Glycaemic control and control of risk factors in diabetes patients in an ophthalmology clinic: what lessons have we learned from the UKPDS and DCCT studies?

PURPOSE: The Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) have studied glycaemic control as well as other risk factors in preventing the progression of diabetic end-organ disease, including diabetic retinopathy. We wished to determine to what extent a cross-section of diabetes patients attending our eye clinic met the targets laid down by recent landmark studies. METHODS: We prospectively assessed 44 consecutive diabetes patients attending outpatient clinics for assessment of diabetic retinopathy. Each patient had HbA1c levels, serum cholesterol and blood pressure checked. A proforma was completed for each patient. RESULTS: Of the 44 patients studied, 11 had type 1 diabetes mellitus (DM) and 33 had type 2 DM (11 insulin-dependent DM [IDDM], 22 non-insulin-dependent DM [NIDDM]). The mean age of type 1 DM patients was 43 years; that of type 2 DM patients was 62 years. Five of 11 (46%) type 1 DM patients had poorly controlled diabetes (HbA1c > 9%) compared with four of 33 (12%) type 2 DM patients. Overall, 27 of 44 (62%) patients were on antihypertensive medication. The prevalence of poorly controlled blood pressure (> 150/85 mmHg treated; > 160/90 mmHg untreated) was 16 of 44 (36%) patients overall, and was higher for type 2 DM patients (13/33, 39%) than for type 1 DM patients (3/11, 27%). Random serum cholesterol levels > 5.2 were found in 10 of 44 (23%) patients overall (4/11 [36%] type 1 and 6/33 [18%] type 2 DM patients). CONCLUSIONS: Control of HbA1c, hypertension and hypercholesterolaemia can slow progression of retinopathy and other DM end-points. Many of our patients were poorly controlled in terms of these risk factors. More attention should be addressed to these primary preventative factors in the management of diabetes patients.     

Prevalence of diabetes mellitus and hypertension among Indian glaucoma patients and evaluation of systemic therapy

To study the prevalence and systemic control and evaluate the adequacy of therapy of diabetes mellitus (DM) and hypertension (HT) in glaucoma patients visiting a tertiary care eye facility at a university hospital. Consecutive cases with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG) attending the outpatient services were evaluated for the presence of DM and HT and any systemic/ocular medications being taken were recorded. Of 615 glaucoma cases evaluated, 281 (45.7 %) were POAG and 334 (54.3 %) were PACG. The mean age was 58.19 ± 10.8 years with males comprising 60.5 % of the study group. Two hundred and ninety-two (47.5 %) glaucoma patients had HT and 181 (29.4 %) had DM, including 97 (15.8 %) patients who had both. One hundred and thirty-three (47.3 %) patients with POAG and 159 (47.6 %) patients with PACG had HT. Ninety-seven (34.5 %) POAG patients and 84 (25.1 %) PACG patients were diabetics. One hundred and sixty-one (55.1 %) HT patients had blood pressure above control levels and 88 (48.6 %) diabetics had uncontrolled blood sugars. Twenty-eight (9.6 %) patients with HT were found to be taking combined systemic and topical β-blocker therapy. A large majority of adult glaucoma patients had concurrent systemic disease, which was not adequately controlled. Patients were using systemic medications with known interactions with ocular hypotensive medications. This study highlights the unmet need for better coordination between ophthalmologists and physicians to improve the overall health of glaucoma patients.     

Profile of sight-threatening diabetic retinopathy and its awareness among patients with diabetes mellitus attending a tertiary care center in Kashmir,India

Purpose:To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir.Methods:In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema.Results:The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all).Conclusion:STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.     

