PURPOSE: To compare retinal layer thickness in non-proliferative diabetic retinopathy in type 2 diabetic patients as measured by optical coherence tomography. METHODS: A total of 108 eyes from 71 patients, between January 2015 and July 2016, were included in this study. Of these, 39 eyes were included in the control group, 38 eyes in the diabetic group without non-proliferative diabetic retinopathy, and 31 eyes in the non-proliferative diabetic retinopathy group (NPDR). We measured the thickness of each retinal layer by optical coherence tomography (OCT). A total of ten layers were evaluated including the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retinal layer (IRL), outer retinal layer (ORL), and the total retinal layer (TRL). We compared the superior, inferior, nasal, and temporal regions at 1–3mm from the central fovea. RESULTS: RNFL was thinner in the superior region of the NPDR, as compared with that of the control group, showing statistical significance (p = 0.016). The thickness of all regions in the GCL, IPL, and IRL were decreased in NPDR, as compared to the control group with statistical significance. In addition, the thickness of the superior region in the GCL, IPL, and IRL showed statistically significant differences between controls and the no diabetic retinopathy (DR) group (p = 0.026, 0.003, 0.003). The thickness of the INL, OPL plus ONL, RPE, and ORL in all three groups showed no significant difference. The differences in the decreased thickness in the IRL were similar to that of TRL. CONCLUSIONS: Retinal neurodegeneration was observed in the IRL, which included changes to the RNFL, GCL, and IPL in early type 2 diabetes before microvascular injury was apparent. Thorough control of blood glucose is required in early diabetes, and further studies to delay retinal neurodegeneration are required. OCT might have an important role in early diagnosis and follow up of diabetic retinopathy.
Blood Glucose ; Diabetic Retinopathy* ; Early Diagnosis ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Nerve Fibers ; Retinal Pigment Epithelium ; Retinaldehyde* ; Temporal Lobe ; Tomography, Optical Coherence

PURPOSE: To report a case of bilateral diabetic papillopathy related to rapid hemoglobin A1c (HbA1c) decrease in a type I diabetic patient. CASE SUMMARY: A 39-year-old female who was diagnosed with type I diabetes mellitus for the first time at this hospital was presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms, including blurred vision or visual defect. Her best corrected visual acuity in both eyes was 1.0, but her fundus resembled mild nonproliferative diabetic retinopathy. When diagnosed with type I diabetes mellitus, her HbA1c was 15.3%. She used insulin to control her blood glucose and her HbA1c reached 7.3% two months after controlling the blood glucose. Three months after her diabetic diagnosis, there were no differences in subjective symptoms and best corrected visual acuity. Fundus examination showed optic disc swelling in both eyes. To evaluate for the etiology of optic disc swelling, we did the examinations of the optic disc, fundus, and brain magnetic resonance imaging. No specific signs were observed. We diagnosed diabetic papillopathy and observed the patient without any treatments. Her optic disc swelling showed gradual improvement. CONCLUSIONS: This case shows that the rapid HbA1c decrease in type I diabetes mellitus is related to the occurrence of bilateral diabetic papillopathy. This supports previous studies that estimated that the rapid HbA1c decrease in type I diabetes mellitus in response to insulin treatment is one of the risk factors for bilateral diabetic papillopathy.
Adult ; Blood Glucose ; Brain ; Diabetes Mellitus* ; Diabetic Retinopathy ; Diagnosis ; Female ; Humans ; Insulin ; Magnetic Resonance Imaging ; Risk Factors ; Visual Acuity

OBJECTIVES: Fluorescein angiography (FAG) is currently the most useful diagnostic modality for examining retinal circulation, and it is frequently used for the evaluation of patients with diabetic retinopathy, occlusive diseases, such as retinal venous and arterial occlusions, and wet macular degeneration. This paper presents a method for objectively evaluating retinal circulation by quantifying circulation-related parameters. METHODS: This method allows the semiautomatic preprocessing and registering of FAG images. The arterial input function is estimated from the registered set of FAG images using gamma-variate fitting. Then, the parameters can be computed by deconvolution on the basis of truncated singular value decomposition, and they can finally be presented as parametric color images in a combination of three colors, red, green, and blue. RESULTS: After the estimation of arterial input function, the parameters of relative blood flow and mean transit time were computed using deconvolution analysis based on truncated singular value decomposition. CONCLUSIONS: The parametric color image is helpful to interpret the status of retinal blood circulation and provides quantitative data on retina ischemia without interobserver variability. This system easily provides the status of retinal blood circulation both qualitatively and quantitatively. It also helps to standardize FAG interpretation and may contribute to network-based telemedicine systems in the future.
Biomedical Engineering ; Blood Circulation ; Capillaries* ; Diabetic Retinopathy ; Diagnosis, Computer-Assisted ; Eye Diseases ; Fluorescein Angiography ; Fluorescein* ; Humans ; Ischemia ; Observer Variation ; Ophthalmology ; Retina ; Retinaldehyde ; Telemedicine ; Wet Macular Degeneration

