微创玻璃体手术时代:糖尿病视网膜病变手术的新认识

玻璃体切割手术(PPV)是糖尿病视网膜病变(DR)尤其是增生期DR的首选手术方式。针对DR的PPV比较全面的涉及到了PPV各个方面的操作,是视网膜外科医生成熟的标志之一。随着微创PPV及围手术期抗新生血管药物的广泛应用,其手术指征及手术时机、围手术期用药、手术中玻璃体的处理、是否联合白内障手术均发生了较大变化,需要有新的认识。临床应努力开展新条件下DR手术时机、围手术期药物应用等循证医学研究,为DR的手术治疗提供新的理论依据。     

阿司匹林与糖尿病患者玻璃体出血以及玻璃体切割术疗效的相关性研究

目的 探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者应用小剂量阿司匹林对玻璃体出血发生率以及玻璃体切割术(pars plana vitrectomy,PPV)疗效的影响.方法 回顾性采集具有阿司匹林应用史或玻璃体出血病史458例DR患者,并对其中97例行PPV的DR患者进行随访研究.结果 应用阿司匹林DR患者年龄49～ 85 (69.3±4.2)岁高于未应用阿司匹林患者年龄45 ～ 82 (60.3±3.4)岁(P＜0.05).应用阿司匹林患者中具有玻璃体出血病史患者占45.59％ (93/204),而未应用阿司匹林患者中具有玻璃体出血病史患者占40.94％ (104/254),差异无统计学意义(P＞0.05).应用阿司匹林患者中,具有玻璃体出血病史患者阿司匹林应用剂量和应用时间与无玻璃体出血病史患者比较,差异均无统计学意义(均为P ＞0.05).应用阿司匹林患者与未应用阿司匹林患者术后视力与术前比较均明显提高(均为P＜0.05),且术后玻璃体出血发生率、二次手术率以及视力改善程度差异均无统计学意义(均为P ＞0.05).结论 小剂量阿司匹林的应用并不增加DR患者玻璃体出血的发病率,同时也不增加PPV术后并发症.DR患者可以应用小剂量阿司匹林,且PPV术前仍可继续应用.     

糖尿病性视网膜病变的治疗进展

激光光凝、药物治疗、玻璃体切割术(PPV)是目前治疗糖尿病性视网膜病变(DR)的主要方法。传统激光光凝治疗具有相对安全、疗效作用持久等优势,但激光可损害患者视觉质量;PPV虽能挽救部分患者的视力,但手术风险及创伤较大;药物治疗可在DR早期应用,但糖皮质激素类药物具有明确的副作用,故不能作为主要治疗方法;抗血管内皮生长因子(VEGF)药物治疗能从发病机制上有效抑制DR的发生发展,但疗效相对较短,反复治疗的安全性和有效性目前仍需进一步大样本研究。本文旨在对DR的临床治疗进展进行综述,以期为制定有效的临床治疗方案提供参考。     

玻璃体后脱离与糖尿病视网膜病变

玻璃体后脱离(posterior vitreous detachment,PVD)在糖尿病视网膜病变(diabetic retinopathy,DR)的发展过程、手术治疗和转归等方面发挥了重要作用.部分PVD可以加重DR的病情,完全PVD可以消除新生血管生长支架,减少玻璃体出血,增加氧气浓度,使玻璃体手术简单化等.副作用小的纤溶酶等药物玻璃体内注射可以诱导PVD,其可改变DR的转归和减少玻璃体手术并发症.     

