English

Abstract

BACKGROUND The nailfold capillaroscopy (NFC) has been used to analyse capillary microarchitecture in diseases like Raynaud’s disease, scleroderma, and other collagen disorders earlier but recently researchers have documented capillaroscopic findings in diabetic patients which correspond to their ophthalmoscopic findings. Every diabetic patient after ten years of the disease is at risk of diabetic retinopathy and should thereby be referred to an ophthalmologist for screening. But for various factors the referral to ophthalmologists is poor and the patients usually present to the ophthalmologist when their vision is threatened. Our study intends to correlate the nailfold capillaroscopic microvascular changes with duration of diabetes, severity of diabetic retinopathy (DR), compare the changes of patients with DR and without DR and determine its role as a screening tool. METHODS This was a hospital based cross-sectional study for over 18 months in patients (15 - 75 yrs. of age) with diabetes mellitus. Patients with other vascular disorders were excluded. The study subjects were evaluated for diabetic retinopathy by indirect ophthalmoscopy, fundus pictures and optical coherence tomography. The nailfold capillaroscopy findings were recorded and co-related with fundus findings. Statistical analysis was done by using the STATA software version 15.1. RESULTS Two hundred and fifty patients were recruited with 125 patients in each group, patients with and without DR respectively. Poor glycaemic control was seen most commonly in patients with proliferative diabetic retinopathy. The reduced capillary density, tortuosity, microhaemorrhages, neoangiogenesis and avascular areas were seen more frequently in proliferative diabetic retinopathy than nonproliferative diabetic retinopathy and patients without DR. (P value 0.00). CONCLUSIONS Changes in nailfold capillaroscopy in diabetics have significant association with severity of DR, duration of diabetes, and glycaemic control. It could be used as screening and early diagnostic tool for non-ophthalmology medical fraternities to refer to ophthalmologist for follow-up and treatment of diabetic retinopathy. KEYWORDS Diabetes Mellitus, Diabetic Retinopathy, Nailfold Capillaroscopy, Microangiopathy