Retinal neurodegeneration in diabetic retinopathy with systemic hypertension

• Published in: Acta diabetologica Vol. 61; no. 4; pp. 495 - 504
• Main Authors: Sung, Jae-Yun, Kim, Jae-Jun, Hwang, Jae-Yul, Lee, Min-Woo
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.04.2024; Springer Nature B.V
• Subjects: Cross-Sectional Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetic retinopathy; Diabetic Retinopathy - complications; Eye; Humans; Hypertension; Hypertension - complications; Internal Medicine; Ischemia; Medicine; Medicine & Public Health; Metabolic Diseases; Neurodegeneration; Original Article; Retina; Retinal Ganglion Cells; Retinopathy; Retrospective Studies; Tomography, Optical Coherence - methods; Hypertension; Diabetic retinopathy; Ganglion cell-inner plexfirm layer; Retinal nerve fiber layer; Optical coherence tomography
• ISSN: 1432-5233; 0940-5429; 1432-5233
• DOI: 10.1007/s00592-023-02226-5

Purpose To identify the impact of hypertension (HTN) on inner retinal layer thickness in patients with diabetic retinopathy (DR). Methods In this retrospective cross-sectional study, participants were divided into three groups: type 2 diabetes patients without DR (DM group), patients with DR (DR group), and patients with both DR and HTN (DR+HTN group). The peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses, measured using optical coherence tomography, were compared among the groups. Results A total of 470 eyes were enrolled: 224 eyes in the DM group, 131 eyes in the DR group, and 115 eyes in the DR+HTN group. The mean RNFL thicknesses were 95.0 ± 7.7, 92.5 ± 10.1, and 89.2 ± 11.2 μm, and the mean GC-IPL thicknesses were 84.0 ± 5.7, 82.0 ± 7.6, and 79.2 ± 8.1 μm in each group, respectively (all P  < 0.001). In the DR+HTN group, the DR stage showed a significant association with pRNFL (B = − 5.38, P  = 0.014) and GC-IPL (B = − 5.18, P  = 0.001) thicknesses in multivariate analyses. Subgroup analyses revealed that pRNFL ( P  = 0.007) and GC-IPL ( P  = 0.005) thicknesses decreased significantly as DR progressed only in the DR+HTN group. Conclusions Patients with both DR and HTN exhibited much thinner pRNFL and GC-IPL, compared with patients with DR only. These results may have been related to the amplified diabetic retinal neurodegeneration and synergistic impact of ischemia in DR patients with concurrent HTN. Additionally, the progression of DR resulted in more severe inner retinal damage when combined with HTN.