Prevalence Of Retinopathy In Patients Research Articles

Prevalence and Risk Factors of Retinopathy in Type 1 Diabetes: A Cross-Sectional Study.

Introduction Diabetic retinopathy (DR) is a severe complication of diabetes. It remains a major cause of visual impairment and blindness, especially in young people. It is a silent affection that only becomes symptomatic at the onset of complications. Our study aimed to estimate the prevalence of retinopathy in patients with type 1 diabetes mellitus (T1DM) and evaluate the associated risk factors in our population. Materials and methods A descriptive and analytical study, with a cross-sectional study involving 359 patients with type 1 diabetes, was followed up in the Department of Endocrinology, Diabetology, and Nutrition of the University Hospital Center Mohammed VI Oujda, Morocco. Data were collected from medical records and analyzed by binary logistic regression using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results The average age of our patients was 24.2 ± 11.4 years. The mean duration of diabetes was 11.8±4.4 years. The average glycated hemoglobin (HbA1c) at admission was 10.1 ± 2.4%. DR was found in 30% of patients, including 28.6% with minimal non-proliferative diabetic retinopathy (NPDR), 19.1% with moderate NPDR, 19.1% with severe NPDR, and 33.3% with proliferative DR. Patients with diabetic retinopathy appear to have a longer duration of diabetes (13.05±9.05 vs. 10.6±8.07 years). The longer duration of diabetes, neuropathy, and nephropathy was significantly associated with diabetic retinopathy (p=0.02, p=0.002, and p=0.0001, respectively). Conclusion The frequency of diabetic retinopathy increases with age, poor glycemic control, and the duration of diabetes. Therefore, cooperation between diabetologists and ophthalmologists is essential for making an early diagnosis and providing early treatment.

Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment

PurposeDespite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies.MethodsStudy included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted.ResultsThe patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09–1.19), HbA1c level (OR 1.41; 95% CI, 1.08–1.84), LDL level (OR 1.79; 95% CI, 1.16–2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16–3.03).ConclusionsIn this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.

Evaluation of hydroxychloroquine induced retinal toxicity in systemic lupus erythematosus patients

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, which affects the major organs in the human body. Pathophysiology of SLE is unknown. It mainly affects the joints, and restricts their movement. Hydroxychloroquine (HCQ) an anti-malarial drug is used as the first line of drugs used to treat SLE. The major adverse effect of this drug is irreversible retinopathy. The aim of the study was to evaluate the incidence and prevalence of retinopathy in patients with long-term usage of hydroxychloroquine (for more than 1 year).Methods: In patients with SLE, we recorded a review on HCQ induced toxicity among those taking it for longer period (>1 year). All the patients were above 18 years of age. A total data of 210 patients suffering from SLE and taking HCQ for more than one year was collected. Patients were categorized according to gender and dose pattern. Out of 210 patients, 0 patients were found to be retinal toxic induced by HCQ.Results: Suitable statistical tools were used and data was analysed which showed the incidence and prevalence of HCQ induced toxicity. With the results of our study we can understand that incidence and prevalence rates were very low among the subjects.Conclusions: HCQ is said to reduce the risk of disease remission, improves survival, minimizes the risks of vital organ damage, reduces the frequency of flares and has a protective effect on cardiovascular health. HCQ medication is usually well tolerated. But irreversible retinopathy is the major effect on long term use of HCQ. The present study concludes that in the nominal daily dose of 200mg did not reveal any signs of retinal toxicity in 100% of the population tested within 5 years of HCQ treatment suggesting that the toxicity is rare and can be prevented by reducing the dose of the drug.

