The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy?

Chowdhury, Tahseen A; Hopkins, David; Dodson, P M; Vafidis, Gilli

doi:10.1038/sj.eye.6700205

Cited by 87 publications

(53 citation statements)

References 45 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, further investigation is underway with two large prospective randomised controlled trials, ASPEN and the CARDS study, due to report later in 2004. 7,17,18 The CARDS study will support more widespread statin prescription in type II diabetic patients, and if the conclusions from this study are correct we may in turn see a delay or reduction in the episodes of preretinal or vitreous haemorrhage in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…recently: hyperlipidaemia appears to have a role in the progression of maculopathy for type II patients; 6,7 similarly, nephropathy (probably through its effects on lipid profiles and blood pressure) is implicated in the progression of maculopathy. 6 It might thus seem that control of well-established risk factors for macrovascular disease (glycaemia, hypertension, hyperlipidaemia, smoking) would result in benefits in retinopathy also.…”

Section: Clinical Studymentioning

confidence: 99%

See 1 more Smart Citation

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Banerjee

Denniston

Gibson

et al. 2004

Eye

Self Cite

View full text Add to dashboard Cite

Aims To review the role of cardiovascular disease and therapy in the onset and recurrence of preretinal/vitreous haemorrhage in diabetic patients. Methods Retrospective case note analysis of diabetic patients with vitreous haemorrhage from the Diabetic Eye Clinic at Birmingham Heartlands Hospital. Results In total, 54 patients (mean age 57.1, 37 males, 20 type I vs 34 type II diabetic patients) were included. The mean (SD) duration of diagnosed diabetes at first vitreous haemorrhage was significantly longer, 21.9 (7.6) years for type I and 14.8 (9.3) years for type II diabetic patients (Po0.01, unpaired t-test, two-tailed).Aspirin administration was not associated with a significantly later onset of vitreous haemorrhage. Four episodes were associated with ACE-inhibitor cough. There was a trend towards HMGCoA reductase inhibitor (statin) use being associated with a delayed onset of vitreous haemorrhage: 21.4 years until vitreous haemorrhage (treatment group) vs 16.2 years (nontreatment group) (P ¼ 0.09, two-tailed, unpaired t-test, not statistically significant).During follow-up 56 recurrences occurred, making a total of 110 episodes of vitreous haemorrhage in 79 eyes of 54 patients. The mean (range) follow-up post haemorrhage was 1067 (77-3842) days, with an average of 1.02 recurrences. Age, gender, diabetes type (I or II) or control, presence of hypertension or hypercholesterolaemia, and macrovascular complications were not associated with a significant effect on the 1-year recurrence rate.Aspirin (and other antiplatelet or anticoagulant agents) and ACE-inhibitors appeared to neither increase nor decrease the 1-year recurrence rate. However, statin use was significantly associated with a reduction in recurrence (Fisher exact Po0.05; two-tailed) with an odds ratio (95% CI) of 0.25 (0.1-0.95). Conclusion In this retrospective analysis, the onset of preretinal/vitreous haemorrhage was not found to be accelerated by gender, hypertension, hypercholesterolaemia, evidence of macrovascular disease, or HbA1c. Neither aspirin nor ACE-inhibitor administration accelerated the onset or recurrence of first vitreous haemorrhage. Statins may have a protective role, both delaying and reducing the recurrence of haemorrhage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Clinical Studymentioning

confidence: 99%

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Banerjee

Denniston

Gibson

et al. 2004

Eye

Self Cite

View full text Add to dashboard Cite

show abstract

“…9 In addition, there is limited evidence that statins may reduce retinal exudation in patients with diabetic maculopathy, an effect to be confirmed in ongoing large randomised clinical trials. 15,16 This study has demonstrated that there is still much input required to achieve optimal metabolic and BP control to delay progression and need for laser treatment of DR. In view of the above findings, we feel that ophthalmologists responsible for the care of patients with DR should ensure that the patients receive both adequate medical therapies to optimise glycaemic and BP control, as well as laser photocoagulation.…”

Section: Discussionmentioning

confidence: 99%

Is measurement of blood pressure worthwhile in the diabetic eye clinic?

