辛伐他汀对糖尿病大鼠视网膜血管内皮钙黏蛋白表达的影响

目的观察链脲佐菌素（STZ）诱导的糖尿病视网膜血管内皮钙黏蛋白（VE-cadherin）的表达及辛伐他汀对VE-cadherin表达的影响,探讨他汀类药物可能的非调脂性治疗作用。方法尾静脉注射STZ法建立糖尿病大鼠模型,造模成功48只。成模次日起,24只大鼠每日给予辛伐他汀20 mg/kg灌胃为辛伐他汀组,24只等量生理盐水灌胃为糖尿病组;另选24只大鼠作为正常对照组。分别在造模后2、5、8周各组取8只大鼠采用伊凡思蓝（EB）法检测视网膜的渗透性,免疫组织化学和Western blot法检测各组大鼠视网膜VE-cadherin的表达情况。结果与正常对照组比较,辛伐他汀组和糖尿病组大鼠体重明显下降,差异均有统计学意义（P〈0.01）,血糖显著上升,差异均有统计学意义（P〈0.01）。与糖尿病组大鼠比较,各时间点辛伐他汀组大鼠体重均明显上升,而血糖均显著下降（P〈0.05）。免疫组织化学分析证实,VE-cadherin在糖尿病组大鼠视网膜血管呈黄褐色阳性表达。Western blot分析表明随着糖尿病视网膜病变（DR）的发生发展,糖尿病组视网膜血管表达VE-cadherin的量显著减少,与正常对照组和辛伐他汀组比较,差异均有统计学意义（P〈0.05）。糖尿病组和辛伐他汀组EB渗透量明显高于正常对照组（P〈0.01）,辛伐他汀组低于糖尿病组（P〈0.05）。结论STZ诱导的糖尿病大鼠视网膜血管中VE-cadherin表达量减少,辛伐他汀可改善这种改变,提示辛伐他汀对DR有预防和治疗作用。     

Advances in the treatment of diabetic retinopathy

Diabetic retinopathy, the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic macular edema and are an effective adjunctive treatments to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, pharmacologic vitreolysis, rennin-angiotensin system blockers, and peroxisome proliferator-activated receptor gamma agonists.     

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy: review, consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy (DR), and associated morbidity is high in the Asia-Pacific region. Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR, especially in patients with cardiovascular risk, and pre-existing mild-to-moderate DR. Fenofibrate has also been found to reduce maculopathy, and the need for laser treatment in these patients. Considering these benefits of fenofibrate, a group of experts from the fields of endocrinology and ophthalmology convened in May 2017, to discuss on the the mechanism of action, and clinical efficacy of fenofibrate in DR. The findings from key clinical studies on fenofibrate in DR were reviewed by the experts, and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR. The statements were rated based on the GRADE criteria. An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes (T2D), and the place of fenofibrate was defined in the algorithm. The expert recommendations, and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.     

Medical treatment of retinopathy of type-2 diabetes

The medical treatment of retinopathy in type-2 diabetes should be considered as a major component in the overall management of diabetic retinal disease. It is clear that specific and timely interventions, such as glycemic and blood pressure control, are the basis for good management of diabetic retinopathy. The American Diabetes Association has developed specific recommendations concerning diabetic retinopathy for the primary care physician and diabetologist. The ophthalmologist must be aware of these recommendations and establish efficient communication channels with the colleagues who follow their patients and the progression of diabetes closely. The challenge for the ophthalmologist is to make sure that, when signs of retinopathy are detected, information regarding the status of the retina, prognostic factors and the rate of progression must be given to the primary care physician and diabetologist. Under these circumstances, excellent glycemic control, aggressive management of blood pressure and normalization of lipids are all needed, and the goals to be achieved must be shared between the ophthalmologist and the primary care physician or diabetologist. Appropriate medical management of diabetic retinopathy is fundamental to reduce the risk of blindness. This goal can only be achieved if the ophthalmologist is fully aware of the role of medical management and establishes an efficient flow of communication with the primary care physician or diabetologist, particularly for the diabetic patients whose eyes show signs of risk for rapid progression of their retinopathy.     

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.     