Prevalence of diabetic retinopathy in patients reporting to a tertiary care diabetic center of western Uttar Pradesh

Purpose: To measure the prevalence of diabetic retinopathy in patients reporting to a tertiary care diabetic and endocrinology center, in western Uttar Pradesh. Materials and Methods: A hospital-based, cross-sectional study conducted on 240 eyes of 120 diabetic patients. The fundus photographs using visucam 500 were taken and classified using the abbreviated ETDRS grading system for the severity of retinopathy. The data was analysed using SPSS version 16.0 version (Chicago, Inc., USA). The Chi-square test was used to compare categorical variables. The binary logistic regression analysis was carried out to find the strength of association between prevalence of DR with various factors. The odds ratio (OR) with its 95 per cent confidence interval was calculated. Result: The overall prevalence of DR was found to be 52.5% (63 patients), out of 120 diabetic patients who were included in the study. Out of which nine (14.3%) had a unilateral involvement and 54 (85.7%) had a bilateral involvement. Conclusion: The overall prevalence of DR was found to be 52.5% among the patients reporting to a tertiary care diabetes and endocrinology center, in western Uttar Pradesh. Out of the affected patients, 14.3% patients had a unilateral involvement and 85.7% patients had a bilateral involvement. Mild NPDR was observed to be the most common stage. Severe NPDR, high risk PDR and ADED were found to be uncommon. This signifies a good control of the disease, minimizing the occurrence of severe grades of diabetic retinopathy, which are mainly responsible for vision loss. Keywords: Diabetic retinopathy, ETDRS grading, Prevalence.

The prevalence of retinopathy among type 2 diabetic patients in Iran: A systematic review and meta-analysis.

Diabetic retinopathy is one of the most major causes of blindness and disability in diabetic patients and imposes very high cost on Health Care System. Studies conducted in the country showed different and inconsistent prevalence of the disease. The study aims to determine the overall prevalence of retinopathy in patients with type 2 diabetes in Iran through a systematic review and meta-analysis. The present study was conducted via meta-analysis method during March, 2000 to October, 2018. The articles related to the subject under study were obtained from Magiran, SID, Medline (PubMed), Science Direct, Scopus and Google Scholar databases. I2 index was used to examine the heterogeneity of articles studied; and the data was analyzed by Comprehensive Meta-Analysis Software. Through the study of 34 articles and 17,079 individuals with age range of 5-83, the overall prevalence of retinopathy for type 2 diabetic patients in Iran and on the basis of meta-analysis, was obtained that was 37.8% (32.84-43%, 95% confidence interval); the highest prevalence of retinopathy for type 2 diabetic patients was in Tehran province with 78% (68.8-85.1%, 95% confidence interval) in 2006 and the lowest prevalence of retinopathy for type 2 diabetic patients was in Isfahan province with 9% (7.1-11.4, 95% confidence interval) in 2006; furthermore, the prevalence of retinopathy for type 2 diabetic patients in Iran increases with increased sample size that it was statistically significant (P < 0.05). Regarding the high prevalence of retinopathy for type 2 diabetic patients in the country, it is essential that health policy makers take effective measures to reduce the disease incidence in diabetic patients.

The prevalence of retinopathy in patients with type 1 diabetes treated with education-based intensified insulin therapy and its association with parameters of glucose control

AimPrevalence of retinopathy (DR) in patients with type 1 diabetes treated with education-based intensified insulin therapy (EBIIT) and its association with parameters of glucose control. Methods151 patients with mean diabetes duration of 14.3 years [SD ± 5.8]) were analyzed. Eyes were examined using standardized 7 field ETDRS (Early Treatment Diabetic Retinopathy Study) settings and images analyzed by a professional external reading center. The glucose exposure over time was defined as HbA1c years, i.e. the sum of the differences between annual mean HbA1c (in %) minus the ideal HbA1c of 6.0% (42 mmol/mol) for each diabetes year (e.g. HbA1c of 8% (64 mmol/mol) over 6 years gives an excess HbA1c of 2.0% (22 for mmol/mol) for 6 years, resulting in 12 HbA1c years (or 131 for mmol/mol)). ResultsThe median (interquartile range) of individual mean HbA1c was 7.3% (6.8–7.8) [56 mmol/mol (51–62)]. and the median HbA1c years was 16.8 (9.1–29.1) [183 mmol/mol (99–319)]. No evidence for DR was found in 59 patients (39%), stage 1 DR in 43 (28.5%), stage 2 in 41 (27.2%), stage 3 in 7 (4.6%) and proliferative DR stage 4 in 1 patient. The best correlation between severity of DR and diabetes control measures was found for HbA1c years (Pearson r = 0.41, p < 0.001). ConclusionsIn type 1 diabetes EBIIT is associated with good diabetes control and a low prevalence of DR. The cumulative glucose exposure over time given as HbA1c years is the best predictor for development of DR.ClinicalTrials.gov Identifier: NCT02307110.

