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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Diabetic retinopathy in blacks. 226 43

About 5% of total world population is affected by diabetes mellitus syndrome, with an expected increasing trend in the next years. Retinopathy, among the different diabetic complications, is the second cause (being cataract the first) of legal blindness in the industrialized countries. The range of results obtained from prevalence studies, mainly conducted in Anglo-saxon countries, varies from 5% to 70% in connection with the following risk factors: patient's age at the diagnosis date, duration of disease, metabolic control, arterial hypertension and lipidoproteinosis. Smoke and alcohol do not seem to be statistically relevant. The most probable mechanisms causing the retinopathy onset have been identified in the tissue hypoxia and in the vascular occlusion: the former is induced by the HA1c increase associated with hyperglycaemia; this is due to structural and hemorheologic alterations associated with diabetes syndrome. This study analysis the relations between diabetic retinopathy and beta-cellular reserve and cardio-vascular risk factors. 181 diabetics have been considered, subdivided into three groups: Type I diabetics and Type II diabetics and Type II diabetics (both without considering the duration of disease) and diabetics with over 10 years of disease. In each group the correlations between retinopathy severity and cardiovascular risk factors and beta-cellular reserve have been investigated. The results confirm that patient's age, duration of disease and metabolic control are statistically significant in relation to retinal lesion severity. The investigation on beta-cellular reserve, even though the results are not statistically significant, presents a trend towards lower values in more severe retinopathy.
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PMID:[Epidemiology of diabetic retinopathy]. 248 33

A 3-year-old boy with chronic papilledema, bilateral coronal synostosis and Pfeiffer syndrome underwent an orbitofrontal advancement. One month postoperatively, his papilledema had resolved, however, his vision progressively deteriorated over the ensuing 3 months to legal blindness. He had no symptoms or signs of increased pressure. Multiple imaging studies were unremarkable except for dilatation of the optic nerve sheaths. A lumbar puncture revealed intracranial hypertension, which resolved after treatment with a lumboperitoneal shunt. Intracranial hypertension may persist after craniofacial reconstruction. In patients who have progressive neurological deterioration after craniofacial reconstruction, direct measurement of intracranial pressure is indicated, despite a lack of clinical signs or symptoms of intracranial hypertension and normal imaging studies.
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PMID:Intracranial hypertension after cranial vault decompression for craniosynostosis. 754 60

Diabetic retinopathy is a major cause of morbidity and the leading cause of legal blindness in working-age persons in the United States. Retinopathy affects both juvenile-onset and noninsulin dependent diabetics. Most visual loss occurs in patients because they are seen late in the course of their disease. Several clinical trials have aided in establishing recommended screening and referral guidelines for patients with diabetes mellitus. Treatment strategies based on clinical trials are reviewed as well as the importance of control of both hyperglycemia and hypertension. Ocular findings are illustrated and discussed. The primary care physician can substantially reduce the risk of blindness and visual impairment in diabetic patients by prompt recognition of the ocular findings and understanding the importance of timely ophthalmologic evaluation.
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PMID:Diabetic retinopathy. Preserving your patients' sight. 804 60

The Houston Diabetes Control Program is part of an effort by the State of Texas and approximately 30 other programs throughout the United States to ensure that persons with diabetes-related complications receive ongoing state-of-the-art preventive care and treatment. For the past 5 years, this program has served an urban, high-risk patient population with special cultural, ethnic, and economic challenges. The intervention has included the development and implementation of protocols for the prevention and care of diabetes-related complications of the eyes, lower extremities, and cardiovascular system, as well as general management of diabetes and patient and professional education. The program is ongoing in nine community health centers located in low-income neighborhoods of a large metropolitan area. The results thus far indicate an increase in sensitive eye examinations from 8 percent to 26 percent of the patient population, a reduction in incidence of legal blindness from 9.5 to 2.7 per 1,000 during a 4-year period, an increase in foot examinations from 18 percent to 44 percent of the patient population, and 77 percent of hypertensive patients in good control of blood pressure at less than 160 over 95 mmHg (millimeters of mercury). On the average, there have not been significant long-term improvements in weight reduction or blood glucose control. The major challenges for this program are (a) improvement in control of glycemia, hypertension, and cholesterol; (b) more effective diet and physical activity interventions; and (c) more effective education approaches that help patients to understand metabolic and cardiovascular functions. These challenges will require collaboration of health care professionals in constructive and imaginative ways through their unselfish commitment toward common goals.
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PMID:A diabetes control program in a public health care setting. 821 Feb 58

A long-standing history of insulin-dependent diabetes mellitus can result in multiple organ damage. We present a case of successful pregnancy in a patient who underwent combined renal-pancreas transplantation for end-stage renal disease due to diabetic nephropathy. A 29-year-old white gravida 7, para 2 female was diagnosed with diabetes mellitus at age 7. She was well controlled with insulin until age 21. She developed complications of diabetes mellitus which included retinopathy resulting in legal blindness, nephropathy resulting in end-stage renal disease, and chronic hypertension. Following nine months of dialysis she underwent a combined renal-pancreas transplant. She subsequently became pregnant 21 months after transplantation and delivered a healthy male at 35 1/2 weeks gestation. Renal-pancreas transplant recipients who become pregnant may be at an increased risk for adverse outcome. We present a successful pregnancy outcome in a combined transplant recipient who had a prior poor obstetrical history.
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PMID:Successful pregnancy after combined renal-pancreas transplantation: a case report and literature review. 886 87

