This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Diabetic Retinopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Conceição L. Lobo, MD, MSc; Rui C. Bernardes, MSc; J. R. Faria de Abreu, MD, PhD; José G. Cunha-Vaz, MD, PhD

Arch Ophthalmol. 2001;119:1469-1474.

Objective  To examine the 1-year alterations of the blood-retinal barrier and changes in retinal thickness occurring in the macular region in patients with type 2 diabetes mellitus and mild nonproliferative retinopathy.

Methods  We classified 12 eyes of 12 patients with type 2 diabetes mellitus and mild nonproliferative retinopathy by 7-field stereoscopic fundus photography, levels 20 and 35 of Wisconsin grading, and examined them 3 times, at 6-month intervals, by fluorescein angiography, retinal leakage analyzer (RLA) (modified confocal scanning laser ophthalmoscope), and retinal thickness analyzer. The maps of retinal leakage and retinal thickness were aligned and integrated into one image. Data from the group of individuals with diabetes were compared with those from a healthy control population (n = 14; mean age, 48 years; age range, 42-55 years) to establish reference maps for the RLA and the retinal thickness analyzer.

Results  Areas of abnormally increased fluorescein sodium leakage and increased thickness were detected in all eyes examined at baseline. The sites of increased fluorescein leakage reached values as high as 483% above normal, but in 10 of the total 36 examinations performed, fluorescein leakage returned to normal levels. A statistically significant correlation was found between changes in hemoglobin A_1c values and variations in percentage of abnormal fluorescein leakage between the 6- and 12-month examinations (P<.001). When comparing the RLA-leaking sites among the 3 examinations, a good correlation was seen among the location of these sites of maximum leakage, but there was a clear fluctuation in the percentage of increases. A correlation was noted between the location of the RLA-leaking sites and the location of areas of increased retinal thickness in subsequent examinations, either 6 or 12 months later. Microaneurysms showed relatively little leakage and leaked progressively less in successive examinations.

Conclusions  The dominant alteration in the retina of patients with type 2 diabetes mellitus and mild nonproliferative retinopathy is the presence of RLA-leaking sites, indicating spotty retinal vascular damage characterized by alteration of the blood-retinal barrier. This damage appears to be reversible and directly associated with variations in glycemic metabolic control. Retinal edema appears to develop mainly as a result of retinal vascular leakage.

From the Center of Ophthalmology, University Hospital and Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra (Drs Lobo, Faria de Abreu, and Cunha-Vaz), and the Center of New Technologies for Medicine, Association for Biomedical Research and Innovation on Light and Image (Mr Bernardes), Coimbra, Portugal.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Ophthalmology Reader's Choice: Continuing Medical Education
Arch Ophthalmol. 2001;119(10):1569-1570.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Increased-Resolution OCT Thickness Mapping of the Human Macula: A Statistically Based Registration
Bernardes et al.
IOVS 2008;49:2046-2052.
ABSTRACT | FULL TEXT  

Acute orbital effects of retrobulbar injection on optic nerve head topography
Akar et al.
Br. J. Ophthalmol. 2004;88:1573-1576.
ABSTRACT | FULL TEXT  

Three-Year Follow-up Study of Blood-Retinal Barrier and Retinal Thickness Alterations in Patients With Type 2 Diabetes Mellitus and Mild Nonproliferative Diabetic Retinopathy
Lobo et al.
Arch Ophthalmol 2004;122:211-217.
ABSTRACT | FULL TEXT  

Eccentricity and measurement variability and repeatability with the retinal thickness analyser
Gilmore and Hudson
Br. J. Ophthalmol. 2004;88:62-65.
ABSTRACT | FULL TEXT  

Retinal Thickness in Eyes With Mild Nonproliferative Retinopathy in Patients With Type 2 Diabetes Mellitus: Comparison of Measurements Obtained by Retinal Thickness Analysis and Optical Coherence Tomography
Pires et al.
Arch Ophthalmol 2002;120:1301-1306.
ABSTRACT | FULL TEXT