Regional differences in the prevalence of diabetic retinopathy: a multi center study in Brazil

BackgroundDiabetic retinopathy has a significant impact in every healthcare system. Despite that fact, there are few accurate estimates in the prevalence of DR in Brazil’s different geographic regions, particularly proliferative DR and diabetic macular edema. This study aims to determine the prevalence of diabetic retinopathy in Brazil’s five continental regions and its determinant factors.MethodsThis multi center, cross-sectional, observational study, conducted between August 2011 and December 2014, included patients with type 1 diabetes from the 5 Brazilian geographic regions (South, Southeast, North, Northeast and Midwest). During a clinical visit, a structured questionnaire was applied, blood sampling was collected and each patient underwent mydriatic binocular indirect ophthalmoscopy evaluation.ResultsData was obtained from 1644 patients, aged 30.2 ± 12 years (56.1% female, 54.4% Caucasian), with a diabetes duration of 15.5 ± 9.3 years. The prevalence of diabetic retinopathy was 242 (36.1%) in the Southeast, 102 (42.9%) in the South, 183 (29.9%) in the North and Northeast and 54 (41.7%) in the Midwest. Multinomial regression showed no difference in the prevalence of non-proliferative diabetic retinopathy in each geographic region, although, prevalence of proliferative diabetic retinopathy (p = 0.022), and diabetic macular edema (p = 0.003) was higher in the Midwest. Stepwise analyses reviled duration of diabetes, level of HbA1c and hypertension as independent variables.ConclusionsThe prevalence of non proliferative diabetic retinopathy in patients with type 1 diabetes was no different between each geographic region of Brazil. The Midwest presented higher prevalence of proliferative diabetic retinopathy and diabetic macular edema. Duration of DM and glycemic control is of central importance to all. Hypertension is another fundamental factor to every region, at special in the South and Southeast. Glycemic control and patients in social and economic vulnerability deserves special attention in the North and Northeast of Brazil.

Hospital Prevalence of Retinopathy in Patients with Newly-Diagnosed Type 2 Diabetes.

Aims:To determine the period prevalence of diabetic retinopathy (DR) and the associated factors in patients with newly-diagnosed Type 2 diabetes mellitus (T2DM).Subjects and Methods:In this prospective study, all newly-diagnosed T2DM patients who attended the ophthalmology clinic at King Fahad Hospital of the University between January 2012 and January 2015, were examined for DR. After pupillary dilation, the ophthalmic fundus was examined by a retina consultant using slit-lamp indirect ophthalmoscopy. Risk factors such as gender, age, hypertension, nephropathy, the level of glycated hemoglobin (Hb), microalbuminuria, and hyperlipidemia were evaluated for possible association with DR at the time of diagnosis.Results:The study included 112 newly-diagnosed T2DM patients. DR was present in seven patients (6.25%) with a mean age of 53.4 ± 6.4 years, four of whom were females (57%). Nonproliferative DR was present in all patients with DR, two patients (28.6%) presented with bilateral clinically significant macular edema requiring laser photocoagulation treatment and intravitreal anti-vascular endothelial growth factor therapy. In the study cohort, elevated hemoglobin A1C levels (HbA1C) were detected in 55 patients (49.1%), microalbuminuria in 28 (25.0%), hypertension in 31 (27.6%), hyperlipidemia in 65 (58.0%) and obesity in 43 (38.1%). At the time of T2DM diagnosis, uncontrolled HbA1C levels were significantly associated with the presence of retinopathy (P = 0.045); however, no statistical significance was observed for the remaining risk factors.Conclusion:The frequency of retinopathy in newly-diagnosed T2DM patients was similar to previous reports. Vision-threatening maculopathy was present in two of seven patients, requiring further intervention. Therefore, early screening is strongly recommended for all newly-diagnosed T2DM patients. Prospective studies with a large sample size are needed to verify the risk factors for these patients.