Al-Husainy

Farmer

Gibson

et al. 2004

Eye

Self Cite

View full text Add to dashboard Cite

Purpose The UK Prospective Diabetic Study has confirmed the importance of blood pressure (BP) as a major risk factor for diabetic retinopathy (DR). We wanted to investigate whether measuring the BP in the diabetic eye clinic could identify new hypertensive patients and monitor control in existing ones. Patients and methods We compared BP in patients attending the diabetic eye clinic with home blood pressure measurement (HBPM) and ambulatory BP measurement (ABPM). In all, 106 patients attending a diabetic eye clinic were selected at random from clinic attendees. BP measurement (on an Omron 705 CP) was performed in the eye clinic and also compared to HBPM three times per day with an Omron 705 CP machine, and was compared to diabetic clinic measurements. In addition, 11 randomly chosen patients had 24 h ABPM to validate the above techniques. Results In all, 106 patients (70 male and 36 female) were recruited for the study, of which 71 were known to be hypertensive on antihypertensive medication. Of the total, 75 patients (70.8%) had BP4140/85 in the eye clinic, of which 51 (68%) were known to be hypertensive on treatment and this was confirmed in 46 (90%) on HBPM. A total of, 24 patients (22.6%) were newly diagnosed as hypertensive in the eye clinic, which was confirmed by HBPM in 22 patients (92%). The mean BP of the measurements performed in the eye clinic was significantly higher than that carried out in the diabetic clinic (Po0.01). Tropicamide 1% and phenylephrine 2.5% eye drop instillation had no effect on BP. In 11 randomly chosen patients, 24 h ABPM validated both diabetic eye clinic and home BP measurements. Conclusion Attendance at the diabetic eye clinic is an important chance to detect both new patients with systemic hypertension and those with inadequate BP control.Ophthalmologists should be encouraged to measure BP in their diabetic patients attending diabetic eye clinics, as it is an important risk factor for DR. On the basis of our findings, good BP control is a goal yet to be achieved in diabetic patients with retinopathy.

show abstract

“…[39][40][41] However, there was no evidence of improvement in visual acuity, which was not surprising as patients had severe retinopathy and poor vision at baseline. A number of subsequent studies showed improvement in macular oedema and regression of hard exudates with statin therapy, [42][43][44][45] as well as significant improvement in worsening of visual acuity. 44 However, these studies were in small numbers of patients, and in most cases, involved limited treatment duration.…”

Section: Statins and Fibratesmentioning

confidence: 99%

Management of diabetic retinopathy: could lipid-lowering be a worthwhile treatment modality?

Dodson

2009

Eye

Self Cite

View full text Add to dashboard Cite

Diabetic eye disease confers substantial burden on the patient quality of life. Current therapeutic strategies indicate an unmet clinical need for preventive therapy. Tight control of blood pressure and glycaemia are mandatory components of primary prevention strategies, but are insufficient to eliminate risk in all patients. A body of evidence supports a role for lipid-modifying therapy in reducing the diabetic retinopathy endpoints. Although inconclusive for statin therapy, results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study show beneficial effects of fenofibrate in reducing the requirement for laser therapy, and particularly in preventing disease progression in patients with pre-existing diabetic retinopathy. However, there is a need for confirmation of these findings in large prospective studies with progression of retinopathy as the primary endpoint, such as the ACCORD-EYE (Action to Control Cardiovascular Risk in Diabetes-EYE) study, and in a clinical trial specifically conducted for diabetic maculopathy. In addition, elucidation of the mechanism(s) of effect of fenofibrate is indicated.

show abstract

The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy?

Cited by 87 publications

References 45 publications

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Is measurement of blood pressure worthwhile in the diabetic eye clinic?

Management of diabetic retinopathy: could lipid-lowering be a worthwhile treatment modality?

Contact Info

Product

Resources

About