Прогрессирование Начальной Диабетической Ретинопатии: Связь С состоянием Углеводного Обмена

Abstract

Background. Recognizing the early stages of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) and predicting their progression is important and is an urgent challenge of modern ophthalmology. The study aimed at investigating the peculiarities of occurrence and progression of DR initial studies and establishing its relationship with the severity of carbohydrate metabolism disorders in patients with T2DM. Materials and methods. We examined 91 patients (182 eyes) with T2DM. Based on the ETDRS system of clinical signs Airlie House, there were determined the microaneurysms (MA), microhemorrhages (MH), intraretinal microvascular anomalies (IRMA), retinal venous anomalies, retina nonperfusion, and their relationship with the severity of carbohydrate dysmetabolism in T2DM patients. Results. Most patients (72.5 %) had no retinopathy at the start of the study (ETDRS level was 0–10 in both eyes). The rest (27.5 %) had the ETDRS level 10 in one eye, while the other showed single changes in the caliber of blood vessels, dilatation, and tortuosity of the veins, IRMA or MH, which corresponded to the ETDRS level 14/15. In these patients, the duration of T2DM was longer (on average by 3 years), and the carbohydrate disorders were more pronounced. During one year of observation, eye changes progressed in different ways: in the absence of DR at the beginning of the study, progression was noted in 50.0 % of cases, while in their presence — in 92.0 %. The patients with progression had a longer history of diabetes and worse indicators of carbohydrate metabolism. Conclusions. It has been established that diabetic changes in the retina begin from a single vascular injury. With its presence within one year, DR develops in most cases.