Prevalence of diabetic retinopathy in patients in a tertiary hospital in south India

Aims: To estimate the prevalence of Retinopathy in patients attending a diabetic clinic and to evaluate the risk factors underlying its development. Methods: 750 diabetic patients who reported for executive check up in a preventive clinic were evaluated for absence or presence of retinopathy. Diabetic Retinopathy (DR) present was graded as non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Risk factors were then evaluated in order to delineate those related to retinopathy. Investigations included complete blood count, blood sugar, serum lipids, ECG, Renal function tests and complete clinical examination. Results: DR was detected in 111 patients (14.8 %) with NPDR in 106 patients (14.1%) and PDR in 5 patients (0.7%). Factors related to the incidence of retinopathy were duration of diabetes, presence of hypertension, high blood sugar level and hyperlipidemia. It was found that duration of diabetes, level of glycemic control and high levels of cholesterol were statistically significant for the occurrence of retinopathy. Conclusion: In addition to glycemic control, lowering of serum lipids may be effective in lowering the incidence of retinopathy in diabetic patients .Hypertension was not related to the occurrence of retinopathy.

A study on the association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes mellitus.

Background Diabetic dermopathy is one of the most prevalent skin complications in diabetes patients. Some studies have pointed to association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes as microangiopathy presentations, but no rigorous study has been conducted to confirm this association. Objectives This study investigated association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes referring specialty clinic of Shahrekord. Patients and Methods This descriptive, cross-sectional study was conducted on 102 type 2 diabetes patients with dermopathy referring clinic constantly or as outpatient. Dermatological and ophthalmological examinations and examination for nephropathy were done for all patients. Demographic data and results of examinations and patients history, and biochemical tests were gathered and recorded by researcher developed checklists. Results Mean age of patients was 83.8 2.60 years, of whom 64 (63.7%) were female and 37.3% were male. Prevalence of retinopathy in patients was 4.31% and nephropathy 3.33%. In this study, significant associations of diabetic dermopathy with diabetic nephropathy (P = 0.001), with retinopathy (P < 0.001), age (P < 0.001), duration of diabetes (P = 0.001), and also with glycosylated hemoglobin (P < 0.01) was detected. No significant association between diabetic dermopathy and other studied variables was seen (P > 0.05). Conclusions Results of this study confirm the association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes. Since dermopathy is usually developed before retinopathy and nephropathy, dermopathy could be used as a clinical finding in early diagnosis and prevention of retinopathy and nephropathy in diabetes patients.

Interrelation of retinopathy with peripheral neuropathy in diabetes mellitus

Context: Retinopathy and neuropathy are two most important complications of diabetes mellitus. As both the complications are dealt by two different medical fraternities, a better understanding of the association between the two will help us in its early management and prevention. Aim: To study the association of various risk factors with diabetic retinopathy and diabetic peripheral neuropathy (DPN) and to find out the association of prevalence of retinopathy with neuropathy. Settings and Design: Prospective study. Materials and Methods: The cases were selected from ophthalmology outdoor, eye camps, specialty camps, and multispecialty camps. Detailed history and relevant investigations were done. Patients underwent comprehensive ocular examination by ophthalmologist and neurological examination by physiotherapist. Results: Of the 100 patients having Type 2 diabetes for more than 5 years duration, 58% were males. Twenty-seven percent cases had retinopathy and 56% cases had peripheral neuropathy. DPN was seen approximately 2 times more than retinopathy. The occurrence of retinopathy in patients with mild (glycosylated hemoglobin [HbA1c] <7%) and moderate (HbA1c between 7% and 10%) deranged blood sugar was 19.0% and 67%, respectively, and peripheral neuropathy 64% and 83%, respectively. Among the uncontrolled cases, 32% had retinopathy and 68% had peripheral neuropathy. The prevalence of retinopathy increased 2.75 times in patients with neuropathy (37%) than in patients without peripheral neuropathy (14%). Conclusion: We found a higher prevalence of retinopathy in patients with neuropathy and thus a lookout for peripheral neuropathy should be kept in diabetics presenting to us with retinopathy.

