Netzhautkomplikationen bei Diabetes

In September 2015 a revised version of the guideline “Prevention and therapy of diabetes-induced retinal complications” was released in Germany. It summarizes current recommendations for diagnosis and therapy of diabetic retinopathy with a special focus on practicability in daily routine. Newly included were the use of optical coherence tomography (OCT) for the diagnosis of diabetic macular edema and the evaluation of the therapeutic effect of anti-VEGF drugs (VEGF: vascular endothelial growth factor) or corticosteroids after intravitreal drug delivery. Screening intervals for diabetic retinopathy were extended to every 2 years for all diabetic patients with no retinopathy and limited systemic risk factors. Patients with known risk factors should be screened annually or in case of retinopathy, followed-up as recommended by the ophthalmologist.     

Factor V Quebec revisited

Factor V Quebec has been described as a bleeding disorder that exhibits an autosomal dominant inheritance pattern and presents severe bleeding after trauma. Two members of a fourth-generation (IV.13 and IV.15) Canadian family have been studied in detail and are the subject of this report. Their clinical presentations and histories have been described previously (Tracy et al: J Clin Invest 74:1221, 1984). Persistent abnormalities include mild thrombocytopenia and defective platelet factor V. Plasma factor V is present at near normal concentration and is fully functional. Thus, the bleeding diathesis appears to reflect the absence of platelet factor V activity. The recent report (Hayward et al: Blood 84:110a, 1994 [suppl, abstr]) of multimerin deficiency in these individuals led us to reevaluate these patients. Western blot analyses of platelet lysates developed with a variety of monoclonal antibodies show that the alpha-granule proteins, fibrinogen, von Willebrand factor, factor V and osteonectin are decreased in concentration and significantly degraded in the platelets of these patients. Thrombospondin, while not degraded, is substantially decreased. In contrast, platelet factor 4 and beta-thromboglobulin do not appear to be affected. These observations suggest that the alpha- granules are correctly assembled but the contents are subsequently subjected to proteolytic degradation. The results indicate that factor V Quebec disorder is probably associated with a generalized defect that leads to degradation of most proteins of the alpha-granules.