Inflammatory markers and retinopathy in pregnancies complicated with type I diabetes

AIM: The relation of maternal cytokine levels to retinopathy progression during diabetic pregnancy is a less studied subject. Therefore, we investigated levels of systemic proinflammatory markers, C-reactive peptide (CRP), interleukin-6 (IL-6) and circulating vascular cell adhesion molecule-1 (VCAM-1) during pregnancy and postpartum in relation to the progression of diabetic retinopathy (DR). METHODS: A prospective follow-up study of 39 pregnant women with Type I diabetes and eight nondiabetic pregnant women was performed. DR was graded from fundus photographs. Plasma levels of systemic proinflammatory markers were measured by immunofluorometric assay (CRP) and by enzyme-linked immunosorbent assay (IL-6 and VCAM-1) in the first, second (diabetics only), third trimester of pregnancy, and 3 and 6 months postpartum (diabetics only). RESULTS : Our diabetic women had good glycaemic control (HbA1c 6.9 +/- 0.8). The levels of IL-6, VCAM-1, and CRP did not differ between diabetic and nondiabetic women throughout pregnancy and postpartum (repeated measures ANOVA between the groups). An association between CRP and progression of retinopathy was observed in diabetic women (P = 0.037). Additional evidence of inter-relationship could be revealed as CRP was higher in those diabetic women with worse glycaemic control (HbA1c) (P = 0.038). CONCLUSIONS :During pregnancy and postpartum, levels of proinflammatory factors (IL-6, CRP, VCAM-1) seem to be generally similar in Type I diabetic women compared to nondiabetic controls. However, CRP levels were higher in those diabetic women with progression of retinopathy and in those with worse glycaemic control.     

Vasoactive mediators and retinopathy during type 1 diabetic pregnancy

PURPOSE: To evaluate the role of various vasoactive hormones in the evolution of diabetic retinopathy during pregnancy and postpartum. METHODS: Retinopathy was graded from fundus photographs of 45 pregnant women with type 1 diabetes and seven pregnant women without diabetes in a prospective study. Markers of renin-angiotensin-system (RAS), plasma renin activity (PRA), angiotensin II (AngII), aldosterone, natriuretic peptides (ANP, BNP, CNP) and adreonomedullin (AM) were measured during the first and third trimesters and at 3 months postpartum. The women with diabetes were grouped by progression of retinopathy during pregnancy and postpartum. RESULTS: Levels of PRA (p = 0.001) and ANP (p = 0.03) were significantly lower in diabetes than in non-diabetes subjects throughout pregnancy and postpartum. No significant differences appeared in levels of AngII, aldosterone, AM, BNP or CNP between the two groups. In multivariate logistic regression analyses with retinopathy progression by the third trimester as the dependent variable, only duration of diabetes qualified in the model (p = 0.027, R = 0.227, Exp(B) = 1.28). CONCLUSIONS: Diabetic pregnancy is associated with lower levels of PRA and ANP compared to non-diabetic pregnancy. Lowered RAS activity may contribute to the hyperdynamic blood flow and progression of DR during diabetic pregnancy. Within the power of this study no clear associations between the vasoactive hormones and progression of retinopathy could be detected.     

Retinal capillary blood flow in diabetic and nondiabetic women during pregnancy and postpartum period

