Lesions of paired eyes at the initial stages of non-proliferative diabetic retinopathy in patients with type 2 diabetes mellitus

Authors

  • S.O. Rykov Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine, Ukraine
  • K.V. Korobov Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine, Ukraine
  • S.Yu. Mogilevskyy Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2309-8147.9.1.2021.229520

Keywords:

diabetic retinopathy, type 2 diabetes mellitus

Abstract

Background. One of the early microvascular complications of type 2 diabetes mellitus (T2DM) is diabetic retino­pathy (DR). Its main cause is prolonged hyperglycemia, which triggers the development of microangiopathy. In this regard, the issue of damage to paired eyes and the spread of DR in the initial stages has not been fully clarified. The purpose: to study the peculiarities of lesions of paired eyes at the initial stages of non-proliferative diabetic retinopathy in patients with type 2 dia­betes mellitus. Materials and methods. We examined 91 patients with T2DM (182 eyes), who did not have retinopathy according to the International Diabetic Retinopathy Severity Scale of the American Academy of Ophthalmology (2002). Paired eyes were divided into three groups: group 1 included 132 paired eyes (66 patients) with 10 points according to the Early Treatment Diabetic Retinopathy Group Study (ETDRS); group 2 consisted of 25 eyes with 10 points on ETDRS, and group 3 — 25 paired eyes with retinal vascular anomalies (14–15 points on ETDRS). The patients were examined again after 1 year. According to the ETDRS, Airlie House classification, microaneurysms, microhemorrhages, intraretinal microvascular abnormalities, retinal vascular abnormalities, and retinal nonperfusion were detec­ted. Results. The majority (58.3 %) of paired eyes without initial changes (group 1) had no progression of DR within 1 year, 12.9 % had vascular anomalies (14–15 points on ETDRS), 13.6 % deve­loped mild, and 15.2 % — moderate non-proliferative DR. The highest progression of DR (88.0 % of eyes) was observed in eyes without diabetic vascular changes, which were paired to eyes with such changes (group 2) that was 2.1 times (p < 0.001) higher than the indicator of paired eyes without diabetic changes (group 1; 41.7 %). Most eyes that had mild vascular changes (group 3) progressed to moderate non-proliferative DR after 1 year, which was four times more often than in eyes that had no initial changes (60.0 versus 15.2 %; p < 0.001). DR in the eyes of group 3 with progression accounted for 43–47 points on EDTRS; the visual acuity of these eyes, both before and after 1 year, was significantly lower than in other groups, and the level of glycated hemoglobin in the blood of patients with such eyes was significantly higher. Conclusions. This study established the features of the progression of early stages of DR in patients with T2DM, and the significance of primary retinal vascular anomalies in the presence of which the progression of DR was faster.

References

Ulyte A., Bähler C., Schwenkglenks M., von Wyl V., Gruebner O., Wei W. et al. Measuring diabetes guideline adherence with claims data: systematic construction of indicators and related challenges. BMJ Open. 2019 Apr 24. 9(4). e027138. doi: 10.1136/bmjo­pen-2018-027138.

Kowall B., Rathmann W., Stang A., Bongaerts B., Kuss O., Herder C. et al. Perceived risk of diabetes seriously underestimates actual diabetes risk: the KORA FF4 study. PLoS One. 2017 Jan 31. 12(1). e0171152. doi: 10.1371/journal.pone.0171152.

Lotfy M., Adeghate J., Kalasz H., Singh J., Adeghate E. Chronic complications of diabetes mellitus: a mini review. Curr. Diabetes Rev. 2017. 13(1). 3-10. doi: 10.2174/1573399812666151016101622.

Khan R.M., Chua Z.J., Tan J.C., Yang Y., Liao Z., Zhao Y. From pre-diabetes to diabetes: diagnosis, treatments and translational research. Medicina. Kaunas. 2019 Aug 29. 55(9). 546. doi: 10.3390/medicina55090546.

WHO. Global Diabetes Report [Internet]. 2020 [cited 20.10.20]. Available on www.who.int/diabetes/ru/.

Nowak M.S., Grzybowski A. Rewie of the epidemiology of dia­betic retinopathy. Modern Retina. Ophtalmology Times [Internet]. 2018 June 11 [cited 15.07.20]. Available from: https://www.modernretina.com/diabetic-retinopathy/review-epidemiology-diabetic-retinopathy.

International Diabetes Federation and The Fred Hollows Foundation. Diabetes eye health: A guide for health care professio­nals. Brussel, Belgium: International Diabetic Federation [Internet]. 2015 [cited 20.10.20]. Available on: https://idf.org/our-activities/care-prevention/eye-health/eye-health-guide.html#sub-content-tab-nav.

Tronko M.D. Priority issues of diabetology in Ukraine at the present stage and ways to solve them. 2020 [Internet] [cited 20.10.2020]. Available on: http://iem.net.ua/endocrinology_task/ [in Ukrainian].

Pankiv V.I. Symposium № 156. Diabetes mellitus: definition, classification, epidemiology, risk factors. Int. J. Endocrin. 2013. 55(7). 95-104. Available on: https://cyberleninka.ru/article/n/tsukroviy-diabet-viznachennya-klasifikatsiya-epidemiologiya-faktori-riziku/viewer [in Ukraine].

Kirsch S., Iroku-Malize T. Eye Conditions in Older Adults: Diabetic Retinopathy. FP Essent. 2016 Jun. 445. 29-37. Quiz 38-9.

Ghandour R., Nahed M., Rmeileh N.A., Lars J., Norberg M., Eriksson J.W., Husseini A. Complications of type 2 diabetes mellitus in ramallah and al-bireh: the palestinian diabetes complications and control study (PDCCS). Prim. Care Diabetes Dec. 2018. 12(6). 547-57. doi: 10.1016/j.pcd.2018.07.002.

