Clinical Profile and Ocular Morbidities in Patients with Both Diabetic Retinopathy and Uveitis

Abstract

PurposeTo describe the clinical profile and complications of diabetic retinopathy (DR) and uveitis in patients with co-existing conditions and to derive associations based on site of primary inflammation, stage of DR and complications of each. DesignSingle-center, cross-sectional observational study. Participants66 patients with co-existing diabetic retinopathy and uveitis. MethodsElectronic medical records of 66 such cases were evaluated. The demographic data, diabetic status, clinical characteristics and complications of DR and uveitis on the final follow-up were recorded. Main Outcome MeasuresAssociations between best corrected visual acuity, prevalence of various stages and complications of DR among eyes with and without uveitis. Also, correlation between the intensity and primary sites of inflammation among eyes with proliferative and non-proliferative changes. ResultsOf the 132 eyes, all had DR and 97 eyes had uveitis (35 unilateral and 31 bilateral cases). Mean age of patients was 53.4±8.7 years, duration of diabetes was 10.5±6.9 years and duration of uveitis was 61.3±68.8 months. 54.6% uveitis patients had anterior uveitis, 20.6% had intermediate, 10.3% posterior and 14.4% pan-uveitis. 49.5% eyes had proliferative diabetic retinopathy (PDR) changes. There was a higher proportion PDR cases among anterior (56.6%), posterior (70%), and pan uveitis (64.3%), with difference in anterior uveitis cases approaching statistical significance (p=0.067). Conversely, significant (p<0.001) intermediate uveitis cases had non-proliferative changes (80%). Final BCVA was significantly poorer in the group with uveitis (p=0.045). The proportion of fibrovascular proliferations, tractional detachments and iris neovascularisation among proliferative retinopathy eyes with uveitis (14.6%, 18.8% and 12.5% respectively) was higher than those without uveitis (5.3%, 10.5% and 5.3%). Among uveitis cases, 58.5% eyes developed cataracts, 44.3% had posterior synechiae, 12.3% developed secondary glaucoma, 4.1% had epiretinal membrane, 4.1% had band-shaped keratopathy and 1.0% developed macular neovascularisation. ConclusionsEyes with co-existing DR and uveitis have a higher prevalence of neovascular and uveitis complications along with a risk of poorer visual outcomes. Treatment should aim at limiting the duration and intensity of inflammation. Strict glycaemic control is essential for inflammation control and preventing the progression of DR to more advanced stages.