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- Agardh, Elisabet, et al.
(författare)
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The importance of early diagnosis of treatable diabetic retinopathy for the four-year visual outcome in older-onset diabetes mellitus
- 1996
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Ingår i: Acta Ophthalmologica Scandinavica. - 1395-3907. ; 74:2, s. 166-170
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Tidskriftsartikel (refereegranskat)abstract
- The four-year visual outcome was retrospectively studied in patients with older-onset diabetes mellitus and diabetic retinopathy in need of laser treatment. Visual acuity in 53 patients examined by ophthalmologists who referred the patients for an evaluation of retinopathy before laser treatment, was compared to that of 47 patients examined by ophthalmologists who also performed the photocoagulation. The number of eyes that became blind (visual acuity < or = 6/60) during the four-year period was higher (23/90 vs 9/91; p < 0.01) among referred patients, whereas the number of retinal examinations per patient during the three-year period prior to laser treatment did not differ between the two groups. Among referred patients, 13% had not been ophthalmologically examined before the treatment-requiring retinopathy was found. Corresponding figure for those examined at the laser centre was 23%. Severe macular oedema in regularly examined patients was more common among referred patients (9/30 vs 1/32; p < 0.01). The results indicate that screening for diabetic retinopathy in older-onset diabetes was not performed satisfactorily. In addition, laser treatment was delayed in older-onset diabetic patients controlled by ophthalmologists who referred patients for photocoagulation, resulting in an increased incidence of legally blind eyes. The study also stresses the importance of carrying out knowledge of when and how to diagnose early sight-threatening diabetic retinopathy to ophthalmologists referring patients for laser treatment.
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| 2. |
- Zhang, Hui, et al.
(författare)
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Retinal nitro blue tetrazolium staining and catalase activity in rat models of diabetes
- 1996
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Ingår i: Graefe's Archive for Clinical and Experimental Ophthalmology. - 1435-702X. ; 234:5, s. 324-330
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent studies have suggested that reactive oxygen species may be involved in the development of diabetic retinopathy. METHODS: Nitro blue tetrazolium (NBT) staining, a marker of reductants which may be induced by free radicals such as superoxide, and catalase activity, as an indirect measure of hydrogen peroxide (H2O2) generation, were studied in the rat retina in three conditions known to cause diabetes-like retinopathy, i.e. rats with spontaneous diabetes (the BB Wistar rat), rats with streptozotocin-induced diabetes mellitus, and rats fed on galactose. Male Wistar BB rats were studied 4-10 weeks after diagnosis of diabetes. Streptozotocin (60 mg/kg) was injected i.p. at 8 weeks of age and the experiments were performed after 8 weeks of diabetes. Young Sprague-Dawley rats were fed a 50% galactose diet for 9, 12 or 22 months. RESULTS: In trypsinized vessel preparations, more intense NBT staining was observed only in rats fed a galactose diet for 22 months. In cross sections, the number of stained vessels were increased in BB rats (p < 0.01), but not in rats with streptozotocin-induced diabetes. Catalase activity did not differ between any of the experimental groups and their matched controls. CONCLUSIONS: Increased amount of NBT reductants in retinal vessels occurred in BB Wistar rats and to some extent in galactose-fed rats, indicating a possible role for free radicals in the development of diabetic retinopathy. There was no evidence of increased retinal H2O2 production or activation of catalase, indicating that this particular enzyme was not affected during the conditions studied.
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| 3. |
- Agardh, Carl-David, et al.
(författare)
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The prognostic value of albuminuria for the development of cardiovascular disease and retinopathy: a 5-year follow-up of 451 patients with type 2 diabetes mellitus
- 1996
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 32:1-2, s. 35-44
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to evaluate the risk for vascular morbidity or death and retinopathy in relation to urinary albumin concentration. To that end, we performed a 5-year follow-up study of all type 2 diabetic patients attending the outpatient-clinic. A total of 444 (98.4%) out of 451 adult patients initially studied were evaluated for the degree of retinopathy and levels of HbA1c blood pressure, serum creatinine and urinary albumin. Vascular morbidity and causes of death were registered by one and the most severe event only. Forty-seven patients developed atherosclerotic vascular disease, i.e. myocardial infarction (n = 19), cerebrovascular disease (n = 20), or amputation (n = 8), and 42 died. The observed annual mortality rate was 22.1/1000 compared to an expected rate of 13.6/1000 for the general population with corresponding age and sex. Urinary albumin concentration was found to be a prognostic marker for the development of vascular disease and death in patients treated with insulin at baseline (P < 0.01), whereas this was not the case in patients treated with diet and/or oral agents at baseline. However, insulin treatment per se was not associated with an increased mortality or mortality or morbidity. Urinary albumin concentration was not correlated with incidence or progression of retinopathy regardless of type of diabetes treatment. In conclusion, this study showed that albuminuria was a prognostic factor for vascular morbidity and death in type 2 diabetic patients treated with insulin but not in patients treated with diet or oral agents. Furthermore, albuminuria was not a predictor for incidence or progression of retinopathy.
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| 4. |
- Agardh, Daniel, et al.
(författare)
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HLA-DQB1*0201/0302 is associated with severe retinopathy in patients with IDDM
- 1996
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 39:11, s. 1313-1317
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Tidskriftsartikel (refereegranskat)abstract
- Some insulin-dependent diabetic (IDDM) patients develop severe forms of retinopathy. Putative risk factors such as hypertension, poor metabolic control, nephropathy and growth hormone levels do not fully explain the progress of retinopathy in these patients. It has been discussed whether there is a genetic marker, since some diabetic patients without any known predisposing risk factors develop severe retinopathy and others do not. In the present study, HLA-DR and DQ were compared in two patient groups with IDDM. One group consisted of patients with early-onset diabetes, with severe non-proliferative or proliferative retinopathy; the other group had no or only mild signs of retinopathy. High resolution HLA typing was carried out by polymerase chain reaction (PCR) and hybridization with allele specific probes. Alleles on the DR3-DQ2 haplotype, DRB1*0301, DQA1*0501 and DQB1*0201, were more frequent in patients with severe retinopathy. A difference was seen when combining certain alleles in the genotypes of DQA1*03/0501 (p > 0.05) and DQB1*0201/0302 (p < 0.01). The findings of the present study suggest that DQB1*0201/0302 is the strongest genetic marker for severe retinopathy and DRB1*0301/0401 only has a secondary influence when combined with this genotype. It seems as if IDDM patients who are positive for the genotype DR3-DQ2/DR4-DQ8 (DRB1*0301-DQA1*0501-DQB1*0201/DRB1*0401 -DQA1*03-DQB1*0302) are at greater risk of developing severe retinopathy.
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