History Of Diabetic Retinopathy Research Articles

New observation of microcystic macular edema as a mild form of cystoid macular lesions after standard phacoemulsification: Prevalence and risk factors.

We present the new observations of postoperative microcystic macular edema (MME) as a mild form of cystoid macular lesions (CMLs) after standard phacoemulsification.To report the incidence, risk factors, and pathophysiology of MME compared to conventional concept of pseudophakic cystoid macular edema (CME), we retrospectively reviewed patients’ records. Pseudophakic CMLs were defined as any cystic fluid collections that were newly formed after cataract surgery, confirmed by preoperative and postoperative optical coherence tomography (OCT) examinations. CMLs were classified into 2 groups, which are CME and MME, according to the change the central retinal thickness. The dataset consisted of 316 patients (mean age, 67.52 ± 12.95 years; range, 42–87 years). Topical nonsteroidal anti-inflammatory drug (NSAID) were administered in 197 eyes during the perioperative period; 147 eyes were not treated. CMLs were present in 22 out of 344 (6.39%) eyes. Six of 344 eyes (1.74%) had CME and 16 of 344 eyes (4.65%) had MME. The incidence of MME significantly decreased in the group of patients treated with topical NSAIDs (P = .039), while the incidence of CME was not different in both groups (P = .408). All of the patients with MME were experienced improvement with only topical NSAIDs. However, 67% (4/6) of patients with CME did not improve with topical NSAIDs alone and needed additional treatments. Pseudophakic MMEs were more likely to have a history of diabetic retinopathy, epiretinal membrane, and eyes were not treated with topical NSAID.This study showed a wide clinical spectrum of CMLs. MME has not been included in the conventional definition of pseudophakic CME. Topical NSAIDs could decrease the CML incidence. People with risk factors for CML should use topical NSAIDs and undergo regular follow-up OCT examinations.

Evaluation of effectiveness of contact transscleral diode laser cyclocoagulation drainage after neovascular glaucoma surgery

Relevance. Recently, drainage surgery has gained prevalence in the treatment of neovascular glaucoma. Unfortunately, studies have reported that their effectiveness does not exceed 70%80%. During the postoperative period, the attending physicians major concern is the normalisation of high IOP.
 Aim.To evaluate the effectiveness of contact transscleral diode laser cyclocoagulation drainage after neovascular glaucoma surgery, which did not lead to the normalisation of elevated intraocular pressure.
 Materials and methods. This study enrolled eight patients in the ophthalmic branch of the Endocrinology Research Center. All patients previously underwent a drainage operation for uncompensated secondary neovascular glaucoma with a history of diabetic retinopathy. During the postoperative period, because intraocular pressure failed to stabilise, we performed contact transscleral diode laser cyclocoagulation as per the original methodology.
 Results. After the execution of contact transscleral diode laser cyclocoagulation, intraocular pressure was compensated in all patients, and any complication was noted for up to 6 months.
 Conclusion. Contact transscleral diode laser cyclocoagulation can be used to normalise abnormal IOP after drainage surgery for the treatment of neovascular glaucoma in patients with diabetes mellitus.

Type 2 Diabetes Mellitus and Hepatitis C are Unlikely Contributors in a Case of Progression of Diabetic Nephropathy to End Stage Renal Disease

Progression of diabetic nephropathy to end stage renal disease can occur in the presence of minimal evidence for type 2 diabetes mellitus, and the recent literature indicates the pathology of diabetic nephropathy arises even in the absence of diabetes, suggesting other contributors like over expression of glucose transporter 1 (GLUT1) may have a similar pathogenesis. Although hepatitis C has been implicated in accelerating declines of renal function in diabetic nephropathy in some cases, evidence of hepatitis C activity cannot be assumed to contribute to the worsening renal function in this case. Here we report a case in a 61 year- old female with minimal elevation of Hemoglobin A1C (HbA1C), seropositivity for hepatitis C and anapparent rapid decline of renal function. The patient presented with a previous elevation of serum creatinine concentration from 1.4 to 4.7 mg/dl over the last 23 months. The patient had been treated with insulin and a recent HbA1C was 6.2%, correlating with an average blood glucose concentration of 130-150 mg/dl. There was no history of diabetic retinopathy or neuropathy. The patient was also taking anangiotensin converting enzyme inhibitor (ACEI) and had controlled hypertension over the 2 years prior to the current hospitalization for hematochezia. The serum creatinine then increased to nearly 6 mg/ dl after admission. Acute kidney injury work-up (super imposed on chronic kidney disease and proteinuria) beyond hematochezia, revealed hepatitis C seropositivity without liver failure. The renal biopsy was typical for established diabetic glomerulosclerosis, without evidence of another disease process. A plot of the reciprocal serum creatinine concentration versus time waned linearly as expected for progression of a single, chronic disease process, despite the appearance of promptly falling renal function on the plot of serum creatinine concentration versus time. We suggest that 1) The appearance of rapid decline ofrenal function was actually the natural progression of chronic diabetic nephropathy; 2) Other contributors rather than mild level of hyperglycemia might associated with development of substantial diabetic nephropathy despite clinical absence of other diabetic tissue complications; 3) A role for hepatitis C -persuaded acceleration of renal disease was not supported in this case.

