THE ROLE OF CLUSTERIN IN THE DEVELOPMENT OF DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Relevance. One of the main causes of visual impairment in patients with type 2 diabetes mellitus (DMT2)
is diabetic macular edema (DME). Complications associated with DME include microglial activation, dysfunction of neurons, their dystrophy and apoptosis.
Purpose. To study the peculiarities of the content of anti-apoptotic factor clusterin in serum and to analyze
the relationship of clusterin with the state of the macula in patients with DMT2 and DME.
Material and research methods. 82 patients with DMT2 (145 eyes) were divided into 4 groups according
to the form of DME. The criteria for inclusion in the open study was voluntary informed consent, age 18 years,
the presence of DMT2. Non-inclusion criteria were the presence of endocrine diseases, which can lead to type
2 diabetes, DMT1, acute infectious diseases, cancer, decompensation of comorbid pathology, mental disorders,
antipsychotics, antidepressants, neurodegenerative diseases of the central nervous system, proteinuria, damage
to the optic nerve, glaucoma and mature cataracts. The following instrumental indices were used for the study:
nerve fiber layer thickness — NFL, ganglion cell layer thickness — GCL, inner posterior layer thickness — IPL,
central retinal thickness, the volume of the macula and central fovea, the minimum thickness of the central
fovea (minimum in fovea), the average thickness of the retina in the macula (area thickness).
Results. By medical statistics, it has been determined that in patients with T2DM and DME, chances of occurrence of low thickness (value > QI) of NFL + GCL + IPL (> 115 μm) and NFL (> 31 μm) are significantly increased with increasing the blood clusterin levels on each 1 μg/ml (OR = 1.04 (95 % CI 1.01–1.08) and OR = 1.04 (95 % CI 1.01–1.08), respectively). It was shown that the optimal threshold value for serum clusterin is 77.0 μg/ml. With a selected clusterin content threshold for NFL + GCL + IPL thickness > 115 μm, the test sensitivity is 59.6 %, specificity is 75 %, and for NFL thickness > 31 μm — 56.7 % and 76.2 %, respectively.
Conclusion. An increasing of the concentration of blood plasma clusterin over the optimal threshold (that we have identified) can be an indicator of the active inflammatory process and edema of the retina.