Tesis

Analisis Unit Neurovaskular Retina pada Pasien Diabetes Melitus dengan dan Tanpa Retinopati Diabetik dan Subjek Non-Diabetik Menggunakan Optical Coherence Tomography dan Optical Coherence Tomography Angiography = Analysis of Retinal Neurovascular Unit on Diabetic Patient with and without Diabetic Retinopathy using Optical Coherence Tomography and Optical Coherence Tomography Angiography.

Retinopati diabetik (RD) merupakan kelainan yang melibatkan neurodegeenrasi dan perubahan mikrovaskular retina, bahkan sebelum manifestasi klinis terlihat pada funduskopi. Parameter seperti peripapillary retinal nerve fiber layer (pRNFL), macular ganglion-cell inner plexiform layer (mGCIPL), vessel density (VD), dan perfusion density (VP) menggambarkan kondisi unit neurovaskular retina. Pemeriksaan menggunakan OCT dan OCTA dapat dilakukan untuk mendeteksi perubahan tersebut. Tujuan: Menilai penurunan mGCIPL, pRNFL, VD dan VP pada DM tanpa RD, NPDR (non-proliferative diabetic retinopathy), PDR (proliferative diabetic retinopathy) dibandingkan dengan nonDM. Metode: Studi observasional analitik dengan desain potong lintang. Data dikumpulkan melalui anamnesis, pemeriksaan foto fundus, serta pemeriksaan OCT-OCTA. Hasil: pRNFL dan mGCIPL pada kelompok DM tanpa RD, NPDR, PDR lebih rendah dibandingkan subjek non-DM, namun tidak berbeda signifikan. Vessel density secara signifikan lebih rendah seiring meningkatnya tingkat keparahan retinopati diabetik (p=0.010). Perfusion density lebih rendah seiring dengan tingkat keparahan RD, namun tidak berbeda bermakna. Tidak ditemukan korelasi antara mGCIPL dan VD maupun PD. Terdapat korelasi positif lemah pRNFL dengan VD dan PD. Kesimpulan: pNRFL, mGCIPL, dan PD lebih rendah pada kelompok DM tanpa RD, NPDR, dan PDR dibandingkan dengan non-DM. VD secara signifikan lebih rendah pada kelompok DM tanpa RD, NPDR, dan PDR dibandingkan dengan non-DM. Kata Kunci: Diabetik retinopati, OCT, OCTA, vessel density, perfusion density, peripapillary nerve fiber layer, macular ganglion cell inner plexiform layer


Diabetic retinopathy (DR) involves both neurodegeneration and retinal microvascular alterations, which may occur even before clinical manifestations are visible on fundus examination. Parameters such as peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell–inner plexiform layer (mGCIPL), vessel density (VD), and perfusion density (PD) reflect the status of the retinal neurovascular unit. Optical coherence tomography (OCT) and OCT angiography (OCTA) allow early detection of these changes. Objective: To evaluate the reduction of mGCIPL, pRNFL, VD, and PD in patients with diabetes mellitus (DM) without DR, non-proliferative DR (NPDR), and proliferative DR (PDR) compared to non-DM subjects. Methods: An analytical observational cross-sectional study was conducted. Data were collected from patient history, fundus photography, and OCT/OCTA examinations. Results: The pRNFL and mGCIPL were thinner in DM without DR, NPDR, and PDR groups compared to non-DM, but the differences were not statistically significant. VD decreased significantly with increasing DR severity (p = 0.010). PD showed a decreasing trend with DR severity but was not statistically significant. No correlation was found between mGCIPL and VD or PD, while pRNFL showed a weak positive correlation with VD and PD. Conclusion: pRNFL, mGCIPL, and PD were lower in DM without DR, NPDR, and PDR compared to non-DM, while VD was significantly reduced in all diabetic groups.
Keywords: Diabetic retinopathy, OCT, OCTA, vessel density, perfusion density, peripapillary nerve fiber layer, macular ganglion cell inner plexiform layer