Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation: response

Raman, Rajiv; Gupta, Aditi

doi:10.1186/1758-5996-2-20

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…This probably indicates effective medical, laser, and surgical intervention practices in place or spontaneous resolution of DR without any intervention. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Four-year incidence and progression of visual impairment in a South Indian population with diabetes

Srinivasan

Raman

Ganesan

et al. 2017

Indian J Ophthalmol

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Purpose:The aim of this study is to investigate the 4-year incidence and progression of visual impairment (VI) and the associated risk factors for incident VI in a South Indian population with type 2 diabetes.Methods:A total of 634 participants with type 2 diabetes were found eligible after 4 years. Visual acuity (VA) was estimated using the modified Early Treatment Diabetic Retinopathy Study protocol. VA in the better eye was considered for the assessment of VI based on the World Health Organization criteria. Mild VI was defined as VA <20/40 but up to 20/60, moderate VI as VA <20/60 but up to 20/200, severe VI as VA <20/200 but up to 10/200, and blindness as VA worse than 10/200.Results:The 4-year incidence of any VI, mild VI, moderate VI, severe VI, and blindness was 21.7%, 18.3%, 3.4%, 0.0%, and 0.0%, respectively; of the 13 participants with VI at baseline, 12 (92%) showed worsening/progression of VI on follow-up. Multiple logistic regression showed that nuclear cataract of grades >4.0 (odds ratio [OR]: 2.612 [1.148–5.942], P = 0.022) and lower socioeconomic score (OR: 0.965 [95% confidence interval, (0.933-0.998)], P = 0.040) were associated with the risk of future incident VI. Refractive error (47%) and cataract (30%) were identified as the leading causes of incident VI at follow-up.Conclusions:VI seems to be a significant problem among diabetic participants in the South Indian population. Refractive error and cataract are the leading but treatable causes of incident VI in this population and would benefit from intervention.

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“…This probably indicates effective medical, laser, and surgical intervention practices in place or spontaneous resolution of DR without any intervention. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Four-year incidence and progression of visual impairment in a South Indian population with diabetes

Srinivasan

Raman

Ganesan

et al. 2017

Indian J Ophthalmol

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“…low lipid levels, hypogonadism, growth hormone deficiency, reduced IGF-1 levels, high myopia, raised intraocular pressure and moderate carotid stenosis. 34 – 41 …”

Section: Discussionmentioning

confidence: 99%

Does Insulin Like Growth Factor-1 (Igf-1) Deficiency Have a “Protective” Role in the Development of Diabetic Retinopathy in Thalassemia Major Patients?

Sanctis¹,

Incorvaia

Soliman

et al. 2015

Mediterr J Hematol Infect Dis

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RationaleBoth insulin and IGF-1 have been implicated in the control of retinal endothelial cell growth, neovascularization and diabetic retinopathy. Recent findings have established an essential role for IGF-1 in angiogenesis and demonstrated a new target for control of retinopathy that explains why diabetic retinopathy initially increases with the onset of insulin treatmentObjectiveThis cross-sectional study was designed to give insights into relationship between Insulin-Growth-Factor 1 (IGF-1) levels and diabetic retinopathy (DR) in a sample of thalassemia major (TM) patients with insulin dependent diabetes mellitus (IDDM). This relation was not previously evaluated, despite the fact that both diseases co-exist in the same patient. The study also describes the clinical and biochemical profile of the associated complications in TM patients with and without IDDM.DesignA population-based cross-sectional study.ParticipantsThe study includes 19 consecutive TM patients with IDDM and 31 age- and sex-matched TM patients without IDDM who visited our out-patient clinics for an endocrine assessmentMethodsAn extensive medical history, with data on associated complications and current medications, was obtained. Blood samples were drawn in the morning after an overnight fast to measure the serum concentrations of IGF-1, glucose, fructosamine, free thyroxine (FT4), thyrotropin (TSH) and biochemical analysis. Serologic screening assays for hepatitis C virus seropositivity (HCVab and HCV-RNA) were also evaluated; applying routine laboratory methods. Plasma total IGF-1 was measured by a chemiluminescent immunometric assay (CLIA) method. Ophthalmology evaluation was done by the same researcher using stereoscopic fundus biomicroscopy through dilated pupils. DR was graded using the scale developed by the Global Diabetic Retinopathy Group. Iron stores were assessed by direct and indirect methods.ResultsEighteen TM patients with IDDM (94.7 %) and ten non-diabetic patients (32.2 %) had IGF-1 levels below the 2.5th percentile of the normal values for the Italian population. The mean serum IGF-1 concentrations were significantly lower in the diabetic versus the non-diabetic TM groups (p < 0.001). DR was present in 4 (21 %) of 19 TM patients with IDDM and was associated with the main classical risk factors, namely inefficient glycemic control and duration of the disease but not hypertension. Using the scale developed by the Global Diabetic Retinopathy Group, the DR in our patients was classified as non proliferative diabetic retinopathy (NPDR). Only a few numbers of microaneurysms [1–3] were detected. Our data also confirm the strong association of IDDM in TM patients with other endocrine and non-endocrine complications.

