High HbA1c level was the most important factor associated with prevalence of diabetic retinopathy in Taiwanese type II diabetic patients with a fixed duration.

BACKGROUND: To identify the prevalence and related risk factors for diabetic retinopathy (DR) in non-insulin dependent diabetes in Taiwan. METHODS: A retrospective review of type II diabetic patients in the Diabetes Shared Care System database of our Hospital enrolled from 2002 to 2009. A retinopathy severity score was assigned according to fundus examination by indirect ophthalmoscopy or binocular biomicroscopy. RESULTS: Data was collected on 901 subjects, 497 males and 404 females. Of these, 230 (25.53 %) had DR at enrolment. Compared with patients without DR, those with DR were more likely to be female (p = 0.03) or have higher HbA1c (p < 0.001), longer duration of diabetes (p < 0.001), hypertension (p < 0.001), higher systolic blood pressure (p < 0.001), higher diastolic blood pressure (p = 0.05), as well as impaired renal function (p = 0.001). In subgroup analysis stratified by diabetes duration, HbA1c was the most consistent independent risk factor associated to the prevalence of DR. Higher systolic blood pressure and female sex were significantly independent risk factors only in patients with a duration of diabetes < 4 years. On the contrary, old onset age showed a protective effect against DR only in those with a disease duration > 8 years. CONCLUSIONS: High HbA1c level was the most important factor associated with prevalence of DR in Taiwanese type II DM patients with a fixed duration.

Analysis of factors correlated with the development of pseudophakic retinal detachment--a long-term study in a single medical center.

BACKGROUND: To analyze the possible factors correlated with the development of retinal detachment (RD) after cataract extraction and intraocular lens (IOL) implantation in a single medical center. METHODS: We performed a retrospective chart review of patients receiving cataract extraction and posterior chamber IOL implantation from January 2000 to June 2010 at one medical center. We analyzed demographic characteristics, medical history, axial length (AL), operation method, intraoperative and postoperative complications, Nd-YAG posterior capsulotomy and records for RD. RESULTS: The 9,184 patients analyzed included 6,464 males and 2,720 females, mean age 71.8 ± 9.1 years. The cumulative 7-year RD rate was 0.84 %. Young age, long axial length and intraoperative complications were significantly associated with the risk of pseudophakic RD. Although not a statistically significant factor for the whole group, Nd-YAG posterior capsulotomy represented a significant risk in those with high myopia stratified by axial length. In moderate myopic group, both intra-operative complication and Nd-YAG posterior capsulotomy showed more tendencies to increase risk of RD, but only intra-operative complication had significant difference. CONCLUSIONS: Young age, myopia and intra-operative complications were significant risk factors for the development of RD after cataract extraction and IOL implantation. Post-operative Nd-YAG posterior capsulotomy led to more risk for pseudophakic RD in myopic eyes, especially high myopia. The risk of pseudophakic RD should be considered before deciding to perform cataract extraction and the following capsulotomy in myopic eyes, particularly those for refractive indication in young patients.

Ocular sarcoidosis and tuberculous lymphadenopathy: coincidence or real association.

Tuberculosis and sarcoidosis share similarity in histopathologic findings and clinically occur in association with each other occasionally. Tuberculosis should always be ruled out before the diagnosis of sarcoidosis. But, the diagnosis is often complicated, especially in extrapulmonary cases. Here we present a case of bilateral vitreous hemorrhage with uveitis. Ocular sarcoidosis was initially diagnosed based on the characteristic ocular findings, negative results on chest radiography, tuberculosis culture, and polymerase chain reaction of aqueous, as well as simultaneous presence of panda and lambda sign on gallium-67 scans. The ocular condition improved after pars plana vitrectomy and systemic steroid therapy. However, TB lymphadenopathy but no recurrent ocular inflammation was found 6 years later. The patient received anti-TB treatment for 6 months thereafter. The eyes remained silent except cataract progression and glaucoma under two medications during this period. In conclusion, TB could occur coincidently or in association with sarcoidosis, continued follow-up is important for patients with ocular sarcoidosis.