PURPOSE: To evaluate the response of retinal capillary circulation to pregnancy in women with diabetes and to correlate microcirculatory changes with progression of retinopathy during pregnancy. METHODS: A prospective follow-up study of 32 pregnant women with insulin-dependent diabetes and 11 nondiabetic pregnant women. Perimacular capillary blood flow measured noninvasively by retinal flowmetry in the inferior perimacular retina. Eleven nonpregnant diabetic women served as diabetic control subjects. RESULTS: In diabetic women, blood flows, measured by small-box analysis, were 233 +/- 69 (mean +/- SD) arbitrary units (AU) during the first trimester, 248 +/- 55 AU during the third trimester, and 238 +/- 46 AU 3 months postpartum, compared with 204 +/- 32, 195 +/- 22, and 196 +/- 34 AU in nondiabetic pregnant women (P = 0.007 between groups). A difference of the same magnitude was evident between the two groups when the mean of the 50th (P = 0.032), 75th (P = 0.004), and 90th (P = 0.007) percentiles of the individual pixel flow values were used in point-wise analysis. In nonpregnant diabetic women, the small-box mean value was 201 +/- 36, and the mean of the 75th percentile value in point-wise analysis was 316 +/- 49. Blood flow was lower in nonpregnant than in pregnant diabetic women during the third trimester (P = 0.023 and P = 0.012, respectively). CONCLUSIONS: Compared with nondiabetic pregnant women, retinal capillary blood flow was higher in diabetic women during pregnancy and after delivery. Together with the hormonal and metabolic changes occurring during pregnancy, hyperdynamic retinal capillary circulation may contribute to the progression of retinopathy in pregnant diabetic women.     

Glycodelin: a novel serum anti-inflammatory marker in type 1 diabetic retinopathy during pregnancy

PURPOSE: Inflammation may play a role in the development of diabetic retinopathy during pregnancy. Glycodelin is a glycoprotein whose secretion from the endometrial glands increases during pregnancy. Glycodelin has immunosuppressive properties thought to play a role in the protection of the fetoplacental unit. We studied the role of glycodelin in the development and progression of retinopathy in type 1 diabetes during pregnancy. METHODS: Retinopathy was graded from fundus photographs in 45 diabetes subjects and nine non-diabetes subjects prospectively during pregnancy. Serum glycodelin concentration was measured by an immunofluorometric assay. RESULTS: In women with diabetes with progression of retinopathy, serum glycodelin concentration was 263 ng/ml (range 116-505 ng/ml) during the first trimester, 61 ng/ml (range 30-106 ng/ml) during the second trimester, and 29 ng/ml (range 13-53 ng/ml) during the third trimester, compared with values of 595 ng/ml (range 376-870 ng/ml), 104 ng/ml (range 75-228 ng/ml) and 45 ng/ml (range 32-74 ng/ml), respectively, in diabetes subjects without progression (p = 0.005 between the groups). Low glycodelin concentration was associated with progression of diabetic retinopathy in multiple regression analysis. Serum glycodelin concentration was similar in women with and without diabetes throughout pregnancy (p = 0.63 by repeated measures ANOVA). CONCLUSIONS: Low glycodelin concentration is associated with progression of retinopathy in pregnant women with diabetes. A possible causal relationship between low glycodelin levels and progression of retinopathy may be mediated by the immunomodulatory properties of glycodelin.     

Progression of retinopathy during pregnancy in type 1 diabetes mellitus

PURPOSE: The incidence and risk factors for progression of retinopathy during pregnancy in women with type 1 diabetes mellitus were retrospectively evaluated. METHODS: Fifty-four insulin-dependent diabetic patients at a teaching hospital in Saudi Arabia were followed throughout the pregnancy/puerperium with serial ophthalmic examination. Dilated fundus examination was performed in each trimester and puerperium. RESULTS: Progression of diabetic retinopathy in the study occurred in 13/54 (24%) patients--2/22 (9.1%) patients had no diabetic retinopathy initially, 4/20 (20%) had non-proliferative diabetic retinopathy (NPDR) and 7/12 (58.3%) had proliferative diabetic retinopathy (PDR). Of the eight patients with PDR who had no laser treatment before pregnancy, six (75%) showed progression but only one of the four patients who had PDR and laser treatment prior to pregnancy experienced progression of retinopathy. Eight patients in total received panretinal photocoagulation to arrest the progression of retinal disease during pregnancy and only one of them had laser treatment prior to pregnancy. CONCLUSION: Laser photocoagulation for severe NPDR or early PDR prior to pregnancy may protect against rapid progression of PDR. Visual impairment resulting from progression of PDR can be prevented by aggressive laser treatment during pregnancy. Duration of diabetes>15 years, poor glycaemic control and hypertension are high-risk factors in the progression of diabetic retinopathy in pregnancy.     