抗血管内皮生长因子在辅助增生性糖尿病视网膜病变手术治疗中的应用

增生性糖尿病视网膜病变(PDR)是糖尿病患者严重眼部并发症之一,是导致患者失明的主要原因.玻璃体切除术(PPV)是治疗严重玻璃体积血、增生性糖尿病视网膜病变的有效方法.但是由于PDR患者眼内血管内皮生长因子(VEGF)浓度异常增高,使得玻璃体腔内和视网膜表面存在大量的新生血管,极易渗漏、出血,术中常常出现活动性出血而降低手术野的清晰度,降低操作精准度进而影响手术进程.在较严重活动性出血的情况下,继续进行气/液交换可导致血小板的残留,术后再次出现机化膜的概率非常高,严重影响手术的成功率.另外,新生血管可引起术后前房出血、再次玻璃体积血以及视网膜表面出血等,炎症、积血造成的术后高眼压,机化膜再次牵拉视网膜脱离等并发症也将随之而来,严重影响其术后视功能的恢复和远期预后.随着近几年抗VEGF药物的广泛临床应用,研究发现PPV前玻璃体腔注射抗VEGF药物可抑制新生血管的活动性,显著减少术中及术后出血的发生,降低手术难度,缩短手术时间,有效提高手术成功率.本文就抗VEGF辅助PPV治疗增生性视网膜病变的分子机制、临床应用、有效性及安全性等进行综述.     

曲安奈德在增生性糖尿病视网膜病变玻璃体切除术中的应用

目的:讨论曲安奈德(triamcinolone acetonide,TA)在增生性糖尿病视网膜病变(proliferate diabetic retinopathy,PDR)玻璃体切除术(pars plana vitrectomy,PPV)中的辅助作用。方法:增生性糖尿病视网膜病变患者107例107眼随机分为曲安奈德玻璃体切除组(治疗组53眼)和传统玻璃体切除组(对照组54眼),其中TA组经大部分玻璃体切除后,术中抽取0.3~0.5mLTA注入玻璃体腔,完成余下玻璃体皮质切除及视网膜前膜的剥离。观察术中并发症如视网膜裂孔形成、视网膜脱离、玻璃体出血。术后最佳矫正视力(BCVA)、眼压、黄斑水肿情况。结果:总共有104例(97.2%)患者完成6~12mo随访,其中TA组51例(96.2%),传统玻璃体切除组53例(98.1%)。TA组术中视网膜裂孔明显低于对照组(P<0.05),术中视网膜脱离、玻璃体出血及术后BCVA、眼压、黄斑水肿两组无明显差异。结论:增生性糖尿病视网膜病变玻璃体切除时注射TA能够加玻璃体皮质的可视性,使视网膜前膜的剥离更安全有效,减少术中视网膜破裂,术后没有与之相关的严重不良反应。     

雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变

目的 对比观察玻璃体切除术(pars plana vitrectomy,PPV)联合应用或不应用雷珠单抗玻璃体注射(intravitreal ranibizumab,IVR),对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者手术中操作及术后预后的影响.方法 前瞻性对照性研究.将2013年2～6月在沈阳军区总医院眼科就诊的34例(37只眼)合并牵拉性视网膜脱离的PDR患者,分为雷珠单抗玻璃体注射联合玻璃体切除术(IVR/PPV)组及单纯玻璃体切除术(PPV)组.IVR/PPV组术前1周注射雷珠单抗0.5 mg.观察两组手术中出血量(积液盒红细胞平均计数)、手术时间、术后短、长期再出血发生率及视力预后的差异.结果 随访6个月,总共29例(31只眼)最终纳入研究,其中IVR/PPV组12只眼,单纯PPV组19只眼.IVR/PPV组术中出血量(平均红细胞计数)为(79±62.24)×106/mL,显著低于单纯PPV组的(156.54±123.2) ×106/mL,差异有统计学意义(t=2.315,P=0.028),手术时间(79.47± 15.44) min也显著低于单纯PPV组(102.08±22.2) min,差异有统计学意义(t=3.087,P=0.006).两组患者术后视力均较术前显著提高,差异有统计学意义(t =4.92,5.75;P=0.01,0.000),但两组间的视力预后及术后再出血发生率差异均无统计学意义(P＞0.05).结论 术前雷珠单抗玻璃体注射,能显著减少PDR患者玻璃体切除手术中出血及手术时间,为复杂糖尿病史网膜患者的手术治疗提供了便利.     

