Diagnosis Of Proliferative Diabetic Retinopathy Research Articles

Ciliary detachment after pars plana vitrectomy: an ultrasound biomicroscopic study.

To determine the incidence, duration, risk factors, and clinical outcomes for ciliary detachment after pars plana vitrectomy (PPV). A total of 109 eyes of 103 patients who underwent PPV for various disease entities were included. Ultrasound biomicroscopy was applied to determine the tomographic features of the ciliary body before and 1, 3, and 7 days after the surgery. All eyes were then examined once weekly for 2 months. Demographic, preoperative, intraoperative, and postoperative parameters were evaluated to assess their predictive value in the formation of postvitrectomy ciliary detachment. Ciliary detachment was observed in 46 eyes (42%) after surgery and persisted for less than 3 weeks in 40 of 46 eyes. It most frequently occurred in eyes of patients with proliferative diabetic retinopathy (PDR) (64%) or retinal vascular obstructive diseases (RVO) (47%). Extensive retinal photocoagulation and retinal cryopexy positively predisposed to its formation whereas fluid-gas exchange had a protective effect. No clinical complications were observed in eyes with postoperative ciliary detachment. Ciliary detachment occurred frequently after PPV. A diagnosis of PDR or RVO and surgical procedures with extensive retinal photocoagulation and retinal cryopexy may have a higher incidence of its occurrence.

Factors that influence the decision to receive treatment for proliferative diabetic retinopathy.

Educational messages aimed at health professionals have stressed the importance of regular eye examinations for people with diabetes and the value of early treatment. To investigate whether the messages need to be expanded or tailored in a specific way, we asked people with diabetes (N = 37) to describe their reactions to the diagnosis of proliferative diabetic retinopathy and the factors that influenced their decision to seek treatment. The findings reaffirm the importance of the physician's recommendation in pursuing treatment. Furthermore, a constructive response (eg, "knew it had to be taken care of") to the diagnosis was associated with prior knowledge of the consequences of proliferative diabetic retinopathy. Minimal racial and gender differences were observed. White women reported being influenced by the experiences of others, and African Americans reported being influenced by the diabetes educator. These findings emphasize the importance of providing patient education not only following a diagnosis but also in anticipation of probable complications.

The Diagnosis of Diabetic Retinopathy: Ophthalmoscopy versus Fundus Photography

To compare fundus photography with ophthalmoscopy in the detection of diabetic retinopathy. Ophthalmoscopy and fundus photographs with a nonmydriatic camera, both performed through dilated pupils, were compared to diagnose retinopathy in a cohort of 410 Oklahoma Indians with noninsulin-dependent diabetes mellitus. A total of 795 eyes were examined using both methods. The mean age of participants was 60.3 years, with a mean duration of diabetes of 17.3 years. An overall agreement of 86.3% with a kappa statistic kappa of 0.74 was found between ophthalmoscopy and fundus photography with a nonmydriatic camera. For the diagnosis of proliferative diabetic retinopathy, kappa = 0.84 with an agreement of 98.1%. With a total of 61 cases of proliferative retinopathy diagnosed by either method in our study, ophthalmoscopy alone detected 88.5% and fundus photography, 78.7%. When compared on a lesion-by-lesion basis, agreement between the two diagnostic methods was highest for nonproliferative retinopathy, as well as fibrous proliferation. The fundus photography with a nonmydriatic camera, performed with mydriasis, is comparable to ophthalmoscopy for the detection of retinopathy. It may prove to be a suitable, cost-effective method for routine screening in diabetes clinics, provided ophthalmologic referral is ensured for those with a diagnosis of any form of retinopathy, questionable retinopathy, nondiabetic retinopathy, those with poor quality photographs, as well as those with acute changes in visual acuity.

Development of proliferative retinopathy in NIDDM. A follow-up study of American Indians in Oklahoma.

To determine the incidence of and risk factors for the development of proliferative diabetic retinopathy (PDR) in Oklahoma Indians, we performed a cohort follow-up study of 927 Indians who underwent detailed eye examinations between 1972 and 1980. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. At follow-up, 513 (55.3%) were alive, 407 (43.9%) were deceased, and 7 (0.8%) could not be traced. After a mean follow-up time of 12.7 yr, the overall incidence of PDR among those who survived and who underwent follow-up ophthalmic examinations (354 participants) was 18.6%; 45% of those with background retinopathy at baseline developed PDR. Significant independent predictors of PDR, determined by multivariate analysis, were fasting plasma glucose level, duration of diabetes, plasma cholesterol, systolic blood pressure, and therapeutic regimen. A fasting plasma glucose level greater than or equal to 11.1 mM (200 mg/dl) increased the risk of retinopathy to 3.6 times that for a level less than 7.8 mM (140 mg/dl); 74% of those who had background retinopathy and a baseline fasting glucose greater than or equal to 11.1 mM (200 mg/dl) developed PDR. Over half of all participants with plasma cholesterol levels greater than or equal to 7.8 mM (300 mg/dl) developed PDR in the follow-up interval. Elevated systolic blood pressure was a particularly significant risk factor for those with a long duration of diabetes. Proliferative retinopathy poses a serious health threat to Oklahoma Indians and represents a cause of visual impairment that may be preventable by early diagnosis of PDR and intervention with photocoagulation therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of Diabetic Eye Disease

To the Editor.— It is interesting to note in the article by Sussman et al (1982;247:3231) and the editorial by Skyler (1982;247:3247) that nonophthalmologists missed the diagnosis of proliferative diabetic retinopathy around 50% of the time under ideal conditions (ie, dilated pupils and no time limit). I believe a more revealing, but difficult study would have been to examine the nonophthalmologists' patients after a routine examination, ie, with the physicians' normal time constraints and examining conditions. Appropriate questions put to the physician dealing with diabetic patients are (1) Did you dilate the pupils? and (2) If not, do you think you did an adequate examination? Why or why not? The answers that seem to be most common are that dilating the pupils takes too long and that it annoys the patient. To respond to the first complaint, the dilating drops could be instilled by a nurse before the examination or

Diagnosis of Proliferative Diabetic Retinopathy

To the Editor.— Sussman et al (1982; 247:3231) are to be commended for their well-designed study of errors in the diagnosis of proliferative diabetic retinopathy. This is a treatable disease, and timely, correct diagnoses can help prevent serious visual loss or blindness. The authors correctly suggest that many physicians may need additional training in eye examination skills and that referral for ophthalmologic opinion is sometimes appropriate.

Severe adolescent-onset proliferative diabetic retinopathy: the effect of pituitary ablation.

Proliferative diabetic retinopathy (PDR) is uncommon in patients younger than the age of 20 and has been rarely reported. Since 1969, 14 adolescents with severe PDR have been seen, the youngest of whom was 16 years old and the oldest, 19 years old. The shortest duration of diabetes mellitus prior to diagnosis of PDR was eight years. Ten patients had a positive family history of diabetes. Thirteen patients had suboptimal metabolic control. Ten patients had some degree of azotemia, seven were hypertensive, and six had proteinuria. Ophthalmic findings included advanced neovascular and fibrous proliferation on initial classification, and rapid progression to blindness-which was most frequently secondary to traction retinal detachment. In a small retrospective study, pituitary ablation may have offered greater preservation of vision than that observed in untreated patients.