Abstract
to investigate changes in clinical, functional, and morphological parameters of the retina in type 2 diabetes patients with diabetic retinopathy (DR) and those with combined fundus pathology (DR plus age-related macular degeneration (AMD)) before and after a course of antioxidants and angioprotectors in the form of mono- or combination therapy. The study included 180 patients (180 eyes) with type 2 diabetes divided into 6 groups of 30 each. DR was graded according to E. Kohner and M. Porta classification, AMD--AREDS classification. Thus, group 1 consisted of patients with DRO,; group 2--DR1 without DM, group 3--DR1 with DM, group 4--DRO and "dry" AMD (AREDS 1-3), group 5--DR1 with no DM but with AMD (AREDS 1-3), and group 6--DR1 with DM and AMD (AREDS 1-3). A drug containing lutein 6 mg, zeaxanthin 0.5 mg, vitamin C 60 mg, vitamin E 7 mg, vitamin A 1.5 mg, vitamin B2 1.2 mg, rutin 25 mg, zinc 5 mg, selenium 25 mcg, and bilberry extract 60 mg was used for antioxidative therapy. Ginkgo biloba leaf extract 60 mg was chosen as the angioprotector. In all patients visual acuity, macular thickness and morphology (OCT) as well as light sensitivity (microperimetry) were assessed before and after the treatment course. Analysis of baseline measurements demonstrated a significant decrease in best corrected visual acuity (p < 0.05) in study groups 2-6 as compared with group 1. Macular thickness was increased in all groups, however, the changes were statistically significant only in groups 3 and 6 (p<0.05). Light sensitivity of the macula showed a reduction, which was statistically significant in groups 4-6 (p < 0.05). After the course of antioxidant and angioprotective therapy, these parameters improved in all groups. The greatest effect was achieved with simultaneous antioxidant and double-dose angioprotective therapy (240 mg per day): visual acuity increased significantly (p < 0.05) in all groups except group 1; macular thickness decreased in all groups, however, the changes were statistically significant (p < 0.05) only in groups 1-3 and 5; light sensitivity also improved in all groups, significantly (p < 0.05) in groups 1-3 and 4. Extended analysis of clinical, functional and morphological changes in the retina at the onset of DR in type 2 diabetes patients with concomitant "dry" AMD enables timely diagnosis, prognosis, prevention, and early treatment. Conservative treatment with antioxidant and angioprotective agents has been proved effective in type 2 diabetes patients with preclinical (DRO) and early (DR1) diabetic retinopathy and those with DR and "dry" AMD (AREDS 1-3) in terms of functional and morphological parameters of the retina. From all the regimens, a combined antioxidant and double-dose angioprotective (240 mg) therapy appeared to be the most effective and can be considered not only a preventive, but also a therapeutic measure in type 2 diabetes patients with initial stages of DR (DRO, DR1) or those with DR and DM or combined DR and AMD (AREDS 1-3).
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