Diabetic retinopathy: association with type and duration of diabetes mellitus, mode of treatment and glycaemic control

To assess the association of Diabetic Retinopathy [DR] with type and duration of Diabetes Mellitus, mode of treatment and glycaemic control. An observational study was carried out. Patients with the diagnosis of either Type1, insulin dependent diabetes mellitus [IDDM] or Type 2, non-insulin dependent diabetes mellitus [NIDDM] were enrolled into the study through non-probability, convenient sampling method from Jinnah Medical College Hospital Karachi from July 2012 to March 2013. Thorough history and physical examination was done on each patient. Glycaemic control was assessed by glycosylated Hb level [HbAIc]. All information so collected was entered into a proforma. Data was analyzed using SPSS version 20. A total of 108 patients were examined. Out of these, 33 [30.6%] had Type 1 and 75 [69.4%] had Type 2 diabetes. In Type 1 group, 18 [54.5%] were female while in Type 2 group, 37 patients [49.3%] were female. In Type 1 group, 60.6% [n=20] had DR compared to 37.3% [n=28] in Type 2 group [p <0.005]. DR. was seen less frequently in subjects with less than five years duration in both the groups i.e. 12.6% in Type 1, and 15.7% in the Type 2 group. This increased to 100% [p<0.001] in Type 1, and 77.7% [p<0.02] in the Type 2 group with a duration of over 20 years of diabetes. In patients on insulin therapy, 60.6% in Type 1 group and 53.1% subjects in Type 2 had DR. In Type 2 group, 25.6% subjects on oral hypoglycaemics and/or diet therapy had DR. None of the subjects in both groups with HbA1c <7% had any evidence of DR. The frequency of DR. is higher in patients with Type 1, than those with Type 2, in patients receiving insulin therapy and with long duration of diabetes. Higher levels of HbA1c have clear relationship with development of DR

Interferon-induced central retinal vein thrombosis

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy

Primary pulmonary hypertension with retinal neovascularization

A middle aged lady presented with gradual increase in shortness of breath and reduced vision bilaterally. The patient had no history of Diabetes mellitus, hypertension or any other co-morbid illness. Examination revealed signs of right sided heart failure, pulmonary hypertension and neovascularization of retina. Echocardiography confirmed pulmonary hypertension and fluorescence angiography confirmed neovascularization of retina. Treatment with Sildenafil resulted in symptomatic improvement