Retinal Circulatory Changes Related to Retinopathy Progression in Insulin-dependent Diabetes Mellitus

Feke, Gilbert T.; Tagawa, Hiroshi; Yoshida, Akitoshi; Goger, Douglas G.; Weiter, John J.; Buzney, Sheldon M.; McMeel, J. Wallace

doi:10.1016/s0161-6420(85)33827-7

Cited by 64 publications

(34 citation statements)

References 17 publications

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“…One previous study (20) using laser Doppler velocimetry in a small number of subjects showed an increase in the Data are Pearson correlation coefficients (associated P values). A significant correlation was taken at r Ͼ 0.140 and P Ͻ 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…Kohner et al (16) suggested that increased blood flow led to increased shear stress on the vessel wall. Support for this was found in a number of studies that showed decreased blood flow with insulin treatment to lower blood glucose (48) and increased blood flow with advancement of retinopathy (20,49). However, the nature of the blood flow alteration is far from conclusive, even when only considering data published by the same authors.…”

Section: Discussionmentioning

confidence: 99%

“…The minimum vessel diameter that the CLBF can measure is ϳ80 m, and, therefore, the instrument cannot be used to assess capillary hemodynamics. The assessment of retinal blood flow with the CLBF will provide new insights into retinal vascular disease (20). Evaluation of the instrument in normal subjects to determine its variability and repeatability has been established (21,22).…”

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confidence: 99%

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Retinal Hemodynamics in Early Diabetic Macular Edema

et al. 2006

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The objective of this study was to establish the baseline retinal hemodynamic characteristics of stratified groups of diabetic patients at increasing risk for the development of diabetic macular edema (DME). Group 1 had 50 control subjects, group 2 had 56 diabetic patients without clinically visible retinopathy, group 3 had 54 diabetic patients with microaneurysms and/or hard exudates within two disc diameters of the fovea in the absence of clinically manifest DME, and group 4 had 40 patients with clinically manifest DME. Retinal hemodynamics (diameter, velocity, maximum-to-minimum velocity ratio, and flow) were assessed. Intraocular pressure, blood pressure, and relevant systemic markers of diabetes control and complications were also undertaken. The maximum-to-minimum velocity ratio was elevated with increasing risk of clinically significant DME (P < 0.0001). No significant differences were found between the groups with respect to diameter, velocity, or flow. The maximum-to-minimum velocity ratio was correlated to age, duration of diabetes, blood pressure, pulse rate, intraocular pressure, and serum potassium levels. In conclusion, the maximum-to-minimum velocity ratio was significantly increased with increasing risk of development of DME. Retinal arteriolar hemodynamics were positively correlated to age, duration of diabetes, and blood pressure. These findings suggest a reduction in the compliance (i.e., an increase of vascular rigidity) of the arteriolar circulation with increasing risk of DME. Diabetes 55:813-818, 2006

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Retinal Hemodynamics in Early Diabetic Macular Edema

et al. 2006

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“…A progressive increase in vessel diameter has also been unequivocally observed [5,8,10]. Some contradictory results have been reported where severity of retinopathy has been correlated with a progressive reduction in blood flow with no subsequent increase [11] but the aforementioned results are the most widely accepted.…”

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confidence: 98%

The influence of plasma glucose upon pulsatile ocular blood flow in subjects with Type II diabetes mellitus

et al. 2001

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The development of diabetic retinopathy is a major concern in the management of diabetes mellitus. Previous research into this complication, using techniques such as fluorescein angiography [1] and Laser Doppler velocimetry [2±5], has contributed to the understanding of the process and progression of retinopathy [2, 4±7].Clinical studies have shown that ocular haemodynamic changes in diabetes are complex and still have to be fully defined. Generally an initial reduction in retinal blood flow velocity has been observed in the early stages of diabetes before the onset of any clinically recognisable retinopathy [4,5,7,9,10]. A positive transition is then seen as retinal blood speed in- Diabetologia (2001) Abstract Aims/hypothesis. This study investigated the influence of plasma glucose upon pulsatile ocular blood flow in subjects with Type II (non-insulin-dependent) diabetes mellitus. Methods. A total of 19 subjects with Type II diabetes and 8 normal control subjects undertook a meal tolerance test after an overnight fast. The pulsatile ocular blood flow, using the Ocular Blood Flow Tonometer, and plasma glucose concentrations were taken at times 0 min, 90 min and 240 min. Blood pressure and glycated haemoglobin concentrations, in the subjects with diabetes, were also measured at time 0 min. Pulsatile ocular blood flow and plasma glucose were also measured at times 0 and 90 min in 5 subjects with Type II diabetes mellitus who remained fasting.Results. It was found that the subjects with diabetes who undertook the meal tolerance test showed a significant increase in both plasma glucose concentrations and pulsatile ocular blood flow from time 0±90 min, followed by a decrease from 90 min to the end of the session at 240 min. (p < 0.001 in each case). Regression analysis showed a significant correlation between the change in pulsatile ocular blood flow and the change in plasma glucose concentration (r = 0.671, p = 0.001). Control subjects showed no significant change in either plasma glucose or pulsatile ocular blood flow during the meal tolerance test. Subjects with diabetes mellitus who remained fasting also showed no significant change in pulsatile ocular blood flow or plasma glucose concentrations. No correlation was found between glycated haemoglobin concentrations or blood pressure and pulsatile ocular blood flow. Conclusion/interpretation. Pulsatile ocular blood flow is influenced by changes in plasma glucose concentrations in Type II diabetes mellitus, indicating that uncontrolled hyperglycaemia might result in a higher pulsatile ocular blood flow than might otherwise be expected. [Diabetologia (2001) 44: 700±705]

