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