增殖性糖尿病玻璃体视网膜病变玻璃体切割术后持续性玻璃体出血

目的：探讨增殖性糖尿病玻璃体视网膜病变玻璃体切割术后持续性出血的发生率及处理方法。方法：回顾性分析1998年1月至2000年12月共42例(53眼)增殖性糖尿病玻璃体视网膜病变玻璃体切割术后患者的临床资料。根据出血量分别给予局部糖皮质激素、降低眼内压药物、前房冲洗或玻璃体腔灌洗。结果：增殖性糖尿病玻璃体视网膜病变玻璃体视网膜病变玻璃体切割术后持续性出血共22眼，发生率52．38％收，自发清除率86．3％。2眼经前房冲洗吸收，1眼经玻璃体腔灌洗吸收。结论：持续性出血是增殖性糖尿病玻璃体视网膜病变玻璃体切割术后早期的常见并发症之一。     

糖尿病视网膜病变玻璃体手术干预治疗时机探讨

目的探讨糖尿病视网膜病变（DR）增殖期不同阶段玻璃体手术干预的临床效果。方法将我院就诊的增殖期DR患者65例（90只眼）,分为增殖晚期、增殖早期,在增殖期不同阶段实施玻璃体手术。所有患者进行术前、术后的视力及眼前节记录,眼底可见者行荧光素眼底血管造影（FFA）、部分患者行三维光学相干断层扫描;术中应用高速玻璃体切割,眼内注入0．02ml曲安奈德（TA）,充分剥离新生血管膜,眼内视网膜激光光凝,如伴有裂孔及视网膜脱离,术后采用眼内气体或硅油填充,其余患者手术结束后玻璃体腔再次注入0．05ml TA。结果增殖期DR早期实施玻璃体切割术,术后可最大限度保留患者视力,术中联合应用TA,术后黄斑水肿减轻,加快视功能的恢复。结论增殖期DR患者,应及时进行玻璃体手术;对于DR早期增殖病变,玻璃体手术干预治疗可防止病变发展,有效保护患者的视功能,应做为糖尿病患者玻璃体手术适应证。     

糖尿病视网膜病变患者玻璃体样本中白细胞介素-8和肿瘤坏死因子-α水平

目的:测量糖尿病性视网膜病变(DR)行玻璃体切除术(PPV)患者玻璃体样品中白细胞介素-8(IL-8),肿瘤坏死因子-α(TNF-α)的水平,与对照组比较结果并探讨其对DR的影响。方法:将伊斯坦布尔Bilim大学眼科系的57例(57眼)DR患者和22例黄斑裂孔未伴有增生性玻璃体视网膜病变患者分为研究组和对照组。对所有79例患者行3切口,20G PPV。PPV手术眼内灌注前,用Vitrector抽吸0.5mL玻璃体样品并稀释。样品转至冷藏室,存放在-70℃。IL-8和TNF-α的测量结果用酶联免疫吸附法以pg/mL为单位计算。结果:DR患者玻璃体样本中IL-8水平[82.7891±74.08700(0.08-307.09)pg/mL]明显高于对照组患者[2.9805±3.77546(0.08-18.53)pg/mL](P<0.001)。同样,DR患者TNF-α水平[18.0007±13.90015(2.32-51.11)pg/mL]也显着高于对照组[1.7005±1.26949(0.1-5.17)pg/mL](P<0.001)。结论:在视网膜新生血管形成中起重要作用的TNF-α和作为炎症和血管生成介体的IL-8水平在DR患者玻璃体样本中明显高。     

糖尿病视网膜病变玻璃体中CTGF,SDF-1的质量浓度测定

目的:定量测定结缔组织生长因子(connective tissue growth factor,CTGF)和基质细胞衍生因子1(stromal cell-derived factor-1,SDF-1)在糖尿病视网膜病变(diabetic retinopathy,DR)患者玻璃体中的质量浓度,探讨其在糖尿病(diabetic retinopathy,DR)发病机制中的作用。方法:采用双抗体夹心酶联免疫吸附测定法(enzyme linked immunosorbent assay,ELISA)定量检测33例增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)、5例单纯型糖尿病性视网膜病变组(background diabetic retinopathy,BDR组)及5例正常对照组玻璃体中CTGF的质量浓度。结果:PDR组玻璃体中CTGF质量浓度大于对照组(P<0.01)、BDR组(P<0.01)。PDR组玻璃体中SDF-1质量浓度大于BDR组(P<0.05)。结论:SDF-1,CTGF在DR发展过程中起着一定的作用。     