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“…El hecho de tener pacientes con HbA1c elevada puede implicar descubrir lesiones en retina compatibles con posible retinopatía diabética como hemorragias, exudados y neovascularización, tal y como se reporta en la presente investigación. Dichos resultados están en línea con lo expuesto por Feke (1985) y Ali et al (2013). Al igual que plantea Low (1996) y Zangemeister, Gronow y Grzyska (2009) en el presente análisis hubo diferencias significativas entre el tiempo de evolución de la diabetes (cinco años y diez años) y la respuesta pupilar a la luz.…”

Section: Discussionunclassified

Estudio de la asociación entre neuropatía autonómica pupilar y retinopatía diabética en pacientes diabéticos tipo 2

Estepa¹,

Rojas²

2014

Cienc. Tecnol. Salud Vis. Ocul.

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Estudio de la asociación entre neuropatía autonómica pupilar y retinopatía diabética en pacientes diabéticos tipo 2Study of the association between pupillary autonomic neuropathy and diabetic retinopathy in type 2 diabetic patients Héctor Pérez Estepa* Lucy Rivera Rojas** * Optómetra, Universidad de la Salle, Bogotá, Colombia. MSc. Universidad de La Salle. Especialista en Salud Familiar, Universidad El Bosque, Bogotá, Colombia. Docente investigador, Universidad de La Salle. ** Licenciada Química, Universidad Pedagógica Nacional, Bogotá, Colombia. MSc. en Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia. Docente investigadora, Universidad de La Salle, Bogotá, Colombia.Cómo citar este artículo: Pérez Estepa, H. y Rivera Rojas, L. (2014). Estudio de la asociación entre neuropatía autonómica pupilar y retinopatía diabética en pacientes diabéticos tipo 2. Ciencia y Tecnología para la Salud Visual y Ocular, 12 (1), 33-41. RESUMENLa alteración pupilar en la diabetes se interpreta como una manifestación de la neuropatía autonómica y lesión microvascular, lo que se refleja en hallazgos fundoscópicos no normales. Objetivo: describir la asociación entre neuropatía autonómica pupilar y retinopatía diabética en pacientes diabéticos tipo 2. Materiales y métodos: estudio descriptivo analítico comparativo. Se incluyeron 76 sujetos, divididos en dos grupos, 46 pacientes diabéticos tipo 2 y 30 sujetos sanos (no diabéticos) mayores de 40 años. Se midió el diámetro y la velocidad de respuesta pupilar con una cámara de alta resolución en sistema de videoscopia, y evaluación de retina en cámara retinal. Resultados: se encontró diferencia entre la velocidad pupilar y HbA1c del grupo de pacientes diabéticos tipo 2 (0,512 mm/s DE 0,283; HbA1c 7,89 % DE 1,88) con respecto al grupo de pacientes sanos (3,5 mm DE 0,52; 0,785 mm/s DE 0,368; HbA1c 6,31 DE 0,59). Los principales hallazgos fundoscópicos localizados en retina fueron neovascularización (78,26 %), exudados (67,39 %) y hemorragias (60,87 %). Se observó asociación entre HbA1c mayor a 7,89 % y velocidad pupilar menor a 0,598 mm/s con la presencia de neovascularización y hemorragias retinales. Conclusiones: se evidenció asociación entre las respuestas pupilares, la HbA1c y los hallazgos retinales en pacientes diabéticos tipo 2. INTRODUCCIÓNLa diabetes es una enfermedad de salud pública que genera múltiples complicaciones, de las cuales el daño ocular es una de las más importantes, pues el proceso patológico degenerativo en la retina lleva a la ceguera. La Federación Internacional de Diabetes (FID) reveló en 2006 que la diabetes afecta a 246 millones de personas alrededor del mundo y se estima que el número se acrecentará a 552 millones en 2030 (Reiber, 1991; Scanlon, Aldington y Stratton, 2013). Tanto la prevalencia como la incidencia de la diabetes han aumentado rápidamente, con hallazgos en el 59 % de hispanos, 16,2 % de afroamericanos, 15,3 % de nativos americanos, 9,3 % de isleños del Pacífico y 3,4 % de blancos (Zellweger et al., 2004) y se espera una rápida amplia...

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Retinal Circulatory Changes Related to Retinopathy Progression in Insulin-dependent Diabetes Mellitus

Cited by 64 publications

References 17 publications

Retinal Hemodynamics in Early Diabetic Macular Edema

Retinal Hemodynamics in Early Diabetic Macular Edema

The influence of plasma glucose upon pulsatile ocular blood flow in subjects with Type II diabetes mellitus

Estudio de la asociación entre neuropatía autonómica pupilar y retinopatía diabética en pacientes diabéticos tipo 2

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