We performed a cross-sectional, population-based survey of persons 20 years of age and older living in Cairo and surrounding rural villages. The purpose was to describe glycaemic control and the prevalence of microvascular and neuropathic complications among Egyptians with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. A total of 6052 households were surveyed. The response rate was 76% for the household survey and 72% for the medical examination. Among people with previously diagnosed diabetes, mean haemoglobin A1c, was 9.0%. Forty-two per cent had retinopathy, 21% albuminuria, and 22% neuropathy. Legal blindness was prevalent (5%) but clinical nephropathy (7%) and foot ulcers (1%) were uncommon in persons with diagnosed diabetes. Among people with diagnosed diabetes, microvascular and neuropathic complications were associated with hyperglycaemia. Retinopathy was also associated with duration of diabetes; albuminuria with hypertension and hypercholesterolaemia; and neuropathy with age, female sex, and hypercholesterolaemia. Albuminuria was as common in people with previously undiagnosed diabetes (22%) as those with diagnosed disease (21%). Mean haemoglobin A1c was lower (7.8%) and retinopathy (16%) and neuropathy (14%) were less prevalent in people with previously undiagnosed disease. Ocular conditions, blindness, and neuropathy were prevalent in the non-diabetic population. The microvascular and neuropathic complications of diabetes are a major clinical and public health problem in Egypt.
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PMID:Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications. 986 80

The number of patients with diabetes mellitus will increase over the coming years, so that there will also be more patients with diabetic macular oedema. Diabetic macular oedema and diabetic retinopathy are the most important causes of legal blindness in adults. The current therapy of diabetic macular oedema consists of the prevention, detection and treatment of risk factors (e.g., hypertension, hyperglycaemia, dyslipidaemia, proteinuria and obesity), complemented if necessary by photocoagulation therapy. Photocoagulation therapy may prevent or reduce vision loss in many patients, but usually does not improve visual acuity. New treatment strategies include intravitreal corticosteroids or vascular endothelial growth factor (VEGF) inhibitors, and oral protein kinase C inhibitors, angiotensin converting enzyme (ACE) inhibitors, acetylsalicylic acid or statins. The long-term positive effect of these strategies is controversial and the side effects can be serious.
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PMID:[Therapeutic possibilities for diabetic macular oedema]. 1706 28

Diabetic retinopathy continues to be the leading cause of legal blindness among working-age individuals. The earliest histological features of diabetic retinopathy include neuroretinal damage, capillary basement membrane thickening, loss of pericytes and loss of endothelial cells. At advanced stages, neovascularization, the hallmark of proliferative diabetic retinopathy (PDR) occurs, and blindness can result from relentless abnormal fibrovascular proliferation with subsequent bleeding and retinal detachment. Macular oedema is another retinal complication of diabetes that is responsible for a major part of vision loss, particularly in type 2 diabetes. The breakdown of the blood retinal barrier and the consequent vascular leakage and thickening of retina are the main events involved in its pathogenesis. Although a tight control of both blood glucose levels and hypertension are essential to prevent or arrest progression of the disease, the recommended goals are difficult to achieve in many patients. Laser photocoagulation treatment soon after the onset of PDR significantly reduces the incidence of severe vision loss. However, the optimal timing for laser treatment is frequently passed and, in addition, it is not uniformly successful in halting visual decline. For all these reasons, new pharmacological treatments based on the understanding of the pathophysiological mechanisms of diabetic retinopathy have been developed in recent years. There is mounting evidence to suggest that angiogenic factors play a crucial role in PDR development, vascular endothelial growth factor (VEGF) being the most relevant. Other growth factors or cytokines such as insulin-like growth factor I (IGF-1), hepatocyte growth factor (HGF), basic fibroblast growth factor (b-FGF), platelet derived growth factor (PDGF), pro-inflammatory cytokines and angiopoetins, are also involved in the pathogenesis of PDR. However, the intraocular synthesis of angiogenic factors is counterbalanced by the synthesis of antiangiogenic factors. Therefore, the balance between the angiogenic and antiangiogenic factors rather than angiogenic factors themselves will be crucial in determining the progression of PDR. The main antiangiogenic factor is the pigment epithelium derived factor (PEDF) but the transforming growth factor beta (TGF-beta), thrombospondin (TSP) and somatostatin are also among the intraocullary synthesized antiangiogenic factors.
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PMID:Angiogenic and antiangiogenic factors in proliferative diabetic retinopathy. 1822 Jun 19

Diabetic retinopathy (DR) occurs in about 95% of patients with type 1 diabetes mellitus (DM) and in 60% of type 2 DM patients and it is the main cause of legal blindness in adult people. The aim of this manuscript was to review the main risk factors for DR. The major environmental risk factors are hyperglycemia, high blood pressure levels, and long-term duration of DM. However, not all patients will not develop DR, suggesting the presence of a genetic predisposition to DR, especially for severe forms of DR. Special strategies has been used to evaluate the genetic role in DR. Family studies shown that there is a familial aggregation of DR. Candidates genes have been studied (RAGE; VEGF; PPAR-delta; ICAM-1; ECA; ENPP 1; eNOS) and positive or negative associations with DR were demonstrated. Some chromosomes were also associated to DR in selected populations. Finally, genetic expression studies reinforce the association of candidate genes, or participation of others genes, with the presence of DR. DR is a common complication of DM and, along with non-genetic or environmental risk factors, the identification of genes related to DR could result in more specific and efficient DR treatment.
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PMID:[Diabetic retinopathy risk factors]. 1850 68


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