妊娠对糖尿病视网膜病变影响的研究进展

妊娠对糖尿病性视网膜病变的影响与孕前视网膜病变状况有很大关系。妊娠被认为是糖尿病性视网膜病变恶化的一个主要危险因素。目前已经明确了妊娠期糖尿病性视网膜病变的一些危险因素，但是，对其发生机制却不甚明了。本研究就妊娠对糖尿病性视网膜影响的危险因素、妊娠与糖尿病性视网膜病变的相互关系以及妊娠期糖尿病视网膜病变的治疗作一综述。     

Preventing diabetic retinopathy through control of systemic factors

PURPOSE OF REVIEW: Diabetic retinopathy (DR), the leading cause of vision loss in working-age adults, is associated with many systemic factors that contribute to the severity and progression of this disease. Intensive glycemic and blood pressure control has been shown to delay both the onset and progression of diabetic retinopathy. RECENT FINDINGS: Studies involving angiotensin-converting enzyme inhibitors are currently underway to elucidate the efficacy of these drugs in further reducing the progression of diabetic retinopathy by means other than just hypertensive control. Dyslipidemia is associated with macular exudates and vision loss. Anticoagulation with aspirin is neither contraindicated in diabetics nor associated with prevention or progression of diabetic retinopathy. The effects of smoking on diabetic retinopathy are equivocal. Pregnancy may be associated with the progression of diabetic retinopathy in the absence of long-term effects if serum glucose levels are well monitored and controlled prior to and during pregnancy. SUMMARY: Genetic research is providing more insight into the pathogenesis and mechanisms of diabetic retinopathy, allowing possible identification of those at higher risk for developing diabetic retinopathy.     

Macular capillary blood flow velocity by blue-field entoptoscopy in diabetic and healthy women during pregnancy and the postpartum period

PURPOSE: To study macular capillary blood flow velocity in diabetic and healthy women during pregnancy and the postpartum period. METHODS: A prospective study of 46 pregnant women with insulin-dependent diabetes and 11 healthy pregnant women was performed. Macular capillary blood flow velocity was measured by blue-field entoptic simulation. Diabetic retinopathy was graded from colour fundus photographs. RESULTS: In diabetic women, the macular capillary blood flow velocity was 0.94+/-0.27 mm/s (mean +/- SD) during the first trimester, 1.00+/-0.28 mm/s during the third trimester and 1.03+/-0.24 mm/s 3 months postpartum, compared with values of 0.71+/-0.20, 0.77+/-+/-0.20 and 0.82+/-0.19 mm/s, respectively, in healthy women (P=0.0026 between groups). Diabetic women with no or very mild retinopathy had lower macular capillary blood flow velocities than those with more severe retinopathy (P=0.0164), but higher velocities than healthy women (P=0.0167). An increase temporally from the first trimester to the postpartum period was observed in diabetic women (P=0.0294) but not in healthy (P=0.2449) women. CONCLUSIONS: According to our study macular capillary blood flow velocity is higher in diabetic than in healthy women during pregnancy and the postpartum period. Further, capillary blood flow velocity seems to depend on the grade of retinopathy in pregnant diabetic women. These data support the concept that capillary hyperperfusion may play a role in the development of diabetic retinopathy during pregnancy.     

