European Association for the Study of Diabetic Eye Complications

Annual Meeting Munich 21-23rd May 2004

Poster Abstracts

CIRCULATING LEVELS OF THIAMINE IN TYPE 1 DIABETIC PATIENTS WITH AND WITHOUT RETINOPATHY

Attilio Allione, Elena Beltramo, Elena Berrone, Paola Massarenti, Marina Trento, Massimo Porta. Depts. of Internal Medicine, University of Turin, and Clinical Nutrition, S. Gioavnni Hospital, Turin, Italy.

Background: Previous studies in vitro and in animal models suggest that thiamine (vitamin B1) and benfotiamine may protect endothelium from damage induced by chronic hyperglycaemia.

Aim: To determine if circulating levels of thiamine in patients with type 1 diabetes (T1DM) and no diabetic retinopathy (DR) differ from those of patients with proliferative retinopathy or healthy control subjects.

Materials and methods: 40 patients with T1DM of at least 10 year duration were studied. Eighteen patients had proliferative DR, already treated by photocoagulation, and 22 had no sign of DR. Forty blood donors represented the control group. Venous blood was collected after overnight fasting between 8 and 9 am. Blood analyses included: thiamine pyrophosphate (TPP) and HbA1c by HPLC, and full blood count and creatinine by standard methods. Creatinine clearance was calculated by Cockroft‘s formula [Clearance = K (M=1,23, F=1,03) x Weight x (140-age)/Creatinine (_mol/l)]. The results are expressed as mean ± standard deviation and t-test was used for statistical analisys

   n  Age  Gender  Disease duration  HbA1c   Hb (g/dl)  TPP (_g/l)  Creatinine clearance
T1DM, no DR
22 38.5±12.1 M=13 22.3±7.8 7.3±1.3 14.0±1.2 66.9±15.9
121.9±38.2
T1DM prolif DR 18 48.4±12.8 M=10 30.6±8.3 7.9±1.2 12.3±1.9
55.2±16.2 82.0±36.1
Controls 40 40.2±7.8 M=19  -  -   61.3±10.6  -

The two diabetic groups had similar HbA1c but were significantly different (p<0,05) for age, disease duration, Hb and creatinine clearance. TPP levels were significant lower in the patients with than in those without DR (p = 0,027) but, after adjusting by Hb and creatinine clearance, the differences were no longer statistically significant.

Conclusions: Thiamine circulating levels may be reduced in patients with severe DR. Since circulating vitamin B1 is mostly stored in red cells, this might be the result of subclinical anaemia associated with reduced renal function. Future studies should define whether thiamine supplementation could represent a new approach to preventing and/or treating this microvascular complication.


COMPARISON OF DIFFERENT COMBINATIONS OF 45 DEGREES IMAGE FIELDS OBTAINED WITH THE TOPCON CRW6 NONMYDRIATIC CAMERA FOR DIABETIC RETINOPATHY SCREENING: RESULTS OF A 1000 CONSECUTIVE PATIENTS SERIES.


Karine Angioi, Charles Pêcheur, Toufic Maalouf. Opththalmologiy department, Brabois Hospital, Nancy, France

Purpose: Non mydriatic cameras are now widely accepted as an efficient tool for diabetic retinopathy screening. Routine examination usually includes analysis of 5 fields. As we postulated that the relative contribution of each field to the screening was not similar, we aimed to determine whether the combination of 3 or 4 fields would ensure satisfactory results as compared to the 5-field standard.

Methods: We retrospectively analyzed the results of 1000 consecutive patients with suitable images. Routine examination included 5 images per eye (centred respectively on the macula (1), on the disc (2), temporal to the macula (3), superotemporal to the macula (4), inferotemporal to the macula (5)). We compared the assessment of diabetic retinopathy using different combinations of these fundus images. The images were graded using the ALFEDIAM classification.

