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

The metabolic disorder in diabetics often results in progressive retinopathy with severe visual impairment. Changes in metabolism can influence corneal autofluorescence. This has led to speculation that diabetic retinopathy might be associated with changes in corneal autofluorescence. Corneal autofluorescence of both eyes was determined by fluorophotometry in 94 insulin-dependent diabetes mellitus patients and in 46 healthy controls to evaluate its correlation with diabetic retinopathy. The modified Airlie House classification was used for grading diabetic retinopathy: (1) no or negligible retinopathy; (2) minimal background retinopathy; (3) background retinopathy; and (4) (pre-) proliferative retinopathy. The corneal autofluorescence values of grade 1 retinopathy patients did not differ significantly from those of the healthy controls (mean +/- standard deviation in ng equivalent fluorescein/ml: 11.6 +/- 3.0 and 11.4 +/- 2.8, respectively; P = 0.8). The means of grade 2, 3, and 4 retinopathy patients (mean +/- standard deviation in ngEq fluorescein/ml: 16.2 +/- 4.4, 16.7 +/- 4.3, 20.9 +/- 5.4, respectively) were significantly higher than the means of grade 1 patients and healthy controls (P less than 0.004). The mean values of patients with grade 4 were significantly higher than those of patients with grades 2 and 3 (P less than 0.01). The sensitivity and specificity of corneal autofluorescence as a screening test for diabetic retinopathy were 80% and 76%, respectively; the positive predictive value for the presence of retinopathy was 90%. The values for screening on (pre-) proliferative diabetic retinopathy were 68%, 72%, and 58%, respectively. These data show corneal autofluorescence to be an adequate indicator of diabetic retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Corneal autofluorescence: an indicator of diabetic retinopathy. 173 May 50

Insulinlike growth factor I (IGF-I) has been suggested to play a role in the pathogenesis of proliferative diabetic retinopathy (PDR). We determined IGF-I levels in subjects in a large population-based study of 928 people with diabetes diagnosed at 30 yr of age or older. PDR was found in 15.7% of the insulin-using group (n = 517) and in 2.8% of those not using insulin (n = 397). The mean serum level of IGF-I was 208 micrograms/L in individuals using insulin and 222 micrograms/L in those not using insulin, both significantly lower than in a nondiabetic comparison group (278 micrograms/L, P less than 0.0001). Logistic regression analysis was used to examine the relationship between IGF-I and PDR while controlling for other factors associated with the presence of PDR. After controlling for duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of proteinuria, and age at diagnosis, higher levels of IGF-I were significantly associated with an increased frequency of PDR (P = 0.025) in the group using insulin. In individuals not using insulin, higher levels of IGF-I were associated with an increased frequency of PDR or moderate non-PDR (P = 0.08). These data suggest that higher IGF-I levels may be a risk factor for the development of severe retinopathy in people with diabetes diagnosed at 30 yr of age or older.
Diabetes 1991 Dec
PMID:Association of elevated IGF-I levels with increased retinopathy in late-onset diabetes. 175 14

Medical practitioners often have difficulty in assessing the presence or severity of diabetic retinopathy. The tourniquet test is a method of assessing diabetic capillary fragility that has been felt to reliably correlate with background and proliferative diabetic retinopathy. We studied 100 consecutive diabetic patients and 50 age-matched controls in a masked fashion, using fundus photographs and fluorescein angiography to correlate the amount of capillary fragility with the presence and severity of background and proliferative diabetic retinopathy. Although the severity of diabetic capillary fragility did correlate with the presence and severity of diabetic retinopathy (p less than 0.001), this test was not as good an indicator of diabetic retinopathy as were other risk factors such as duration of diabetes (p much less than 0.001). The tourniquet test is unreliable in predicting the presence or severity of diabetic retinopathy because of its high false negative response rate.
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PMID:Evaluation of the tourniquet test as a predictor of diabetic retinopathy. 177 17

The present study was conducted on 25 patients with Diabetes Mellitus (DM) having positive indication of diabetic retinopathy on ophthalmoscopic examination. The patients were examined clinically, ophthalmoscopically and with Fluorescein Angiography (FA). It was found that the maximum number of patients with retinopathy were in their 5th and 6th decade and that retinopathy was more common in Non Insulin dependent diabetics (NIDDM) than Insulin dependent Diabetics (IDDM). It was also seen that retinopathy takes longer time to develop in IDDM patients (16.37 years vs 11.7 years). Proliferative diabetic retinopathy was more common with patients having poor glycemic control and in IDDM patients. FA was very helpful in detecting microaneurysms and for exact localization of neovascularization, and other microangiopathic lesions as well as for permanent record.
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PMID:Diabetic retinopathy: a clinical study with special reference to fluorescein angiography. 184 1

The course of diabetic retinopathy following cataract extraction was studied retrospectively in 89 patients (89 eyes). Cataract extraction was extracapsular in 12 eyes (13.5%), extracapsular with intraocular lens implantation in 37 (41.6%), and intracapsular in 40 (45%). In 55 eyes (61.8%) there was no change in the retinal status after surgery, and in 34 (38.2%) there was progression of diabetic retinopathy. In the eyes showing progression there was appearance or aggravation of non-proliferative changes in 85.3% and development of proliferative diabetic retinopathy in 14.7%. Most of these eyes (91%) deteriorated within six months of surgery. Risk factors for the progression of diabetic retinopathy were the preoperative existence of diabetic retinopathy (p less than 0.005) and the need for antidiabetic agents in addition to dietary control in the management of diabetes (p less than 0.025).
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PMID:Progression of diabetic retinopathy after cataract extraction. 191 58