A proposed new classification for diabetic retinopathy: the concept of primary and secondary vitreopathy

BACKGROUND: Many eyes with proliferative diabetic retinopathy (PDR) require vitreous surgery despite complete regression of new vessels with pan retinal laser photocoagulation (PRP). Changes in the vitreous caused by diabetes mellitus and diabetic retinopathy may continue to progress independent of laser regressed status of retinopathy. Diabetic vitreopathy can be an independent manifestation of the disease process. AIM: To examine this concept by studying the long-term behavior of the vitreous in cases of PDR regressed with PRP. MATERIALS AND METHODS: Seventy-four eyes with pure PDR (without clinically evident vitreous traction) showing fundus fluorescein angiography (FFA) proven regression of new vessels following PRP were retrospectively studied out of a total of 1380 eyes photocoagulated between March 2001 and September 2006 for PDR of varying severity. Follow-up was available from one to four years. RESULTS: Twenty-three percent of eyes showing FFA-proven regression of new vessels with laser required to undergo surgery for indications produced by vitreous traction such as recurrent vitreous hemorrhage, tractional retinal detachment, secondary rhegmatogenous retinal detachment and tractional macular edema within one to four years. CONCLUSION: Vitreous changes continued to progress despite regression of PDR in many diabetics. We identifies this as "clinical diabetic vitreopathy" and propose an expanded classification for diabetic retinopathy to signify these changes and to redefine the indications for surgery.     

VEGF在PDR中的表达及作用的研究

目的:研究增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者血液、房水、玻璃体中血管内皮生长因子(vascular endothelial growth factor,VEGF)含量的变化,探讨VEGF与PDR的关系,为抗VEGF药物治疗的给药途径及剂量等提供理论依据。方法:采用双抗体夹心酶联免疫吸附测定法定量检测无糖尿病视网膜病变(NDR)组,单纯性糖尿病视网膜病变(BDR)组,增殖性糖尿病视网膜病变(PDR)组患者和正常对照组血浆中VEGF含量,还检测PDR患者房水、玻璃体中和正常对照组房水、玻璃体中VEGF含量,并进行综合分析。试剂盒购自美国R&D公司,其质量和灵敏度相对较高。结果:PDR组房水中VEGF含量有增高趋势,但与正常对照组比较,无统计学差异(P>0.05)。PDR患者玻璃体中VEGF含量明显增高,与正常对照组比较差异非常显著(P<0.01)。PDR组自身血浆、房水、玻璃体中VEGF含量比较有逐渐增高趋势,三者之间有显著性差异(P<0.01)。正常对照组血浆、房水、玻璃体中VEGF含量三者之间无显著性差异(P>0.05)。血浆VEGF含量在正常对照组中最高,而玻璃体中VEGF含量在PDR患者中最高。结论:PDR患者眼内尤其是玻璃体中VEGF含量大幅度增高,可能对促进DR发展恶化起了关键性的作用。在正常人,VEGF更多地存在于血浆中发挥其生物学效应。在严重DR患者中,玻璃体中异常地出现大量VEGF,推测来自缺血缺氧的视网膜,并可能有向眼前段扩散的趋势。     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.     