Results: With the 5-image fields examination, diabetic retinopathy was present in 735 eyes (36.8%). Diabetic lesions were noted on 26.2% of field 1 images, 22.5% of field 2 images, 19.9% of field 3 images, 23.2% of field 4 images and 18% of field 5 images. Using the 5-field as a reference, the percentage of false negative exams was 1.5% with the combination of fields 1, 2, 3 and 4, 4.3% with the combination of fields 1, 2 and 3, 3.3% with the combination of fields 1, 2 and 4 and 4.6% with the combination of fields 1, 2 and 5. The kappa coefficients of agreement between the 5-field standard and these combinations were 0.967, 0.906, 0.929, 0.900 respectively.

Conclusion: Diabetic retinopathy screening with a nonmydriatic camera using 3 or 4 fields appears to be as effective as those using 5 fields. Reducing the number of fields will decrease the duration of the examination and may contribute to the improvement of the images quality.


SCREENING OF DIABETIC RETINOPATHY WITH THE TOPCON CRW6 NONMYDRIATIC CAMERA : RESULTS OF A 2000 CONSECUTIVE PATIENTS SERIES.

Karine Angioi, Charles Pêcheur, Toufic Maalouf. Opththalmologiy department, Brabois Hospital, Nancy, France

Purpose : The use of nonmydriatic cameras is gaining acceptance for the screening of diabetic retinopathy. We report our initial experience in a department of diabetology.

Methods : Since November 2002, all the patients of the department of diabetologia had undergone fundus photographs with the Topcon CRW6 nonmydriatic camera. Routine examination included 5 images per eye (centred respectively on the macula, on the disc, temporal to the macula, superotemporal to the macula, inferotemporal to the macula). The images were taken by an orthoptist and analysed by an ophthalmologist specialized in retinal diseases and graded using the ALFEDIAM classification. All the patients with a grade greater than mild non proliferative diabetic retinopathy as well as those with images of poor quality were referred to an ophthalmologist.

Results : The images of 2000 consecutive patients have been analysed. 12,2% of the patients had at least an image of poor quality. 54,5% had no diabetic retinopathy, 22,8% had a mild non proliferative diabetic retinopathy, 7,9% a moderate non proliferative diabetic retinopathy, 2,1% severe non proliferative diabetic retinopathy and 0,5% a proliferative diabetic retinopathy. The rate of patients with at least one image of poor quality which was 24% for the first 200 examinations, rapidly decreased to 14% for the next 400 to reach 9,5% for the 200 last patients. In the group with at least one image of poor quality, patients were significantly older (68±13 versus 58±14 years, p<0.00001) with a longer duration of diabetes (16±11 versus 14±11 years, p<0.00001).

Conclusion : After a short learning period, the use of a nonmydriatic camera for diabetic retinopathy screening is easy. It allows to detect an increased number of patients and to select those that will require ophthalmologic care for closer follow-up or for treatment.


FIRST RESULTS OF DIABETIC RETINOPATHY SCREENING IN SAINT-PETERSBURG

Yuri S. Astakhov, Nyurguyana N. Grigorieva, Evgeny B. Shklyarov, Olga N. Alexandrova, Olga Ya Kryaneva, Elena L. Rutenburg, Fedor E. Shadrichev St-Petersburg State Pavlov Medical University

Purpose: To determine the prevalence of diabetic retinopathy (DR) and clinically significant macular edema (CSME) in patients with type 1 diabetes.

Research design and methods: 1303 consecutive diabetic patients were examined using seven-field standard stereo retinal photography (Topcon TRC-501X fundus camera, Agfachrome 100 colour film), direct ophthalmoscopy and slit-lamp biomicroscopy with aspheric lenses. Retinal photography was performed according to the ETDRS strategy. DR level and CSME were graded according to the ETDRS criteria

Results: Out of total 1303 diabetic patients 946 (72.6 %) had DR. Nonproliferative, severe nonproliferative (preproliferative) and proliferative DR was detected in 622 (47.7 %), 85 (6.6 %) and 239 patients (18.3 %), respectively 98 patients (7.5 %) had high-risk proliferative DR, and advanced DR was present in 29 patient (2.2 %). CSME prevalence was 8.6 % (113 patients – 179 eyes). 66 diabetics (58.4 %) had bilateral CSME. The incidence of DR and CSME depended on diabetes duration. DR / CSME was found in 16.6 % / 0.4 % respectively when diabetes duration was less than 5 years, 53.0 % / 1.3 % (duration of 6-10 years), 88.6 % / 10.1 % (11-15 years), 90.0 % / 17.2 % (16-20 years), 96.7 % / 14.1 % (21-25 years), 96.1 % / 15.7 % (26-30 years), and 98.4 % / 7.8 % when diabetes was present for more than 30 years.

