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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Topical and systemic steroids have proven to be invaluable agents in the treatment of a wide range of disorders, but their use is not without potential complications. Before initiation of therapy with systemic steroids, a personal or family history of cataracts, glaucoma, hypertension, diabetes, hyperlipidemia, renal stones, peptic ulceration, and current infection or pregnancy should be ascertained, because these patients have an increased risk of complications. Prior to long-term therapy with systemic steroids, blood pressure measurement, tuberculin skin test, and anergy panel are recommended. Monthly follow-up may include measurements of weight, blood pressure, electrolytes, and blood sugar and guaiac testing of the stool. To prevent the ocular complications of steroid therapy, routine screening is indicated (Table 1). Screening for cataracts, which occur most commonly as a sequela of continuous systemic steroid use, may be performed by slit-lamp examinations conducted three or four times a year for patients on long-term therapy and twice a year for patients taking intermittent topical ocular or systemic steroids. Glaucoma is more often associated with topical ocular or periocular steroids than with systemic steroids; recommended screening includes a baseline intraocular pressure measurement, then routine pressure measurements taken every few weeks initially, then every few months. Ocular rebound inflammation may develop secondary to rapid tapering or abrupt discontinuation of topical ocular steroid use and is best prevented with gradual tapering. Opportunistic infections of the eye include bacterial, viral, and fungal infections and are most often associated with the use of topical ocular steroids. Ophthalmologic evaluation is indicated promptly if patients treated with ocular steroids develop ocular discharge, pain, photophobia, or redness.
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PMID:Ocular effects of topical and systemic steroids. 161 9

Viscoelastic substances in correlation with intraocular hypotony have gained great significance in low-irritation cataract surgery within the last few years. The differences in their chemical properties, and thus in their effect on the eye, formed the grounds for a controlled clinical study comparing sodium hyaluronic acid, representing the group of glucosamine glykanes, and hydroxypropylmethyl cellulose (HPMC), representing the group of cellulose ethers. Two hundred cataract patients, excluding those suffering from diabetes mellitus, glaucoma and severe corneal damage, were examined on the 1st, 2nd and 5th postoperative day, as well as 4 weeks postoperatively. Statistically, no significant differences were found as regards IOP and postoperative anterior chamber irritation. From the economical point of view, methocel (HPMC) should be preferred to sodium hyaluronic acid in routine cataract surgery due to the lower costs.
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PMID:[Controlled clinical study of two viscoelastic substances]. 175 27

A retrospective analysis was performed on the transient and steady-state pattern electroretinograms recorded from 42 patients with glaucoma, 13 patients with senile dementia of the Alzheimer's type, 58 patients with diabetes mellitus, and 92 control subjects to evaluate the pattern of electroretinographic changes associated with retinal and optic nerve disease. The amplitudes of both the initial positive component (N1 to P1) and the subsequent negative component (P1 to N2) of the transient (4 rps) responses were measured. From these measurements the (P1 to N2)/(N1 to P1) was derived. The N1 to P1 amplitude of the steady-state pattern electroretinogram also was measured. In the glaucoma patients all three amplitude measures, as well as the amplitude ratio of the components of the transient response, were reduced significantly compared with age-matched controls (p less than 0.05). A similar pattern was detected in the patients with Alzheimer's disease, but in this case the only statistically significant amplitude reduction was in the steady-state pattern electroretinogram. A different pattern was observed among the diabetic patients (both with and without retinopathy). Only minor reductions in the amplitude of the transient pattern electroretinogram, which were not statistically significant, were noted. In addition, the ratio of the amplitudes of the components of the transient response did not differ from age-matched controls. The amplitude of the steady-state pattern electroretinogram was reduced in diabetics, but this was significant only for those patients with retinopathy (p less than 0.01). These findings support the suggestion that an analysis of both the positive and negative components of the pattern electroretinogram may be useful for differentiating the contributions of retinal and optic nerve dysfunction to visual impairment. The results also indicate that in both retinal and optic nerve disease the steady-state pattern electroretinogram can be an earlier sign of dysfunction than the transient pattern electroretinogram.
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PMID:The pattern electroretinogram in retinal and optic nerve disease. A quantitative comparison of the pattern of visual dysfunction. 176 Sep 71

Because people with diabetes may be at increased risk of glaucoma, we performed a pilot study using automated visual field testing for screening them. One hundred and seventy-six diabetic persons who had participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy were tested with the Armaly-Drance screening pattern on the Humphrey Visual Field Analyzer. Individuals with moderate diabetic retinopathy or worse tended to have lower sensitivity of the central visual field and missed more points than those with no or only mild retinopathy. People with a history of glaucoma had slightly less sensitivity and missed more points than controls. These preliminary findings suggest that although people with diabetes and glaucoma may more frequently have visual field defects than people with diabetes but no glaucoma, a larger study is needed. This pilot study shows that such a study would be feasible and should be designed to indicate the sensitivity, specificity, and cost-benefit ratio of a screening program so as to assess the utility of the screening visual field test for finding glaucoma amongst people with diabetes.
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PMID:A pilot study of glaucoma visual field screening in diabetes. 184 65