Prevalence of retinopathy in patients with type 1 diabetes diagnosed before and after puberty.

There is conflicting evidence to support the concept that the years with diabetes preceding puberty may not contribute to the development of vascular complications. In this paper, duration-related prevalence of retinopathy was compared in patients who developed type 1 diabetes before and after pubertal age. Retrospective analysis of prospectively collected data of 1,483 patients was screened for retinopathy in 1991-2010, with diabetes onset at age ≤29, who were on insulin treatment and aged ≤60. Prepubertal age was defined as 0-12 in males and 0-11 in females. A total of 647 patients had developed diabetes before and 836 after puberty. Cumulative prevalence of retinopathy was initially lower among those with prepubertal onset diabetes but rates became superimposable after 20-year duration. Patients with prepubertal onset diabetes had higher lifetime HbA1c and lower blood pressure than those who became diabetic after puberty. Retinopathy is infrequent during childhood and develops later than in patients with post-pubertal onset diabetes. After 20-year duration, however, retinopathy becomes just as prevalent suggesting that, in the long term, prepubertal years do contribute to the development of retinopathy. In this series, higher blood pressure may have played a role in the earlier appearance of retinopathy in patients with diabetes onset after puberty, whereas worse metabolic control may have contributed to the late "catch-up" effect in those with prepubertal onset disease.

Retinopathy and CKD as Predictors of All-Cause and Cardiovascular Mortality: National Health and Nutrition Examination Survey (NHANES) 1988-1994

Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of U.S. adults. Prospective cohort study. 7,640 adults from NHANES (National Health and Nutrition Examination Survey) 1988-1994 with mortality linkage through December 31, 2006. CKD, defined as low estimated glomerular filtration rate (<60 mL/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30 mg/g), and retinopathy, defined as the presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph. All-cause and cardiovascular mortality. Multivariable-adjusted Cox proportional hazards. Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women, and 81% were non-Hispanic whites. The prevalence of retinopathy in patients with CKD was 11%. We identified 2,634 deaths during 14.5 years' follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, HRs for all-cause mortality were 1.02 (95% CI, 0.75-1.38), 1.52 (95% CI, 1.35-1.72), and 2.39 (95% CI, 1.77-3.22) for individuals with retinopathy only, those with CKD only, and those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50-1.84), 1.72 (95% CI, 1.47-2.00), and 2.96 (95% CI, 2.11-4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (P=0.04). The presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied. In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.

Decreased Reactivity of Skin Microcirculation in Response to l-Arginine in Later-Onset Type 1 Diabetes

