A comparative study of structural and microcirculatory parameters in patients with primary open-angle glaucoma and diabetes mellitus

Purpose: to study the structural and microcirculatory changes in the optic nerve and retina in patients with primary open-angle glaucoma (POAG)  in diabetes using OCT  and OCT-A.

Material  and methods. The study involved 156 eyes of 104 patients, divided into 4 groups: group 1 — 47 eyes (26 patients aged 66.96 ± 6.05) with stage I POAG and diabetes, group 2 — 36 eyes (24 patients aged 64.64 ± 7.91) with stage I POAG; group 3 — 36 eyes (28 patients aged 63.03 ± 7.10) with stage III POAG and diabetes; group 4 — 37 eyes (26 patients, aged 69.70 ± 7.44) with stage III POAG. All patients underwent a complete ophthalmologic examination, spectral OCT, OCT-A of the optic disc and the macula.

Results. In groups 1 and 3 (with POAG and diabetes), a decrease in the parameters of best corrected visual acuity and MD was revealed, which became worse as glaucoma progressed. A thinning of retinal nerve fiber layer (RNFL), neuroretinal rim, ganglion cells and inner plexiform layer (GCL  + IPL) was noted, with the lowest values in patients with stage III POAG and diabetes. The analysis of hemodynamics showed a pronounced decrease in perfusion (39.04 ± 3.42 %) as well as vascular density of the optic disc (0.35 ± 0.04 / mm) and the macular area (22.96 ± 5.82 % and 12.19 ± 4.04 / mm) in stage III of POAG and diabetes. This decrease is strongly correlated with functional  and structural changes, the stage of glaucoma and the presence of diabetes.

Conclusion. A comparative  analysis of structural, functional and vascular changes between groups of patients with stage I and III POAG, both accompanied and unaccompanied by diabetes, revealed signs of significant deterioration in perfusion of the optic nerve and retina in patients with diabetes. In combined  glaucoma and diabetes, early diagnosis, monitoring and adequate timely therapy require careful attention of specialists.

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