The effects of glycemic control on ophthalmic refraction in diabetic patients / 中华内科杂志

ABSTRACT

Objective To evaluate effects of glycemic control on refraction in diabetic patients.Methods Twenty newly diagnosed diabetic patients were included in this study. The random blood glucose,glycosylated hemoglobin A1c( HbA1c) levels, fasting C-peptide and postprandial 2 h C-peptide levels were measured before treatment. The patients with random blood glucose ≥ 12. 0 mmol/L and HbA1c ≥ 10. 0%were selected. Refraction, intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length, and axial length were measured on admission and at the end of week 1,2, 3 and 4 during glycaemic control. Results A transient hyperopic change occurred in all the patients receiving glycemic control with a mean maximum hyperopic changes of 1.6 D ( 0. 50 D ～ 3.20 D). There was a positive correlation between the magnitude of the maximum hyperopic changes and the HbA1 c levels on admission ( r = 0.84, P ＜ 0.05 ). There was a positive correlation between the magnitude of the maximum hyperopic changes and the daily rate of blood glucose reduction over the first 7 days of the treatment ( r = 0.53, P ＜ 0.05 ). There was no significant correlation between the magnitude of the maximum hyperopic changes and the levels of random blood glucose on admission. No significant correlation was observed between the maximum hyperopic changes and fasting C-peptide or postprandial 2 h C-peptide.There were no significant correlations between the magnitude of the maximum hyperopic changes and age,blood press, body mass index, triglyceride, total cholesterol, low-density lipoprotein or high-density lipoprotein. No significant changes were observed in the intraocular pressure, radius of the anterior corneal curvature, depth of the anterior chamber, lens thickness, vitreous length and axial length during glycemic control. Conclusions Transient hyperopic changes occur after glycemic control in diabetic patients with severe hyperglycaemia. The degrees of transient hyperopia are highly dependent on HbA1c levels before treatment and the rate of reduction of glucose level over the first 7 days of treatment. This is probably due to the decrease of refractive power by lens hydration, not morphological change of lens.