广东省东莞市横沥镇居民2型糖尿病患者糖尿病视网膜病变危险因素分析

背景国外研究表明,随着糖尿病发病率的升高,糖尿病视网膜病变（DR）已成为青壮年患者首要的致盲因素,而加强中国对DR发病危险因素的分析对于DR的防治具有重要意义。目的调查广东省东莞市横沥镇40岁及以上居民2型糖尿病患者发生DR的危险因素。方法采用横断面研究设计及整群抽样法,对广东省东莞市横沥镇40岁及以上居民进行糖尿病和DR发生率的现场流行病学调查。首先根据2010年美国糖尿病协会（ADA）制定的糖尿病诊断标准对糖尿病患者进行筛查,然后根据2002年悉尼国际DR分期标准对糖尿病患者进行DR筛查。所有受检者均接受一般资料调查、问卷调查、体格检查和实验室检查,专科检查包括裸眼视力、矫正视力、日常生活视力、验光检查以及眼压测量（非接触眼压计）、裂隙灯显微镜检查、眼底检查和眼底照相。分别采用,检验、独立样本t检验和单因素方差分析对DR患者与非DR者（NDR）的各项调查和检测结果进行比较,采用Logistic相关回归模型对DR危险因素进行分析。结果Logistic逐步回归分析结果显示,男性、糖尿病病程、收缩压、空腹血糖（FPG）和糖化血红蛋白（HBA1c）是影响2型糖尿病患者发生DR的独立危险因素,其中男性糖尿病患者发生DR的风险明显高于女性患者（OR=1．914,95％CI：1．382～2．651）;糖尿病病程为1—4年、5～9年和≥10年的患者发生DR的风险明显高于新诊断糖尿病患者,分别为新诊断患者的3．336倍（95％CI：2．322～4．880）、3．890倍（95％CI：2．327～6．503）和12．499倍（95％CI：6．607～23．647）;相对于收缩压≤120mmHg（1mmHg=0．133kPa）的糖尿病患者,收缩压为120～139mmHg、≥140mmHg的糖尿病患者发生DR的风险分别为1．953倍（95％CI：1．081～3．528）和1．950倍（95％CI：1．076～3．532）;与FPG≤5．6mmol／L的糖尿病患者比较,FPG为5．6—6．9mmol／L、≥7．0mmol／L的糖尿病患者发生DR风险分别增加1．567倍（95％CI：0．889～2．732）和2．170倍（95％CI：1．252～3．761）;此外,HBA1c≥6．5％的糖尿病患者DR发生风险明显高于HBA1c〈6．5％的糖尿病患者（OR=1．577,95％CI：1．105～2．253）。结论男性、糖尿病病程、平均收缩压、FPG和HBA1c是2型糖尿病患者发生DR的独立危险因素。早期诊断、控制高血糖、高血压等相关危险因素可以减少DR的患病率,并控制其进展。     

Systemic blood pressure in glaucoma patients

Blood pressure was monitored for 24 h in 32 control patients, 38 open-angle glaucoma patients referred because of decompensated IOP despite maximum treatment, 40 patients with open-angle glaucoma referred because of progressive damage despite controlled IOP, and 39 normal-tension glaucoma patients. In the control group a physiological drop in blood pressure during the night was observed. The patients referred with uncontrolled IOP had blood pressure very similar to that of the control group during both day and night. However, the open-angle glaucoma patients with progression despite well-controlled IOP and also the patients with normal-tension glaucoma had markedly, and statistically significantly, lower systolic blood pressure during both day and night. The difference in diastolic blood pressure was smaller. Thus, blood pressure should be considered in diagnosis.     

Central corneal thickness in the Ocular Hypertension Treatment Study (OHTS)

OBJECTIVE: Central corneal thickness influences intraocular pressure (IOP) measurement. We examined the central corneal thickness of subjects in the Ocular Hypertension Treatment Study (OHTS) and determined if central corneal thickness is related to race. DESIGN: Cross-sectional study. PARTICIPANTS: One thousand three hundred one OHTS subjects with central corneal thickness measurements. INTERVENTION: Central corneal thickness was determined with ultrasonic pachymeters of the same make and model at all clinical sites of the OHTS. MAIN OUTCOME MEASURES: Correlation of mean central corneal thickness with race, baseline IOP, refraction, age, gender, systemic hypertension, and diabetes. RESULTS: Mean central corneal thickness was 573.0 +/- 39.0 microm. Twenty-four percent of the OHTS subjects had central corneal thickness > 600 microm. Mean central corneal thickness for African American subjects (555.7 +/- 40.0 microm; n = 318) was 23 microm thinner than for white subjects (579.0 +/- 37.0 microm; P < 0.0001). Other factors associated with greater mean central corneal thickness were younger age, female gender, and diabetes. CONCLUSIONS: OHTS subjects have thicker corneas than the general population. African American subjects have thinner corneas than white subjects in the study. The effect of central corneal thickness may influence the accuracy of applanation tonometry in the diagnosis, screening, and management of patients with glaucoma and ocular hypertension.     

