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Elevated advanced glycation end products are associated with subfoveal ellipsoid zone disruption in diabetic macular
Nibha Mishra1, Malvika Singh1, Rajendra K Singh2
1Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Purpose:
Advanced glycation end products (AGEs), due to increased production and a slow turnover rate, serve as mediators of "metabolic memory" even after the resolution of hyperglycemia. A prospective study was undertaken to evaluate the association of AGEs with subfoveal ellipsoid zone (EZ) disruption in diabetic macular edema (DME).
Methods:
A tertiary-care-center-based cross-sectional study included 40 consecutive cases with DME and 20 healthy controls in the age group of 40-65 years. All the study subjects underwent spectral-domain optical coherence tomography (SD-OCT) for cross-sectional imaging of the retina. The EZ was defined as a hyperreflective band below the external limiting membrane. The disruption of EZ was graded as intact EZ and disrupted EZ. Serum AGEs were assessed by assay of Nε-carboxymethyl-lysine (Nε-CML) using the standard protocol. Data were analyzed statistically.
Results:
Subfoveal EZ disruption was noted in 80% (32/40) of the cases of DME. In the cases without EZ disruption, visual acuity (LogMAR VA) was 0.60 ± 0.52, whereas in cases with EZ disruption, LogMAR VA was 0.96 ± 0.56 (P < 0.001). In the cases without EZ disruption, Nε-CML was 94.31 ± 57 ng/mL, whereas in cases with EZ disruption Nε-CML was 120.64 ± 71.98 ng/mL (P < 0.001).
Conclusion:
In DME, increased levels of AGEs are significantly associated with EZ disruption on SD-OCT.
