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. 1996 Apr;80(4):327–331. doi: 10.1136/bjo.80.4.327

Retinal haemodynamics in patients with early diabetes mellitus.

J E Grunwald 1, J DuPont 1, C E Riva 1
PMCID: PMC505459  PMID: 8703884

Abstract

AIMS/BACKGROUND: The retinal circulation was investigated in a group of 19 patients with insulin dependent diabetes mellitus with less than 4 years of disease duration and no evidence of diabetic retinopathy. Results of these patients were compared with those of 16 age-matched normal controls. METHODS: Venous diameter (D) was measured from monochromatic fundus photographs. Maximum erythrocyte velocity (Vmax) was assessed by bidirectional laser Doppler velocimetry in the major retinal veins of one eye of each subject. Total volumetric blood flow rate (QT) was calculated by adding the flow rates of the major retinal veins. RESULTS: Average QT was 12% larger than normal in diabetic patients (one tailed, non-paired Student's t test, p < 0.05). A statistically significant correlation was observed between QT and disease duration (r = 0.35, p < 0.04). Patients with longer disease duration tended to have somewhat larger QT. The average retinal vascular regulatory responses to hyperoxia were not significantly different from normal in diabetic patients. In these patients, however, higher blood glucose levels were associated with decreased regulatory responses to hyperoxia. CONCLUSIONS: Patients with diabetes mellitus of relatively short duration have mildly increased QT, suggesting that increased blood flow may play an early role in the development of diabetic retinal microangiopathy.

