Multifocal Electroretinogram Can Detect the Abnormal Retinal Change in Early Stage of type2 DM Patients without Apparent Diabetic Retinopathy
Jiang Huang, Yi Li, Yao Chen, Yuhong You, Tongtong Niu, Weijie Zou, Weifeng Luo
Abstract
Purpose. To study retinal function defects in type 2 diabetic patients without clinically apparent retinopathy using a multifocal electroretinogram (mf-ERG). Methods. Seventy-six eyes of thirty-eight type 2 diabetes mellitus(DM) patients without clinically apparent retinopathy and sixty-four normal eyes of thirty-two healthy control (HC) participants were examined using mf-ERG. Results. Patients with type 2 DM without apparent diabetic retinopathy demonstrated an obvious implicit time delay of P1 in ring 1, ring 3, and ring 5 compared with healthy controls ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>t</a:mi> <a:mo>=</a:mo> <a:mn>5.184</a:mn> </a:math> , <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>p</c:mi> <c:mo>≤</c:mo> <c:mn>0.001</c:mn> </c:math> ; <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>t</e:mi> <e:mo>=</e:mo> <e:mn>8.077</e:mn> </e:math> , <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo>≤</g:mo> <g:mn>0.001</g:mn> </g:math> ; <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>t</i:mi> <i:mo>=</i:mo> <i:mn>2.000</i:mn> </i:math> , <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo>=</k:mo> <k:mn>0.047</k:mn> </k:math> , respectively). The implicit time (IT) in ring 4 of N1wave was significantly delayed in the DM group ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>t</m:mi> <m:mo>=</m:mo> <m:mn>2.327</m:mn> </m:math> , <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>p</o:mi> <o:mo>=</o:mo> <o:mn>0.021</o:mn> </o:math> ). Compared with the HC group, the implicit time of the P1 and N1 waves in the temporal retina zone was significantly prolonged ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>t</q:mi> <q:mo>=</q:mo> <q:mn>3.66</q:mn> </q:math> , <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mi>p</s:mi> <s:mo>≤</s:mo> <s:mn>0.001</s:mn> </s:math> ; <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>t</u:mi> <u:mo>=</u:mo> <u:mn>2.187</u:mn> </u:math> , <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>p</w:mi> <w:mo>=</w:mo> <w:mn>0.03</w:mn> </w:math> , respectively). And the amplitude of P1 in the temporal retina decreased in the DM group, which had a significantly statistical difference with the healthy controls ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mi>t</y:mi> <y:mo>=</y:mo> <y:mo>−</y:mo> <y:mn>6.963</y:mn> </y:math> , <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mi>p</ab:mi> <ab:mo>≤</ab:mo> <ab:mn>0.001</ab:mn> </ab:math> ). However, there were no differences in either the amplitude of the response or the implicit time of the nasal retina zone between DM and HC. The AUC of multiparameters of mf-ERG was higher in the diagnosis of DR patients. Conclusions. Patients with type 2 DM without clinically apparent retinopathy had a delayed implicit time of P1 wave in temporal regions of the postpole of the retina compared with HC subjects. It demonstrates that mf-ERG can detect the abnormal retinal change in the early stage of type2 DM patients without apparent diabetic retinopathy. Multiparameters of mf-ERG can improve the diagnostic efficacy of DR, and it may be a potential clinical biomarker for early diagnosis of DR.