Conclusions. The incidence of DR and CSME in patients with type 1 diabetes depends on diabetes duration and varies from 16.6. % to 98.4 % for DR and from 0.4 % to 17.2% for CSME. Since the prevalence of proliferative DR is great (18.3 %), many diabetics require panretinal photocoagulation.

CHARACTERIZATION OF VASOMOTION IN LARGE RETINAL ARTERIOLES FROM NORMAL PERSONS AND PATIENTS WITH DIABETIC MACULOPATHY

Toke Bek, Christian Frederiksen, Pernille A. Gregersen, Peter Jeppesen Department of Ophthalmology, University of Aarhus, Denmark

Purpose: To characterize vasomotion in large retinal arterioles from normal persons and diabetic patients with and without maculopathy using the retinal vessel analyzer (RVA).

Method: Twenty-one type 2 diabetic patients and seven normal persons were studied. The diabetic patients consisted of three matched groups characterized by A) macular oedema, B) mild retinopathy, C) no retinopathy. The diameter changes over a 3-min. period of a first order retinal arteriole was measured using the RVA. The measurements were analyzed by Fourier transformation and the most prominent peaks in the frequency domain were compared using one-way ANOVA.

Results: There was no significant difference between the peak frequency of vasomotion (3.9±2.0, 2.6±2.7, 2.9±1.7, 3.4±1.9, (mean±SD) between group A-C and the normals, p=0.68).

Conclusion: The lack of relation between diabetic maculopathy and vasomotion frequency in large retinal arterioles is in contrast to previous studies where such a relationship has been found in smaller retinal arterioles. This suggests that changes in vasomotion involved in the development of diabetic maculopathy mainly affects the microcirculation.

PREDICTORS FOR VISUAL OUTCOME AFTER PANRETINAL LASER PHOTOCOAGULATION FOR PROLIFERATIVE DIABETIC RETINOPATHY

Toke Bek1 and Mogens Erlandsen2
1. Dept of Ophthalmology, Aarhus University Hospital, Denmark
2. Statistical Research Unit, Aarhus University

Purpose: To identify predictors for visual outcome after panretinal laser photocoagulation for proliferative diabetic retinopathy.

Methods: The material includes 4422 photocoagulation treatment sessions from 1013 eyes of 601 patients with proliferative diabetic retinopathy (253 males, 348 females, 297 type 1 diabetic and 297 type 2 diabetic patients. All patients had received at least 2000 laser applications per treated eye. The proportional odds method for ordinal data was used to study the effect on post treatment visual acuity of the following pre-treatment variables: Visual acuity, age, diabetes type and duration, number of laser applications, number of treatment sessions and time interval between sessions, and the number of post- treatment vitrectomies and cataract operations.

Results: Patients who started laser treatment in the age interval between 31 and 40 years had a significantly better visual prognosis than those who started treatment at younger or older ages. This was independent of diabetes type. The other variables were unrelated to visual prognosis.

Conclusions: The visual prognosis after panretinal laser photocoagulation for proliferative diabetic retinopathy depends on age, but not on diabetes type or treatment strategy.

STUDY OF PREVALENCE OF RETINOPATHY AND ITS RISK FACTORS IN TYPE 1 DIABETES PATIENTS IN ANANTAPUR SOUTH INDIA.

Dr.Sabitha Chichilli. Diabetologist, Diabetes research Center, Sainagar, Anantapur, A.P, India.

Background and Aims: Retinopathy is not only related to glycaemic control and diabetes duration, but also to blood pressure and B.M.I, as was shown by the UKPDS and the HOORN study.