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“…Some studies have shown that patient characteristics such as age, type of diabetes control and HbA1C levels, in the pre-treatment, treatment and post-treatment period could affect the response to medications used for treatment of diabetic retinopathy (DR). [ 23 24 25 26 ] Furthermore, other studies have reported the effect of genetic factors and other patient characteristics on the response to intravitreal ranibizumab therapy in age-related macular degeneration (ARMD). [ 27 28 29 ] Thus, comparing the efficacy of various DME treatment protocols, baseline and systemic individual factors should be taken into account.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation in bilateral diabetic macular edema; application of bivariate generalized linear mixed model with asymmetric random effects in a subgroup of a clinical trial

Yaseri

Zeraati

Mohammad

et al. 2014

J Ophthalmic Vis Res

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Purpose:To compare the efficacy of intravitreal bevacizumab (IVB) injection alone or with intravitreal triamcinolone acetonide (IVB/IVT) versus macular photocoagulation (MPC) in bilateral diabetic macular edema (DME).Methods:In this study we revisited data from a subset of subjects previously enrolled in a randomized clinical trial. The original study included 150 eyes randomized to three treatment arms: 1.25 mg IVB alone, combined injection of 1.25 mg IVB and 2 mg IVT, and focal or modified grid MPC. To eliminate the possible effects of systemic confounders, we selected fellow eyes of bilaterally treated subjects who had undergone different treatments; eventually 30 eyes of 15 patients were re-evaluated at baseline, 6, 12, 18, and 24 months. Using mixed model analysis, we compared the treatment protocols regarding visual acuity (VA) and central macular thickness (CMT).Results:Improvement in VA in the IVB group was significantly greater compared to MPC at months 6 and 12 (P = 0.037 and P = 0.035, respectively) but this difference did not persist thereafter up to 24 months. Other levels of VA were comparable at different follow-up intervals (all P > 0.05). The only significant difference in CMT was observed in favor of the IVB group as compared to IVB/IVT group at 24 months (P = 0.048).Conclusion:Overall VA was superior in IVB group as compared to MPC up to 12 months. Although the IVB group showed superiority regarding CMT reduction over 24 months as compared to IVB/IVT group, it was comparable to the MPC group through the same period of follow up.

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Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation: response

Cited by 3 publications

References 8 publications

Four-year incidence and progression of visual impairment in a South Indian population with diabetes

Four-year incidence and progression of visual impairment in a South Indian population with diabetes

Does Insulin Like Growth Factor-1 (Igf-1) Deficiency Have a “Protective” Role in the Development of Diabetic Retinopathy in Thalassemia Major Patients?

Intravitreal bevacizumab injection alone or combined with triamcinolone versus macular photocoagulation in bilateral diabetic macular edema; application of bivariate generalized linear mixed model with asymmetric random effects in a subgroup of a clinical trial

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