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Alteration of choroidal vascular structure in diabetic retinopathy
  1. Satoru Kase1,
  2. Hiroaki Endo2,
  3. Mitsuo Takahashi2,
  4. Michiyuki Saito1,
  5. Masahiko Yokoi3,
  6. Yuki Ito3,
  7. Satoshi Katsuta4,
  8. Shozo Sonoda4,
  9. Taiji Sakamoto4,
  10. Susumu Ishida1,
  11. Manabu Kase2
  1. 1 Ophthalmology, Hokkaido University, Sapporo, Hokkaido, Japan
  2. 2 Ophthalmology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
  3. 3 Ophthalmology, Teine Yokoi Eye Clinic, Sapporo, Hokkaido, Japan
  4. 4 Ophthalmology, Kagoshima University, Kagoshima, Japan
  1. Correspondence to Dr Satoru Kase, Ophthalmology, Hokkaido University, Sapporo 060-0808, Japan; kaseron{at}


Purpose The aim of this study was to analyse choroidal structures in normal patients and patients with diabetes with various severities of diabetic retinopathy (DR).

Methods This is a retrospective observation case control study. Three hundred and forty-two diabetic eyes, and age-matched 112 eyes without diabetes mellitus (DM) were enrolled in this study. Patients with DM were classified into no DR, mild/moderate non-proliferative DR (mNPDR), severe NPDR and proliferative DR (PDR). Patients with DM were further divided into two groups based on information regarding systemic DM treatment situation: DM-treated and untreated groups. Central choroidal thickness (CCT), and total choroidal area (TCA), luminal area (LA) and stromal area (SA) were determined using enhanced depth imaging optical coherence tomography and a binarisation method, respectively. The ratio of LA in the TCA was defined as L/C ratio.

Results The haemoglobin A1c (HbA1c) value was significantly higher in the DM-untreated than in the DM-treated subjects. L/C ratio was significantly lower in all the diabetic eyes than control eyes (p<0.05). TCA, LA, L/C ratio and CCT were significantly greater in the DM-untreated than treated group (each p<0.05). In the DM-untreated group, TCA and LAs (p<0.05) and L/C ratio (p<0.01) were significantly lower in mNPDR subjects than normal controls (p<0.05). PDR in the DM-untreated group showed significantly larger SA and LA, and greater CCT than normal controls (each p<0.05).

Conclusions These results suggest that choroidal vasculature was initially involved at an early DR, whereas thickened LA and SA were noted in advanced DR.

  • diabetic retinopathy
  • choroidal vasculature
  • binarization
  • diabetes mellitus

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  • Contributors SK wrote the entire manuscript and evaluated data. HE and YI obtained data and analysed them statistically. MT, MY, MS and SK collected patients’ demographics. SS, TS, SI, and MK did critical revision based on their special experiences.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review committee of Teine Keijinkai hospital approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. There are no data in this work. Data are available upon request. Data may be obtained from a third party and are not publicly available. No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

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