2型糖尿病视网膜病变与糖尿病其他并发症的相关性

目的：探讨2型糖尿病视网膜病变（ diabetic retinopathy, DR）与糖尿病的全身并发症的相关性。方法：分析2型糖尿病住院患者702例,将其分为NDR组、DR组两组,DR组又分为非增生性糖尿病视网膜病变（non－proliferative diabetic retinopathy,NPDR）组和增生性糖尿病视网膜病变（ proliferative diabetic retinopathy, PDR）组,分析DR与糖尿病大血管并发症、糖尿病肾病（ diabetic nephropathy, DN ）、糖尿病周围神经病变（ diabetic peripheral neuropathy,DPN）,糖尿病周围血管性疾病（ peripheral vascular disease of diabetes mellitus, PVD）、糖尿病足（ diabetic foot,DF）、糖尿病酮症酸中毒（ diabetic ketoacidosis,DKA）等糖尿病并发症的相关性。结果：DR的发生、发展与高血压、高血脂、颈部血管硬化、斑块,下肢动脉硬化、斑块, DN、DPN、DF及PVD等并发症有关。 PDR与高血压、DPN关系密切。结论：血管内皮损伤、微循环障碍是DR及糖尿病的全身大、小血管并发症的共同病理基础。糖尿病患者出现全身并发症时,DR的患病率增加,尤其是合并高血压、DPN时,PDR的患病率增加。所以糖尿病患者尤其是出现全身并发症者必需定期行眼底检查,以早期发现、早期治疗DR,降低致盲率。     

增殖性糖尿病视网膜病变玻璃体中PEDF的定量分析

目的:定量测定色素上皮细胞衍生因子(PEDF)在增殖性糖尿病视网膜病变(PDR))患者玻璃体中的质量浓度,探讨其在PDR发病机制中的作用。方法:采用双抗体夹心酶联免疫吸附测定法定量检测26例PDR、5例NPDR及7例对照组患者玻璃体中PEDF的质量浓度。结果:PDR组玻璃体中PEDF质量浓度小于对照组(P<0.05)及NPDR组(P<0.01)。PDR组中Ⅵ期患者玻璃体中PEDF质量浓度小于IV期(P<0.05)及V期(P<0.05)。结论:PDR患者玻璃体中PEDF降低,PEDF降低可能与视网膜新生血管的形成有关,其在PDR发展过程中起着重要作用。     

Neovascular glaucoma and vitreous hemorrhage following cataract surgery in patients with diabetes mellitus

The potential complications of cataract surgery in the general population are well known. In addition, cataract extraction in the patient with diabetes mellitus is associated with other potential complications common to this disease: neovascular glaucoma and acceleration of proliferative diabetic retinopathy with or without vitreous hemorrhage. We analyzed the records of 154 patients with diabetes mellitus who had undergone standard intracapsular cataract extraction in one eye only with the other eye serving as the unoperated control eye. We were able to determine the status of the diabetic retinopathy before the operation and to note the development of vitreous hemorrhage and rubeosis iridis/neovascular glaucoma after the operation. If either event occurred within six weeks of the surgery, it was considered to be a complication of the cataract extraction. Intracapsular cataract extraction in this diabetic population, without regard of the preoperative status of the retinopathy, was associated with a statistically significant incidence of postoperative rubeosis iridis/neovascular glaucoma (7.8% vs 0%). In patients with preoperative active proliferative diabetic retinopathy, the risk of developing postoperative rubeosis iridis/neovascular glaucoma was even higher (40% vs 0%). There was also a statistically significant incidence of vitreous hemorrhage after surgery in eyes with no diabetic retinopathy or background diabetic retinopathy (6.5% vs 0%). In patients with active proliferative diabetic retinopathy, there was an increased incidence of vitreous hemorrhage after surgery (20% vs 6.5%), but this was not statistically significant due to the small number of patients studied. Possible explanations for these findings are explored and therapeutic and prophylactic measures recommended.     

All-trans retinoic acid increases ARPE-19 cell apoptosis via activation of reactive oxygen species and endoplasmic reticulum stress pathways

