International Ophthalmology

, Volume 39, Issue 10, pp 2237–2243 | Cite as

Hyperglycemia potentiates the effect of ionic calcium in photoreceptor ellipsoid zone disruption in diabetic retinopathy

  • Ankita
  • Jana Stefanickova
  • Sandeep SaxenaEmail author
  • Dwividendra K. Nim
  • Kaleem Ahmad
  • Abbas A. Mahdi
  • Apjit Kaur
  • Shashi K. Bhasker
  • Jela Valaskova
  • Peter KruzliakEmail author
Original Paper



To study the association of serum ionic calcium and glycated hemoglobin (HbA1c) with retinal photoreceptor ellipsoid zone (EZ) disruption in diabetic retinopathy (DR).


This is a tertiary care center-based observational cross-sectional study. Sixty-three consecutive cases, divided into 21 cases each with no diabetic retinopathy, non-proliferative diabetic retinopathy and proliferative diabetic retinopathy were included. Twenty-one healthy controls were also included. Ellipsoid zone disruption was assessed using spectral-domain optical coherence tomography. Serum ionic calcium and HbA1c were measured using standard protocol. Patient data from cases were divided into two groups according to their HbA1c levels: group 1 (HbA1c < 7, n = 26) and group 2 (HbA1c > 7, n = 37). Data were analyzed statistically.


Mean ionic calcium levels in group 1 and group 2 were 1.131 ± 0.073 mmol/dL and 1.170 ± 0.070 mmol/dL, respectively. In group 1, 11 out of 26 had EZ disruption (42.3%). Similarly, in group 2, 29 out of 37 had EZ disruption (78.4%). On logistic regression analysis, as compared to group 1, ellipsoid zone disruption was found to be positively associated with serum ionic calcium (p = 0.01) in group 2 cases.


Increased levels of serum ionic calcium are associated with increased EZ disruption in patients with HbA1c > 7 in DR.


