Several clinical studies have shown that cataract development occurs more frequently and at an earlier age in diabetic compared to nondiabetic patients Data from the Framingham and other eye studies indicate a three to fourfold increased prevalence of cataract in patients with diabetes under the age of 65, and up to a twofold excess prevalence in patients above 65 .The risk is increased in patients with longer duration of diabetes and in those with poor metabolic control. A special type of cataract—known as snowflake cataract—is seen predominantly in young type 1 diabeticpatients and tends to progress rapidly. Cataracts may be reversible in young diabetics with improvement in metabolic control. The most frequently seen type of cataract in diabetics is the age-related or senile variety, which tends to occur earlier and progresses more rapidly than in nondiabetics.
Research has also indicated that type 2 diabeticpatients who reduce their HbA1c level by1% are (Association of glycaemia with macrovascular and micovascular complications of Type 2 diabetes: 2000). 19% less likely to develop, cataracts 16%less likely to develop heart, failure 43% less likely to develop amputation or mortality due to peripheral vascular disease There is a growing body of evidence that one of the risk factor associated with diabetes is hyperlipidemia which contributes to the development and severity of DR. High content of lipid in diabeticpatients increases the risk of DR and particularly diabetic macular edema. Still, it is unclear how altered lipid levels affect the onset and progression of DR, may be through alterations in the levels of compounds suchas ketone bodies, acylcarnitine, oxidized fatty acids, polyunsaturated fatty acids and sphingolipids. The Early Treatment of DR study demonstrated that elevated serum lipid levels are associated with an increased risk of retinal hard exudates, accompanying diabetic macular edema with an increased risk of visual impairment. The presence of hard exudates in DR patients has been shown to be associated with increased serum cholesterol levels. In diabetes, a high-fat diet may increase oxidative stress and contribute to the inflammatory response and alters metabolite pools in the retina. On the opposite side, treatment with a lipid lowering agent like fenofibrate reduced the need for laser treatment and reduced the progression of DR (Bobeck, et al., 2016; Gunjan, et al., 2017).
There were some limitations in our study: first, our study focused primarily on the adult Chinese popula- tion in Shanghai. Thus, our findings might not be gen- eralisable to the entire population due to racial and cultural differences, which may affect how participants respond to items in the standardised questionnaires. Second, there were no objective measurements of con- trast sensitivity, glare sensitivity and visual field that might have captured other components of visual func- tion that were not explained by visual acuity alone . Third, the postoperative follow-up period was relatively short since we performed our evaluation 3 months after the cataractsurgery was performed on the patients. Progression of diabeticretinopathy, degenerative retinal neural function and posterior capsular opacification may deteriorate the vision acuity and vision-related quality of life in the long term. Posterior capsular opa- cification can be cured by Nd:YAG laser, the others were due to both aging and diabeticretinopathy and Table 2 Change in BCVA in operated eyes before and aftercataractsurgery
This prospective study included 40 diabeticpatients with or diabeticpatients. All patients underwent tion surgery with clear corneal temporal incision with foldable intraocular lens implantation. Follow up was done on day 1, day 7, after 1month,3 months and 6 months. During follow up all the patients underwent visual acuity testing and The final best corrected visual acuity at the end of 1 month and 6 months was in 6/6 in 95% of cases as well as controls.2 diabetic cases (5.55%) without operative diabeticretinopathy developed mild diabeticretinopathy at the end of 6 months. One case (2.5%) where vision was deteriorated from 6/12 to 6/36 due to The final visualoutcome was improved in both the groups and was comparable. The progression of diabeticretinopathy was related to the duration of diabetes and the uncontrolled diabetic status and not to the uncomplicated phacoemulsification
The questionnaire was administered to collect data on socio-demographics such as age, gender, and level of educa- tion. The participants were then asked to complete the questionnaire which assessed their knowledge about four ocular diseases: glaucoma, cataract, diabeticretinopathy (DR) and dry eye disease (DED). Awareness of these diseases was documented if the participant was able to describe the disease and mention one or more of its related symptoms. Participants were then required to report any risk factor for each of the four diseases. Even participants who were not able to describe the disease in the previous question, but had heard about it were required to answer this question. The following question required each participant to report the source of knowledge about the disease, whether it was from the ophthalmologist, optometrist, family and friends, media, books or the web. More questions followed about each disease in terms of being a blinding, preventable, treat- able and whether the vision is restored after treatment.
