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<p><b>BACKGROUND</b>The various risk factors for retinal hard exudates are still poorly understood in type 2 diabetic patients. The aim of this study was to determine the association between urinary albumin excretion rate (UAER) and hard exudates in macular region in north Chinese patients.</p><p><b>METHODS</b>A total of 272 patients (272 eyes) were enrolled for this study, including 154 subjects from group 1 (mild hard exudates), 91 subjects from group 2 (moderate hard exudates) and 27 subjects from group 3 (severe hard exudates) confirmed using colour fundus photography, optical coherence tomography (OCT) as well as slit-lamp biomicroscopy with 78 diopter (D) lens. Each participant underwent a comprehensive assessment that included biochemical, clinical characteristics test and detailed ophthalmic evaluation. One-way analysis of variance (ANOVA) test and chi-square test were performed to analyze the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), full blood counts, urinary albumin excretion rate (UAER), blood creatinine (CREA), duration of diabetes, body mass index (BMI), systolic blood pressures (SBP) and diastolic blood pressures (DBP) between groups. Ordinal logistic regression analysis was further performed in order to eliminating the possible confounding factors.</p><p><b>RESULTS</b>Three groups were matched in terms of age and gender. Risk factors which showed significant difference between groups include FBG (P < 0.001), HbA1c (P < 0.001), LDL (P < 0.001), UAER (P < 0.001), duration of diabetes (P = 0.001), TC (P = 0.005), SBP (P = 0.026), CREA (P = 0.004) and haemoglobin (Hb) (P = 0.012). There was no significant difference between groups for the TG, HDL, DBP, platelet, total white blood cells and BMI. Using ordinal Logistic regression analyses, of all the variables, HbA1c, LDL and UAER which were independent risk factor for hard exudates showed a significantly odds ratio of 1.25, 3.07, and 1.39, respectively. There were also significant differences in UAER level between patients with mild, moderate, severe hard exudates groups (P < 0.001).</p><p><b>CONCLUSIONS</b>UAER was an independent risk factor associated with retinal hard exudates in macular region in type 2 diabetic patients. This study highlights the need for close monitoring and fundus examination for hard exudates in patients with elevated UAER to prevent irreversible visual loss.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Albuminuria , Diabetes Mellitus, Type 2 , Urine , Macular Edema , Urine , Retrospective Studies , Risk FactorsABSTRACT
The corticosteroids are the first-line therapeutical agents for non-infectious uveitis patients, but systemic corticosteroids are ineffective for some chronic or recurrent patients, and have many long term usage-related side effects; these patients may need treatment of immunosuppressive agents and/or biologic agents. However, the mechanism, indication, efficacy and side-effects of each type of the immunosuppressive agents or biologic agents are not identical. In clinical practice, we should use different and sensitive immunosuppressive agents or biologic agents for different types of uveitis, and watch their efficacy and toxic effects closely. In order to improve the effectiveness of the treatment, the classification,efficacy and existing concerns of commonly used uveitis drugs need to be further clarified.
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Objective To examine the levels of interferon-γ(INF-γ).tumor necrosis factor-α (TNF-α)and interleukin-6(IL-6)in serum of patients with acute uveitis before and after treatment,and to explore the possible roles of those cytokines in the initiation and progression of the u,ieitis. Methods A series of 75 patients with acute uveitis.and 30 healthy persons from our hospital were investigated.The Ievels of INF-γ,TNF-α and IL-6 in acute phase and convalescent phase were measured by the enzymelinked immunosorbent assay. Result The serum 1evels of INF-γ,TNF-α and IL-6 in acute phase were significantly higher than that of the convalescent phase and the healthy controls(F=65.805/50.418/155.381,P=0.000).A significant negative correlation was found between the serum leveis of INF-γ,TNF-α and IL-6 in acute phase with their initiaI visual acuity(r=-0.656,-0.592 and-0.653,P＜O.01).There was also a positive correlation among the serum levels of INF-γ,TNF-α and IL-6(r=0.340,0.467 and 0.338,P＜0.05). Conclusions There are high serum levels of INF-γ,TNF-α and IL-6 in patients with acute uveitis,and the cytokines levels were decreased after the treatment.The results suggested that the INF-γ,TNF-α and IL-6 involved in initiation and progression of uveitis.