Materials and Methods: 500 type1 diabetic patients from the O.P. of our Diabetes center, Sainagar, Anantapur, India are taken up for the study. But 25 patients with major cardiovascular disease, amputation or serum creatinine level >1.5 mg/dl were excluded ( M/F:265/210, mean age : 41+or- 12 yrs, duration of diabetes 19+or-11 yrs, HbA1c 7.8+or-1.1%). Retinopathy was examined by fundoscopy (Airlie House classification), neuropathy by electromyography, blood pressure was taken 5 min. rest and a mean of 4 measurements was used. B.M.I and HbA1c are measured to all patients.

Results: Retinopathy was present in 53%, Hypertension (>130/80 mm Hg.) in 41%, neuropathy in 41%. Retinopathy is more prevalent in over weight subjects than in normal weight (62% Vs 45% P < 0.0001). Patients with retinopathy were older (46+- 11 vs 36+-11 yrs p<0.0001), had longer diabetes duration (25+- 10 vs 13+-9 yrs p<0.0001), a higher HbA1c (8.0+-1.0 vs 7.7+-1.2% p=0.004) and a higher B.M.I ( 26.0+-4.2 vs 24.8+-4.4 p=0.005) than those with out retinopathy. Logistic regression analysis showed that diabetes duration (p<0.0001), blood pressure (p=0.013), HbA1c (p=0.019) were independent risk factors for retinopathy.

Conclusions: Retinopathy is present in 53% of type 1 diabetic patients and is more prevalant in patients who has hypertension (>130/80 mm Hg), longer diabetes duration (24+- 5 years), higher HbA1c (8.0+-1.0%) and higher B.M.I (>- 25).

EFFICACY OF CALCIUM DOBESILATE (DOXIUM“) ON THE BRB PERMEABILITY IN EARLY DIABETIC RETINOPATHY

José G. Cunha-Vaz on behalf of the DX-1991/4 study group

Purpose: This study was designed to confirm the efficacy of calcium dobesilate (Doxium“, DX) on the blood-retinal barrier (BRB) permeability.

Methods: Adults with type II diabetes and early DR were enrolled in this double-blind placebo (PL)-controlled study. Treatment was 2g daily during 24 months. The primary parameter, Posterior Vitreous Penetration Ratio (PVPR), was measured every 6 months by fluorophotometry. Secondary parameters were fundus photography, fluorescein angiography and safety assessment. Metabolic control was performed every 3 months.

Results: 194 patients were randomised (98 DX, 96 PL), 137 completed the 24-month study (69 DX, 68 PL). Both treatment groups were comparable at baseline. Mean PVPR change from baseline after 24 months was significantly lower in the DX group (- 3.87 (SD 12.03)) than in the PL group (+2.03 (SD 12.86)), p=0.0016. Moreover, PVPR global evolution compared by least squares regression showed significant superiority of DX over PL (p=0.0378) with mean slopes of respectively –0.142 (SE 0.050) and +0.010 (SE 0.052). PVPR evolution was also analysed by HbA1c classes (<7%, between 7 and 9%, ≥9%) and results confirmed the superiority of DX independently of the diabetes control level. Highly significant difference was also obtained with a subgroup of patients without chronic concomitant medications, such as antihypertensive or lipid-lowering agents (p=0.0002 at 24 months). No significant differences between groups were found for the secondary parameters.

Conclusion: Doxium 2g daily for 2 years shows a significantly better activity than PL on prevention of the disruption of the BRB, independently of the diabetes control. Tolerance was very good.

EVOLUTION OF RETINAL THICKNESS IN A TWO YEAR FOLLOW UP OF NONPROLIFERATIVE RETINOPATHY IN TYPE 2 DIABETES

João P. Figueira,1,2,3 Lilianne G. Duarte,1 Teresa S.Torrent,2 Rui C. Bernardes,1 Mário A. Soares,2 Conceição L. Lobo,1,2,3 José G. Cunha-Vaz1,2,3
1 AIBILI
2 Centre of Ophthalmology, Coimbra University Hospital
3 IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Objective: To characterize retinal thickness progression in the initial stages of retinal disease in Diabetes type 2.