OBJECTIVEThe aim of our study was to evaluate the vasodilatory effect of l-arginine infusion on the skin microcirculation and to assess the relationship between this effect and the presence of microangiopathy in patients with type 1 diabetes.RESEARCH DESIGN AND METHODSCapillaroscopy was performed before and after l-arginine infusion in 48 diabetic patients (26 women and 22 men; age, 39.8 ± 6.3 years) and 24 volunteers free of any chronic disease (13 women and 11 men; age, 38.0 ± 6.7 years). The skin microcirculation reactivity, as expressed by the percentage of area covered by capillaries (coverage) and the distance between capillaries (distance), and the relationship between microcirculation reactivity and the presence of microangiopathic complications were assessed.RESULTSThe distance before l-arginine infusion was significantly lower in patients than in controls (221 [153–311] vs. 240 [185–356] µm; P = 0.02) and did not differ after l-arginine infusion (223.5 [127–318] vs. 242.5 [181–341] µm; P = 0.27). The difference between the coverage values obtained before and after l-arginine infusion (Δcoverage) was significantly different from zero in the control group but not in the diabetes group. Patients with later onset of diabetes were characterized by decreased skin microcirculation reactivity when compared with patients with earlier onset of diabetes (−1.18 [−5.07 to 11.60] vs. 1.36 [−6.00 to 8.06]; P = 0.02) despite the higher prevalence of retinopathy in patients with earlier onset of diabetes (64% vs. 26%; P = 0.02).CONCLUSIONSSkin microvascular reactivity is impaired in patients with later onset of type 1 diabetes. Capillaroscopy with l-arginine infusion is useful for the identification of skin microangiopathy in type 1 diabetes.

Effect of duration of diabetes mellitus on the prevalence of diabetic retinopathy in patients with type 2 diabetes and metabolic syndrome

Aim. To study effect of duration of diabetes mellitus on the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes (DM2) andmetabolic syndrome (MS) or without it. Materials and methods. The study included 115 patients with type 2 diabetes and metabolic syndrome and 45 patients with DM2 without MS (controls).Of 115 MS patients and of 45 control ones, 42 and 17 respectively presented with different forms of DR. Ophthalmological examination was performedby generally accepted methods including visiometry, tonometry, biomicroscopy, ophthalmoscopy, and fluorescent angiography. Results. The study revealed a well-apparent tendency toward an increase of DR occurrence in MS patients with duration of DM2 (10.0%, 53.1%,82.6% during 0-4, 5-9, and 10 or more years respectively). Significant difference between DR incidence was recorded in MS patients having DM2for 0-4 and 5-9 years (p0.05 in controls). Conclusion. Occurrence of DR increases with duration of DM2 with and without MS but fails to correlate with HbA1c levels in either condition.

Increased prevalence of proliferative retinopathy and cardiovascular autonomic dysfunction in IDDM patients with proteinuria.

The purpose of the present cross-sectional clinical study was to evaluate the prevalence of retinopathy in Type 1 diabetic patients without nephropathy and with different degrees of nephropathy. In addition we investigated the association between retinopathy, nephropathy, and other variables, and studied the importance of cardiovascular autonomic dysfunction to these conditions. 76 Type 1 diabetic patients were investigated. All patients were initially selected on the basis of body weight, and 47 proteinuric patients were further selected for age, diabetes duration and the duration of insulin treatment (see Table 1). Proteinuric diabetic patients were categorized by degree of nephropathy, i.e. for incipient nephropathy (proteinuria of less than 0.5 g/day), for overt nephropathy (proteinuria of more than 0.5 g/day), and for renal failure (serum creatinine of more than 103 mumol/l). Retinopathy was assessed by ophthalmoscopy. Cardiovascular autonomic dysfunction (CAD) was assessed by heart rate variations, 30:15 ratios, the Valsalva maneuver, and systolic blood pressure fall upon standing. Our findings revealed increased prevalence of retinopathy in patients with more advanced stages of nephropathy. CAD abnormalities exhibited increased prevalence among proteinuric patients. Our data clearly revealed differences between proteinuric and non-proteinuric patients. In both proteinuric and non-proteinuric patients there were found correlations of retinopathy with diabetes duration, and only in proteinurics was retinopathy correlated with kidney function, systolic blood pressure and CAD findings. In patients in identical stages of nephropathy, increased prevalence of CAD abnormalities was shown in patients suffering from proliferative retinopathy. Thus our data suggest that CAD abnormalities might be related in some way to both the proliferative retinopathy and to diabetic nephropathy.