AIM: To explore the apoptosis of ARPE-19 cells after the treatment with different doses of all-trans-retinoic acid (ATRA). METHODS: ARPE-19 cells were used in the in-vitro experiment. Flow cytometry assay was employed to evaluate the level of reactive oxygen species (ROS) and apoptosis. The effects of ATRA (concentrations from 2.5 to 20 μmol/L) on the expression of endoplasmic reticulum stress (ERS) markers in vitro were evaluated by Western blot and real-time quantitative polymerase chain reaction (qRT-PCR) assays. The contribution of ROS and ERS-induced apoptosis in vitro was determined by using N-acetyl-L-cysteine (NAC) and Salubrinal, an antagonist of NAC and ERS, respectively. RESULTS: Flow cytometry showed that ATRA significantly increased ARPE-19 cell apoptosis and ROS levels in each group (F=86.39, P<0.001; F=116.839, P<0.001). Western blot and qRT-PCR revealed that levels of CHOP and BIP were elevated in a concentration-dependent pattern after the cells were incubated with ATRA (2.5-20 μmol/L). The upregulation of VEGF-A and CHOP induced by ATRA could be inhibited by NAC (antioxidant) and Salubrinal (ERS inhibitor) in vitro. CONCLUSION: ATRA induces the apoptosis of ARPE-19 cells via activated ROS and ERS signaling pathways.     

糖尿病视网膜病变患者玻璃体中肝细胞生长因子的含量检测

目的 定量研究肝细胞生长因子(hepatocyte growth factor, HGF)在糖尿病视网膜病变(diabetic retinopathy, DR)患者玻璃体中的水平，探讨HGF在增生性糖尿病视网膜病变 (proliferative diabetic retinopathy, PDR)等新生血管形成病理过程中的作用。 方法 采用双夹心酶联免疫吸附测定法检测对照组10只眼玻璃体以及单纯型DR组7只眼、PDR组33只眼和其它与新生血管生成有关的视网膜疾病组8只眼玻璃体切割手术中所取玻璃体内HGF的含量。PDR组中无虹膜新生血管者24只眼，伴虹膜新生血管者9只眼。 结果 玻璃体中HGF的含量对照组为（3.34±1.9）μg/L；单纯型DR组为（4.8±2.5）μg/L；PDR组中不伴虹膜新生血管生成者为（13.0±5.2）μg/L；PDR伴有虹膜新生血管生成者为（18.6±7.2）μg/L，其它与新生血管生成有关的视网膜疾病组为（12.1±8.9）μg/L。PDR组和其它与新生血管生成有关的视网膜疾病组玻璃体中HGF的含量比对照组显著升高(t=6.49, 5.70, 3.01, P<0.01)；PDR组中伴有虹膜新生血管生成者较PDR不伴虹膜新生血管生成者以及单纯型DR组玻璃体中HGF的含量均高，其差异有显著性意义(t=2.47, P<0.05或t=4.84, P<0.01)。 结论 在PDR和与新生血管生成有关的视网膜疾病患眼玻璃体内HGF的含量升高，提示HGF可能在视网膜新生血管生成的病理过程中起一定作用。 (中华眼底病杂志, 2002, 18: 131-13)     

Clinical correlation of diabetic retinopathy with nephropathy and neuropathy

Purpose:To evaluate the presence of nephropathy and neuropathy in patients with diabetic retinopathy (DR) and to correlate the severity of DR to that of diabetic nephropathy and diabetic neuropathy.Methods:This prospective noninterventional hospital-based study included 57 consecutive cases of DR of either sex, presenting to the eye OPD between January 2019 and November 2020 with minimum 5-year duration of Type 1 and 2 DM. Complete ophthalmic examination was done and DR was classified according to early treatment diabetic retinopathy study classification. Severity of diabetic nephropathy was based on urine albumin creatinine ratio and estimated glomerular filtration rate. Severity of diabetic neuropathy was based on nerve conduction velocity.Results:The study was conducted on 57 patients of whom patients 45 were males and 12 were females. Mild nonproliferative diabetic retinopathy was present in 22 patients, moderate in 14 patients, severe in 18 patients, and proliferative diabetic retinopathy in 3 patients. In our study, group 30 patients of DR presented without clinically significant macular edema (CSME) and 27 patients presented with CSME. The distribution of severity of DR according to CSME was observed to be statistically significant (P<<0.05). The association of severity of DR with severity of diabetic nephropathy was observed to be statistically significant (P<<0.05). The association of severity of DR with that of diabetic neuropathy was inconclusive.Conclusion:The association of severity of DR with severity of diabetic nephropathy and diabetic neuropathy can be used as a marker for future chronic kidney diseases progression and also to prognosticate neurological outcomes in diabetic patients.