2型糖尿病患者糖尿病视网膜病变相关危险因素分析

目的：探讨2型糖尿病( type 2 diabetic mellitus,T2DM)患者糖尿病视网膜病变(diabetic retinopathy,DR)相关危险因素。

方法：回顾性分析2013-01/2017-04收治入院的1 013例T2DM患者病例资料,将DR患者纳入观察组,非DR患者纳入对照组。分析T2DM患者DR相关危险因素。

结果：经调查统计DR发生率为27.74%(281/1 013)。经单因素分析,两组患者性别、年龄、T2DM病程、血压、糖化血红蛋白、高密度脂蛋白胆固醇、肌酐以及24h尿蛋白比较,差异有统计学意义(P<0.05)。经多因素Logistic回归分析,男性、年龄>60岁、T2DM病程>10a以及血压、糖化血红蛋白、高密度脂蛋白胆固醇以及肌酐和24h尿蛋白表达异常均是T2DM患者并发DR的危险因素(P<0.05)。

结论：T2DM患者并发DR风险较高,男性、年龄>60岁、T2DM病程>10a以及血压、糖化血红蛋白、高密度脂蛋白胆固醇以及肌酐和24h尿蛋白的高水平表达均可能是诱发DR的危险因素。     

新疆乌苏市糖尿病患者视网膜病变的患病率及危险因素

目的：：了解糖尿病患者糖尿病性视网膜病变( diabetic retinopathy,DR)的患病率及危险因素。方法：对已经确诊的3465例糖尿病患者进行系统的眼部检查,并对相关因素如患者的年龄、性别、居住地域、民族、糖尿病病程、空腹血糖、血脂及血压进行统计分析。结果：本组3465例糖尿病患者中,发生DR者1079例,患病率为31.14％。患者的居住地域、糖尿病病程、空腹血糖水平、血压与糖尿病人群DR患者病率的差异有统计学意义(P<0.05)。年龄、性别、民族及血脂与DR患病率差异无统计学意义(P>0.05)。结论：农村糖尿病人群DR患病率高于城市人群,DR的主要危险因素是糖尿病病程、血糖控制水平和高血压。     

Hypertension,diabetes, and longitudinal changes in intraocular pressure

PURPOSE: Diabetes and hypertension are recognized risk factors for raised intraocular pressure (IOP). This report examines the longitudinal relationship of hypertension and diabetes to a 4-year IOP change in a black population with high prevalence of these conditions. DESIGN: Population-based cohort study of a simple random sample of residents of Barbados, West Indies, aged >/=40 years. PARTICIPANTS: A total of 2996 persons without open-angle glaucoma or receiving IOP-lowering medication at baseline. METHODS: Participants underwent standardized examinations including applanation tonometry, measurement of blood pressure, and anthropometric indices; a detailed interview; various ocular measurements; and venipuncture for glycosylated hemoglobin (GHb). Diabetes was defined by self-reported physician diagnosis and hypertension by blood pressure >/=140/90 mmHg and/or treatment history. MAIN OUTCOME MEASURES: The 4-year person-based IOP change between baseline and follow-up was defined as the more positive IOP difference in either eye. RESULTS: An IOP >21 mmHg at baseline was more likely in black and in mixed (black and white) participants (age-gender adjusted odds ratio [OR], 3.9 and 3.8, respectively) than in whites. Similarly, these groups had more hypertension (age-gender adjusted OR, 2.4 and 2.1, respectively) and diabetes (age-gender adjusted OR, 3.9 and 1.7, respectively) than did whites. Mean IOP in black participants increased by 2.5 (standard deviation, 3.9) mmHg over 4 years. Multiple regression analyses showed that baseline diabetes history and hypertension, as well as older age, elevated GHb, higher blood pressures, and lower baseline IOP were associated with a 4-year increase of IOP. The association between diabetes history/GHb and IOP increase became borderline/nonsignificant when persons who underwent cataract surgery during follow-up were excluded. CONCLUSIONS: This report provides new data on the relationship of systemic factors to longitudinal increases in IOP in an African-origin population. Results highlight the increased risk of elevated IOP in populations with high prevalences of diabetes and hypertension.     