The effect of pregnancy on retinal hemodynamics in diabetic versus nondiabetic mothers

PURPOSE: To investigate retinal circulatory changes that occur during the third trimester of pregnancy in diabetic patients and control subjects. METHODS: Bidirectional laser Doppler velocimetry and monochromatic fundus photography were used to assess the retinal circulation in seven pregnant diabetic patients and 13 age-matched pregnant control subjects. Retinal venous diameter (D), maximum erythrocyte velocity (Vmax), and retinal volumetric blood flow rate (Q) were measured in one eye of each subject during the third trimester of pregnancy (DPREG, VmaxPREG, and QPREG, respectively). These measurements were repeated during the postpartum period for both diabetic patients (11+/-7 weeks postpartum) and control subjects (16+/-6 weeks postpartum; P = .203; DPOST, VmaxPOST, and QPOST). RESULTS: In control subjects, DPREG was significantly reduced by -4.5%+/-4.4% (mean percent difference +/-1 standard deviation; paired t test, P =.006) relative to DPOST. In diabetic women, DPREG was also significantly reduced by -8.1%+/-3.2% compared with DPOST (P = .001), a change that was significantly larger than that seen in control subjects (unpaired t test; P = .035). Compared with QPOS T, QPREG was reduced by -7.1%+/-14.2% (P = .123), in control subjects. In diabe tic women, QPREG was significantly decreased by -18.4%+/-9.3% compared with QPOST (P = .012). This reduction in QPREG was significantly greater in diabetic patients than in nondiabetic control subjects (unpaired t test, P = .040). No significant differences between VmaxPREG and VmaxPOST were observed in either diabetic patients (-3.1%+/-12.9%; P =.400) or control subjects (+1.9%+/-14.4%; P = .787). CONCLUSIONS: Retinal venous diameter is decreased during the third trimester of pregnancy in both diabetic and nondiabetic mothers. This decrease is significantly larger in diabetic than in nondiabetic mothers. In addition, we observed a reduction in retinal volumetric blood flow in diabetic patients during pregnancy that was significantly larger than that present in nondiabetic women. This fall in retinal volumetric blood flow in diabetic patients may exacerbate retinal ischemia and hypoxia and thus may be associated with the progression of diabetic retinopathy.     

Diabetic retinopathy in pregnancy - A review

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.     

Risk factors for progression of diabetic retinopathy in Alberta First Nations communities

ObjectiveThe Screening for Limb, I-Eye, Cardiovascular, and Kidney Complications (SLICK) Program was implemented in 1999 to improve diabetic care for Alberta First Nations individuals living on reserve. The purpose of this review is to determine the rate and predictors of progression of diabetic retinopathy (DR) over a 10-year period.DesignCohort study.ParticipantsNine hundred and eighty First Nations patients with diabetes that underwent at least 2 teleophthalmology examinations during the study period.MethodsPatients underwent serial laboratory testing, and stereoscopic, mydriatic, retinal photography. Modified Early Treatment Diabetic Retinopathy Study grading of retinal images was performed via teleophthalmology. Progression was defined as an increase of 2 or more steps on the Diabetes Control and Complications Trial classification.ResultsAt baseline, most patients had no diabetic retinopathy (n = 777, 79.3%) whereas 203 people (20.7%) had either nonproliferative DR (n = 179, 18.3%) or proliferative DR (n = 24, 2.5%). Two-step progression occurred in 163 patients (16.6%), with only a minority of these individuals progressing to proliferative DR (n = 23). The median time to progression was 7.6 years. Multivariate Cox regression demonstrated that elevated hemoglobin A1C (hazard ratio [HR] = 1.42; p < 0.0001) and systolic blood pressure (HR = 1.24 per 10 mm Hg; p = 0.009) were independent predictors of progression of DR.ConclusionsThis population-based study has shown that the rate and predictors of progression of DR among First Nations individuals parallels non-First Nations populations, with HbA1C and systolic blood pressure being the strongest predictors. These findings suggest that targeted, individualized care to reduce blood pressure and control blood sugars could reduce progression of diabetic retinopathy, and possibly blindness in First Nations individuals living on reserve.     

Systemic considerations in the management of diabetic retinopathy.

