Clinical study on diabetic retinopathy and its management

INTRODUCTION: Diabetes mellitus is a syndrome characterized by chronic hyperglycemia and disturbances in carbohydrate, protein and fat metabolism associated with absolute or relative deficiencies in insulin secretion or it’s action. The metabolic dysregulation associated with diabetes mellitus causes secondary pathophysiological changes in multiple organ systems that impose a tremendous burden on the individual with diabetes. AIM OF THE STUDY: 1. To study the magnitude of diabetic retinopathy in diabetic individuals with relation to age and sex of the individual and duration of diabetes. 2. To assess the possible risk factors associated with diabetic retinopathy. 3. To assess the associated systemic disorders in diabetic retinopathy. 4. To assess the relationship of the biochemical parameters like baseline lipid, fasting blood glucose and HbA1c to diabetic retinopathy. 5. To assess the incidence of maculopathy in diabetic retinopathy. 6. To assess the benefits of laser in diabetic retinopathy. MATERIALS AND METHODS: The diabetic individuals reporting or being referred to Coimbatore Medical College Hospital, Eye Department during the period of January 2006 to October 2007 were taken into the study. This included both type I and type II diabetic individuals of either sex. Pregnant women and children were excluded from the study. A total of 90 visually symptomatic diabetic patients with retinopathy were evaluated. A careful history of the patients regarding their age and sex, duration of diabetes mellitus, risk factors, associated systemic disorders like nephropathy, hypertension, coronary artery disease (CAD) and neuropathy was recorded. The nature of the treatment of diabetes was noted. Materials used 1. Snellen's visual acuity chart 2. Schiotz tonometer 3. Haag Streit / Carl Zeiss slit lamp 4. Direct ophthalmoscope 5. Indirect ophthalmoscope 6. Goldmann three mirror, +78D and 90D lens 7. Topcon fundus camera The diabetics attending the Eye department, Coimbatore Medical College Hospital, from January 2006 to October 2007 are enrolled and studied for the pattern of presentation of diabetic retinopathy. 270 diabetics attended the OPD of whom 90 diabetics had diabetic retinopathy were studied. SUMMARY: Diabetic retinopathy more commonly presented in 51-60 years and a significant number occurred in the next decade (61-70 years). Males were commonly affected with diabetic retinopathy than females. Most of the individuals with the PDR had a positive family history of diabetes. There is an increased risk of proliferative changes in individuals with a positive history. CONCLUSION: •Diabetic retinopathy is more common after 50 years of age. •There is a preponderance of males for diabetic retinopathy. •Individuals having positive family of diabetes have progressive and severe retinopathy changes. •33% of individuals had retinopathy and among them NPDR is the most common form of retinopathy. •Increased duration of diabetes is associated with increased risk of developing retinopathy. •Abnormal level of lipids, abnormal fasting blood glucose and HbA1c and elevated blood pressure are important risk factors of diabetic retinopathy. •Diabetic retinopathy causes a morbid decrease in vision. •Common complication associated is vitreous haemorrhage and common systemic disorder associated is systemic hypertension followed by nephropathy. •Periodic ocular examination in all diabetics should be carried out. •Early diagnosis of maculopathy and its early treatment with laser reduces significant visual loss. •Diabetic retinopathy is a preventable cause of blindness especially in developing countries. Timely intervention with laser treatment saves the individual from severe visual loss by controlling the progression of retinopathy