社区糖尿病视网膜病变流行病学1.5a随访结果

目的：调查沈阳市风雨坛社区2型糖尿病(type 2 diabetes mellitus, T2DM)人群中糖尿病视网膜病变(diabetic retinopathy, DR)患病率及相关危险因素。

方法：2011年筛查社区T2DM患者457例,2013年复查其中的92例,并新增312例T2DM患者,调查其基本情况及生活方式,并进行糖尿病视网膜病变筛查,运用Logistic多元回归分析相关危险因素。

结果：风雨坛社区2011年和2013年DR患病率分别为15.8%和41.2%。DR与NDR组比较,年龄、DM家族史、DM病程、空腹和餐后2h血糖、糖化血红蛋白(HbA1c)、总胆固醇(TC)、血清肌酐(Scr)、收缩压(SBP)及高、低密度脂蛋白胆固醇(HDL-C、LDL-C)差异有统计学意义(P<0.05)。Logistic回归分析表明：年龄、DM病程、HbA1c、SBP及HDL-C是DR的独立危险因素。2013年参与复查的92例DM患者,DR进展和新发共31例(33.7%),主要与血糖控制不良有关。

结论：风雨坛社区居民DR患病率远高于我国北方的其他研究,主要与患者DM病程长、血糖控制不良、对DM及其眼病的重视程度不够以及高血压、高血脂等全身疾病的共同作用相关。     

糖尿病视网膜病变相关危险因素分析

目的 分析糖尿病（DM）发生糖尿病视网膜病变（DR）的危险因素,为DM并发症的预防和治疗提供理论依据。方法 采用多中心大样本的临床横断面研究方法,对630例DM患者的DR的分期与相关因素如病程、体重指数、血糖控制、血脂、血压等进行统计学分析。结果 DR临床前期、非增生期与增生期患者的DM平均病程、HbA1c水平、收缩压差异有统计学意义（P〈0.01）;DR各期体重指数、空腹及餐后血糖、血脂等指标差异无统计学意义。结论 DM的病程、血糖控制与血压是DR发生的主要危险因素,因此在DM二级预防中要加强降糖、降压等综合治疗。     

视网膜微血管异常的5年发病率及其与高血压的相关性

目的 描述“北京眼病研究”人群从2001年至2006年5年随访间非糖尿病老年人中视网膜微血管异常的累积发病率,并分析其与高血压的相关性。设计 人群为基础的队列研究。研究对象 “北京眼病研究”基线人群中参加2006年随访调查者3251人。方法 对每位受检者在基线调查和随访调查时均进行了问卷调查和全面的眼科检查,其中包括散瞳后彩色眼底照相。每位受检者随机选一眼进行眼底照片中视网膜血管异常的评价。评价指标包括局限性视网膜动脉缩窄（FN）、动静脉交叉压迫征（AVN）和视网膜病变,评价采用半定量的方法进行。问卷调查以了解一般情况、眼部及全身疾病史、治疗史和吸烟饮酒史。随访调查时进行了身高、体重和血压测量,并收集空腹血液标本检测血糖、血脂。考虑的危险因素包括：年龄、性别、城乡、人均收入、教育程度、高血压、高血脂、冠心病病史、脑卒中病史、糖尿病、体重指数（BMI）、吸烟饮酒、眼局部可能相关疾病（青光眼、老年性黄斑变性和中央/分支视网膜静脉阻塞等）和屈光状态等。通过对比基线和5年随访时受检者视网膜微血管的变化,确定视网膜微血管异常的5年发病率和改变情况（进展或消退）。根据治疗情况,将高血压患者分为血压控制的治疗组、未控制的治疗组和未治疗组。比较血压正常者与高血压病患者、不同高血压治疗情况组间视网膜微血管异常的发病率、进展率和好转率的差异。主要指标 视网膜微血管异常的发病率、进展率和好转率。结果 排除患有糖尿病或任何视网膜视神经疾病等眼局部病变的患者后,2058例受检者纳入本研究,其中女性1409例（68.5%）。平均年龄（53.8±9.5）岁。FN、AVN和视网膜病变的5年累积发病率分别为4.1%,1.4%和3.3%。高血压患者中FN、AVN和视网膜病变的5年发病率明显高于血压正常者（P均<0.01）。对年龄、性别和居住地区进行调整后,平均动脉压每增加10 mmHg,FN、AVN和视网膜病变的5年发病率分别增加1.58倍（95% CI：1.24~2.00;P<0.001）,1.55倍（95% CI：1.04~2.32;P=0.03）,1.46倍（95% CI：1.12~1.91;P=0.005）。对年龄、性别和居住地区进行调整后,高血压分级每增加1级,FN好转率减少28%。相应的,血压控制组的FN的好转率（44.4%）明显高于未控制组（22.6%）和未治疗组（11.5%）（P=0.01）。结论 在非糖尿病患者中,高血压与视网膜微血管异常的发病率和进展变化具有强相关性。血压控制理想者的视网膜微血管异常发病率较低,局限性动脉缩窄消退率较高。这表明如果高血压控制良好,作为视网膜微血管异常的早期表现,局限性视网膜动脉缩窄是可逆的。     

