Abstract
PurposeWe report the clinical course and visual outcome of patients with diabetes mellitus (DM) who subsequently developed uveitis from any cause.MethodsLongitudinal, retrospective case note review.ResultsA total of 36 patients (M/F: 18/18, 58 eyes) were included, Of the 36 patients, 35 had Type 2 DM and one had Type 1 DM. Mean age of onset of DM was 49 years and uveitis 55 years. The uveitis was bilateral in 22 (61%) patients. There were 19 patients with anterior uveitis, 12 with panuveitis and 5 with intermediate uveitis. Mean follow up was 4.4 years (range 1-18). Mean number of uveitis recurrences was 3 (range 1-7). Causes of vision of 6/18 or worse appeared related to the uveitis in 9 eyes and diabetes in 4 eyes. Cataract occurred in 22 eyes, glaucoma in 17 eyes, and cystoid macular oedema in 10 eyes. Diabetic retinopathy was detected in 38 (65.5%) eyes (29 non-proliferative including 6 with clinically significant macular oedema, and 9 proliferative). Progression of diabetic retinopathy to proliferative stage occurred in 7 eyes of 4 patients over a mean duration of 4.4 years. In 10 patients with active uveitis the mean HbA1c was 80 mmol/mol [9.5%], (range 49-137 [6.6-14.7]), and 67 mmol/mol [8.3%] (range 46-105 [6.4-11.8]) when the uveitis was quiescent, p = 0.01. Better glycaemic control was required in 10 patients during episodes of uveitis.ConclusionsPatients with DM who develop uveitis may have a high complication rate, reduced vision and poor glycaemic control. Checking blood glucose during episodes of uveitis is important.
Highlights
Diabetic retinopathy is the third commonest cause of blindness in the Western world, with a 20% prevalence of blindness in the middle age group [1]
Apart from 1 patient who was diagnosed with diabetes mellitus (DM) at presentation and had bilateral fibrinous uveitis and proliferative diabetic retinopathy all other patients were known to have pre-existing DM
Impairment of glycaemic control had occurred in 10 patients with uveitis. 2 patients on diet control were started on oral hypoglycaemic agents (OHA), 2 patients on OHA had another agent added to their treatment, 1 patient who had stopped using OHA had to be restarted on it, 2 patients on OHA had to be started on insulin and 3 patients on insulin had to have their insulin dose increased to achieve better glycaemic control
Summary
Diabetic retinopathy is the third commonest cause of blindness in the Western world, with a 20% prevalence of blindness in the middle age group [1]. The incidence of diabetes mellitus (DM) is increasing rapidly in developed nations, and in the UK the number of people diagnosed has increased from 1.4 to 2.6 million since 1996 [2]. Uveitis may be idiopathic, associated with a range of systemic diseases, or caused by an infectious agent leading to variable intervals and degrees of vision impairment [3]. It is the fifth commonest cause of blindness in the middle age group with a prevalence of 10% in the developed world [1].
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