We report the case of a young man with a 20-year history of insulin-dependent diabetes mellitus, proliferative diabetic retinopathy OD, and uveitis OS. None of the common reported causes contributing to this difference between eyes was present. No features of diabetic retinopathy appeared OS after a follow-up of 36 months. This is the first case, to our knowledge, in which uveitis appeared to be associated with an asymmetric presentation in diabetes.
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PMID:Unilateral proliferative diabetic retinopathy and uveitis in the fellow eye: report of a case. 192 93

Diabetic retinopathy is the leading cause of acquired blindness among Americans of working age. The resulting economic and societal burdens are of profound magnitude. Epidemiologic and clinical trials data were used to analyze the impact of improved recruitment of patients with Type I diabetes mellitus into screening and treatment programs. The analysis predicted annual savings of $101.0 million and 47,374 person-years-sight at the currently estimated 60% screening and treatment implementation level. If all patients received appropriate eye care, the predicted savings exceed 167.0 million and 79,236 person-years-sight. Approximately two thirds of all savings result from treatment of proliferative diabetic retinopathy, while nearly one third arises from treatment of clinically significant macular edema. Additional savings of $9571 are realized with each recruitment of a newly diagnosed patient with diabetes. Initiating screening immediately upon diagnosis of diabetes, rather than the currently recommended 5-year deferral, would be cost effective if 1 additional individual in 56 were recruited. This model suggests that improved delivery of ophthalmic care to patients with diabetes would yield substantial financial and visual savings, thus making major recruitment programs such as the National Eye Institute's National Eye Health Education Program and the American Academy of Ophthalmology's Diabetes 2000, both economically and clinically effective.
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PMID:Detecting and treating retinopathy in patients with type I diabetes mellitus. Savings associated with improved implementation of current guidelines. American Academy of Ophthalmology. 196 46

The authors analysed and compared three groups of patients who had undergone surgery. In the first group of 72 patients with diabetes and cataract, intraocular lens implantation was carried out. In the second group of 96 patients with diabetes and cataract, cataract surgery was not followed by intraocular lens implantation. The third group of 100 nondiabetic patients, selected by random choice, had intraocular lens implanted after the cataract surgery. Retinal status, postoperative complications and visual acuity were the parameters analysed in correlation with the intraocular lens implantation. In the authors' opinion, the prognosis following cataract surgery and intraocular lens implantation in diabetic patients is good, if diabetic complications do not occur, particularly retinopathy and vitreal hemorrhage which impair the vision considerably. Intraocular lens can be implanted even in cases of maculopathy and preproliferative diabetic retinopathy, provided a thorough diagnostic evaluation has been performed (echography, fluorescein angiography). Laser photocoagulation procedure should also be carried out before surgery and repeated as long as the transparence of the lens enables it. The treatment should be resumed two weeks after the cataract surgery and intraocular lens implantation at the latest. Intraocular lens implantation is contraindicated in proliferative diabetic retinopathy, and especially iridal rubeosis, as the risk of neovascular glaucoma development is considerable.
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PMID:[Implantation of intraocular lenses in patients with diabetes]. 203 42

The authors analyze the results of treatment of 30 eyes of 28 patients suffering from various forms of diabetes mellitus for 1 to 15 years; no cases with neovascularization or proliferative diabetic retinopathy were included in the study. Extracapsular cataract extraction with intraocular lens (IOL) intracapsular implantation was carried out according to the method developed by B. N. Alexeyev. Polymethylmethacrylate lens with a 5 mm diameter of the optic section with polymethylmethacrylate supporting elements was implanted into the capsular sac. In 4 cases lenses with 7 mm optic section diameter and with polypropylene supporting arches were implanted. IOLs were implanted in both eyes to 2 patients. The methods of examination included visometry, biomicroscopy, measurements of the blood sugar before and after surgery, tonometry, tonography, echography, ophthalmometry, gonioscopy, fluorescent angiography. The findings permit a conclusion that IOL intracapsular implantation to diabetics was effective in all 30 cases analyzed. High visual acuity was achieved in more than 80 percent of patients. No grave complications of the ocular or general condition due to diabetes mellitus were recorded. Therefore IOL intracapsular implantation is safe and possible in type I and II diabetes mellitus patients.
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PMID:[Intracapsular implantation of intraocular lenses in patients with diabetes mellitus]. 207 49

Six hundred sixteen eyes with recent severe diabetic vitreous hemorrhage reducing visual acuity to 5/200 or less for at least 1 month were randomly assigned to either early vitrectomy or deferral of vitrectomy for 1 year. The proportion of eyes with visual acuity of 10/20 or better was higher in the early vitrectomy group than in the deferral group throughout the 4-year follow-up period. Up to the 18-month visit, the early group had a higher proportion of eyes with visual acuity of no light perception. An increased chance of obtaining good vision with early vitrectomy was clearly present in the type I diabetes group, particularly in patients who developed severe vitreous hemorrhage after less than 20 years of diabetes, a patient group tending to have more severe proliferative retinopathy. This advantage was not found in the type II diabetes group, in which patients were older and tended to have less severe retinopathy. The findings of this and previous Diabetic Retinopathy Vitrectomy Study reports support early vitrectomy in eyes known or suspected to have very severe proliferative diabetic retinopathy as a means of increasing the chance of restoring or maintaining good vision.
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PMID:Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. 219 36


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