Assessment of blood flow in the ocular circulation in type 2 diabetes patients with Color Doppler imaging

PURPOSE: Color Doppler assessment of blood flow in ocular circulation in type 2 diabetes patients. MATERIAL AND METHODS: Total of 56 patients were included in the study and divided into 3 groups: group I--control group, group II--type 2 diabetes patients without diabetic retinopathy, group III--type 2 diabetes patients with nonproliferative diabetic retinopathy. USG Color Doppler method was used in all patients to assess peak systolic blood velocity (PSV), end-diastolic blood velocity (ESV) and resistivity index (RI) in the following arteries: ophthalmic artery (OA), central retinal artery (CRA), short posterior ciliary artery (SPCA). In addition several clinical parameters including age, diabetes duration, blood pressure, body mass index (BMI) and blood glucose level with empty stomach were statistically analyzed. RESULTS: Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in ophthalmic artery (OA) in diabetic patients were significantly lower in comparison to the control group. Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in central retinal artery (CRA) were significantly lower only in patients with diabetic retinopathy. In short posterior ciliary arteries (SPCA) only peak systolic blood velocity (PSV) was decreased in patients with diabetic retinopathy. Average age of patients was significantly higher in the group with diabetic retinopathy. Diabetes duration was significantly longer in group III in comparison to group II. CONCLUSIONS: Color Doppler imaging method is useful for assessing blood flow in ocular circulation. Blood flow in ophthalmic artery is decreased in patients with diabetes. Reduction of blood flow in central retinal artery and short posterior ciliary arteries can be significant in the development of diabetic retinopathy.     

Assessment of nerve fiber layer in diabetic patients with scanning laser polarimetry

OBJECTIVES: To evaluate the effects of diabetes mellitus, diabetic retinopathy and degree of blood glucose (BG) regulation on retinal nerve fiber layer (RNFL) thickness by using a scanning laser polarimeter (NFA-GDx). METHODS: We prospectively assessed RNFL thickness in four groups of patients, who were all age matched. Diabetic patients without diabetic retinopathy were grouped according to their BG regulation level into two, as: BG-regulated group (BG <140 mg/dl, HbA1c <8%, fructosamine <285 micromol/l, TG <200 mg/dl, n = 50), and BG-non-regulated group (BG = 140-250 mg/dl, HbA1c >8%, fructosamine >285 micromol/l, TG >200 mg/dl, n = 44). A group of patients with nonproliferative diabetic retinopathy (NPDR) formed the 3rd group (n = 41). The 4th group consisted of healthy subjects and acted as a control group (n = 50). Symmetry, superior maximum, ellipse modulation and the average thickness variables of NFA-GDx were used for the assessment. ANOVA test was used for the statistical analysis of variables between groups. RESULTS: The mean superior maximum and ellipse modulation values were statistically significantly lower than the control group in BG-non-regulated and NPDR groups (P < 0.05). The average thickness value was also statistically significantly lower than the control group in NPDR group. These values in the BG-regulated group were not statistically significantly different from the control group (P > 0.05). CONCLUSIONS: This is the first clinical study demonstrating the effects of diabetic glucose regulation level on RNFL by using NFA-GDx. RNFL thickness was seen to decrease with development of diabetic retinopathy and with impairment of metabolic regulation. This issue should be taken into account while assessing RNFL in diabetic glaucomatous patients.     

Retinal circulatory changes related to retinopathy progression in insulin-dependent diabetes mellitus

To quantify the vascular deterioration of the diabetic retina, retinal circulatory changes in 45 insulin-dependent diabetic patients, and in 17 normal controls, were measured and divided into four groups according to severity of retinopathy. The noninvasive laser Doppler technique was used to measure the systolic/diastolic variation of red blood cell velocity (V) at sites along temporal retinal arteries. Flow pulsatility [V (systole)/V (diastole)] was 18% lower (P less than 0.00001) in the mild-retinopathy group than in normal controls, but 35% higher (P less than 0.001) in the severe-retinopathy group than in the mild-retinopathy group. Repeated measurements in three eyes during the progression from mild or moderate to severe retinopathy showed progressive increases in both flow pulsatility and mean retinal blood flow. Altered flow pulsatility appears to be a sensitive indicator of vascular alterations during the progression of diabetic retinopathy.     

