Resistive index of ophthalmic artery correlates with retinal pigment epithelial alterations on spectral domain optical coherence tomography in diabetic retinopathy.

Background: Retinal pigment epithelium (RPE) plays a significant role in maintenance of integrity of retinal photoreceptors and choriocapillaries. RPE derives its blood supply through ophthalmic artery (OA) via choriocapillaries. RPE topographic alterations have been observed to be associated with severity of retinopathy. The present study was undertaken to assess the correlation between resistive index (RI) of the OA with RPE topographic alterations on Spectral-Domain optical coherence tomography (SD-OCT), to our knowledge, it is for the first time.

Methods: A tertiary care center based cross-sectional study was undertaken after informed consent. Sample size was calculated using 95% confidence interval. Seventy five consecutive cases of type 2 diabetes mellitus between the ages of 40 and 70 years were included. The cases were divided into three groups according to Early Treatment Diabetic Retinopathy Study classification: diabetes mellitus with no retinopathy (No DR) (n = 24); non-proliferative diabetic retinopathy (n = 27); and proliferative diabetic retinopathy (n = 24). Healthy control subjects of similar age group were included (n = 24). RI in OA was studied using Color Doppler imaging. Grades of RPE topographic alterations and retinal photoreceptor ellipsoid zone (EZ) disruption were studied using SD-OCT. Data was analysed using Chi square (χ2 ) test, analysis of variance (ANOVA), Pearson correlation analysis and Neuman-Keuls test.

Results: LogMAR best corrected visual acuity was found to increase significantly with the severity of DR (F = 105.74, p  < 0.001). ANOVA revealed a significant increase in RI of OA (F = 14.23, p  < 0.001) with severity of diabetic retinopathy. χ2 test revealed significant increase in grades of RPE alterations (χ2  = 71.83, p  < 0.001) and EZ disruption (χ2  = 60.59, p  < 0.001) with the severity of diabetic retinopathy. Pearson correlation analyses revealed a significant positive correlation between RI of OA with grades of RPE alterations (r = 0.48, p  < 0.001) and also between grades of RPE alterations and EZ disruption (r = 0.82, p  < 0.001).

Conclusions: Decrease in ocular blood flow resulting from an increase in RI of OA correlates with severity of DR and grades of topographic alterations in RPE. Integrity of EZ was observed to be dependent on RPE.