Corneal endothelial morphology and central corneal thickness in type 2 diabetes mellitus patients

Purpose:This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls.Methods:This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher’s exact test, and Spearman’s rho correlation analysis were used as appropriate.Results:Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM.Conclusion:Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities.     

糖尿病患者视网膜病变的筛查分析

目的 了解糖尿病(diabetes mellitus,DM)住院患者中糖尿病视网膜病变(diabetic retinopathy,DR)的发生情况,并探讨其相关危险因素.方法 回顾性临床调查研究.对2007年9月至2010年7月期间,在广西医科大学第一附属医院眼科住院的1610例DM患者采用眼底照相方法确立DR诊断,部分患者进行眼底血管荧光造影检查,计算DR发病率,并分析病程、年龄、发病年龄及血压对发病率的影响.结果 1610例(3201只眼)DM患者中DR发病率为30.2%,其中男性为27.3%,女性为35.0%.新确诊的340例DM患者中DR发病率为12.6%.3201只眼中,背景型DR 797只眼,占24.9%,增殖型124只眼,占3.9%.51～60岁年龄组以及在41～50岁间发病的DM患者,DR的发病率最高.45°眼底彩照与FFA检查结果比较,符率为78.1%.结论 以黄斑为中心单视野眼底照像作为早期DR的筛查方法是有效、实用且简便易行的.病程、年龄及发病年龄是DR发病的危险因素,随着病程延长其发病率显著增高.早期对DM 患者进行筛查、定期眼科检查,能及时发现病变、把握治疗时机,降低DR致盲率有着极其重要的意义.

Abstract：

Objective To determine the prevalence of diabetic retinopathy (DR) and to investigate the associated risk factors in patients with diabetes mellitus (DM).Methods Totally 1610 patients diagnosed DM by the WHO diagnostic criteria attending at the First Affiliated Hospital of Guangxi Medical University from 2007 to 2010.The data of disease history, visual acuity, eye disease and intraocular pressure were collected by inquiry and examination.Photography of ocular fundus was used to confirm the diagnosis of DR.According to the criteria of DR, diagnosis and statistics of DR were made and the relationship between the prevalence of DR and duration, age, the age of onset and blood pressure were analyzed.Results The prevalence of DR was 30.2% in 1610 diabetic patients,27.3% for male and 35.0% for female.The prevalence of DR of 340 newly onset diabetes was 12.6%.In 3201 eyes, the incidence of nonproliferative and proliferative DR (PDR) was 24.9% and 3.9%, respectively.The highest prevalence of DR was in the age group of 51 to 60 and the age of onset was 41 to 50 in patients with DM.Compared with FFA, the agreement rate of 45° fudus photography was 78.1%.Conclusions One-field mydriatic digital fudus photography centered at fovea is feasible and handy for screening of early diabetic retinopathy.Age, the age of onset and duration of disease are the risk factors of DR, longer the duration of DM, higher the incidence of DR.For early diagnosis and management of DR, the patient with DM should be examined regularly.It is very important to decrease the rate of blindness of DR.     

