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ORIGINAL ARTICLE
Year : 2018  |  Volume : 111  |  Issue : 1  |  Page : 25-32

Ganglion cell complex changes with long-standing diabetic macular oedema among Egyptian diabetic patients: an optical coherence tomography study


Ophthalmology Department, Research Institute of Ophthalmology, Giza, Egypt

Correspondence Address:
Tamer A Refai
Ophthalmology Department, Research Institute of Ophthalmology, Giza, 12211
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejos.ejos_9_18

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Introduction Optical coherence tomography (OCT) is a valuable tool for imaging retinal thickness and structure as well as performing good evaluation for the ganglion cell complex (GCC) parameters, reflecting the status of retinal nerve fiber layer, the ganglion cell layer and the inner-plexiform layers. In this study, these parameters were evaluated in eyes with long-standing diabetic macular oedema, thus emphasising the importance of seriously treating macular oedema. Patients and methods Sixty eyes of 38 patients were included in the study. There were 38 eyes of 25 male patients and 22 eyes of 13 female patients. These 60 eyes were divided into two groups: group A (30 eyes) included eyes of patients with long-standing diabetic macular oedema (>1 year duration) and group B (30 eyes) included eyes of patients without apparent ocular pathology as a control. The age range was 23–73 years (mean 56.57±11.42) in group A and 30–74 years (mean 53.33±12.10) in group B. The duration of diabetes ranged from 1 to 25 years (mean 15.2±5.97) in group A. The patients were examined by an ocular response analyser (OCT-Optovue) that performs different GCC studies in addition to macular map analysis (EMM5). Best-corrected visual acuity in Snellen lines was also reported. Collected data were arranged and subjected to analysis using suitable statistical methods. Results In this study, a highly significant difference (P<0.01) was found with higher mean values for the diabetic macular oedema group for the GCC average (116.95±21.14 μm), GGC superior (121.80±28.36 μm), GCC inferior (116.16±25.52 μm) and focal loss volume (FLV=5.55±2.50%) compared with the control group, with GCC average of 97.29±6.32 μm, GCC superior of 96.49±7.90 μm, GCC inferior of 97.77±6.44 μm and the FLV of 1.26±0.90%. In addition, a statistically significant difference (P<0.05) was found with higher mean values for the global loss volume in diabetic macular oedema group [global loss volume (GLV=7.40±3.90%)] versus control group (GLV=5.49±3.27%). For the diabetic macular oedema group, the central macular thickness (μm) showed a highly significant correlation (<0.01) with the thickness (μm) of GCC average, GCC superior and GCC inferior and a statistically significant correlation (<0.05) with both of the GLV% and FLV%. For the diabetic macular oedema group, the duration of diabetes mellitus showed a statistically significant correlation (<0.05) with the FLV%, with a nonsignificant correlation (>0.05) with the other studied GCC parameters. Compared with normative data, FLV% was abnormal in 70% of eyes, borderline in 6.67% of eyes and normal in 23.33% of eyes in diabetic macular oedema group compared with the control group, which showed values of 0, 6.67 and 93.33% for abnormal, borderline and normal values respectively, with χ2-test showing a highly significant difference (χ2=30.718 P<0.001) between both the groups. Conclusion Compared with normal group, patients with long-standing diabetic macular oedema showed higher mean values for all GCC parameters, which were strongly correlated with the central macular thickness. The FLV% values in particular was abnormal in ∼70% of eyes with diabetic macular oedema in comparison with normative data, and it correlated strongly with the duration of diabetes, so we recommend considering this parameter (FLV%) for seriously treating diabetic macular oedema before permanent GCC damage occurs.


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