[Contrast sensitivity and fluorescein angiography in evaluating the ocular changes in the relation to the diabetes mellitus type I compensation in young adult patients]. / Citlivost na kontrast a fluorescencní angiografie pri hodnocení ocních zmen v rámci posouzení kompenzace diabetes mellitus 1. typu u mladých dospelých pacientu.

UNLABELLED: The authors performed simultaneous contrast sensitivity examination (CS) and fluorescein angiography (FAG) in 42 patients older than 18 years of age; in 65% of them the duration of the diabetes mellitus type I (T1DM) was longer than 10 years. In these 27 patients, the diagnosis of non-prolipherative diabetic retinopathy (NPDR) was established by means of FAG in 44%, in contrast to only 19% by means of the direct ophthalmoscopy solely. The other findings (56%) were corresponding with diabetic preretinopathy (DpR) due to rare micro-aneurysms (establishes by means of FAG), and changes of the macular structure and pronounced dilation and tortuosity of the capillaries (by means of direct ophthalmoscopy). Out of the other 15 patients with T1DM duration of less than 10 years, the NPDR was established in 3 patients, and DpR confirmed in other 7 patients from the group. The authors compared the decrease in every single space frequency marked on the CS curvature for 31 eyes with NPDR and 39 eyes with DpR with the normal findings in patients without T1DM established in previous studies. Comparing NPDR with the norm, the authors found important and fundamental pathological defect of the CS (p = 0.0058). DpR comparing with the norm showed significant defect of the CS (p = 0.0197). Comparing NPDR and DpR, the difference was found in more noticeable pathological defect of the CS (p = 0.0228). The compensation of the metabolic state was evaluated from average year long values of the glycolated hemoglobin (Hb1Ac) in the last 10 years of the T1DM duration by means of DCCT method. The group of followed-up patients consisted of pairs of matched patients with NPDR and DpR of the same gender, time of beginning and duration of the metabolic disease. In the NPDR patients, the compensation was not good in 72% of this period, whereas in DpR patients the satisfactory compensation lasted for 53% of this period. During the follow up period, in NPDR the average Hb1Ac level was 8.49 +/- 0.88%, and in DpR this Hb1Ac value was 7.61 +/- 0.28%, with statistically significant difference (p = 0.0033). During the period, in DpR patients no serious complication was marked, in the NPDR group, the incipient diabetic nephropathy twice and slight diabetic neuropathy were noticed. The occasional pathological values of the microalbuminuria were not possible to correlate with beginning of the NPDR. CONCLUSION: The contrast sensitivity (CS) represents in the differential diagnosis of the NPDR and DpR a screening examination method. To specify the NPDR, the FAG is suitable and for both clinical entities specifies the extent of foveolar and perifoveolar involvement. Only the many years lasting follow up of Hb1Ac values documents the importance of long-term T1DM compensation in the prevention of pathological ocular changes development.

[The human lens' transparence changes in children, adolescents, and young adults with diabetes mellitus type I]. / Zmeny transparence cocky u detí, mladistvých a mladých dospelých s diabetes mellitus 1. typu.

Authors followed up the changes' development of the human lens' transparence in 213 children and young adult patients with diabetes mellitus type I. As initial changes of the lens' transparence they considered the posterior "Y" suture accentuation, because it was noticed in 44.4 % of lenses during the first 10 years of the metabolic disease duration, in contrast to 28.1 % representation of this dissociation in the control group of patients without diabetes (p = 0.012), and it was always markedly more often in patients with myopia. Substantial changes were detected predominantly during the sixth until the tenth year of duration of the basic disease as fine subcapsular opacities graded as first degree of lens transparency changes in 48 % of eyes. After 10 years of the disease duration, the lenses were never clear. Consequently, the changes in the transparency in the anterior subcapsular layer associated in 18 %. After 15 years of diabetes duration, we detected opacities in the anterior and posterior subcapsular layers of the lenses, graded as second degree of lenses transparence changes in 85 % of eyes. This subjective evaluating of lenses' opacity changes by means of the slit lamp examination was correlated with densitometric examination by means of Pentacam camera in a representative sample of 29 patients. In the first degree of lenses' transparence changes, the posterior subcapsular layer was affected in 50 %, and in the second degree, the opacities in this layer were found practically in 90 % of cases. False positive result in clear lenses or congenital opacities or "Y" suture was not detected. In general, the affected lens transparency did not basically influence the visual acuity and the decrease of contrast sensitivity was not statistically significant (p = 0.34). For the initial change of the lenses' transparency is also determining the patient's age at the onset of the diabetes mellitus type I. The changes are more common if the onset of the disease is after the fifteenth year of age as before that (p = 0.026). The authors also detected sporadic opacities in 4.2 % of eyes, probably of congenital origin (out of them, in two patients there was bilateral finding of the cerulean cataract) without visual acuity decrease.

Effect of successful combined renal and pancreatic transplantation on diabetic retinopathy.

UNLABELLED: The treatment of diabetic retinopathy (DR) is one of the most challenging problems in ophthalmology. The possibility of modulating DR by successful combined kidney and pancreas transplantation thus holds an attractive promise for the ophthalmologist. From June 1983 until April 1997, a total of 86 combined kidney and pancreas transplantation procedures were performed at the Prague-based Institute for Clinical and Experimental Medicine. All recipients are on close follow-up in terms of their ophthalmic status. However, evaluation of the effect of transplantation is problematic because of the advanced status of DR prior to the procedure. We divided the transplant recipients into two groups according to type of transplantation. In Group I (segmental transplantation), proliferative DR was present in 100% eyes, 70% had undergone vitrectomy, and there were 21% of blind eyes. All eyes had been treated by laser. In this group, long-term stabilization of the finding was observed in three patients. In Group II (whole pancreas transplantation), proliferative and non-proliferative DR was diagnosed in 86% and 14%, respectively. There were 12% of blind eyes, and 70% had been treated by laser prior to transplantation. After a successful transplantation, stabilization was found in 60%, improvement in 18%, and deterioration in 22% of eyes in this group. The stabilization and improvement can be explained by subsequent normoglycemia (HbAlc 5.6%). By contrast, we were unable to provide a satisfactory explanation for the deterioration and progression of these findings. While the effect of immunosuppression on DR remains unclear, it obviously accelerates the existing cataract. CONCLUSION: Successful combined transplantation has a beneficial effect on DR and is worthwhile even for patients at the end stage on account of its beneficial psychosocial effect and prevention of dolorous glaucoma. However, many effects of the procedure on the eye of diabetics remain to be identified in future studies.