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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is rare for young diabetic patients to develop severe complications in the first years of their disease. We describe three patients, aged 14-23 years who developed cataracts and severe retinopathy within one to five years of diagnosis of diabetes. During the same period, one patient developed peripheral neuropathy and a second severe autonomic neuropathy. Rapid development of chronic complications in these patients raises the possibility that there may be a subset of patients with unusual susceptibility to complications. We re-emphasize the need for vigilant monitoring for complications in young diabetic patients, even in the first few years of their disease. In particular, young patients with visual complaints should be evaluated carefully for evidence of treatable eye disease.
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PMID:Rapid onset of severe retinopathy, cataracts and neuropathy in young patients with diabetes mellitus. 160

There is a need for greater educational emphasis, both at undergraduate and postgraduate level, on the detection of diabetic eye disease, in particular diabetic retinopathy. The early diagnosis of the sight-threatening lesions of proliferative retinopathy and maculopathy is a prerequisite for the prevention or reduction of the visual loss and blindness associated with this diabetic complication. It is also essential that patients are aware that diabetes can result in visual loss due to diabetic retinopathy. Patients should understand that diabetic retinopathy may be present without ophthalmic or diabetic symptoms and that its incidence increases with duration of diabetes, poor diabetes control, and hypertension. They must also be aware that, if detected early, retinopathy can be treated successfully and vision preserved. Early detection depends on regular eye examination involving both visual acuity assessment and ophthalmoscopy through dilated pupils by experienced personnel. A comprehensive programme of screening followed by prompt and adequate treatment would made a significant contribution to eradicating diabetic retinopathy as a cause of blindness.
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PMID:Screening for diabetic retinopathy. 182 56

Although death certificates are a primary source of data for characterizing mortality patterns in the United States, the underreporting of diabetes as a cause of death limit the use of death certificates for monitoring diabetes mortality. To determine whether diabetes was underreported on the death certificates of patients with known diabetic eye disease, CDC analyzed data from death certificates for persons identified as deceased by the Diabetic Eye Disease Follow-Up Study (DEDFUS).
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PMID:Sensitivity of death certificate data for monitoring diabetes mortality--diabetic eye disease follow-up study, 1985-1990. 192 66

Disorders of lipid metabolism, either hyperlipidemia or hypolipidemia, are associated with the formation of corneal opacities. Corneal arcus, the most commonly encountered peripheral corneal opacity, is frequently associated with abnormal serum lipid levels, but may occur without any predisposing factors. Reports also have linked corneal arcus with alcoholism, diabetes mellitus and atherosclerotic heart disease. Unilateral arcus is a rare entity that is associated with carotid artery disease or ocular hypotony. Diffuse corneal opacities associated with hypolipidemic disorders such as LCAT deficiency, fish eye disease and Tangier disease, may be the initial manifestation of these disorders and puts the ophthalmologist in a position to make an early diagnosis. Corneal arcus, along with a central corneal opacity, is seen in Schnyder's crystalline stromal distrophy. The association of the disorder with a dyslipidemia remains controversial. A review of lipid metabolism, corneal arcus and several disorders of lipid metabolism that affect the cornea are presented.
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PMID:The cornea and disorders of lipid metabolism. 192 41

Compliance with screening recommendations was evaluated following an eye examination administered to a population-based sample of diabetic individuals (The Wisconsin Epidemiologic Study of Diabetic Retinopathy). The relationship between certain characteristics and compliance with a recommendation to seek ophthalmologic follow-up care was examined among 819 study subjects found to have retinopathy at examination. Compliance with the screening recommendations was reported by 77% of all subjects, and was lowest among older-onset non-insulin taking subjects (65%). A history of ophthalmologic care strongly influenced compliance. Subjects who had never seen an ophthalmologist were far less likely to follow the recommendation (50%) than were those who had seen an ophthalmologist in the previous two years (87%). A previous diagnosis of retinopathy, and more severe retinopathy, were determinants of compliance among subjects taking insulin. Increasing duration of diabetes was also an important predictor. Better blood glucose control was found more frequently among subjects who received the recommended ophthalmologic follow-up. Certain demographic factors, such as increasing age, higher education, and being a woman, were associated with compliance in the younger-onset group. Among older-onset non-insulin taking subjects, compliance was more likely if subjects were urban residents. In order to optimize the effectiveness of a screening program for diabetic eye disease, the results of this study might be used to identify subjects who may be unlikely to receive appropriate diagnosis and treatment following screening.
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PMID:Factors associated with compliance following diabetic eye screening. 214 44