The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus

Purpose:  To evaluate the prevalence of and risk factors for, retinopathy in a geographically defined population with type 2 diabetes mellitus compared with a control group of subjects without diabetes, matched by age, sex and residence in order to find the retinopathy attributable to type 2 diabetes. Methods:  The study populations are, on one hand, a prevalence cohort of subjects with type 2 diabetes resident in the community of Laxå, Sweden, and on the other a control group, matched by age, gender and residence with those with a diagnosis of type 2 diabetes mellitus. Retinopathy was graded from fundus photographs using a modification of the Early Treatment Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy (DR). Results:  Any retinopathy was found in 34.6% in the type 2 diabetes cohort and in 8.8% in the control group without diabetes. Among the diabetic patients, any retinopathy was significantly associated with duration of diabetes (p = 0.0001), HbA1c (p = 0.0056), systolic blood pressure (p = 0.0091) and lower serum cholesterol (p = 0.0197) in multivariate logistic regression analyses. Having retinopathy in the control group was associated only with systolic blood pressure (p = 0.0014) in logistic regression analysis. Conclusions:  The prevalence of retinopathy among patients with type 2 diabetes in Laxå, Sweden, was similar or somewhat lower compared with other studies in the Nordic countries. The prevalence of retinopathy in a control group without diabetes equalled numbers from population studies worldwide. Our study indicates that the retinopathy that can be attributed to hyperglycaemia in the diabetic state is less common than is usually accounted for. A considerable fraction of retinopathy in subjects with diabetes may instead be due to other factors such as hypertension and should thus be treated correspondingly.     

Prevalence and Associated Factors of Diabetic Retinopathy among Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Cross-sectional Study

PurposeTo determine the prevalence of diabetic retinopathy (DR) and the factors associated with retinopathy among type 2 diabetes mellitus (DM) patients in Brunei Darussalam.MethodsCross-sectional study of all type 2 DM patients who attended diabetic eye screening over a 3-month period at one of four government hospitals. We assessed association between DR with the following variables: age, sex, glycated hemoglobin (HbA1c), duration of DM, hypertension, hyperlipidemia, and microalbuminuria.ResultsThere were 341 patients (female, 58.9%; mean age, 55.3 ± 11.9 years) with a mean duration of DM of 9.4 ± 7.4 years and mean serum HbA1c of 8.4% ± 1.9%. The overall prevalence of any DR was 22.6% (95% confidence interval, 18.8–27.1) with prevalence rates of 4.1% (95% confidence interval, 2.1–6.4) for proliferative DR and 9.7% (95% confidence interval, 6.8–13.2) for vision-threatening DR. Multivariate analysis showed that DR was significantly associated with certain age groups (reduced in older age groups), longer duration of DM (11 years or more), poor control (HbA1c >9.0%) and presence of any microalbuminuria.ConclusionsDR affects one in five patients with DM in Brunei Darussalam, comparable to rates reported for other Asian populations. It is especially worrying that one in ten patients with DM had vision-threatening DR. DR was significantly associated with longer duration of DM, poor control and presence of microalbuminuria but reduced in older age groups. It is important to advocate good control right from the time of diagnosis of DM and institute timely and effective management of retinopathy. DR was significantly associated with longer duration of DM, poor control of diabetes, and presence of microalbuminuria but reduced in older age groups.     

Dry eye rate and its relationship with disease stage in patients with primary hypertension: a cross-sectional study in Vietnam

AIM: To determine the dry eye (DE) rate and its relationship with disease stage in patients with primary hypertension. METHODS: A cross-sectional study included 432 patients with primary hypertension (with an equal number of patients in each group: 144 in stage I, II, and III hypertension) and 144 healthy subjects as a control group. The Ocular Surface Disease Index (OSDI) and Schirmer I test without anesthetics were conducted on all 576 subjects. Subjects with OSDI scores <13 and Schirmer I values equal to or under 10 mm were diagnosed with DE. RESULTS: The ratio of DE in hypertension patients was higher than in the control group (41.7% versus 18.8%; P<0.001). The proportion of patients with DE increased gradually according to the hypertension stage: 27.1% in stage I, 40.3% in stage II, and 57.6% in stage III, P<0.001. Age, duration of hypertension, plasma urea, creatinine, and high-sensitivity C-reactive protein (CRP-hs) levels in hypertension patients with DE were higher than those without DE, P<0.001. Advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma creatinine, and CRP-hs levels were independent factors associated with DE in primary hypertension patients, P<0.001. CONCLUSION: DE is a common disorder associated with advanced age, a long duration of hypertension, diabetes mellitus, elevated plasma CRP-hs, and creatinine levels in patients with primary hypertension.     

