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. 2016 Dec 2:22:1352-1360.
eCollection 2016.

Increased serum level of homocysteine correlates with retinal nerve fiber layer thinning in diabetic retinopathy

Khushboo Srivastav  1 , Sandeep Saxena  1 , Abbas A Mahdi  2 , Rajendra K Shukla  3 , Carsten H Meyer  4 , Levent Akduman  5 , Vinay K Khanna  3
Affiliations

Increased serum level of homocysteine correlates with retinal nerve fiber layer thinning in diabetic retinopathy

Khushboo Srivastav et al. Mol Vis. .

Abstract

Purpose: To study the correlation between serum levels of vitamin B12, folic acid, and homocysteine and the severity of diabetic retinopathy and the correlation with retinal nerve fiber layer (RNFL) thinning on spectral domain optical coherence tomography (SD-OCT).

Methods: In a tertiary care center-based prospective cross-sectional study, 60 consecutive cases and 20 healthy controls in the age group of 40-65 years were included. The eyes of the cases were divided into three groups according to Early Treatment Diabetic Retinopathy Study (ETDRS) classification: diabetes mellitus without retinopathy (n = 20), non-proliferative diabetic retinopathy with macular edema (n = 20), and proliferative diabetic retinopathy with macular edema (n = 20). The serum levels of vitamin B12 and folic acid were measured using a standard protocol. The serum homocysteine assay was performed using an enzyme-linked immunosorbent assay (ELISA) kit. Average RNFL thickness was measured using SD-OCT. Statistical analysis was used to assess the correlations between the study variables.

Results: Increased severity of diabetic retinopathy was found to correlate with an increase in the serum levels of homocysteine (F = 53.79; p<0.001). The mean serum levels of vitamin B12 and folic acid were found to be within the normal reference range. A positive correlation was found between retinal nerve fiber layer thinning and serum levels of homocysteine (p<0.001).

Conclusions: This study, for the first time, demonstrated a correlation between increased homocysteine with a decrease in RNFL thickness and increased severity of diabetic retinopathy.

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Figures

Figure 1
Figure 1
Retinal nerve fiber thickness analysis using optic disc cube 200x200 feature depicting thickness map, thickness deviation, TSNIT (Temporal, Superior, Nasal, Inferior, Temporal ) normative data and extracted tomograph of both eyes. The quadrant map shows thinning in the superior quadrant of both eyes and thinning in inferior quadrant of left eye.
Figure 2
Figure 2
Box and whisker plot graphically representing the descriptive statistics for serum levels of homocysteine among the study groups. The horizontal line within the box indicates the median, boundaries of the box indicate the 25th- and 75th -percentile, and the whiskers indicate the highest and lowest values. An increase in serum level of homocysteine with increase in severity of diabetic retinopathy is observed.
Figure 3
Figure 3
Scatter plot showing a negative correlation between the serum levels of homocysteine and the average retinal nerve fiber layer thickness observed on Pearson correlation analysis.
See this image and copyright information in PMC

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