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. 2000 Oct;84(10):1097–1102. doi: 10.1136/bjo.84.10.1097

Refractive changes in diabetic patients during intensive glycaemic control

F Okamoto 1, H Sone 1, T Nonoyama 1, S Hommura 1
PMCID: PMC1723257  PMID: 11004091

Abstract

AIMS—To evaluate the clinical course and the characteristics of transient refractive error occurring during intensive glycaemic control of severe hyperglycaemia.
METHODS—28 eyes of patients with persistent diabetes were included in this prospective study. During the observation period, patients underwent general ophthalmological examination and A-mode scan ultrasonography was performed at each examination—at days 1, 3, and 7, and then once every week or every other week until recovery of hyperopia.
RESULTS—A transient hyperopic change occurred in all patients receiving improved control after hyperglycaemia. Hyperopic change developed a mean of 3.4 (SD 2.0) days after the onset of treatment, and reached a peak at 10.3 (6.1) days, where the maximum hyperopic change in an eye was 1.47 (0.87) D (range 0.50-3.75 D). Recovery of the previous refraction occurred between 14 and 84 days after the initial assessment. There was a positive correlation between the magnitude of the maximum hyperopic change and (1) the plasma glucose concentration on admission (p<0.01), (2) the HbA1c level on admission (p<0.005), (3) the daily rate of plasma glucose reduction over the first 7 days of treatment (p<0.001), (4) the number of days required for hyperopia to reach its peak (p<0.001), and (5) the number of days required for the development and resolution of hyperopic changes (p<0.0001). There was a negative correlation between the maximum hyperopic change of an eye and baseline value of refraction (p<0.01). During transient hyperopia, no significant changes were observed in the radius of the anterior corneal curvature, axial length, lens thickness, or depth of anterior chamber.
CONCLUSIONS—The degree of transient hyperopia associated with rapid correction of hyperglycaemia is highly dependent on the rate of reduction of the plasma glucose level. A reduction of refractive index in intraocular tissues, especially in lens, appears to be responsible for this hyperopic change.



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Figure 1  .

Figure 1  

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Change of refraction and of plasma glucose concentration in a diabetic patient (case 4) over a period of 16 weeks after starting intensive glycaemic control on day 0. The change of refraction in an eye at a given time point represents the difference between the refractive error on that day and the refractive error at the time of admission. Transient bilateral hyperopic change was similar in both eyes, and appeared in response to a rapid reduction in plasma glucose.

Figure 2  .

Figure 2  

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Relation between maximum hyperopic change of an eye (dioptres) and the plasma glucose concentration (mg/dl) on admission (left). There was a significant positive correlation between them (r=0.49, p<0.01). Relation between maximum hyperopic change of an eye (dioptres) and HbA1c (%) on admission (right). There was a significant positive correlation between them (r=0.57, p<0.005).

Figure 3  .

Figure 3  

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Relation between maximum hyperopic change of an eye (dioptres) and the day on which the maximum hyperopic change was attained (left). There was a significant positive correlation between them (r=0.68, p<0.001). Relation between maximum hyperopic change of an eye (dioptres) and the day on which the patient recovered from hyperopia (right). There was a significant positive correlation between them (r=0.78, p<0.0001).

Figure 4  .

Figure 4  

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Relation between maximum hyperopic change of an eye and the daily rate of plasma glucose reduction over the first 7 days of treatment. There is a positive correlation between them (r=0.59, p<0.001).

Figure 5  .

Figure 5  

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Relation between maximum hyperopic change of an eye and baseline refraction of the eye. There is a negative correlation between them (r=−0.48, p<0.01).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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