中老年人高血压和糖尿病与年龄相关性白内障的关系

目的：探讨中老年人高血压、糖尿病与年龄相关白内障（age-relatedcataract,ARC）危险性之间的关系。方法：采用以医院为基础的病例对照研究方法。病例由45～85岁的360例因患ARC施行白内障手术摘除的患者组成,对照由同期入住相同医院的360例非白内障患者组成,采取1∶1匹配。采用标准调查表对研究对象进行面对面调查,内容包括人口学特征、生活方式、疾病既往史等,同时对血压、血糖进行测量。应用多因素Logistic回归分析估计高血压及糖尿病与ARC关联的比值比（OR）及其相应的95%可信区间（CI）。结果：在调整了年龄和性别因素后,高血压与ARC呈显著正相关（OR=1.573,P=0.005）。与收缩压正常者相比较,收缩压≥180mmHg者发病的危险性增加（OR=2.812,95%CI：1.450～5.455,P=0.002）。高血压病程10a～的研究对象发病的危险性显著地高于病程〈10a者（OR=1.867,95%CI：1.053～3.307,P=0.033）。同样,与非糖尿病患者相比,糖尿病患者发生ARC的危险性显著升高（OR=2.151,95%CI：1.470～3.149,P〈0.001）。与非糖尿病患者相比,糖尿病病程〈10a和10～19a者发生ARC的OR分别为2.374（95%CI：1.502～3.752,P〈0.001）和2.683（95%CI：1.267～5.683,P=0.010）。结论：ARC患病率增高与高血压、糖尿病及其病程增加有关。对这些可变危险因素采取干预性措施,尤其是对高危人群,可能意味着对ARC导致的视觉障碍必须采取控制性措施,因为此症是全球致盲的首要原因。     

Effects of orally administered beta-adrenergic blockers and calcium-channel blockers on the intraocular pressure of patients with treated hypertension.

Little attention has been paid to the influence of orally administered antihypertensive drugs on intraocular pressure (IOP). Therefore, we evaluated the effects of oral medications on the IOPs and visual fields of 70 patients with systemic hypertension who had no ocular symptoms and had not visited any eye hospital. In patients with systemic hypertension treated with medication, the IOP value (mean, 18.3 +/- 4.2 mmHg; age range, 63.3 +/- 11.6 years) was significantly higher than in a control group with a similar age range who were not receiving oral medication (mean, 13.7 +/- 2.0 mmHg; age range, 62.5 +/- 7.8 years). In the group in which hypertension was controlled by medication, the IOPs were lower when orally administered beta-adrenergic blockers were given than in those patients with uncontrolled hypertension. In the group to whom calcium-channel blockers were administered orally, the IOPs were not lower. Angiotensin-converting enzyme inhibitors made the visual fields worse. This study suggests a modulating influence of orally administered drugs on the IOP and visual fields, which may be affected by whether or not the patient's blood pressure is controlled.     

视网膜中央静脉阻塞发病因素的病例对照观察

目的 观察视网膜中央静脉阻塞(CRVO)患者与主要的全身性疾病、眼局部疾病以及相关危险因素的关系。 方法 病例对照研究。患者组：76例病程在3个月内、经荧光素眼底血管造影(FFA)检查确诊、未进行过药物治疗的CRVO患者；对照组：76例非CRVO患者，既往无眼底血管性疾病史，以年龄和性别与患者组一对一相匹配。患者组按年龄分为≤45岁（25例，占32.9%）和＞45岁（51例，占67.1%）两个亚组；按FFA检查结果分为非缺血型（40例，占52.6%）和缺血型（36例，占47.4%）两个亚组。检测血脂、血压和空腹血糖等。各组之间分别进行全身性和眼局部性疾病以及相关危险因素的统计学比较。 结果 患者组高血压和高脂血症患病率明显高于对照组（P＜0.001，P=0.001），而心、脑血管疾病、开角型青光眼的发病率、以及吸烟和饮酒生活习性上差异无统计学意义（P＞0.05）。年龄≤45岁组中，患者组各项指标与对照组差异无统计学意义（P＞0.05）。缺血型CRVO组，除高血压和高脂血症外, 糖尿病发病率明显高于对照组（P＜0.001，P=0.031，P=0.024）。 结论 高血压和高脂血症为CRVO发病的全身性因素。此外，糖尿病与缺血型CRVO发病也相关。及时诊断和治疗全身性疾患对于CRVO的防治具有重要指导意义。 (中华眼底病杂志，2007，23：159-162)