Methods: Thirty seven eyes of 37 patients with type 2 diabetes mellitus and mild nonproliferative retinopathy classified by 7 field stereoscopic fundus photography (levels 10, 20 and 35 of Wisconsin grading), were examined 5 times at six-months intervals using a retinal thickness analyzer (RTA – Talia) and vitreous fluorometry. Measurements of retinal thickness were performed in the foveal area or covering a large portion of the macula. Comparison with a normal reference population were made taking into account the value of maximal and area of retinal thickness increase.

Results: The eyes were analyzed in to main groups taking into account the duration of their diabetes. There were 12 eyes of 12 patients with diabetes of more than 10 years of duration (mean 12,2 ± 2,4), where marked increases in retinal thickness were registered in 9 eyes. Of these, 8 (89%) showed stabilized increase in retinal thickness throughout the follow-up period. There were 25 eyes of 25 patients with diabetes of less than 10 years duration (mean 5,6 ± 2,5). Of these, 21 eyes showed marked increase in retinal thickness in at least one visit during the follow-up. The increases in retinal thickness were stable in only 9 eyes and reversible in 12 eyes. In this group, the isolated increases in retinal thickness were associated with increases in fluorescein leakage either in the same or previous visits.

Conclusions: In the two years period of this study, the increases in retinal thickness either remained stable during the follow-up or appeared as isolated increases showing reversibility. Stable increases in retinal thickness were seen mostly in eyes with longer duration of diabetes, whereas isolated and reversible increases were seen in eyes with shorter duration of diabetes.

FOLLOW-UP OF PATIENTS WITH SIGHT-THREATENING DIABETIC RETINOPATHY BY COLOUR FUNDUS PHOTOGRAPHY IN A DIABETIC EYE CLINIC.

A S Ioannidis, S Morris , C Davey

An assessment of 200 patients  attending a diabetic retinal clinic was carried out to estimate, in the doctors view, the suitability for follow –up by colour retinal photography instead of medical consultation.The case mix included from patients with pre- proliferative diabetic retinopathy those having laser treatment, those being followed up after laser treatment and patients with other co-existing ophthalmic disease. 30% were found to be unsuitable for follow-up by photography because of cataract, glaucoma, small pupils and other co- existing ophthalmic diseases.70% were considered to be suitable. 80% of those assessed stated that they would be happy to be monitored by photography instead of seeing a doctor, especially if this would involve less waiting time in the clinic. 20% were not happy to be assessed in this way because of issues of communication ( especially non-English speakers) or because they would prefer to be able to ask questions during a consultation. Our unit has 1890 visits per year by patients requiring review or laser treatment. As 70 % of those surveyed were found to be suitable for photographic assessment, this would reduce the number of visits to the clinic to 567 visits per year, allowing more time to assess and treat difficult cases or patients with multiple pathologies.This service would require staff trained in the use of a digital camera. Appropriate changes in the configuration of the clinic would also be required as doctors would have to assess and grade the photographs taken at another instance. Overall, we feel that productivity and efficiency is enhanced through better time management, thus streamlining the provision of care for our diabetic patients.

DIABETES WITHOUT RETINOPATHY IS NOT ELECTROPHYSIOLOGICALLY IDENTICAL TO HYPOXIA IN NONDIABETIC VOLUNTEERS

Kristian Klemp, Birgit Sander, Michael Larsen, Henrik Lund-Andersen Department of Ophthalmology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

Purpose. To compare multifocal electroretinogram (mfERG) parameters in diabetic patients without retinopathy with mfERG parameters in acute hypoxic nondiabetic volunteers.

Method. Nondiabetic group: mfERGs were recorded in 10 eyes of 10 healthy volunteers both during normal oxygenation (21% oxygen) and during mild hypoxia, induced by breathing 10% oxygen. Diabetic group: in 14 eyes of 14 Type 1 diabetic patients without retinopathy mfERGs were recorded in patients who breathed normal air (21% oxygen). MfERG responses in Type 1 diabetic patients without retinopathy were compared to mfERG responses in hypoxic healthy volunteers.