Four years incidence of diabetic retinopathy and effective factors on its progression in type II diabetes

PURPOSE: To study the 4 years incidence of diabetic retinopathy in patients with type II diabetes and effective factors on its progression. METHODS: Among diabetic patients referred to Yazd Diabetes Research Center, 120 patients with type II diabetes without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), postprandial blood sugar, triglyceride, and cholesterol were measured and height, weight, and blood pressure (BP) were recorded. Then patients were followed with eye examination yearly for 4 years. RESULTS: Four-year cumulative incidence of diabetic retinopathy was 47.5% (95% CI: 38.6-56.4). The retinopathy was mild nonproliferative diabetic retinopathy (NPDR) in 43 (35.8%) whereas 10 (8.3%) patients had moderate NPDR, 3 (2.5%) patients had severe NPDR, and only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in the second year, 24.4% in the third year, and 7.4% in the fourth year. Duration of diabetes, FBS, and systolic BP had statistically significant relation with grades of diabetic retinopathy. However, there was no significant association between age, sex, body mass index, triglyceride, cholesterol, method of treatment, smoking, and diastolic BP with grades of diabetic retinopathy. CONCLUSIONS: These data provide 4-year cumulative incidence of diabetic retinopathy in defined type 2 diabetic patients. The present study shows that duration of diabetes, hyperglycemia, and systolic BP appear to be the major factors associated with the development of any level of retinopathy in type 2 diabetic patients.     

Management of diabetic retinopathy

Diabetic retinopathy remains a major cause of blindness despite increased understanding of this disease and identification of successful treatments. The Diabetic Retinopathy Study identified risk factors associated with a high risk of blindness and confirmed the benefits of panretinal photocoagulation. The Early Treatment Diabetic Retinopathy Study defined the retinal characteristics, indications of treatment and results of laser treatment of clinically significant macular oedema. The Diabetic Retinopathy Vitrectomy study established the benefits and timing of vitrectomy for non-clearing vitreous haemorrhage and severe proliferative diabetic retinopathy. The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study have also demonstrated the value of tight control of blood sugar and blood pressure in diabetic retinopathy. These studies developed specific recommendations for the management of diabetic retinopathy. Optimum use of this information can minimize visual loss due to diabetic retinopathy.     

灯盏细辛联合激光光凝治疗糖尿病视网膜病变

目的:探讨灯盏细辛注射液联合视网膜激光光凝术治疗糖尿病视网膜病变的临床效果。 方法:糖尿病视网膜病变患者50例用灯盏细辛注射液联合视网膜激光光凝术治疗,对照组患者50例单纯采用羟苯磺酸胶囊口服,观察治疗前后的眼底改善和视力提高情况及血液流变学的改变。 结果:糖尿病视网膜病变患者用灯盏细辛注射液联合视网膜激光光凝术治疗后,能明显提高糖尿病视网膜病变患者的视力,明显改善患者眼部微循环,总有效率达90％,与对照组相比,差异有统计学意义（P<0.05）。 结论:灯盏细辛注射液联合视网膜激光光凝术治疗糖尿病视网膜病变,具有良好的临床疗效,能更好改善糖尿病视网膜病变的微循环状态,并延缓和改善糖尿病视网膜病变。     

The therapeutic effects of angiotensin-converting enzyme inhibitors in severe non-proliferative diabetic retinopathy

PURPOSE: To evaluate the effects of angiotensin-converting enzyme inhibitors (ACE-I) in retarding progression of severe non-proliferative diabetic retinopathy (NPDR) in normotensive type 2 diabetic patients. METHODS: This was a retrospective case control study of 128 patients with normotensive type 2 diabetes with lower than +1 dipstick proteinuria and severe NPDR who were classified into either an ACE-I treated group (Enalapril maleate 10 mg, n=12 , Ramipril 5 mg, n=17) or an ACE-I untreated group (n=99). Medical records were reviewed for endpoints of (a) occurrence of proliferative diabetic retinopathy (PDR) or macular edema (ME) for which laser phototherapy was necessary or (b) development of proteinuria of higher than +1 level requiring medication of ACE-I. RESULTS: From the total of 128 patients, there were 29 ACE-I treated patients and 99 ACE-I untreated patients. There were no differences in the average age, duration of diabetes, body mass indices, blood pressure and levels of hyperglycemia or HbA1C between the two groups. Blood pressure and HbA1C levels in both groups remained unchanged during the study. The mean follow-up period was 41.6 months. In the ACE-I group, 6 patients progressed to PDR, 5 to ME and 6 developed proteinuria of greater than +1 over the follow-up period. In the control group, 30 patients progressed to PDR, 6 to ME and 9 developed proteinuria of greater than +1 over the follow-up period. CONCLUSIONS: Small doses of ACE-I did not yield any beneficial effects in retarding the progression of severe NPDR.     