Diabetic retinopathy Glycated hemoglobin Serum calcium Spectral-domain optical coherence tomography Ellipsoid zone 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Fox CS, Sullivan L, D’Agostino RB Sr, Wilson PW, Framingham Heart Study (2004) The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. Diabetes Care 27:704–708CrossRefGoogle Scholar
  2. 2.
    Pop-Busui R, Lu J, Brooks MM, Albert S, Althouse AD, Escobedo J, Green J, Palumbo P, Perkins BA, Whitehouse F, Jones TL, BARI 2D Study Group (2013) Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) cohort. Diabetes Care 36:3208–3215CrossRefGoogle Scholar
  3. 3.
    Valensi P, Giroux C, Seeboth-Ghalayini B, Attali JR (1997) Diabetic peripheral neuropathy: effects of age, duration of diabetes, glycemic control, and vascular factors. J Diabetes Complicat 11:27–34CrossRefGoogle Scholar
  4. 4.
    Viswanathan V, Tilak P, Kumpatla S (2012) Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: a 12 years observational study. Indian J Med Res 136:46–53PubMedPubMedCentralGoogle Scholar
  5. 5.
    Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412CrossRefGoogle Scholar
  6. 6.
    IDF annual report 2014. Belgium: International Diabetes Federation, 2015. Report NoGoogle Scholar
  7. 7.
    Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, Sharma T (2009) Prevalence of diabetic retinopathy in India: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study report 2. Ophthalmology 116:311–318CrossRefGoogle Scholar
  8. 8.
    el Haddad OA, Saad MK (1998) Prevalence and risk factors for diabetic retinopathy among Omani diabetics. Br J Ophthalmol 82:901–906CrossRefGoogle Scholar
  9. 9.
    Rodrigues M, Waldbillig RJ, Rajagopalan S, Hackett J, LeRoith D, Chader GJ (1988) Retinal insulin receptors: localization using a polyclonal anti-insulin receptor antibody. Brain Res 443:389–394CrossRefGoogle Scholar
  10. 10.
    Diaz B, Serna J, De Pablo F, de la Rosa EJ (2000) In vivo regulation of cell death by embryonic (pro)insulin and the insulin receptor during early retinal neurogenesis. Development 127:1641–1649PubMedGoogle Scholar
  11. 11.
    Saxena S, Srivastav K, Cheung CM, Ng JY, Lai TY (2014) Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography. Clin Ophthalmol 8:2507–2522PubMedPubMedCentralGoogle Scholar
  12. 12.
    Jaeryung O, William ES, Harry WF, Giovanni G, Brandon L (2010) Photoreceptor inner/outer segment defect imaging by spectral domain OCT and visual prognosis after macular hole surgery. Invest Ophthalmol Vis Sci 82:1651–1658Google Scholar
  13. 13.
    Ferenc BS, Tunde P, Catherine E, Ute EKW, Traci EC, Mark CG, Daniel P, Gary SR, Emily YC, Alan CB (2012) En face” OCT imaging of the IS/OS junction line in type 2 idiopathic macular telangiectasia. Investig Ophthalmol Vis Sci 53:6145–6152CrossRefGoogle Scholar
  14. 14.
    Borrelli E, Abdelfattah NS, Uji A, Nittala MG, Boyer DS, Sadda SR (2017) Postreceptor neuronal loss in intermediate age-related macular degeneration. Am J Ophthalmol 181:1–11CrossRefGoogle Scholar
  15. 15.
    Early Treatment Diabetic Retinopathy Study Research Group (1991) Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS Report Number 10. Ophthalmology 98(5 Suppl):786–806Google Scholar
  16. 16.
    Sharma SR, Saxena S, Mishra N, Akduman L, Meyer CH (2014) The association of grades of photoreceptor inner segment-ellipsoid band disruption with severity of retinopathy in type 2 diabetes mellitus. J Case Rep Stud 2:502Google Scholar
  17. 17.
    Gray-Keller MP, Detwiler PB (1996) Ca2+ dependence of dark- and light-adapted flash responses in rod photoreceptors. Neuron 17:323–331CrossRefGoogle Scholar
  18. 18.
    Krizaj D, Copenhagen DR (2002) Calcium regulation in photoreceptors. Front Biosci 7:d2023–d2044CrossRefGoogle Scholar
  19. 19.
    Chang GQ, Hao Y, Wong F (1993) Apoptosis: final common pathway of photoreceptor death in rd, rds, and rhodopsin mutant mice. Neuron 11:595–605CrossRefGoogle Scholar
  20. 20.
    Ulshafer RJ, Garcia CA, Hollyfield JG (1980) Sensitivity of photoreceptors to elevated levels of cGMP in the human retina. Invest Ophthalmol Vis Sci 19:1236–1241PubMedGoogle Scholar
  21. 21.
    Frasson M, Sahel JA, Fabre M, Simonutti M, Dreyfus H, Picaud S (1999) Retinitis pigmentosa: rod photoreceptor rescue by a calcium-channel blocker in the rd mouse. Nat Med 5:1183–1187CrossRefGoogle Scholar
  22. 22.
    Fernyhough P, Calcutt NA (2010) Abnormal calcium homeostasis in peripheral neuropathies. Cell Calcium 47:130–139CrossRefGoogle Scholar
  23. 23.
    Chen S, He FF, Wang H, Fang Z, Shao N, Tian XJ, Liu JS, Zhu ZH, Wang YM, Wang S, Huang K, Zhang C (2011) Calcium entry via TRPC6 mediates albumin overload-induced endoplasmic reticulum stress and apoptosis in podocytes. Cell Calcium 50:523–529CrossRefGoogle Scholar
  24. 24.
    Schlondorff J, Del Camino D, Carrasquillo R, Lacey V, Pollak MR (2009) TRPC6 mutations associated with focal segmental glomerulosclerosis cause constitutive activation of NFAT-dependent transcription. Am J Physiol Cell Physiol 296:C558–C569CrossRefGoogle Scholar
  25. 25.
    Jorde R, Sundsfjord J, Fitzgerald P, Bønaa KH (1999) Serum calcium and cardiovascular risk factors and diseases: the Tromsø study. Hypertension 34:484–490CrossRefGoogle Scholar
  26. 26.
    Jain A, Saxena S, Khanna VK, Shukla RK, Meyer CH (2013) Status of serum VEGF and ICAM-1 and its association with external limiting membrane and inner segment-outer segment junction disruption in type 2 diabetes mellitus. Mol Vis 19:1760–1768PubMedPubMedCentralGoogle Scholar
  27. 27.
    Sharma S, Saxena S, Srivastav K, Shukla RK, Mishra N, Meyer CH, Kruzliak P, Khanna VK (2015) Nitric oxide and oxidative stress is associated with severity of diabetic retinopathy and retinal structural alterations. Clin Exp Ophthalmol 43:429–436CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyKing George’s Medical UniversityLucknowIndia
  2. 2.Department of Ophthalmology, Faculty of MedicineComenius University in Bratislava and University HospitalBratislavaSlovakia
  3. 3.Department of PharmacologyLady Hardinge Medical CollegeNew DelhiIndia
  4. 4.Department of BiochemistryKing George’s Medical UniversityLucknowIndia
  5. 5.2nd Department of Internal Medicine, Faculty of MedicineComenius University and University HospitalBratislavaSlovakia
  6. 6.2nd Department of Surgery, Faculty of MedicineMasaryk University and St. Anne’s University HospitalBrnoCzech Republic
  7. 7.Department of Internal MedicineBrothers of Mercy HospitalBrnoCzech Republic

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