PURPOSE: To highlight the systemic factors which affect onset and/or progression of diabetic retinopathy (DR) and to emphasize the role and responsibilities of ophthalmologists and other eye care providers to ensure that appropriate systemic medical evaluation of the patient with diabetes is being pursued. DESIGN: Literature review of publications relevant to diabetic retinopathy, blood glucose control, diabetes mellitus type, hypertension, renal disease, elevated serum lipids, exercise, pregnancy, anticoagulation, thrombolysis, smoking, anemia and antioxidant ingestion. FINDINGS: Intensive blood glucose control and control of systemic hypertension reduce the risk of new onset DR and slow the progression of existing DR. Severe DR may be an indicator of renal disease while severe renal disease and its treatment can affect the progression of DR. Elevated serum lipids are associated with macular exudate and moderate visual loss. Certain types of excessive exercise in patients with advanced stages of retinopathy may aggravate vitreous hemorrhage. During pregnancy, DR should be monitored closely as transient progression of DR can occur. Therapeutic anticoagulation and thrombolysis are not contraindicated at any stage of DR. Anemia can result in progression of DR, smoking in general should be discouraged, and the role of antioxidant therapy requires further study. CONCLUSIONS: Blindness from diabetic retinopathy is now largely preventable with timely detection and appropriate interventional therapy. Routine, repetitive, lifelong, expert clinical retinal examination is essential for the fundamental ophthalmic care of the patient with diabetes. However, diabetes mellitus is a systemic disease and thus optimal ophthalmic care must include diligent evaluation and treatment of concomitant systemic disorders that influence the development, progression and ultimate outcome of diabetic retinopathy. Optimization of these systemic considerations through an intensive, multi-disciplinary, healthcare team-based approach will maximize the ophthalmic and general health of these patients. Ophthalmologists and other eye care providers are critical members of this team with unique responsibilities to ensure that appropriate systemic medical evaluation is being pursued.     

HLA-DR3 and DR4 and their relation to the incidence and progression of diabetic retinopathy

PURPOSE: Cross-sectional data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy indicated that patients with HLA-DR4, but not DR3, were more likely to have prevalent proliferative retinopathy than those without both antigens. We describe the relation of HLA-DR3 and DR4 antigens to the 14-year incidence and progression of diabetic retinopathy and macular edema in this cohort. DESIGN: A population-based cohort study. PARTICIPANTS: A probability sample of male and female patients receiving primary care for diabetes in 11 counties of southern Wisconsin. METHODS: Participants were invited for a baseline examination in 1980 to 1982, with follow-up examinations at 4, 10, and 14 years later. At the 4-year examination, a random sample of participants (n = 428) diagnosed with diabetes before the age of 30 and taking insulin were selected for HLA-DR typing. MAIN OUTCOME MEASURES: Fourteen-year incidence and progression of diabetic retinopathy and macular edema based on masked stereoscopic fundus photographic grading. RESULTS: There was no relation between HLA-DR3 and DR4 status with the 14-year incidence and progression of diabetic retinopathy, progression to proliferative retinopathy, and incidence of macular edema. Patients with either HLA-DR3 or DR4 were less likely to progress to proliferative retinopathy compared with those who were negative for both, although these relations were not statistically significant. The associations did not vary after adjusting for hypertension status, baseline retinopathy, and glycosylated hemoglobin levels, or after stratifying by duration of diabetes (less than 10 years vs. 10 years or more) and age at diagnosis of diabetes (less than 15 years vs. 15 years or more). Furthermore, 10-year mortality and 14-year nephropathy rates did not differ by HLA-DR3 or DR4 status, suggesting that selective mortality did not explain the pattern of associations seen. CONCLUSIONS: In contrast to the initial cross-sectional findings, these data suggest that HLA-DR3 or DR4 status is unrelated to 14-year incidence and progression of diabetic retinopathy. The discrepancy may be related to increasing homogeneity of retinopathy and diminishing power to detect small differences, but it may also reflect the uncertain and inconsistent effects of HLA-DR3 or DR4 on the development and progression of diabetic retinopathy.     