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Selected References

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

  1. Almér L. O., Pandolfi M., Nilsson I. M. Diabetic retinopathy and the fibrinolytic system. Diabetes. 1975 Jun;24(6):529–534. [PubMed] [Google Scholar]
  2. Atherton A., Hill D. W., Keen H., Young S., Edwards E. J. The effect of acute hyperglycaemia on the retinal circulation of the normal cat. Diabetologia. 1980 Mar;18(3):233–237. doi: 10.1007/BF00251922. [DOI] [PubMed] [Google Scholar]
  3. Bertram B., Wolf S., Fiehöfer S., Schulte K., Arend O., Reim M. Retinal circulation times in diabetes mellitus type 1. Br J Ophthalmol. 1991 Aug;75(8):462–465. doi: 10.1136/bjo.75.8.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blair N. P., Feke G. T., Morales-Stoppello J., Riva C. E., Goger D. G., Collas G., McMeel J. W. Prolongation of the retinal mean circulation time in diabetes. Arch Ophthalmol. 1982 May;100(5):764–768. doi: 10.1001/archopht.1982.01030030768009. [DOI] [PubMed] [Google Scholar]
  5. Bursell S. E., Clermont A. C., Shiba T., King G. L. Evaluating retinal circulation using video fluorescein angiography in control and diabetic rats. Curr Eye Res. 1992 Apr;11(4):287–295. doi: 10.3109/02713689209001782. [DOI] [PubMed] [Google Scholar]
  6. Cringle S. J., Yu D. Y., Alder V. A., Su E. N. Retinal blood flow by hydrogen clearance polarography in the streptozotocin-induced diabetic rat. Invest Ophthalmol Vis Sci. 1993 Apr;34(5):1716–1721. [PubMed] [Google Scholar]
  7. Damon D. N., Duling B. R. A comparison between mean blood velocities and center-line red cell velocities as measured with a mechanical image streaking velocitometer. Microvasc Res. 1979 May;17(3 Pt 1):330–332. doi: 10.1016/s0026-2862(79)80008-4. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. Feke G. T., Buzney S. M., Ogasawara H., Fujio N., Goger D. G., Spack N. P., Gabbay K. H. Retinal circulatory abnormalities in type 1 diabetes. Invest Ophthalmol Vis Sci. 1994 Jun;35(7):2968–2975. [PubMed] [Google Scholar]
  10. Feke G. T., Tagawa H., Yoshida A., Goger D. G., Weiter J. J., Buzney S. M., McMeel J. W. Retinal circulatory changes related to retinopathy progression in insulin-dependent diabetes mellitus. Ophthalmology. 1985 Nov;92(11):1517–1522. doi: 10.1016/s0161-6420(85)33827-7. [DOI] [PubMed] [Google Scholar]
  11. Grunwald J. E., Brucker A. J., Braunstein S. N., Schwartz S. S., Baker L., Petrig B. L., Riva C. E. Strict metabolic control and retinal blood flow in diabetes mellitus. Br J Ophthalmol. 1994 Aug;78(8):598–604. doi: 10.1136/bjo.78.8.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. 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]
  13. 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]
  14. Grunwald J. E., Riva C. E., Baine J., Brucker A. J. Total retinal volumetric blood flow rate in diabetic patients with poor glycemic control. Invest Ophthalmol Vis Sci. 1992 Feb;33(2):356–363. [PubMed] [Google Scholar]
  15. 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]
  16. Grunwald J. E., Riva C. E., Brucker A. J., Sinclair S. H., Petrig B. L. Effect of panretinal photocoagulation on retinal blood flow in proliferative diabetic retinopathy. Ophthalmology. 1986 May;93(5):590–595. doi: 10.1016/s0161-6420(86)33691-1. [DOI] [PubMed] [Google Scholar]
  17. 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]
  18. 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]
  19. HICKAM J. B., SIEKER H. O. Retinal vascular reactivity in patients with diabetes mellitus and with atherosclerosis. Circulation. 1960 Aug;22:243–246. doi: 10.1161/01.cir.22.2.243. [DOI] [PubMed] [Google Scholar]
  20. Kohner E. M., Hamilton A. M., Saunders S. J., Sutcliffe B. A., Bulpitt C. J. The retinal blood flow in diabetes. Diabetologia. 1975 Feb;11(1):27–33. doi: 10.1007/BF00422814. [DOI] [PubMed] [Google Scholar]
  21. Kohner E. M., Patel V., Rassam S. M. Role of blood flow and impaired autoregulation in the pathogenesis of diabetic retinopathy. Diabetes. 1995 Jun;44(6):603–607. doi: 10.2337/diab.44.6.603. [DOI] [PubMed] [Google Scholar]
  22. Little H. L. The role of abnormal hemorrheodynamics in the pathogenesis of diabetic retinopathy. Trans Am Ophthalmol Soc. 1976;74:573–636. [PMC free article] [PubMed] [Google Scholar]
  23. Lowe G. D., Ghafour I. M., Belch J. J., Forbes C. D., Foulds W. S., MacCuish A. C. Increased blood viscosity in diabetic proliferative retinopathy. Diabetes Res. 1986 Feb;3(2):67–70. [PubMed] [Google Scholar]
  24. McMillan D. E. The effect of diabetes on blood flow properties. Diabetes. 1983 May;32 (Suppl 2):56–63. doi: 10.2337/diab.32.2.s56. [DOI] [PubMed] [Google Scholar]
  25. McMillan D. E., Utterback N. G., La Puma J. Reduced erythrocyte deformability in diabetes. Diabetes. 1978 Sep;27(9):895–901. doi: 10.2337/diab.27.9.895. [DOI] [PubMed] [Google Scholar]
  26. 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]
  27. Patel V., Rassam S., Newsom R., Wiek J., Kohner E. Retinal blood flow in diabetic retinopathy. BMJ. 1992 Sep 19;305(6855):678–683. doi: 10.1136/bmj.305.6855.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Riva C. E., Grunwald J. E., Sinclair S. H., Petrig B. L. Blood velocity and volumetric flow rate in human retinal vessels. Invest Ophthalmol Vis Sci. 1985 Aug;26(8):1124–1132. [PubMed] [Google Scholar]
  29. Schmid-Schönbein H., Volger E. Red-cell aggregation and red-cell deformability in diabetes. Diabetes. 1976;25(2 Suppl):897–902. [PubMed] [Google Scholar]
  30. Schmid-Schönbein H., Volger E. Red-cell aggregation and red-cell deformability in diabetes. Diabetes. 1976;25(2 Suppl):897–902. [PubMed] [Google Scholar]
  31. Schröder S., Palinski W., Schmid-Schönbein G. W. Activated monocytes and granulocytes, capillary nonperfusion, and neovascularization in diabetic retinopathy. Am J Pathol. 1991 Jul;139(1):81–100. [PMC free article] [PubMed] [Google Scholar]
  32. Sinclair S. H., Grunwald J. E., Riva C. E., Braunstein S. N., Nichols C. W., Schwartz S. S. Retinal vascular autoregulation in diabetes mellitus. Ophthalmology. 1982 Jul;89(7):748–750. doi: 10.1016/s0161-6420(82)34720-x. [DOI] [PubMed] [Google Scholar]
  33. Skovborg F., Nielsen A. V., Lauritzen E., Hartkopp O. Diameters of the retinal vessels in diabetic and normal subjects. Diabetes. 1969 May;18(5):292–298. doi: 10.2337/diab.18.5.292. [DOI] [PubMed] [Google Scholar]
  34. Small K. W., Stefánsson E., Hatchell D. L. Retinal blood flow in normal and diabetic dogs. Invest Ophthalmol Vis Sci. 1987 Apr;28(4):672–675. [PubMed] [Google Scholar]
  35. Sullivan P. M., Davies G. E., Caldwell G., Morris A. C., Kohner E. M. Retinal blood flow during hyperglycemia. A laser Doppler velocimetry study. Invest Ophthalmol Vis Sci. 1990 Oct;31(10):2041–2045. [PubMed] [Google Scholar]
  36. Tilton R. G., Chang K., Pugliese G., Eades D. M., Province M. A., Sherman W. R., Kilo C., Williamson J. R. Prevention of hemodynamic and vascular albumin filtration changes in diabetic rats by aldose reductase inhibitors. Diabetes. 1989 Oct;38(10):1258–1270. doi: 10.2337/diab.38.10.1258. [DOI] [PubMed] [Google Scholar]
  37. Tilton R. G., Hoffmann P. L., Kilo C., Williamson J. R. Pericyte degeneration and basement membrane thickening in skeletal muscle capillaries of human diabetics. Diabetes. 1981 Apr;30(4):326–334. doi: 10.2337/diab.30.4.326. [DOI] [PubMed] [Google Scholar]
  38. Wautier J. L., Paton R. C., Wautier M. P., Pintigny D., Abadie E., Passa P., Caen J. P. Increased adhesion of erythrocytes to endothelial cells in diabetes mellitus and its relation to vascular complications. N Engl J Med. 1981 Jul 30;305(5):237–242. doi: 10.1056/NEJM198107303050501. [DOI] [PubMed] [Google Scholar]
  39. Yoshida A., Feke G. T., Morales-Stoppello J., Collas G. D., Goger D. G., McMeel J. W. Retinal blood flow alterations during progression of diabetic retinopathy. Arch Ophthalmol. 1983 Feb;101(2):225–227. doi: 10.1001/archopht.1983.01040010227008. [DOI] [PubMed] [Google Scholar]
  40. 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]

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