Association of systemic and ocular risk factors with neurosensory retinal detachment in diabetic macular edema: a case–control study

Abstract

BackgroundDiabetic macular edema (DME) with neurosensory retinal detachment (NSD) remains an important cause of visual loss in patients with diabetes. The aim of the study was to elucidate the association of systemic and ocular risk factors with NSD in DME.MethodsIn a retrospective case–control study, we reviewed clinical records of all the subjects with DME seen between January 2010 and December 2010. Cases and controls were selected based on optical coherence tomography and stereoscopic biomicroscopy review. NSD was defined as subfoveal fluid accumulation under detached retina with or without overlying foveal thickening. The association between the presence of NSD, blood pressure, lipid status and various other biochemical parameters was evaluated.ResultsGroup I (cases) included 37 eyes of 33 patients having DME with NSD and Group II (controls) included 30 eyes of 21 patients having DME without NSD. Patients ranged in age (mean ± SD) from 50 to 62 years (56.6 +/-6.78) for cases and from 51 to 65 years (58.4+/-7.84) for controls. The duration of diabetes ranged from 4 to 15 year (mean 9.45+/-6.08) among cases and 4 to 14 years (9.7+/-5.12) among controls. Significant risk factors for NSD were high values of systolic and diastolic blood pressure (p = 0.039 and 0.043 respectively).ConclusionHigh systolic and diastolic blood pressures are independent and significant risk factors for NSD in DME.

Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema

“…To date, the reason why subretinal fluid only appears in a small portion of diabetic macular edema has remained unclear. High glycosylated hemoglobin levels and systemic hypertension have been linked to the breakdown of blood retinal barrier that makes fluid tend to shift into the subretinal space [ 17 , 18 ]. High glucose levels increased osmotic and oxidative stress which impaired RPE pumping function as suggested in the previous study [ 17 ].…”

“…The previous study had much higher average HbA1c, 10.05% in SRF group, compared with 7.0% in our study. In addition to RPE dysfunction, literatures had pointed out that prolonged hyperglycemia and hypertension could directly or indirectly contribute to upregulation of vascular endothelial growth factors due to sustained ischemia and RPE injury [ 18 – 20 ]. One clinical research showed in 15 eyes that subretinal fluid reflectivity quantified by OCT was highly associated with increased levels of intraocular VEGF that led to the breakdown of blood retinal barrier [ 12 ].…”

The Frequency of Serous Macular Detachment in Diabetic Macular Edema

“…Gupta ve ark. 'nın 17 2014 yılında yayınladıkları çalışmada yüksek sistolik ve diyastolik kan basıncının DMÖ'de seröz makuler dekolman gelişimi için bağımsız ve önemli bir risk faktörü olduğu ifade edilmekte olup; yaş, diyabet süresi, açlık kan şekeri, tokluk kan şekeri, HbA1c, hemoglobin düzeyi ve hipertansiyon varlığının SMD oluşma riskini arttırmadığını ifade edilmiştir.HT'nin özellikle de malign hipertansiyonun SMD'nin iyi bilinen bir nedeni olduğunu bildiren çalışmalar da bulunmaktadır. 18 Bizim çalışmamızda seröz makuler dekolman bulunan olgularda sistemik faktörler değerlendirildiğinde HT öyküsü daha yüksek orandaydı ve bu fark istatiksel olarak da anlamlıydı.…”

Vascular risk factors and rhegmatogenous retinal detachment: a follow-up of a national cohort of Swedish men

“…A recent case-control study of neurosensory retinal detachment among patients with diabetic macular oedema suggested that high blood pressure could be a risk factor for retinal detachment 8. Despite its limitations—a very specific research question and a sample size of only 33 cases and 21 controls—the study introduced an interesting hypothesis linking vascular risk factors to retinal detachment.…”