Hyperglycemia potentiates the effect of ionic calcium in photoreceptor ellipsoid zone disruption in diabetic retinopathy
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.
KeywordsDiabetic 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.
- 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
- 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 136:46–53Google Scholar
- 6.IDF annual report 2014. Belgium: International Diabetes Federation, 2015. Report NoGoogle Scholar
- 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 127:1641–1649Google Scholar
- 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 8:2507–2522Google Scholar
- 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
- 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.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
- 20.Ulshafer RJ, Garcia CA, Hollyfield JG (1980) Sensitivity of photoreceptors to elevated levels of cGMP in the human retina. Invest Ophthalmol Vis Sci 19:1236–1241Google Scholar
- 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 19:1760–1768Google Scholar