Diabetic complication is comprised of a wide variety of pathophysiological factors involving proinflammatory cytokines, adipokines, and oxidative stress, among others. Each of these complications differs in their incidence and the stage of their occurrence. We examined cytokines and stress markers in 48 patients with type 2 diabetes mellitus and compared the difference of their contribution to pathogenesis between nephropathy and other diabetic complications. Hemoglobin A1c correlated with the level of low-density lipoprotein-cholesterol, and significantly elevated in the severe macroangiopathy group. Cystatin C increased in the severe microangiopathy groups but did not increase in the macroangiopathy group. The levels of interleukin 18 (IL-18), high-sensitive CRP (H-CRP), liver-type fatty acid binding protein, and 8-hydroxy-2-deoxyguanosine increased in the severe microangiopathy group. These data suggest the participation of proinflammatory signaling and oxidative stress in the progression of microangiopathy. In particular, IL-18 and H-CRP were significantly elevated only in the severe nephropathy group but did not significantly elevate in other complications. These data suggest another effect of IL-18 on glomerulus in addition to its proinflammatory effect. In conclusion, we propose that IL18 has a specific role that contributes more closely to the progression of diabetic nephropathy than other diabetic complications.

BackgroundWe classified iatrogenic retinal break formation during 20-gauge pars plana vitrectomy for proliferative diabetic retinopathy into three types according to the mechanism of development, and evaluated the association of each type with postoperative complications. This is the largest series of such patients published to date.MethodsThis was a retrospective comparative study of 760 eyes from 609 cases who underwent primary 20-gauge vitrectomy for proliferative diabetic retinopathy and were followed-up for at least 6 months after surgery. Postoperatively, the eyes were classified as having vitreous hemorrhage only (group 1), fibrovascular membrane without traction retinal detachment (group 2), or fibrovascular membrane with traction retinal detachment (group 3).ResultsThe overall incidence of iatrogenic retinal breaks was 29%. Fibrovascular membrane dissection was associated with retinal break formation in 50 of the eyes in group 3, an incidence which was significantly higher than that in group 2 (P < 0.001). Posterior vitreous detachment creation and peripheral vitreous shaving were associated with retinal break formation in 8% of eyes overall, and oral dialysis occurred in 2%. Postoperatively, vitreous hemorrhage requiring washout, neovascular glaucoma, recurrent retinal detachments, and fibrovascular proliferation at the sclerotomy sites occurred in 4%, 4%, 3%, and 1%, respectively, of all eyes. Outcomes of eyes with these postoperative complications, other than vitreous hemorrhage, were poor. Multiple regression analysis revealed retinal break formation during fibrovascular membrane dissection to be significantly related to postoperative vitreous hemorrhage (P = 0.019), recurrent retinal detachments (P < 0.001), and neovascular glaucoma (P = 0.048). Oral dialysis was also significantly related to postoperative vitreous hemorrhage (P = 0.001).ConclusionIatrogenic retinal break formation during fibrovascular membrane dissection was more likely to be the cause of poor outcomes than peripheral retinal breaks or oral dialysis.

Visual acuity improved with vitrectomy for diabetic cystoid macular edema in both groups. ILM peeling was not found to improve visual acuity postoperatively.

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We conclude that the level of sIL-6R in vitreous fluid can be considered as a biomarker of PDR.