fibronectin and laminin. Endothelial cells produce heparin sulphate which is negatively charged and forms a regular lattice structure in the anionic sites which hinders the filtration of proteins like albumin that are negatively charged . In diabetes mellitus synthesis of proteoglycan is impaired and increases the in hydroxylysine and its glycosidally related disaccharide units. These alterations results in abnormal peptide chains packing which causes excessive leaking of the membrane . e.g. microalbuminuria occurring in diabetics. Extracellular matrix degradation by matrix metalloproteinase (MMPs) affects endothelial cell function and increases the vascular permeability. Elevated level of MMP-9 and MMP-2 has shown in diabetic neovascular membranes.
The measured serum sodium concentration in uncontrolled diabetes mellitus is variable because of the interaction of multiple factors. The increase in plasma osmolality created by hyperglycemia pulls water out of the cells, and reduces the plasma sodium concentration. Physiologic calculations suggest that, in the absence of urine losses, the serum sodium concentration should fall by about 1.6 mEq/L for each 100 mg/100 mL (5.5 mmol/L) increase in glucose concentration. So, the "corrected" sodium concentration can be approximated by adding 2.0 mEq/L to the plasma sodium concentration for each 100 mg/100 mL increase above normal glucose concentration . 89
Visually significant VAO is a common complication after pediatric cataractsurgery and can be amblyogenic, occurring in up to 71% of pediatric patients who receive primary PPC-AntVx and virtually 100% of pediatric patients who have the capsule left intact . This is consistent with our data in which 80% of the patients who had the capsule left intact required treatment for VAO within 2.5 years of the original cataractsurgery. In young children or patients who are developmentally delayed, PPC-AntVx is routinely performed due to a high risk of development of VAO soon aftercataractsurgery ; in our study, this pro- cedure reduced the development of VAO from 80% to 40%. If possible, we pre- fer to manage VAO with Nd:YAG laser capsulotomy, but many of our patients required a surgical posterior capsulotomy with anterior vitrectomy due to deve- lopmental delay causing inability to cooperate or, even when cooperation was good, nystagmus causing eye movement during the procedure. Due to the risk of retinal re-detachment, collaboration with a retinal surgeon may be required to perform the surgical posterior capsulotomy.
a study in diabetic rats with an aldose reductase inhibi- tor showed that polyol pathway activity is involved in the hyperaggregability of platelets . High plasma glucose could increase the intracellular glucose level, which leads to abnormal activation of aldose reductase, a key enzyme in the polyol pathway, reducing glucose to sorbitol [44, 45]. Sorbitol is a polyhydroxy alcohol, hydrophilic, not easy to penetrate the cell membrane, accumulating intracellularly with possible osmotic consequences . The accumula- tion of sorbitol causes depletion of other osmolytes, such as taurine, causing dysfunction of cell volume regulation . Retinal microvascular lesion of DR is characterized by thickening and microthrombosis of capillary base, and platelet dysfunction has an important influence on devel- opment of microvascular complications. The larger MPV, the more likely formation of thrombosis, and in other hand, vascular endothelial injury triggers platelet adhesion and aggregation to accelerate thrombosis. Subgroup analy- sis exhibited MPV level in NPDR was no difference with T2DM without DR, but in PDR was higher than both of them, which was consistent with theory that platelets do not initiate the pathology of early DR. We reached con- clusions that DR grade resulted in the heterogeneity and MPV level was also upregulated in higher DR severity. In addition, in the pooled analysis of MPV, we discovered the heterogeneity was decreased significantly after exclud- ing Papanas et al. . What is special about this article is that only citrate is used in it, while other included articles using EDTA. Citrate is mainly used for hemostasis test and blood sedimentation test. Because its toxicity is small, also used in blood transfusion maintenance fluid. The antico- agulant mechanism is that citrate forms a soluble chelate with calcium ions in blood to prevent blood coagulation. However, the coagulation time of plasma from different sources of thrombin reagents can vary greatly for the same normal person or patient. The results did not change sig- nificantly after excluding it, so we took the results of exclu- sion. We hold the view that the reason why T2DM without DR patients of it might arise from other potential com- plications affecting real result of MPV, such as nephropa- thy . However, the final result of MPV didn’t change, which suggested the reliability of our results. There were some articles reporting the relationship between other hematological indicators and diabeticretinopathy, such as NLR [47, 48]. A latest systematic review reported, similar to MPV, higher level NLR appears in DR compared to con- trol and T2DM without DR , which may be useful for monitoring DR when combined with MPV.