We examined the physical, sociodemographic, and psychosocial health status of diabetic Mexican Americans aged 45 to 74 years using data from the Hispanic Health and Nutrition Examination Survey. Diabetic Mexican-American women had lower education levels and lower employment rates in comparison with nondiabetics. Glaucoma, retinopathy, and activity limitation were more prevalent in diabetic than in nondiabetic men and women. Diabetic women also had a higher prevalence of hypertension, kidney problems, and cataracts. No significant differences were found in depression levels between diabetic and nondiabetic Mexican Americans of either sex. Among diabetics, duration of diabetes was associated with increased prevalence of stroke and activity limitation. These findings on the health status of diabetic Mexican Americans furthers our understanding of the health service needs of this population.
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PMID:Health status of diabetic Mexican Americans: results from the Hispanic HANES. 184 40

1573 examinations were performed on 397 eyes. hh was found in 55 eyes--thromboses included--at 91 examinations. Part of this material qualified for use in a comparative study with pilocarpine in 81 eyes and timolol in 82 eyes. The relative frequency of hh in the treated groups and in the pretreatment group was not significantly different from that of the whole material. No indication of pressure reduction with effect on the occurrence of hh could be detected. The average probability of hh at an examination chosen at random was 6 per cent in this material of ordinary simple and capsular glaucoma cases. The occurrence of haemorrhages in relation to age, sex, general hypertension and diabetes are discussed.
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PMID:Occurrence of disc haemorrhages in open-angle glaucoma treated with pilocarpine or timolol. 187 41

Of 3632 consecutive admissions to the Wilmer Ophthalmological Institute between July 1, 1987 and June 30, 1989, 27 patients required transfer to a medical or surgical service (0.74%). The major reasons for transfer included acute or decompensated cardiac disease (26%), poorly controlled diabetes mellitus (19%), acute renal failure (11%), coagulopathy, stroke, and hypertension (7% each). Only one transfer was a direct result of an anesthesia complication. The highest rates of transfers were associated with orbital (4.3%), enucleation/evisceration (3.1%), and glaucoma (2.3%) surgeries, while vitreoretinal surgery had the lowest rate of transfer (0.3%). Most of the transfers of patients with orbital disease were for management of related problems such as sinusitis or increased intracranial pressure.
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PMID:Transfer from ophthalmology to another service is a marker of high risk medical events. 190 39

We reviewed the automated visual field tests of 110 nondiabetic and 87 diabetic patients with primary open-angle glaucoma randomly selected from a large glaucoma practice to investigate a possible qualitative difference in the pattern of visual field defects between nondiabetic and diabetic patients with primary open-angle glaucoma. A single reviewer analyzed, in masked fashion, the visual field tests of each patient and decided whether or not visual field defects were present mainly in the inferior half of the visual field. Of the 110 nondiabetic patients, 40 (36.4%) had visual field defects located mainly in the inferior half of the visual field in one or both eyes, whereas 56 of the 87 (64.4%) diabetic patients had such defects. This difference was statistically significant (P = .0001). We believe that a vascular factor, such as that attributable to diabetes mellitus, may influence glaucomatous optic nerve damage, thus causing a difference in the pattern of visual field loss in patients with primary open-angle glaucoma.
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PMID:Visual field defects in diabetic patients with primary open-angle glaucoma. 202 Nov 66

The speed of blood perfusion and the pulsation curve in ciliary arteries was checked by the method of Doppler's pulsating focused ultrasonography in 30 patients aged 46-78 years treated for glaucoma and diabetes. The data obtained were compared with analogical data in nondiabetic patients with glaucoma. It was established that the increase of the intraocular pressure caused a larger and earlier impairment of the regulating mechanism of the ciliary microcirculation in diabetic patients with glaucoma in comparison with the group of glaucomatous patients without diabetes. Particularly high values of pulsation indexes for ciliary arteries were observed in eyes with glaucoma and with diabetic changes rated as the fifth group of diabetic changes.
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PMID:[Ciliary circulation in glaucoma complicated by diabetes mellitus]. 204 89

Data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy from persons with diabetes of older onset whose average age was 65.4 years indicate that 9.9% of the men and 13.3% of the women had some degree of visual impairment, and 1.4% of men and 1.7% of women were legally blind (with an visual acuity of 20/200 or worse in the better eye). Poorer visual acuity was strongly associated with increasing duration of diabetes, but age was also an important factor, with rates of legal blindness increasing markedly after the seventh decade of life in groups of any duration. Conditions responsible for legal blindness were diabetic retinopathy or maculopathy, cataracts, glaucoma, and macular degeneration. Incidence of blindness 4 years after the initial evaluation was related to insulin use, younger age at examination, longer duration of diabetes, and more severe retinopathy at baseline. Worsening of vision was related to higher levels of glycosylated hemoglobin and the presence of macular edema on diabetic retinopathy at baseline. These data indicate that there is a high prevalence of ocular problems among people with diabetes of older onset. The practitioner should suggest to these patients that, soon after the diagnosis of diabetes, they have an ophthalmologic evaluation to determine whether asymptomatic problems are present. This action may lead to timely intervention to prevent loss of vision in some patients.
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PMID:Ocular problems in older Americans with diabetes. 222 49


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