Significant attention is paid to the retinal complications of diabetes mellitus and their potentially devastating effects on vision. Diabetes mellitus, however, is a multisystem disease, and diabetic eye disease is an end-organ response to the effects of the condition on the human system. Each portion of the eye is susceptible to the harmful effects of diabetes. This article reviews diabetic effects on non-retinal ocular structures and provides references for those interested in pursuing further studies on diabetic eye disease.
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PMID:A review of non-retinal ocular complications of diabetes mellitus. 219 52

Diabetic eye disease, particularly diabetic retinopathy, is the leading cause of new cases of legal blindness in people 20-74 yr of age in the United States. The prevalence and rate of diabetes in this age-group are higher in Blacks than in Whites. The rate of blindness from diabetic eye disease is also higher in Blacks than in Whites. Severe macular edema, the most frequent cause of decreased vision in diabetic retinopathy, appears to be more common in Blacks. Risk factors for developing macular edema include poorly controlled hypertension, hyperglycemia, and duration of disease. The higher prevalence of hypertension in Blacks may contribute to the increased severity of diabetic retinopathy. Further evaluation is necessary to determine the influence of race on the severity of diabetic retinopathy.
Diabetes Care 1990 Nov
PMID:Diabetic retinopathy in blacks. 226 43

To test the efficacy and safety of orbital decompression for Graves' ophthalmopathy, the authors studied the records of 60 consecutive patients who were operated on for dysthyroid optic neuropathy or for rehabilitative purposes. Patients decompressed for neuropathy were older, had less proptosis, and a shorter duration of eye disease than patients operated on for disfigurement. The authors compared the results of three surgical procedures including the inferomedial, the inferomedial plus lateral, and the coronal approach. Regarding improvement of visual function, no difference was found between the three techniques. Patients in whom vision failed to recover had a high prevalence of diabetes mellitus. Proptosis reduction varied from 1 to 9 mm, depending on the number of walls decompressed. There was no net change in the prevalence of diplopia. Persistent complications were seen in less than 5% of all decompressions. The authors conclude that orbital decompression for Graves' ophthalmopathy is safe and efficacious, regardless of surgical procedure. However, the coronal approach gives the best cosmetic results.
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PMID:Orbital decompression for Graves' ophthalmopathy by inferomedial, by inferomedial plus lateral, and by coronal approach. 234 9

Scanning Electron Microscopy (SEM) was used to study vascular casts of twenty-four autopsy eyes taken from patients with long-standing insulin-dependent Diabetes Mellitus. These casts were compared to casts of ten 'normal' autopsy eyes from patients without a history of diabetes or other vascular disease. The SEM findings in the choroidal vessels of the diabetic eyes included: increased tortuosity, focal vascular dilations and narrowings, hypercellularity, vascular loops and microaneurysm formation, 'drop-out' of choriocapillaries, and sinus-like structure formation between choroidal lobules in the equatorial area. In the iris, neovascularization was evident in the vascular casts in cases with clinically recognized rubeosis iridis. These findings indicate that there is significant involvement of the uveal tract in diabetic eyes. The present study strongly supports the Hidayat and Fine light microscopic observation that the diabetic choroid demonstrates significant vascular changes (e.g. narrowed vessels with possible 'drop-out' of capillaries and neovascularization). Changes in the diabetic choroid, especially in the choriocapillaris, may be a contributing factor in diabetic retinopathy, resulting in decreased oxygenation of the outer layer of the retina. Short reviews and updated information of diabetic eye disease provide some additional insights into the vascular problems in the eye.
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PMID:Diabetic choroidal and iris vasculature scanning electron microscopy findings. 248 64

The pattern of care and demographic features of diabetes in a largely rural Welsh population were investigated before the introduction of measures to improve diabetic care. All data were obtained from general practice notes. Of the population studied 1.01% were identified as diabetic. There were no demographic differences from recently published English studies. Seventy per cent of the diabetic patients had not seen a consultant within the preceding year. The level of surveillance for biochemical control and complications of diabetes was better in those who had had recent consultant care. However, basic surveillance data was missing in many consultant letters to general practitioners. The prevalence of known serious diabetic eye disease (9%) in the study population was similar to that found in a recent study of a structured care system. Proposed improvements in diabetic care must take into account the large number of patients not attending hospital clinics. Communication between consultant clinics and general practitioners must be improved.
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PMID:Characteristics and pattern of care of a diabetic population in mid-Wales. 256 6


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