 2001;24(2):284-289.
9. Weyer C, Bogardus C, Mott DM, et al. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999;104(6):787-794.
10. Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci. 2018;11;12:930.
11. Karaca C, Karaca Z. Beyond Hyperglycemia, Evidence for Retinal Neurodegeneration in Metabolic Syndrome. Invest Ophthalmol Vis Sci. 2018;1;59(3):1360-1367.
12. Arikan S, Ersan I, Eroglu M, et al. Does Retinal Neurodegeneration Seen in Diabetic Patients Begin in the Insulin Resistance Stage? Turk J Ophthalmol. 2016;46(6):264-269.
13. Kim K, Kim ES, Rhee SY, et al. Clinical characteristics and risk factors for retinal diabetic neurodegeneration in type 2 diabetes. Acta Diabetol. 2017;54(11):993-999.
14. Simo R, Hernandez C. Neurodegeneration in the diabetic eye: new insights and therapeutic perspectives. Trends Endocrinol Metab. 2014;25(1):23-33.
15. Pierro L, Iuliano L, Cicinelli MV, Casalino G, Bandello F. Retinal neurovascular changes appear earlier in type 2 diabetic patients. Eur J Ophthalmol. 2017;11;27(3):346-351.
16. Toprak I, Yildirim C, Yaylali V. Impaired photoreceptor inner segment ellipsoid layer reflectivity in mild diabetic retinopathy. Can J Ophthalmol. 2015;50(6):438-441.
17. Ng DS, Chiang PP, Tan G, et al. Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy. Clin Exp Ophthalmol. 2016;44(4):243-250.
18. Schubert M, Gautam D, Surjo D, et al. Role for neuronal insulin resistance in neurodegenerative diseases. Proc Natl Acad Sci U S A. 2004;2;101(9):3100-3105.
19. Tumminia A, Vinciguerra F, Parisi M, et al. Type 2 Diabetes Mellitus and Alzheimer's Disease: Role of Insulin Signalling and Therapeutic Implications. Int J Mol Sci. 2018;24;19(11). pii: E3306.
20. Kumar P, Raman T, Swain MM, et al. Hyperglycemia-Induced Oxidative-Nitrosative Stress Induces Inflammation and Neurodegeneration via Augmented Tuberous Sclerosis Complex-2 (TSC-2) Activation in Neuronal Cells. Mol Neurobiol. 2017;54(1):238-254.
21. Diehl T, Mullins R, Kapogiannis D. Insulin resistance in Alzheimer's disease. Transl Res. 2017;183:26-40.