An endothelin type A receptor antagonist reverses upregulated VEGF and ICAM-1 levels in streptozotocin-induced diabetic rat retina

Diabetic retinopathy, a cause of blindness, is often associated with the upregulation of vascular endothelial growth factor (VEGF) in the retina. Recently, leukocyte adhesion (leukostasis) is claimed for the occlusion of retinal capillary vascularity, which ultimately assists in the progression of diabetic retinopathy. In addition, intercellular adhesion molecule-1 (ICAM-1), a representative factor for leukostasis, is increased in diabetic retina. Endothelin (ET)-1, a potent vasoconstrictor peptide, is closely linked to the pathogenesis of diabetic retinopathy. Different therapeutic interventions concerning VEGF have already been proposed to prevent diabetic retinopathy. However, no study has yet reported concerning the effects of ET-1 receptor antagonist on the upregulated VEGF and ICAM-1 in morphologically intact diabetic retina. The current study investigated the effect of ET(A) receptor antagonist (TA-0201; 1 mg kg(-1) day(-1)) on the expressions of VEGF and ICAM-1 in rat diabetic retina. Diabetes was induced by intraperitoneal injection of streptozotocin (70 mg/kg) in Sprague-Dawley rats, whereas control rats (Cont) received only citrate buffer. After 1 week, the streptozotocin-administered rats were randomly divided into two groups: ET(A) receptor antagonist-treated group (DM+TA-0201) and saline-treated group (DM+vehicle). After the treatment for 4 weeks, the retina was removed from the eyeball. In DM+vehicle group, the VEGF expression of retina was significantly increased (33.5 pg/mg) in comparison with that in the Cont group (25.1 pg/mg), and the upregulation of VEGF was reversed in DM+TA-0201 group (26.9 pg/mg), a phenomenon consistent with the change in VEGF mRNA levels. The expression of retinal ICAM-1 was increased in DM+vehicle group (55.1 pg/mg) compared with Cont group (43.8 pg/mg), and ET antagonism completely blocked this increase (43.8 pg/mg). Moreover, an increased leukostasis by 3.3-fold in DM+vehicle retina was returned to the control level by ET antagonism. In the current study, there was no obvious retinal morphological alteration from both the hematoxylin and eosin staining and the FITC-dextran angiography. Thus, ET(A) receptor antagonist might be useful in preventing the progression of diabetic retinopathy, as evidenced by suppressing the increase in VEGF and ICAM-1 levels as well as leukostasis in morphologically intact diabetic retina.     

Ocular haemodynamics and colour contrast sensitivity in patients with type 1 diabetes

BACKGROUND: There is evidence that altered ocular blood flow is involved in the development and progression of diabetic retinopathy. However, the nature of these perfusion abnormalities is still a matter of controversy. Ocular haemodynamics were characterised with two recently introduced methods. METHODS: The cross sectional study was performed in 59 patients with type 1 diabetes with a diabetes duration between 12 and 17 years and an age less than 32 years and a group of 25 age matched healthy controls. Scanning laser Doppler flowmetry and laser interferometric measurement of fundus pulsation amplitude were used to assess retinal and pulsatile choroidal blood flow, respectively. In addition, colour contrast sensitivity along the tritan axis was determined. RESULTS: Fundus pulsation amplitude, but not retinal blood flow, increased with the progression of diabetic retinopathy. Retinal blood flow was influenced by plasma glucose levels (r = 0.32), whereas fundus pulsation amplitude was associated with HbA(1c) (r = 0.30). In addition, a negative correlation between the colour contrast sensitivity along the tritan axis and retinal blood flow was observed. CONCLUSIONS: The present study indicates that pulsatile choroidal blood flow increases with the progression of diabetic retinopathy. Increased retinal blood flow appears to be related to loss of colour sensitivity in patents with type 1 diabetes.     

维汉两民族中糖尿病视网膜病变相关生化指标表达的差异性

目的：通过检测维吾尔族与汉族糖尿病视网膜病变患者的相关生化指标,判断糖尿病视网膜病变进展与族别有无相关性,进而更准确地指导临床开展地区性治疗,早期检测、早期预防,降低并发症和提高生活质量。方法：选取年龄38～70岁,眼底荧光造影确诊糖尿病视网膜病变患者120例,其中非增殖期（ NPDR）60例,维吾尔族与汉族各30例;增殖期60（PDR）例,维吾尔族与汉族各30例。所有患者检测空腹静脉血中超敏C反应蛋白（ hs－CRP）、血清总胆红素（ TBIL）、纤维蛋白原（ FIB）、D－二聚体（ D－D）指标。结果：无论是否按族别划分,NPDR组和PDR组在4项指标上均有显著性差异;其中维汉两族中的hs－CRP比较无显著差异,但TBIL、FIB、D－D在两族中比较差异有统计学意义（P＜0．05）,且在维吾尔族人群中更为明显。结论：新疆维吾尔族糖尿病视网膜病变患者病情普遍较汉族严重,临床上更应引起重视。     