Rates and predictors of risk of stroke and its subtypes in diabetes: a prospective observational study

BackgroundSmall vessel disease is reported to be a more common cause of ischaemic stroke in people with diabetes than in others. However, population based studies have shown no difference between...

Suspected retinopathies in Norwegian optometric practice with emphasis on patients with diabetes: a cross-sectional study

BackgroundThe scope of optometry differs worldwide. In Norway the vast majority of optometrists perform ophthalmoscopy as part of their routine examinations. The aim of this study was to describe the frequency of suspected retinopathies in patients seen for routine optometric examination and to determine how optometrists deal with these patients.Methods212 optometrists participated in a questionnaire survey and a practice registration during November 2004 – May 2005. In the practice registration, details for 20 consecutive patient encounters were recorded. Data were analysed by chi-square tests and multiple logistic regression.ResultsAll optometrist stated that ocular history taking was an integrated part of their routine examination, while general health and diabetes history were routinely addressed by 59% and 42% of the optometrists, respectively. During the practice registration 4,052 patient encounters were recorded. Ophthalmoscopy was performed in 88% of the patients, of which 2% were dilated fundus examinations. Retinopathy was suspected in 106 patients, of whom 31 did not report a previous history of ocular or systemic disease. Old age (75+), hypertension and diabetes strongly predicted retinopathy with odds ratio (95% CI) of 6.4 (4.2 to 9.9), 3.8 (2.4 to 6.0) and 2.5 (1.4 to 4.7), respectively. Diabetic retinopathy was seen in 10% of diabetic patients and suspected in 0.2% of patients with no established history of diabetes. Retinopathy was not confirmed in 9 out 18 patients with a history of diabetic retinopathy; seven of these had undergone laser treatment. Out of the 106 patients with findings of retinopathy, 28 were referred to an ophthalmologist or a general practitioner (GP), written reports were sent to a GP in 16 cases, ten patients were urged to contact their GP for further follow up, while 52 were considered in need of routine optometric follow up only.ConclusionOptometric practice provides a low threshold setting for detecting cases of ocular disease and retinal manifestations of systemic disease in the population. At present diagnosis of retinopathy in Norwegian optometric practice is unreliable. There are potentials for improving the optometrists' routine examination, their patient management patterns and collaboration routines with medical doctors.

Prospective, Case-Controlled Study of the Natural History of Diabetic Retinopathy and Maculopathy After Uncomplicated Phacoemulsification Cataract Surgery in Patients With Type 2 Diabetes

Prospective, Case-Controlled Study of the Natural History of Diabetic Retinopathy and Maculopathy After Uncomplicated Phacoemulsification Cataract Surgery in Patients With Type 2 Diabetes

Case Study: Peripheral Neuropathy in Diabetes: Is It Diabetic Neuropathy?

T.T., a 26-year-old woman with type 1 diabetes diagnosed at the age of 14, presented with persistent burning pain in her lower extremities and upper extremity digital paresthesias that made her work as a dental hygienist difficult. Recently, her family had noted that she seemed to be stumbling at times. She reported that neither increased doses of a selective serotonin reuptake inhibitor (SSRI) nor trials of tricyclic antidepressants (phenytoin [Dilantin], carbamazepine [Epitol, Tegretol], or gabapentin [Neurontin]) had relieved her symptoms. T.T. had no known history of diabetic retinopathy or nephropathy. She also denied resting tachycardia, orthostatic lightheadedness, early satiety, early morning nausea, changes in bowel habits, or postprandial sweating. She did note a history of depression, which was treated with counseling and medication. She also noted menstrual irregularity, dysmenorrhea, and premenstrual emotional lability. She had been treated with oral contraceptives in the past, but had discontinued these 6–8 months ago. Her glycemic control had never been optimal despite a multiple-dose insulin program. Her …

The Effect of Pregnancy on the Natural History of Diabetic Retinopathy and Nephropathy

Retinopathy and nephropathy are complications of diabetes mellitus that can affect women of reproductive age. This article focuses on the effect of pregnancy on the risk of progression of microvascular disease, both during gestation and at long-term follow-up. Fortunately, with intensive medical surveillance and appropriate interventions, most women with types 1 and 2 diabetes mellitus can be offered an optimistic prognosis for child bearing.