Results. Hypoxia decreased mfERG amplitudes by 20- 45% in healthy volunteers. Implicit times were not affected by hypoxia. Compared to the normal reference values, mfERG amplitudes did not decrease in diabetic patients without retinopathy, but implicit times were delayed by 1-1,7 ms.

Conclusions. Diabetes without retinopathy is not electrophysiologically identical to hypoxia in nondiabetic volunteers.

VITRECTOMY SEEMS TO BE BENEFICIAL FOR DIABETIC MACULAR OEDEMA NOT RESPONDING TO LASER

Monica Lövestam-Adrian, Jörgen Larsson

Purpose. To evaluate the effect of vitrectomy, with optical coherence tomography, in patients with non-ischemic and ischemic diffuse diabetic macular oedema not responding to laser treatment

Patients and Methods. Ten eyes from nine patients (aged 46.0±20 years, diabetesduration 12.4 ±4 years) operated with vitrectomy for diabetic macular oedema not responding to laser treatment were evaluated before and six months post surgery. Retinal thickness was assessed with optical coherence tomography, OCT, measuring the mean values of the centre of fovea and the second and third concentric rings from foveola. Four patients with type 1 diabetes had ischemic and five patients with type 2 diabetes had non-ischemic diffuse macular oedema diagnosed on FA. All eyes had an attached vitreous diagnosed on OCT.

Results. There was a trend toward improved visual acuity (VA) 6 months after surgery 0.5; range 0.3-0.8 compared to 0.35; range 0.1-0.5 before vitrectomy; p=0.067). Mean foveal thickness for the three concentric rings from centre and out was significantly less 6 months postoperatively 286±67 vs. 437±125 µm; p=0.027, 308±35vs. 426±105 µm; p=0.019 and 318±29 vs. 404±69µm µm; p=0.011 respectively. The decrease in foveal thickness was similar for eyes with and without signs of ischemic maculopathy.

Conclusion. Vitrectomy seems to be a beneficial treatment for diffuse diabetic macular oedema not responding to laser treatment.

RETINAL THICKNESS MEASUREMENT WITH A-SCAN ECHOGRAPHY IN PATIENTS TREATED WITH TRIAMCINOLONE ACETONIDE INTRAVITREAL INJECTION FOR DIABETIC MACULAR OEDEMA

Paolo A. Motolese, Mario Fruschelli, Luigi Donato, Edoardo Motolese Department of Ophthalmology and Neurosurgery University of Siena Italy

PURPOSE: Experimental and clinical studies have recently suggested the use of intravitreal injection of triamcinolone acetonide as treatment of diabetic macular oedema. Purpose of our study was the evaluation of retinal thickness after intravitreal triamcinolone injection in diabetic macular oedema using A-scan echography.

METHODS 18 patients affected by diabetic retinopathy and macular oedema were treated with intravitreal injection of 4 mg in 0.1 ml of triamcinolone acetonide, administered transconjunctivally through the pars plana. Visual acuity and evaluation of retinal thickness were performed before injection and after a 3 months follow-up time using A-scan echography.

RESULTS Mean retino-choroideal thickness before injection was 1.53 mm, after 3 months it was 1.37 mm. Mean visus before injection was 0.06 and 3 months after the injection mean visus improved to 0.115. Intraocular pressure increased significantly in 5 cases (mean 24 mmHg) and lowered under therapy with topical beta-blockers (Timololo maleate 0.50% 1drop every 12 hrs.).

CONCLUSIONS Despite the use of optical coherence tomography (oct) is the most common method to detect central retinal thickness changes in ophthalmological clinical trials, in our study we showed that also A-scan echography may be a useful and relatively low cost method to evaluate significant regression of diabetic macular oedema after intravitreal triamcinolone injection.