In addition to preventing macular edema and the associ- ated loss of visual acuity, increases in macular thickening and volume were also observed to be less severe in patients who received nepafenac than in patients who received vehicle. These results are consistent with previous clinical studies and further support the conclusion that nepafenac effectively reduced the incidence and severity of macular edema. For example, in a retrospective study based upon chart reviews of 450 patients, although visually significant pseudophakic macular edema occurred in patients treated for 4 weeks following cataractsurgery either with a combination of nepafenac and prednisolone or with prednisolone alone, the percentage of patients who developed macular edema was significantly lower in the combination therapy group than in the monotherapy group (0% and 2%, respectively; P = 0.035). 31 Additionally, two published case series have
The first clinical manifestation of diabeticretinopathy is MICROANEURYSM which are nothing but capillary outpouchings due to loss of pericytes. It is seen as tiny red dots initially occuring temporal to fovea. The diameter varies from 12 to 100 microns..It tend to be the earliest sign of DR. Rupture of microaneurysm results in haemorrhages which can be either blot or flame shaped. Majority of microaneurysm occurs in the posterior pole and adjacent to the area of capillary nonperfusion.
This was a cross-sectional study where 100 subjects of both sexes were enrolled. The study sample was recruited from 357 type 2 diabeticpatients who were attending and being followed-up in the diabetic outpatient clinic at Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey. The sample size required for the expected mean difference was calculated as 94 on the basis of the mean values which are 13.1±1.1 and 19.3±1.5 for the patients with normal retinopathy and with NPRP, respectively in literature number 13 (b=80 a=0.05). To conpensate for lost of follow-up, 115 patients were included. One of the three patients that applied to the outpatient clinic was randomly and sequentially included to the study. Of the 115 participants, 15 were excluded from the study for they had not had their blood chemistry tested because they had to be hospitalized due to their medical condition. This study was approved by the local ethical committee and written informed consent was taken from all participants.
Histologically, retinal vascular lesions are considered to be the hallmark and the grading criterion of DR. The first visible alteration in retinal vasculature is the formation of microaneurysms. The further changes are intraretinal focal hemorrhage, venous beading, and intraretinal microvascular abnormalities (IRMAs) showing with microvascular torsion and regional capillary nonperfusion on fluorescence fundus angiography imaging. IRMA is associated with “cotton wool” spots observed with funduscopy, which are focal infarcts of nerve fibers in essence. Following the progression of vascular damage, diabetic macular edema appears, which is one of the major causes of vision loss in DR, linking with lesions at the blood–retinal barrier. 12,13
There are many important strengths to the present study. This is the ﬁ rst study to investigate the prevalence of DR and associated factors in Debre Markose, Ethiopia. The use of a cross-sectional design also provided a suf ﬁ ciently large sample and including many indepen- dent variables. Another strength is that fundus examinations were performed by experienced ophthal- mologists. This study is not without limitations. The study design was cross-sectional, so we could not take account of the temporal relationship between potential risk factors and outcomes. Another limitation is its short duration. Despite these factors, we believe that this study is novel and its ﬁ ndings re ﬂ ect the trend of rising DR frequency in developing countries. Moreover, fasting blood sugar was used to assess glycemic control, due to the lack of facilities to assess HbA 1c in the study area.
The results of analysis for the demographics characteristics of the patients is presented in table 1. An eye inspection of this table reveals that the majority of the patients were suffering from type P DM NIDDM,(94%). The mean age and duration of disease of the patients were 62.9±3.3 and 10.3±2.6 years, respectively. The duration of DM to the onset of CN palsy was much longer in the type I (IDDM) compared to the type P (10 years to 7 years, respectively). In addition, blood glucose levels within 1 week of onset of palsy were less than 200 mg/dl in 68 percent of the patients. Forty-one (48%) patients were suffering from diplopia. The result also showed the presence of this risk in the patient as follow: vasculopathic
The results of the present study are similar to those of previously published studies in this regard among other populations with minor dissimilarities which can be due to population differences. The present study is first of its kind in local population and has identified some very important modifiable risk factors among diabeticpatients, timely identification and management of which can help in reducing the development of diabeticretinopathy.