Comparative evaluation of blood viscosity in diabetic retinopathy

The viscosity of the whole blood, plasma and serum, haematocrit and plasma fibrinogen were studied in diabetic patients with (DR) and without (D) retinopathy and in non-diabetic control subjects (C). Blood viscosity was significantly higher in diabetics than in controls.No significant differences in viscosity of the whole blood were found when various types of retinopathy were compared according to the severity of retinal damage.Plasma viscosity was significantly higher (P < 0.01) than controls (C) only in diabetic patients with retinopathy (DR). Serum viscosity was significantly increased compared with controls (C) only in diabetic patients affected by proliferative retinopathy.Plasma fibrinogen was significantly higher than controls (C) both in diabetics with retinopathy (DR) and without retinopathy (D).Haematocrit did not show a significant difference in the three groups considered (C, D, DR).     

Diabetic retinopathy and pregnancy

Diabetes mellitus and pregnancy have reciprocal influences between them, therefore diabetes mellitus may complicate the course of pregnancy as well as pregnancy can worsen the performance of diabetes especially at the fundus oculi. Several factors seem to play a role in retinal neovascularization. Actually it’s not possible to understand the mechanisms underlying this progression. Moreover chronic hyperglycemia leads to several events such as: the activation of aldose reductase metabolic pathway, the activation of the diacylglycerol-protein kinase C, the non-enzymatic glycation of proteins with formation of advanced glycation endproducts and the increase of hexosamines pathway. Although every structure of the eye can be affected by diabetes, retinal tissue, with all its vessels, is particularly susceptible. Pregnancy may promote the onset of diabetic retinopathy, in about 10 % of cases, as well as contribute to its worsening when already present. The proliferative retinopathy must always be treated; treatment should be earlier in pregnant women compared to non-pregnant women. Pregnancy can also cause macular edema; it spontaneously regresses during the postpartum and therefore does not require immediate treatment. In summary, collaboration between the various specialists is primary to ensure the best outcomes for both mother’s health and sight, and fetus’ health.     

Developmental aspects of diabetic retinopathy during pregnancy]

The course of diabetic retinopathy (DR) was studied in 93 pregnant patients. Results were compared with data from 98 diabetic non pregnant women. Worsening of initial retinal lesions was observed in 16% of the pregnant group whereas only 6% of the control group showed a similar aggravation. The difference between the two groups was statistically significant (p < 0.05). Argon laser panretinal photocoagulation of pre-proliferative and proliferative DR resulted in no subsequent DR-induced complications. On the other hand, the risk of appearance of DR and/or its worsening during pregnancy depends on initial network but mostly on the duration of diabetes mellitus. In conclusion, regular ophthalmologic examination of diabetic patients especially during pregnancy seems crucial for the early screening of any worsening. Furthermore, the importance of pregnancy planning is emphasized.     

外周血循环内皮细胞、血浆内皮素与糖尿病视网膜病变的关系

目的 探讨血管内皮细胞(vascular endothelial cells,VEC)损伤及损坏后的功能变化在糖尿病视网膜病变(diabetic retinopathy,DR)发病机制中的作用。 方法 检测55例糖尿病(diabetes mellitus,DM)患者(包括无视网膜病变组20例,背景型视网膜病变组20例,增生型视网膜病变组15例)及正常人外周血循环内皮细胞(circulating endothelial cells ,CEC)数及血浆内皮素 (endothelin,ET)水平变化,并进行比较。 结果 DM患者CEC数及ET水平显著高于正常人(P<0.001),两指标呈显著正相关(r=0.738,P<0.001,n=55)。CEC数及ET水平随DR程度加重而增高。 结论 VEC损伤及由此所致的血浆ET水平增高,可能共同参与了DR的病理过程。(中华眼底病杂志,2000,16:166-168)     