ASSESSING THE ACCURACY OF A NORTH LONDON DIABETES REGISTER

Murray M.E, Mansell J.A, Corcoran J.S SpeedwEyes Retinal Protection Scheme, London N12

Aim: In the light of the Planning & Priorities Framework, which says that in patients with diabetes 80% must be offered retinal screening once a year by ‘06 & 100% by ‘07, the accuracy of registers is paramount. The effectiveness of screening depends on the accuracy of GP registers as most visual impairment is due to lack of screening rather than the type of screening used. The accuracy of the registers in a North London screening programme running in primary care, seeing 3000 patients /year was assessed. The total population of the area is 147,000

Method:29 practices in the Barnet area participate in the screening programme & are asked to update their registers annually. The total patient numbers of each practice was recorded and working on a 2.4% incidence of diabetes, the expected number of diabetic patients was calculated and compared with the actual number appearing on the register. Ethnicity was also checked as those practices with higher Asian & Afro/Caribbean mixes will have higher incidences of diabetes. Thus 2.4% incidence is a minimum

Results:1 practice does not use the service at all and 3 use it minimally. 9 practices had less than 2.4% of their patients on the register & 16 had more. Single handed GPs had higher case loads per GP than group practices. Ethnic minorities in the area account for 4.7-19.4% of the population so the incidence of diabetes will be around 4%. Only 3 practices are referring this number. Statistically we would expect 6 practices to reflect this. Asian GPs had significantly higher numbers of Asian patients in their case load.

Conclusion: The registers are not as complete as the large numbers screened would suggest. GPs are assuming that hospital managed patients always have the eye screening done at the hospital & this is not the case.( These patients have since been added to the screening register) Asian patients often prefer Asian GPs and this needs to be reflected in the caseload expected and the budget for the increased workload. Accurate registers are vital if the targets are to be met and GPs referring less than 2.4% of their total caseload will be asked to reassess their registers.

FLUORESCEIN ANGIOGRAPHIC CHANGES AFTER INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR PROLIFERATIVE DIABETIC RETINOPATHY.

D. Roman Pognuz , A. Polito, M.C. Napolitano, A. Pirracchio, P. Monaco, F. Bandello. University Eye Clinic, Udine, Italy

Purpose: To evaluate the changes in fluorescein angiograms (FA) after intravitreal injection of triamcinolone acetonide (TA) before panretinal photocoagulation (PRP) in the treatment of proliferative diabetic retinopathy (PDR).

Methods: This prospective, clinical case series study included 4 consecutive patients (4 eyes) who received an intravitreal injection of 4 mg of TA before PRP. Visual acuity (VA), central foveal thickness as mesured by Optic Coherence Tomography (OCT) and angiographic characteristics like vascular abnormalities, ischemic areas and leakage from vessels were evaluated.

Results: Median follow-up was 45 days (range 30-60 days). At most recent visit all patients' VA improved or stabilized. OCT revealed a reduction in diabetic macular edema (DME). Moreover, DME did not occur in eyes where it was not previously detected. FA showed a marked reduction in venous beading, leakage from the vessels and ischemic areas with respect to baseline and to the untreated eye for each patient.

Conclusions: After TA injection, FA demonstrated a regression of retinal vascular leakage due to a stabilization of the blood-retinal barrier (BRB) as a consequence of the inhibition of the endogenous permeability factors released by ischemic retina. This effect is noticed in FA during the first month after TA injection. The same effect is obtained on the BRB by laser treatment in a different way and in a time period longer than 1 month. The stabilizzation of BRB caused by TA injection may be useful in increasing the beneficial effects of PRP and preventing its side effects.

EFFECTIVENESS OF RETINAL PHOTOCOAGULATION IN CLINICALLY SIGNIFICANT MACULAR EDEMA TREATMENT IN PATIENTS WITH TYPE 1 DIABETES

Fedor E. Shadrichev, Yuri S. Astakhov, Nyurguyana N. Grigorieva, Evgeny B. Shklyarov St. Petersburg State Pavlov Medical University

Purpose: To assess the effectiveness of retinal photocoagulation in clinically significant macular edema (CSME) in patients with type 1 diabetes.