may have insulin levels that appear normal or elevated, the higher blood glucose levels in these diabeticpatients would be expected to result in even higher insulin values had their β-cell function been normal. Thus, insulin secretion is defective in these patients and insufficient to compensate for insulin resistance. Insulin resistance may improve with weight reduction and/or pharmacological treatment of hyperglycemia but is seldom restored to normal. The risk of developing this form of diabetes increases with age, obesity, and lack of physical activity. It occurs more frequently in women with prior GDM and in individuals with hypertension or dyslipidemia, and its frequency varies in different racial/ethnic subgroups. It is often associated with a strong genetic predisposition, more so than is the autoimmune form of type 1 diabetes. However, the genetics of this form of diabetes are complex and not clearly defined.
Two hundred seventy-one consecutive patients of dia- betes mellitus in the age group of 40 to 65 years were included in the study. Sample size was calculated to be 271 using the formula for sample size calculation . Power of the study was 80%. Diabetes was diagnosed according to American Diabetes Association criteria as a fasting plasma glucose level ≥ 126 mg/dL (7.0 mmol/L) or 2-h post prandial glucose level ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test . Based on the fundus photography and fluorescein angiography, subjects were divided into three groups according to the early treatment of diabetic retinopa- thy study (ETDRS) classification : diabetes mellitus patients without retinopathy (No DR, n = 97), with non- proliferative diabeticretinopathy (NPDR, n = 91), and with proliferative diabeticretinopathy (PDR, n = 83). Healthy controls (n = 82) with no diabetes mellitus were also included. The different OCT systems show discrep- ancies which can be explained by the differences in the retinal segmentation algorithms. Whereas the Spectralis HRA + OCT and Cirrus HD-OCT include the RPE layer in the retinal segmentation, the other instruments do not. The data imply that the different OCT systems cannot be used interchangeably for the measurement of macu- lar thickness . Thus it is important to have a control group for baseline values.
Regarding the severity of DR, 57.8% of affected patients had non-proliferative DR on angiography, a finding in agreement with the 68.7% found by Nanfack et al. in Yaoundé, Cameroon . The diabetic maculopathy rate was 14.5% in our study. This is about twofold the preva- lence found by Nanfack et al. (7.15%) in Cameroon, Rema et al. (6.4%) in India and Khandekar et al. (6.3%) in Oman [21-23]. Seventeen point four percent of our patients had at least severe non-proliferative DR and thus required treatment by laser photocoagulation. Of these patients, 66.2% had a treatment. This is a good treatment uptake coverage compared to the 26.7% reported by Nanfack et al. in Yaoundé, Cameroon . However, these findings emphasize the need of increasing the access to treatment for the patients affected by DR. In this way, the treatment outcomes in our study are encouraging: 73% of the pa- tients who were treated and who had an angiography two months after treatment for control had an improvement. The association of severe proliferative DR with a poor treatment outcome in our study highlights the necessity of early diagnosis and treatment. The numerous cases of severe retinal disease found in our study is a call for the introduction vitreoretinal surgery in the routine ophthal- mologic practice in Cameroon.
ing cataractsurgery, these indications included the follow- ing variables: presence of ocular comorbidities (simple cataract, cataract with diabeticretinopathy, or cataract with other ocular pathologies that may affect the visual prognosis), visual acuity in the cataractous eye and the contralateral eye, visual function, expected visual acuity aftersurgery, surgical technical complexity, and type of cataract. A total of 765 indications resulted from all possi- ble combinations of the variables described previously and the respective categories. A description of all variables and their categories was reported previously . Third, we compiled a national panel of expert ophthal- mologists who were nationally recognized specialists in the field. Their names were provided by their respective medical societies and members of our research team. The appropriateness ratings were confidential and took place in two rounds, using a modified Delphi process. Cataractsurgery for a specific indication was considered appropriate if the panel's median score was between 7 and 9 without disagreement, inappropriate if the value was between 1 and 3 without disagreement, or uncertain if the median rating was between 4 and 6 or if the members of the panel disagreed. Disagreement was defined as occur- ring when at least one third of the panelists rated an indi-