Prevalence of retinopathy in patients with type 2 diabetes mellitus

The fact that diabetic retinopathy (DP) exists at the preclinical stage of evolution of type 2 diabetes mellitus (DM-2) cannot be' explained in the context of the commonly accepted theory of the etiopathogenesis of diabetic microangiopathy. The purpose of the study was to explore the prevalence of DR among patients with new-onset DM-2 and to analyze the possible causes of development of this complication at an early stage of the disease. The prevalence of DR among patients with new-onset DM-2 was found to be 16.4%. In the new-onset DM-2 patients aged above 45 years, the odds ratio for DR. is 2.6 times greater than that in those aged under 45 years. Based on the results of the study, the authors suggest that there are pathogenetic mechanisms responsible for the initiation of diabetic microvascular pathology to the stabilization of hyperglycemia at the stage of decreased glucose tolerance.

Prevalence of retinopathy in patients with anemia or thrombocytopenia.

Fundus lesions can be the accompanying symptom in many hematological diseases. In cases of anemia or thrombocytopenia, the exact mechanism leading to fundus abnormalities is not completely understood. The aim of this study was to calculate the prevalence of fundus lesions in anemic and thrombocytopenic patients, and define the risk factors for retinopathy. This cross-sectional study involved 226 patients with anemia and/or thrombocytopenia and a control group of 47 age-matched subjects. The studied variables were age, gender, hemoglobin levels, mean cell volume (MCV), red cell distribution width coefficient variation (RDW-CV), the type of onset of anemia, platelet counts, mean platelet volume (MPV), platelet distribution width (PDW), the platelet-large-cell ratio (P-LCR), prothrombin time (PT) and partial thromboplastin time (PTT). Retinopathy was observed in 28.3% of the patients as a whole, the presence of fundus lesions being closely associated with severe anemia (Hb < 8 g/dL) and severe thrombocytopenia (PLT < 50 x 109/L). Among the patients with concomitant anemia and thrombocytopenia, the incidence of retinopathy was 38%. Age, low hemoglobin levels, platelet counts, RDW-CV, and increased MCV, MPV and P-LCR were all significantly associated with the presence of fundus lesions at univariate analysis. Retinopathy is a frequent finding in anemic and thrombocytopenic patients, although it is often not significant clinically. As retinal hemorrhages were found in all of the patients with concomitant severe anemia and thrombocytopenia, it is recommended that all such patients undergo routine fundus examinations.

Prevalence of patients with diabetes mellitus without and with retinopathy in an ophthalmology practice

In a prospective study 10,000 consecutive patients were interviewed and examined in a German ophthalmology practice to evaluate the prevalence of diabetes mellitus and diabetic retinopathy. Out of all patients 496 (4.96%) suffered from diabetes. In most patients (488:230 male, 258 female; mean age: 66 +/- 15 years) a clinical workup including demographic data and binocular ophthalmoscopy was performed. Diabetic retinopathy (DR) was present in 130 (26.6%) of the 488 diabetic patients. Subgroup analysis showed a higher prevalence of diabetic retinopathy in patients with insulin therapy (85 of 149; 57%) to those treated with oral antidiabetics (37 of 198; 19%) or diet only (8 of 141; 6%). The prevalence was significantly correlated with the duration of diabetes in the groups treated with insulin (P < 0.01) and with oral antidiabetic drugs (P < 0.001). Mild or moderate non-proliferative DR was found in 93 patients (19%), severe non-proliferative DR in 23 patients (4.7%) and proliferative DR in 14 of 488 patients (2.9%; 13 with insulin-dependent diabetes). Clinically significant diabetic macular edema was identified in 41 patients (8.4%). In 48 (9.8%) laser coagulation had already been performed: 13 cases with panretinal scatter, 18 with a focal coagulation, 17 cases with both. The prevalence of diabetes mellitus in a German ophthalmological referral practice is similar to the total prevalence in Germany (4.9%). Diabetic retinopathy was found in fewer patients than reported in the Wisconsin Epidemiologic Study and other recent studies in other countries. The data in this study showed that regular screening of all diabetic patients is mandatory.