Research design and methods: 135 type 1 diabetic patients (191 eyes) had CSME at different diabetic retin opathy levels. CSME was assessed using slit-lamp biomicroscopy, stereoscopic retinal photography and Heidelberg Retina Tomnograph II Macula Edema Module (software version 1.6) and was graded according to ETDRS recommendations. Excluded were patients with AMD, aphakic, pseudophakic patients and those with lens opacities more than 2nd degree for the nucleus, and 3rd for the cortex (classification by H.R. Taylor and S.K. West, 1988). Initial best-corrected visual acuity was not less than 0.1. Patients of the main group (86 patients, 138 eyes) received laser treatment with „VISULAS-ARGON II“ and „VISULAS-532“ („ZEISS“,Germany), according to the ETDRS strategy. The control group included 49 patients (53 eyes), left without laser treatment for different reasons. All patients were followed during one-year period. Visual acuity change by two or more lines was accepted as reliably significant.

Results: In a year patients of the main group presented visual acuity decrease in 19.6 %, visual improvement in 26.1 %, and visual acuity remained stable in 54.3 % (in the control group – 49.1%, 11.3 % and 39.6 % of vases , respectively, p<0.01).

Conclusions: Retinal photocoagulation exerts a significant stabilizing effect on diabetic retinopathy course and therefore on visual function.

STUDY ON EFFICACY OF LASER PHOTOCOAGULATION IN TREATMENT OF PATIENTS WITH DIABETIC RETINOPATHY IN UZBEKISTAN

B. Kh. Shagazatova1, D.I. Usupova2, U.S. Faizieva2 , I.G. Ivanova1
The First Tashkent Medical Institute1
The republican ophthalmologic clinic2,The Republic of Uzbekistan

To preserve visual function in patients with diabetes mellitus and diabetic retinopathy is one of the essential tasks both for diabetology and ophthalmology. Laser photocoagulation (LP), a method to treat diabetic retinopathy, has been recently used in Uzbekistan. The work was initiated to study the efficacy of the method above in patients with diabetic retinopathy in Uzbekistan.

Materials and methods: 140 medical cards of patients with diabetes mellitus (57.8% males and 42.2% females) undergoing retina photocoagulation with argon laser within a period from 1997 to 2001 at the republican ophthalmologic clinic were examined. The data were processed statistically with the Student's criterion used.

Results and discussion: OD proliferative, pre- proliferative and non- proliferative diabetic retinopathy was found in 27.1, 64.3 and 1.4% of cases, respectively, OS proliferative, pre-proliferative and non- proliferative diabetic retinopathy being observed in 22.1, 69.5 and 1.4% of cases, respectively. Mean pre- surgery OD and OS visual acuity was 0.30±0.23 and 0.33±0.24, respectively. OD by face finger count was observed in 0.7%, null vision in 3.6% and by face hand movement in 2.1% of patients, OS null vision and by face hand movement in 5.7 and 2.8% of patients, respectively. Mean LP amount, power, exposition and diameter were 508,7±227,5; 0,141±0,034; 0,069±0,012, 88,2±20,4 (OD) and 532,7±247,8; 0,142±0,036; 0,143±0,137 and 85,0±24,9 (OS). At the period of LP diabetes mellitus duration was: up to 1 year in 6,3%; from 1 to 5 years in 9,4%; from 5 to 10 years in 11,5%; from 10 to 15 years in 33,3%; from 15 to 20 years in 23,9% and more than 20 years in 15,6%. Improvement in OD visual acuity (0,13±0,08) was observed in 38%, in OS (0,38±0,03) in 27% of the cases. In the rest 62% of OD and 73% of OS cases no satisfactory improvement was observed. Age (>53,6±2,6 years), DM duration (>15,3±3,2 years), elevated systolic pressure (>142±43 mm Hg), and high blood glucose (>9,7±2,5mmol/l) were found significant for reduction of LP efficacy.

Conclusion: to increase LP efficacy it is necessary to control arterial pressure, systolic, in particular, and glycemia. The age being a risk aggravating LP outcome, the attention should be focused on elder patients with DM.

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