The Ganglion Cell-Inner Plexiform Layer Thickness/Vessel Density of Superficial Vascular Plexus Ratio According to the Progression of Diabetic Retinopathy

Abstract

PURPOSE. The purpose of this study was to identify the relationship between the gangion cell-inner plexiform layer (GC-IPL) and retinal vasculature in the context of the progression of diabetic retinopathy (DR). METHODS. The subjects were divided into four groups according to DR stage: normal controls (group 1), patients with diabetes mellitus (DM) without DR (group 2), patients with mild or moderate nonprogressive DR (NPDR; group 3), and patients with severe NPDR (group 4). GC-IPL thickness, vessel density of superficial vascular plexus (SVD), and the GC-IPL/SVD ratio were compared among the groups. RESULTS. A total of 556 eyes were enrolled; 288 in group 1, 140 in group 2, 76 in group 3, and 52 in group 4. The mean GC-IPL thicknesses were 83.57 ± 7.35, 82.74 ± 7.22, 81.33 ± 6.74, and 79.89 ± 9.16 μm in each group, respectively (P = 0.006). The mean SVDs were 20.40 ± 1.26, 19.70 ± 1.56, 18.86 ± 2.04, and 17.82 ± 2.04 mm-1 in each group, respectively (P < 0.001). The GC-IPL/SVD ratios were 4.11 ± 0.38, 4.22 ± 0.40, 4.36 ± 0.54, and 4.54 ± 0.55 in each group, respectively (P < 0.001). In Pearson's correlation analysis, DR stage was significantly correlated with the GC-IPL/SVD ratio (coefficient = 0.301; P < 0.001). CONCLUSIONS. As the DR stage progressed, the GC-IPL thickness tended to decrease, with the macular SVD showing a significant reduction. Additionally, the impairment of retinal vasculature was more prominent than GC-IPL thinning as DR progressed, which suggests that retinal vasculature changes may precede diabetic retinal neurodegeneration.