الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
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Abstract
Diabetic retinopathy (DR) is a severe sight-threatening complication of diabetes mellitus.
Currently, diagnostic devices like optical coherence tomography have provided quicker and more precise diagnosis of early diabetic retinopathy.
The purpose of this study was to assess changes in the neural retina in eyes with different stages of diabetic retinopathy (DR) in comparison to healthy subjects.prospective analysis optical coherence tomography (OCT) scans of 200 eyes of 150 subjects with diabetes was performed. Key exclusion criteria included with diabetic macular oedema (DME) or other macular diseases, patients with history of retinal laser treatment and patients with chronic glaucoma .
Eyes from diabetic patients were divided into three groups, including no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). A control group of 50 eyes of healthy volunteers was included for comparison .
OCT findings demonstrated that the macula in the diabetic patients with no diabetic retinopathy group was significantly thinner than that of the control group .
Early thinning on the inner retina happens in type 2 diabetes, even before visible vascular signs of DR. This supports the presence of a neurodegenerative process in eyes of patients with diabetes and warrants neuroprotective intervention to prevent chronic neurodegeneration. OCT may represent an indispensable tool for identifying early signs of neurodegeneration in diabetic patients.
Conclusion
Improvements in diabetes care and management have been crucial in lowering the incidence and severity of DR. Nevertheless, the effectiveness of current treatments for DR is limited, and they are currently indicated at advanced stages of the disease. Thus, a multidisciplinary approach and novel strategies to detect, prevent, and treat DR in the early stages are needed. Several therapeutic strategies in the early stages of DR are being evaluated. However, when the early stages of DR are the therapeutic target, it would be recommended that less aggressive and more prudent treatments should be used, avoiding serious adverse effect.
New technologies in retinal imaging , such as OCT, will allow the detection of early changes and designing a personalized, noninvasive treatment. These efforts will be effective in reducing the burden and improving the clinical outcome of this potentially devastating complication of diabetes.
This study detected morphological changes in DM patients using OCT, confirmed that the loss of neural tissue begins in the early stages of diabetes. As diabetes develops, neurodegeneration may be masked by changes in vascular permeability that cause thickening of the retinal layers
Early thinning on the inner retina happens in type 2 diabetes, even before visible vascular signs of DR. This supports the presence of a neurodegenerative process in eyes of patients with diabetes and warrants neuroprotective intervention to prevent chronic neurodegeneration. The OCT may represent an indispensable tool for identifying early signs of neurodegeneration in diabetic patients.
These results may help in close monitoring of diabetic subjects before developing DR..
In conclusion, the central role of neurodegeneration in the pathogenesis of DR is a solid basis for proposing neuroprotection as an effective strategy for preventing or arresting DR. However, clinical trials to determine not only the effectiveness and safety, but also the compliance of a noninvasive route of drug delivery, as well as a standardization of the methods for monitoring neurodegeneration, are needed. In addition, neuroprotection in the setting of DR should be contemplated as an early treatment.