Quantitative Vitreous Fluorophotometry: A Sensitive Technique for Measuring Early Breakdown of the Blood-retinal Barrier in Young Diabetic Patients

Waltman, Stephen R.; Oestrich, Charles; Krupin, Theodore; Hanish, Sidney J.; Ratzan, Susan; Santiago, Julio V.; Kilo, Charles

doi:10.2337/diab.27.2.85

Cited by 121 publications

(31 citation statements)

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“…At the time of this study, six of our patients had demonstrable clinical retinopathy confirmed by fluorescein angiography. Although the remaining six had not undergone fluorescein studies, it is likely that they too had abnormalities of the blood-retinal barrier because the prevalence of capillary leakage (as detected by the sensitive and specific [44] technique of vitreous fluorophotometry) is practically 100%, even very shortly after the diagnosis of diabetes and while fluorescein angiograms are still perfectly normal (4,44,45). The effectiveness of dopamine as a growth hormone secretagogue in our diabetic patients shares the characteristics of the abnormal vitreous fluorophotometry in the general diabetic population: it is a consistent finding and its occurrence is independent of the duration of the disease.…”

Section: Discussionmentioning

confidence: 99%

Increased growth hormone response to dopamine infusion in insulin-dependent diabetic subjects: indication of possible blood-brain barrier abnormality.

Lorenzi¹,

Karam²,

McIlroy³

et al. 1980

J. Clin. Invest.

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Section: Discussionmentioning

confidence: 99%

Increased growth hormone response to dopamine infusion in insulin-dependent diabetic subjects: indication of possible blood-brain barrier abnormality.

Lorenzi¹,

Karam²,

McIlroy³

et al. 1980

J. Clin. Invest.

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“…Abnormal transcapillary escape rate of albumin [95], abnormal urinary albumin excretion during exercise [96] and leakage of fluorescein from the retinal vessels into the vitreous and the anterior segment of the eye have been described [97][98][99][100][101]. Several reports indicate that strict control of blood sugar levels reduces or abolishes these manifestations of functional microangiopathy [95][96][97].…”

Section: Functional Microangiopathy Organ Size and Blood Compositionmentioning

confidence: 99%

Relation of diabetic control to development of microvascular complications

Tchobroutsky

1978

Diabetologia

399

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Summary. This review seeks to supply the arguments which support or deny the relationship between the quality of control of blood glucose levels and the course of diabetic microangiopathy. The ideal study is impossible to do in man but most prospective studies suggest that the better the control the slower the rate of progression and severity of lesions. "Scientific" but indirect arguments from biochemical, enzymatic and functional studies have shown that insulin and/or blood glucose control reverse some early diabetic changes that are probably related to the late events. Recent studies suggest that observations on animals that have shown the beneficial effect of treatment are relevant to the problem of diabetic microvascular lesions in man. Heredity influences the development of diabetic microangiopathy in diabetics but retinal and/or glomerular lesions -which are definitely not pathognomonic for diabetes -do not appear in the absence of hyperglycaemia. Muscle capillary basement membrane thickening that seems not to be a specific abnormality was not observed by several investigators in recently diagnosed diabetics. Therefore most of the arguments that have been given to support the point of view that tight control is not justified may be rejected. The opinion of the author is that strict control of diabetes is worthwile in patients with long life expectancy and no psychological, social or cultural handicaps.

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“…VF brought an important clinical contribution for quantifying BRB permeability in DR and is of particular interest in the preclinical stage since diabetic eyes show increased permeability values even in apparently normal ocular fundi (27,28).…”

Section: Vfmentioning

confidence: 99%

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

et al. 2014

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It is unknown whether independent neural damage may occur in the pre-/absent vascular diabetic retinopathy (DR). To exclude vasculopathy, it is important to measure the integrity of the blood-retinal barrier (BRB). This cross-sectional study addressed this problem in type 1 diabetic patients with normal ocular fundus and absent breakdown of the BRB (confirmed with vitreous fluorometry). These were compared with a group with disrupted BRB (with normal fundus or initial DR) and normal controls. Multifocal electroretinography and chromatic/achromatic contrast sensitivity were measured in these 42 patients with preserved visual acuity. Amplitudes of neurophysiological responses (multifocal electroretinogram) were decreased in all eccentricity rings in both clinical groups, when compared with controls, with sensitivity >78% for a specificity level of 90%. Implicit time changes were also found in the absence of initial DR. Impaired contrast sensitivity along chromatic axes was also observed, and achromatic thresholds were also different between controls and both clinical groups. The pattern of changes in the group without baseline BRB permeability alterations, as probed by psychophysical and electrophysiological measurements, does thereby confirm independent damage mechanisms. We conclude that retinal neuronal changes can be diagnosed in type 1 diabetes, independently of the breakdown of the BRB and onset of vasculopathy.

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Quantitative Vitreous Fluorophotometry: A Sensitive Technique for Measuring Early Breakdown of the Blood-retinal Barrier in Young Diabetic Patients

Cited by 121 publications

References 0 publications

Increased growth hormone response to dopamine infusion in insulin-dependent diabetic subjects: indication of possible blood-brain barrier abnormality.

Increased growth hormone response to dopamine infusion in insulin-dependent diabetic subjects: indication of possible blood-brain barrier abnormality.

Relation of diabetic control to development of microvascular complications

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

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