Abstract
The effects of strict diabetic control on retinal haemodynamics were studied to elucidate whether such effects are associated with retinopathy changes. In 28 patients with poorly controlled insulin dependent diabetes mellitus and non-proliferative retinopathy, retinal haemodynamics were investigated at baseline, 5 days, 2 months, and 6 months after the institution of strict diabetic control using the bidirectional laser Doppler velocimetry technique and monochromatic fundus photography. Changes in retinal blood flow measured in a major retinal vein (Q) on the fifth day of strict diabetic control correlated significantly with changes in retinopathy level observed at the end of the 6 months of this study (rank correlation 0.65, p < 0.01). On the fifth day of strict diabetic control, 16 out of 20 eyes that showed no progression (NP) of retinopathy at the end of the study had decreases in Q, whereas six out of eight eyes that showed progression (P) had increases in Q. The difference in these changes in Q between P and NP eyes was statistically significant (one way analysis of variance, p = 0.001). No significant changes in Q were detected at 2 months or 6 months. Following the institution of strict diabetic control, no significant changes in time were detected in the regulatory response to 100% oxygen breathing characterised as the percentage decrease in Q at 4-6 minutes of oxygen breathing (analysis of variance, p = 0.36). Changes in Q following institution of strict diabetic control are associated with progression of retinopathy. Measurements described in this study may help identify diabetic patients at risk of progression when their metabolic control is improved.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brinchmann-Hansen O., Dahl-Jørgensen K., Hanssen K. F., Sandvik L. Effects of intensified insulin treatment on various lesions of diabetic retinopathy. Am J Ophthalmol. 1985 Nov 15;100(5):644–653. doi: 10.1016/0002-9394(85)90618-x. [DOI] [PubMed] [Google Scholar]
- Dahl-Jørgensen K., Brinchmann-Hansen O., Hanssen K. F., Ganes T., Kierulf P., Smeland E., Sandvik L., Aagenaes O. Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: the Oslo study. Br Med J (Clin Res Ed) 1986 Nov 8;293(6556):1195–1199. doi: 10.1136/bmj.293.6556.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ernest J. T., Goldstick T. K., Engerman R. L. Hyperglycemia impairs retinal oxygen autoregulation in normal and diabetic dogs. Invest Ophthalmol Vis Sci. 1983 Jul;24(7):985–989. [PubMed] [Google Scholar]
- Grunwald J. E., Brucker A. J., Petrig B. L., Riva C. E. Retinal blood flow regulation and the clinical response to panretinal photocoagulation in proliferative diabetic retinopathy. Ophthalmology. 1989 Oct;96(10):1518–1522. doi: 10.1016/s0161-6420(89)32697-2. [DOI] [PubMed] [Google Scholar]
- Grunwald J. E., Brucker A. J., Schwartz S. S., Braunstein S. N., Baker L., Petrig B. L., Riva C. E. Diabetic glycemic control and retinal blood flow. Diabetes. 1990 May;39(5):602–607. doi: 10.2337/diab.39.5.602. [DOI] [PubMed] [Google Scholar]
- Grunwald J. E., Riva C. E., Brucker A. J., Sinclair S. H., Petrig B. L. Altered retinal vascular response to 100% oxygen breathing in diabetes mellitus. Ophthalmology. 1984 Dec;91(12):1447–1452. doi: 10.1016/s0161-6420(84)34124-0. [DOI] [PubMed] [Google Scholar]
- Grunwald J. E., Riva C. E., Martin D. B., Quint A. R., Epstein P. A. Effect of an insulin-induced decrease in blood glucose on the human diabetic retinal circulation. Ophthalmology. 1987 Dec;94(12):1614–1620. doi: 10.1016/s0161-6420(87)33257-9. [DOI] [PubMed] [Google Scholar]
- Grunwald J. E., Riva C. E., Sinclair S. H., Brucker A. J., Petrig B. L. Laser Doppler velocimetry study of retinal circulation in diabetes mellitus. Arch Ophthalmol. 1986 Jul;104(7):991–996. doi: 10.1001/archopht.1986.01050190049038. [DOI] [PubMed] [Google Scholar]
- Janka H. U., Warram J. H., Rand L. I., Krolewski A. S. Risk factors for progression of background retinopathy in long-standing IDDM. Diabetes. 1989 Apr;38(4):460–464. doi: 10.2337/diab.38.4.460. [DOI] [PubMed] [Google Scholar]
- Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1984 Apr;102(4):520–526. doi: 10.1001/archopht.1984.01040030398010. [DOI] [PubMed] [Google Scholar]
- Knowler W. C., Bennett P. H., Ballintine E. J. Increased incidence of retinopathy in diabetics with elevated blood pressure. A six-year follow-up study in Pima Indians. N Engl J Med. 1980 Mar 20;302(12):645–650. doi: 10.1056/NEJM198003203021201. [DOI] [PubMed] [Google Scholar]
- Moss S. E., Klein R., Klein B. E. Ocular factors in the incidence and progression of diabetic retinopathy. Ophthalmology. 1994 Jan;101(1):77–83. doi: 10.1016/s0161-6420(94)31353-4. [DOI] [PubMed] [Google Scholar]
- Nathan D. M., Singer D. E., Hurxthal K., Goodson J. D. The clinical information value of the glycosylated hemoglobin assay. N Engl J Med. 1984 Feb 9;310(6):341–346. doi: 10.1056/NEJM198402093100602. [DOI] [PubMed] [Google Scholar]
- Parving H. H., Viberti G. C., Keen H., Christiansen J. S., Lassen N. A. Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism. 1983 Sep;32(9):943–949. doi: 10.1016/0026-0495(83)90210-x. [DOI] [PubMed] [Google Scholar]
- Riva C. E., Grunwald J. E., Sinclair S. H. Laser Doppler Velocimetry study of the effect of pure oxygen breathing on retinal blood flow. Invest Ophthalmol Vis Sci. 1983 Jan;24(1):47–51. [PubMed] [Google Scholar]
- Zatz R., Brenner B. M. Pathogenesis of diabetic microangiopathy. The hemodynamic view. Am J Med. 1986 Mar;80(3):443–453. doi: 10.1016/0002-9343(86)90719-9. [DOI] [PubMed] [Google Scholar]