Safi H., Safi S., Ali H.-M., Hamid A. Early detection of ­diabetic retinopathy. Survey of Ophthalmology. 2018 Apr. 63(5). 601-8. doi: 10.1016/j.survophthal.2018.04.003.

Voigt M., Schmidt S., Lehmann T., Köhler B., Kloos C., ­Voigt U.A., Meller D. et al. Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes. Exp. Clin. Endocrinol. Diabetes. 2018 Sep. 126(9). 570-6. doi: 10.1055/s-0043-120570.

Pankiv V.I. Diabetic retinopathy: a new approach to drug treatment (literature review). Int. J. Endocrin. 2014. 59(3). 93-5. Available on: http://www.mif-ua.com/archive/article/38677 [in Ukranian].

Lin Y., Jiang H., Liu Y., Gameiro G.R., Gregori G., Dong C., Rundek T. et al. Age-related alterations in retinal tissue perfusion and volumetric vessel density. Invest. Ophthalmol. Vis. Sci. 2019 Feb 1. 60(2). 685-93. doi: 10.1167/iovs.18-25864.

Eleftheriou C.G., Ivanova E., Sagdullaev B.T. Of neurons and pericytes: The neuro-vascular approach to diabetic retinopathy. Vis. Neurosci. 2020 Aug. 37. 5. doi: 10.1017/S0952523820000048.

Dedov I.I., Smirnova O.M. Diabetic retinopathy: current problems (the view of a diabetologist). Diabetes Ophthalmology. 2008. 3. 4. Available on: https://cyberleninka.ru/article/n/diabeticheskaya-retinopatiya-sovremennye-problemy-vzglyad-diabetologa/viewer [in Russian].

Fong D.S., Aiello L., Gardner T.W., King G.L., Blankenship G., Cavallerano J.D., Ferris 3rd F.L. et al. Retinopathy in diabetes. Diabetes Care. 2004 Jan. 27(1). 84-7. doi: 10.2337/diacare.27.2007.s84.

Kashim R.M., Newton P., Ojo O. Diabetic retinopathy screening: a systematic review on patients' non-attendance. Int. J. Environ. Res. Public Health. 2018 Jan 19. 15(1). 157. doi: 10.3390/ijerph15010157.

Balashevich L.I., Izmailov A.S. Diabetic ophthalmopathy. SPb.: Man, 2012. 396 [in Russian].

Vujosevic S., Toma C., Villani E., Gatti V., Brambilla M., Muraca A., Ponziani M.C. et al. Early detection of microvascular changes in patients with diabetes mellitus without and with diabetic retinopathy: comparison between different swept-source OCT-A instruments. J. Diabetes Res. 2019 Jun 12. 254. 7216. doi: 10.1155/2019/2547216.

Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs — an extension of the modified airlie house classification: ETDRS report № 10. Ophthalmology. 2020 Apr. 127(4S). 99-119. doi: 10.1016/j.ophtha.2020.01.030.

Khatri M., Saxena S., Kumar M., Chabbra A.K., Bhas­ker S.K., Akduman E.I., Pham H. et al. Resistive index of central retinal artery is a bioimaging biomarker for severity of diabetic retinopathy. Int. J. Retina Vitreous. 2019 Nov 12. 5. 38. doi: 10.1186/s40942-019-0189-4.

Pappuru R.K., Ribeiro L., Lobo C., Alves D., Cunha-Vaz J. Microaneurysm turnover is a predictor of diabetic retinopathy progression. Br. J. Ophthalmol. 2019. 103(2). 222-26. doi: 10.1136/bjophthalmol-2018-311887.

Schmidt-Erfurth U., Garcia-Arumi J., Gerendas B.S., Midena E., Sivaprasad S., Tadayoni R., Wolf S. et al. Guidelines for the management of retinal vein occlusion by the European society of retina specialists (EURETINA). Ophthalmologica. 2019. 242(3). 123-62. doi: 10.1159/000502041.

Cui Y., Zhu Y., Wang J.C., Lu Y., Zeng R., Katz R., Vingopoulos F. et al. Comparison of widefield swept-source optical coherence tomography angiography with ultra-widefield color fundus photography and fluorescein angiography for detection of lesions in diabetic retinopathy. Br. J. Ophthalmol. 2020 Jun 26. bjophthalmol-2020-316245. doi: 10.1136/bjophthalmol-2020-316245.

Luc K., Schramm-Luc A., Guzik T.J., Mikolajczyk T.P. Oxidative stress and inflammatory markers in prediabetes and diabetes. J. Physiol. Pharmacol. 2019 Dec. 70(6). 111-13. doi: 10.26402/jpp.2019.6.01.

Giri B., Dey S., Das T., Sarkar M., Banerjee J., Dash S.K. Chronic hyperglycemia mediated physiological alteration and meta­bolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: an update on glucose toxicity. Biomed. Pharmacother. 2018 Nov. 107. 306-28. doi: 10.1016/j.biopha.2018.07.157.

Eshaq R.S., Aldalati A.M.Z., Alexander J.S., Harris N.R. Diabetic retinopathy: Breaking the barrier. Pathophysiology. 2017 Dec. 24(4). 229-41. doi: 10.1016/j.pathophys.2017.07.001.

Hussain M., Awan F.R. Hypertension regulating angiotensin peptides in the pathobiology of cardiovascular disease. Clin. Exp. Hypertens. 2018. 40(4). 344-52. doi: 10.1080/10641963.2017.1377218.

Published

2021-04-29

Issue

Section

Clinical Ophthalmology