Retinal function in relation to improved glycaemic control in type 1 diabetes

Abstract

After initiation of CSII, the retinal visual pathway of the rods improved with a delay of more than 4 months, over a time scale comparable with the duration of the diabetic retinopathy early worsening response to sustained glycaemia reduction. This indicates that glycaemia has a long-term effect on the disposition of functional capacity in the retinal visual pathway of rod photoreceptors, the cells that appear to be driving the development of diabetic retinopathy.

Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus

“…17,20 Fluctuations in blood glucose may have an equally important role in predisposing individuals to the adverse outcomes associated with prolonged diabetes. 22,23 The emergence of new technology to quantify neuroretinal dysfunction and degeneration may provide an opportunity to test the hypothesis that glucose variability, in addition to sustained hyperglycemia, 36 contributes to end-organ damage from diabetes in the eye. Our finding that thinning of the INL was associated with high glucose variability complements the recent report by Jaiswal et al 23 describing decreased heart rate variability as a result of dysfunction in peripheral autonomic nerves among patients with high levels of glucose variability.…”

Baseline haemoglobin A1c influences retinal function after long-term insulin pump therapy

“…The follow-up duplicated the primary study [14] except that multifocal ERG was not performed for logistical reasons. Thus, measurements included best-corrected visual acuity (BCVA), dark adaptometry, full-field ERG, fundus photography, optical coherence tomography (OCT), arterial blood pressure, and venous blood sampling for analysis of blood haemoglobin and haemoglobin A 1c (HbA 1c ), plasma creatinine, sodium, and potassium at the laboratory of the Glostrup Hospital.…”

“…Following pupil dilation to >7 mm by topical phenylephrine hydrochloride 10 % and tropicamide 1 %, participants underwent dark adaptometry (AdaptDx, Apeliotus Technologies, Atlanta, GA) [14]. The automated test examined dark adaption kinetics in a localized area of the retina using a 2°500 nm stimulus light centred 5°below the point of fixation.…”

“…Past experience with electroretinography (ERG) and dark adaptometry suggests that these methods could be neurosensory biomarkers of diabetic retinopathy. Thus, 1 year of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) in patients with type 1 diabetes resulted in increased ERG amplitudes under scotopic conditions and accelerated dark adaptation [14]. The aim of the current pilot study was to assess the long-term effects of past metabolic control and changes in metabolic control on the retina.…”

Resolution of diabetic papillopathy after a single intravitreal injection of ranibizumab

“…The presumed mode of action of ranibizumab would involve inhibition of vascular endothelial growth factor, which led to a reduction in vascular exudation and extracellular fluid accumulation, which again led to reduced venous congestion, which led to improved perfusion and reduced retinal nerve fibre swelling and so on. The long-lasting effect of a single injection of ranibizumab suggests that habituation of the retina to improved metabolic control also may have assisted in stabilizing her condition (Holfort et al 2011). A comparable course of recovery of diabetic papillopathy after a single intravitreal injection of bevacizumab, another inhibitor of vascular endothelial growth factor, has Fig.…”