非诺贝特治疗糖尿病视网膜病变的临床研究进展

非诺贝特是过氧化物酶增殖物激活受体α（PPAR-α）激动剂,在临床上作为调脂药物被广泛使用。它能够降低甘油三酯水平,升高高密度脂蛋白胆固醇（HDL-C）水平,降低冠脉血管事件的风险。最近的临床试验表示,非诺贝特能够延缓增殖期糖尿病视网膜病变的进展,且发现非诺贝特的这种作用与其抗炎作用等有关。现主要就非诺贝特在糖尿病视网膜病变发病中的作用及其机制进行综述。     

Changing times for the management of diabetic retinopathy

Laser photocoagulation has led a revolution in the management of diabetic retinopathy. Scatter photocoagulation and focal photocoagulation has been shown to be effective in reducing vision loss. Just as dramatic as laser photocoagulation, medical treatment has led another revolution in the treatment of diabetic retinopathy. Good glycemic, blood pressure, and lipid control have contributed to further reduce vision loss and laser photocoagulation. In the very near future, there will be significant advances in pharmacologic treatment of diabetic retinopathy. Treatment with antioxidants, agents inhibiting hyperglycemia-induced protein kinase activity, and other agents will likely prevent the development/progression of retinopathy. Because pharmacologic agents are aimed at the prevention of retinopathy, patients with retinopathy will need to be examined earlier to diagnose retinopathy at earlier stages. To maximize the opportunity for earlier diagnosis, ophthalmologist may need to adopt screening strategies to identify patients most likely to benefit from these new treatments.     

Evidence-based therapy of diabetic retinopathy

INTRODUCTION: Evidence-based medicine is often misunderstood as 'cookbook medicine with standard recipes' that does not take clinical experience into account. It is, however, supposed to be a basis for decision making in caring for individual patients under consideration of patients' preferences. This seems to be very important, since diabetic retinopathy continues to be the most frequent cause of vision loss in working age adults with negative consequences for patients' quality of life and for health economics. MATERIALS AND METHODS: The most important evidence-based therapy for diabetic retinopathy and maculopathy is laser coagulation. Vitrectomy for proliferative stages has also been proven effective by clinical studies. For more recent treatment options like triamcinolone injection and vitrectomy for diabetic macular edema there is a lower level of evidence so far. RESULTS: The Diabetic Retinopathy Study was the first to show the effectiveness of panfundus laser coagulation for a larger group of patients. The Early Treatment Diabetic Retinopathy Study in turn serves as a basis for laser coagulation of retinopathy and maculopathy. The Diabetic Retinopathy Vitrectomy Study could show the advantages of timely vitrectomy. Both the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study could show the value of intensive blood glucose control. DISCUSSION: Evidence-based medicine on the basis of the studies mentioned above is practiced quite self-evidently in ophthalmo-diabetology. It should be regarded as a helpful tool for special therapeutic situations which still leaves room for one's personal clinical experience to be included. It is somewhat problematic that the term evidence-based medicine seems to be restricted to the results of large randomized studies, because even special problems and very individual, difficult therapeutic questions can be placed on an evidence-based foundation, although at a lower level of evidence, using today's modern means of literature research.     

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.     

Calcium dobesilate in diabetic retinopathy. A retrospective controlled study

The effect of calcium dobesilate (Doxium) therapy on the evolution of diabetic retinopathy has been assessed in a retrospective study. 54 patients with diabetic retinopathy received calcium dobesilate (average 650 mg/day) for 6-30 months (average 18 months) and were compared to a correspondingly selected control group. The patients were divided into three subgroups (mild, moderate, and severe diabetic retinopathy). Microaneurysms, blot hemorrhages, striate hemorrhages, and hard exudates were assessed semiquantitatively from panorama fundus photographs, using a scoring system. The effect of calcium dobesilate was statistically significant for cases with moderate background diabetic retinopathy on summing up the scores of the various retinal lesions. There was no favorable effect on diabetic maculopathy or visual acuity. In the proliferative stages of diabetic retinopathy, photocoagulation is offering, in the majority of cases, the only chance to slow down the progression of this disease; however, drug therapy might be beneficial in nonproliferative diabetic retinopathy.