Z-2 aldose reductase allele and diabetic retinopathy in India

Genetic factors have been identified that regulate the severity and the rapidity of onset of retinopathy in diabetic patients. Polymorphisms in (CA)( n) present upstream of the promoter of the aldose reductase (ALR2 ) gene have been shown to be associated with retinopathy in different ethnic populations. We aimed to study the association between the (CA)( n) polymorphism and type 2 diabetic patients with and without retinopathy in the Asian Indian population. We screened 105 diabetic patients with retinopathy (DR) and 109 diabetic patients without retinopathy (DNR) for the (CA)( n) polymorphism and compared the results with those of an unrelated healthy control group (CT). We identified 13 alleles in our diabetic population. The Z-2 allele (136 bp) showed an association with the DR group (13.81%) with a significant p value (p = 0.029) when compared with the DNR group (7.34%). The Z-2 allele also showed a significant association with those DR patients who had proliferative retinopathy (PDR) and maculopathy (MAC) (p = 0.004). The Z-2 allele is, therefore, a high-risk allele for diabetic retinopathy in the Asian Indian patients.     

糖尿病性视网膜病变患者房水中VEGF与IGF-1的定量测定及分析

目的:探讨糖尿病视网膜病变(DR)程度与房水中VEGF、IGF-1含量之间的关系。方法:研究对象共44例,分为正常对照组(A组)、糖尿病患者无视网膜病变组(NDR组)(B组)、糖尿病性视网膜病变组(DR组)(C组),其中C组又分为单纯型糖尿病性视网膜病变组(BDR组)(C1组)和增殖型糖尿病性视网膜病变组(PDR组)(C2组)。对所有研究对象均收集房水标本。对标本均采用双抗体夹心ABC-ELISA法进行人VEGF和人IGF-1定量ELISA测定。结果:随着糖尿病的进展及DR的逐渐加重,房水中VEGF浓度呈明显增加趋势。房水IGF-1:对照组(A组)、NDR组(B组)、DR组(C组)各组间P<0.01,呈明显增高趋势。BDR组(C1组)与PDR组(C2组)间P<0.01,呈明显增高趋势。房水VEGF与房水IGF-1二者有显著正相关性(P<0.01)。结论:VEGF是影响糖尿病眼底微血管病变发生、发展的重要刺激因子;眼内IGF-1参与了DR进展的病理进程;在DR的发生发展过程中,IGF-1与VEGF有协同作用。     

Management and outcome of sight-threatening diabetic retinopathy in pregnancy

AIMS: To report the management and outcomes of sight-threatening diabetic retinopathy in pregnancy. METHODS: A retrospective review of 8 diabetic females who developed pregnancy related sight-threatening diabetic retinopathy requiring treatment over a 12-year period. RESULTS: In total, 16 eyes of eight patients were included in this series. The mean age of the patients at presentation was 30.75 years +/-3.8 SD and the mean duration of diabetes was 21.0 years +/-5.1 SD. The mean follow-up period was 46.75 months +/-47.2 SD. A total of 87.5% of patients showed progression of diabetic retinopathy during pregnancy, 71% of which were in the sight-threatening proliferative category. In the postpartum period, 81% of patients continued to progress to proliferative diabetic retinopathy, requiring panretinal photocoagulation and multiple other surgical procedures. In all, 69% of eyes retained visual acuity equal to or better than 0.3 logMAR units (6/12). CONCLUSION: Sight-threatening diabetic retinopathy in pregnancy is a rare disease, but it can have devastating consequences for mother and child. Laser photocoagulation should be considered for pregnant women with severe preproliferative diabetic retinopathy. Proliferative diabetic retinopathy may not regress postpartum. Close followup should be extended in the postpartum period in this group of patients until the retinopathy is stabilised. The presence of combined rhegmatogenous and tractional retinal detachment and neovascular glaucoma were associated with the worst outcome.