The Relationship Of Diabetic Papillopathy And Nonarteritic Anterior Ischemic Optic Neuropathy

Diabetic papillopathy（DP）and nonarteritic anterior ischemic opticneuropathy（NAION）are optic nerve diseases that closely linked withdiabetes．Their clinical manifestations have much in common．Since DP isnamed，the problem of the relationship of NAION and DP has been the focusof debate：Some scholars believe that DP is a kind of independent eyedisease and the pathological process is totally different from NAION；andother scholars believe that DP is also a form of optic disc ischemia，similar orequivalent to NAION，just clinical subtype or light type of NAION．But thesestudies are mostly observed based on the difference of clinical manifestationsto determine whether they belong to the same eye disease or not，seldom fromthe perspective of the pathogensis to demonstrate the similarities anddifferences between them． According to the current speculation forpathogenesis of DP and NAION，this study make use of advanced opticalcoherence tomography（optical coherence tomography，OCT），color Dopplerflow imaging （CDFI），as well as glycosylated hemoglobin（HbA1c）testtechnology，to observe the similarities and differences in these aspects ofDP and NAION，in order to improve the cognition and treatment level ofboth．Objective： Making use of OCT，CDFI and HbA1c test technology，we demonstrated the similarities and differences in these aspects between DPand NAION from the perspective of the pathogenesis，in order to improve thecognition and treatment level of both．Methods：The OCT characteristics of optic disc edema，the incidence ofmacular edema，the staging of diabetic retinopathy and the diabetic durationbetween20eyes of19DP patients and30eyes of28NAION patients werecompared. The retrobulbar hemodynamic features and recent HbA1c level between10eyes in9DP patiens and10eyes in10NAION patients all whichcompleted CDFI and HbA1c test were compared.Results:1The average height of superior，inferior，nasal and temporal optic discedema in DP group had no significant difference（P>0.05），presentedproportional edema；and the average height of superior，inferior，nasal andtemporal optic disc edema in NAION group had significant difference（P<0.05），presented disproportional optic edema．Highest value of edematous optic disc（t=2.199，P=0.033）and meanheight in the central disc within1mm circle（t=2.629，P=0.011）of DP groupwere significantly lower than NAION group．The incidence of macular edema in DP group（45%）and NAION group(63.3%) had no statistically significant difference（P=0.251）．2The incidence of DR in DP group was75.0%（nonproliferativeperiod was93.3%，proliferative period was6.7%），without DR was25.0%.The incidence of DR in NAION group was43.3%（nonproliferative periodwas61.5%， proliferative period was38.5%），without DR was56.7%．The incidence of DR in DP group was significantly higher than that ofNAION group （P=0.042）. The incidence of nonproliferative period in DPgroup was significantly higher than that of proliferative period （P=0.035）.The incidence of nonproliferative and proliferative period in NAION grouphad no significant difference（P=0.695）．3The systolic peak flow velocity（P=0.048）and end-diastolic blood flowvelocity （P=0.026）of the ophthalmic arteries of DP eyes were significantlyhigher than that of NAION eyes，and resistance index（P=0.816） had nosignificant difference between them．The systolic peak flow velocity （P=0.003）and end-diastolic blood flowvelocity（P=0.002）of the short posterior ciliary arteries of DP eyes weresignificantly higher than that of NAION eyes，and resistance index（P=0.001）was significantly lower than that of NAION eyes． The systolic peak flow velocity （P=0.038）and end-diastolic blood flowvelocity（P=0.002）of the central artery retinal arteries of DP eyes weresignificantly higher than that of NAION eyes，and resistance index（P=0.041） was significantly lower than that of NAION eyes．4The recent HbA1c level in DP group was significantly higher thanNAION group（t=-2.36，P=0.030）, diabetic duration in DP group wassignificantly shorter than NAION group （z=-2.252，P=0.024）．Conclusion:1DP is closely associated with retinal microcirculation disturbancecaused by diabetes，and NAION is closely associated with hypoperfusion ofretrobulbar vessels，the pathogenesis of them are different.2The degree of optic disc edema in DP is less than that in NAION，andthe distribution of optic disc edema in DP is proportional.3The pathogenesis of DP and NAION is different，and it should be paidmore attention to discriminate them in clinic.