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Objective To observe the clinical features,the complications and treatment effects of intermediate uveitis. Methods The clinical data of 36 patients(66 eyes)with intermediate uveitis were retrospectively analyzed,including the clinical features,fundus fluorescein angiography(FFA)features,complications,treatment effects and prognosis.The patients,21 males and 15 females,aged from 8 to 70 years,with the mean age of 34.8 years.There were 30 eases with bilateral lesions and 6 cases with unilateral lesions. Results The main clinical manifestation were vitreous opacity.peripheral retinal venous lesions,optic disc edema,macular edema and posterior subcapsular cataract.The results of FFA showed that peripheral retinal venous lesions,optic disc hyperfluorescence,cystoid maeular edema and retinal vein staining.After the treatment.the visual acuity of 31 cases(60 eyes,90.9%)were improved,4 cases(5 eyes,7.6%)were stable and 1 case(1 eye,1.5%)was worsening.The main complications were cystoid macular edema,posterior subcapsular cataract and vitreous hemorrhage which Ieads to visual damage. Conelusions Intermediate uveitis was a common bilateral and chronic progressive intraocular inflammation,the anterior vitritis,pars plana and peripheral retinal vascular changes were mainly involved.Early diagnosis and proper treatment may prevent the permanent visual damage.
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Objective To evaluate the clinical characters of retinal arterial macoraneurysms. Methods The routine eye examination and fundus fluorescein angiography in 15 cases with macroraneurysms were reviewed. Results The macroaneurysms in the first,second and third bifurcation were 6,7 and 2 cases respectively.The macroaneurysms in the superio temporal and inferio temporal artery were 4 and 10 cases respectively.There was on case in both superio and inferio temporal artery.The number of macroaneurysms was single in unitary form were 13 cases.The diameter of the macroaneurysms were between 250～500 ?m. Conclusions The FFA is helpful in diagnosis of macroaneurysms,and treatmnet of laser photocoagulation for the bleeding endangering the macular area.
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Objective The retrospective case-control study was applied to investigate the crossing characteristics and the distance between the disc and the first crossing site in super-temporal branch retinal vein obstruction.Methods Fifty-three cases of branch retinal vein obstruction and 53 cases of controls were collected to observe the artery-vein crossing characteristics and to measure the distance between the disc and the first crossing site.Results The average distances of super-temporal and infer-temporal branch in case group were significantly different. The distance of the super-temporal branch in case group was significantly different from that in the control group. The distances of the super-temporal branch and infer-temporal branch were not significantly different in control group. The numbers of the arteries over the veins in the super-temporal branch in case and control group were significantly different. Conclusion The mechanism of super-temporal branch retinal vein obstruction is related with the near distance between the disc and the first crossing, and is also related with the numbers of the arteries over the veins in the crossing site.
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Objective To explore the clinical characters and distributions of the endogenous uveitis.Methods Both clinical examinations and immunologic investigations were performed in 354 patients with cases of uveitis within six years.Results Among 354 uveitis, the anterior uveitis were 165 cases(46.6%), the posterior uveitis 118 cases (33.3%),the pan-uveitis 57 cases(16.1%) and the intermediate uveitis 14 cases(4.0%). The blind rate among the patients was 5.9%, the main causes were proliferative retinopathy, secondary glaucoma and complicated cataract. 167 cases(47.2%)of patients were related to the systemic changes, the bone-joints disease, Vogt-Koyanagi-Harada syndrome, Behcet syndrome and toxoplasma infection were common.Conclusion Complete clinical and immunologic examinations can ensure the defined diagnosis and proper treatment for the patients with endogenous uveitis.
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Objective To explore the clinical manifestations and the characteristics of images of indocyanine green angiography (ICGA) and fundus fluorescein angiography(FFA) of multifocal choroiditis. Methods Eight patients (10 eyes) with multifocal choroiditis were gathered. The clinical manifestations and the images of ICGA and FFA were analyzed. Results Foci of multifocal choroiditis were found in posterior pole and peripheral areas of ocular fundi of all of the 10 eyes. The images of ICGA revealed hypofluorescence in focal area. The images of FFA showed hypofluorescence at the early phase and fluorescein leakage at the late phase in the active focus, and fluorescein staining and window defect fluorescence in the inactive focus. Conclusions The clinical manifestations of multifocal choroiditis varied with disease course, location and numbers of the lesions. ICGA and FFA can show the development of the disease clearly, which may guide the treatment.