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Structural evaluation of the retina and choroid by optical coherence tomography in diabetic patients with or without renal involvement

Grant number: 14/25354-2
Support type:Regular Research Grants
Duration: March 01, 2015 - February 28, 2017
Field of knowledge:Health Sciences - Medicine
Principal researcher:Rony Carlos Preti
Grantee:Rony Carlos Preti
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
Assoc. researchers:Mário Luiz Ribeiro Monteiro ; Walter Yukihiko Takahashi

Abstract

Introduction: The involvement of the retina by diabetes mellitus ( DM ), diabetic retinopathy (DR) is a leading cause of blindness worldwide causing both impairment to the visual acuity (VA) and contrast sensitivity (CS). In the last years, there has been a progress in the diagnosis and monitoring of retinal changes in this disease with the development of the Optical Coherence Tomography (OCT). Recently, due to the technological advancement of this ancilary test ,it was possible to study the choroid, another tissue that is also affected by DM, Diabetic Choroidopathy (DC). It is currently believed that the choroid is related to the development of the DR because it is affected even before of the retina, so their study is now of paramount importance. Beyond the eye, the kidney is another organ commonly affected by DM, Diabetic Nephropathy (DN), and since there is a correlation between DR and DN, the treatment of the rim can improve the thickness of the retina and choroid and classification of the DR.Purpose: Because there is correlation between the DR and DN, this research will evaluate: the thickness of the choroid (CT) in type 1 and 2 diabetics, at the differents stages of DR in patients presenting or not Chronic Kidney Disease (CKD); CT correlation with macular retinal thickness and the consequent impact on visual function, visual acuity (VA) and contrast sensitivity (CS); to study the impact of renal transplantation and the two types of dialysis, hemodialysis and peritoneal dialysis on the thickness of the choroid and retina, staging of the RD and visual function tests; and to evaluate the morphology of the choroid by OCT in diabetic patients with or without chronic kidney disease treated with dialysis or renal transplantation.Methods: The type 1 and 2 diabetic patients in monitoring and/or treatment at the Clinic of Ophthalmology and Nephrology of the Hospital das Clinicas and Medical School of the University of São Paulo, will be submitted to a complete ophthalmological examination and a masked investigators will obtain, best corrected visual acuity with the Early Treatment Diabetic Study Retinopahy table, SC with Visual Contrast Sensitivity Test 6500 table, fluorescein angiography, OCT, ocular biometry, body weight and laboratory tests. In order to study the thickness and the morphology of the retina and choroid in diabetic patients who are not treated with dialysis, there will be a control group of normal individuals and all the exams cited above will be made only once in both groups. In order to evaluate the CT in diabetic patients being treated with dialysis and submitted to renal transplantation, the control group will be of diabetic patients without renal failure. In these cases, patients will be followed for one year with the examinations performed at baseline, 4 and 12-months. Expected results: This study will enable us to analise the changes that DM causes in the choroid at different stages of DR and its influence on visual function and DR development or deterioration. Furthermore, this research will evaluate if the dialysis and renal transplantation reduces the CT, improves and/or stabilize the DR and has a positive effect on the visual function, VA and CS; Reduction of CT in the eyes of diabetic patients, especially those with more advanced DR, which is also expected in those with EMD, which probably will correlate to an increased in the thickness of the retina causing loss of the visual function, AV and SC. Decreased retinal and choroidal thickness with the completion of Dialysis providing improvement of visual function. Stabilization or improvement of the DR with dialysis and renal transplantation and consequent improvement in visual function. We believe that we will find decreased of retinal and choroidal thickness with the completion of dialysis and renal transplantation also providing improvement in visual function. Stabilization or improvement of the RD with dialysis and kidney transplantation and con (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
PRETI, RONY CARLOS; IOVINO, CLAUDIO; ABALEM, MARIA FERNANDA; GARCIA, RAFAEL; VELOSO DOS SANTOS, HELEN NAZARETH; SAKUNO, GUSTAVO; AU, ADRIAN; CUNHA, LEONARDO PROVETTI; ZACHARIAS, LEANDRO CABRAL; RIBEIRO MONTEIRO, MARIO LUIZ; SADDA, SRINIVAS REDDY; SARRAF, DAVID. Prevalence of Focal Inner, Middle, and Combined Retinal Thinning in Diabetic Patients and Its Relationship With Systemic and Ocular Parameters. TRANSLATIONAL VISION SCIENCE & TECHNOLOGY, v. 10, n. 2 FEB 2021. Web of Science Citations: 0.
ABALEM, MARIA FERNANDA; NAZARETH SANTOS VELOSO, HELEN; GARCIA, RAFAEL; CHEN, XING DONG; CARRICONDO, PEDRO C.; CABRAL ZACHARIAS, LEANDRO; PRETI, RONY C. The Effect of Glycemia on Choroidal Thickness in Different Stages of Diabetic Retinopathy. OPHTHALMIC RESEARCH, v. 63, n. 5, p. 474-482, AUG 2020. Web of Science Citations: 0.

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