PURPOSE: The purpose of this study was to evaluate whether any stage of diabetic retinopathy (DR) is associated with levels of plasma erythropoietin and other plasma parameters. METHODS: It was examined a representative sample of 180 type 2 diabetes patients aged 40 to 79 years. Ophthalmic examination including a funduscopic examination, performed by an experienced ophthalmologist and the retinal finding were classified according to the grading system for diabetic retinopathy of ETDRS (Early Treatment Diabetic Retinopathy Study). It was measured the levels of plasma erythropoietin, cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, fasting blood glucose and hemoglobin A1C (HbA1C) in 88 DR patients and 92 controls without DR. Risk factors correlated with DR were compared between groups. RESULTS: The study group of 180 patients included 72 males and 108 females. The mean age of the patients with and without DR was 57.36 ± 8.87 years and 55.33 ± 8.28 years, respectively. Of the 88 patients with DR, only 9 (10%) had proliferative DR and the rest suffered from non-proliferative DR. The mean plasma levels of erythropoietin in proliferative DR group showed a significant difference in comparison to other groups. The mean plasma levels of cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, and fasting blood glucose were not significantly different in the three groups except for HbA1C. The absolute relative risk (ARR) also showed that erythropoietin was an increasing risk for proliferative DR (ARR, 1.17; 95% confidence interval, 1.060 to 1.420; odds ratio,1.060). CONCLUSIONS: Of the factors studied, erythropoietin level showed significant increase in proliferative DR group. The stepwise raised in mean plasma erythropoietin level which demonstrates significant correlation with proliferative DR versus remaining two groups, will be an indication of its role in proliferative DR.
Adult ; Aged ; Blood Glucose/metabolism ; Cholesterol/blood ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/complications ; Diabetic Retinopathy/*blood/diagnosis/*epidemiology ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin/*blood ; Female ; Fluorescein Angiography ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Male ; Middle Aged ; Risk Factors

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.
Adolescent ; Body Mass Index ; Body Weight ; C-Peptide/*blood ; Child ; Child, Preschool ; Diabetes Complications ; Diabetes Mellitus, Type 1/blood/*diagnosis ; Diabetic Ketoacidosis/epidemiology ; Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infant ; Male ; Peripheral Nervous System Diseases/epidemiology ; Retrospective Studies

PURPOSE: To report a case of a rapidly progressive endogenous endophthalmitis with subretinal abscess that involved the macula and was treated with early vitrectomy. CASE SUMMARY: A 42-year-old man with liver cirrhosis, hepatic cellular carcinoma and diabetes, who underwent regular fundus checkup for diabetic retinopathy presented with reduced vision, ocular pain in the left eye and headache. Indirect ophthalmoscopy showed subretinal abscess approximately five times the optic disc size and surrounding retinal hemorrhage in the nasal upper quadrant. A provisional diagnosis of bacterial endophthalmitis was made based on systemic disease and funduscopic findings. Treatment with topical and systemic empirical antibiotics was initiated along with intravitreal vancomycin and ceftazidime injection. Despite the treatment, after 24 hours the abscess size increased to approximately 10 times the optic disc size and began to involve the macula. The patient underwent diagnostic and therapeutic pars plana vitrectomy as well as vitreous and abscess content cultures. MRSA was found in a blood culture test. Five days postoperatively, the patient's vision and symptoms improved significantly and the residual lesion was cleared, with retinal scars. CONCLUSIONS: In a patient with endogenous endophthalmitis with subretinal abscess, presence of macular invasion and rate of progression is important in determining the time and method of operation. In this case, early vitrectomy was a good choice to preserve macular structure and the patient's visual acuity.
Abscess* ; Adult ; Anti-Bacterial Agents ; Blood ; Ceftazidime ; Diabetic Retinopathy ; Diagnosis ; Endophthalmitis* ; Headache ; Humans ; Liver Cirrhosis ; Methicillin-Resistant Staphylococcus aureus ; Ophthalmoscopy ; Retinal Hemorrhage ; Retinaldehyde ; Vancomycin ; Vision, Low ; Vision, Ocular ; Visual Acuity ; Vitrectomy

BACKGROUND/AIMS: Many studies have demonstrated an association between hemoglobin levels and cardiovascular disease in diabetic patients. The aim of this study was to determine whether there is an association between hemoglobin concentrations and various clinical parameters, including metabolic factors, plasma C-peptide response after a meal tolerance test, and microvascular complications, in Korean patients with type 2 diabetes. METHODS: In total, 337 male patients with type 2 diabetes were recruited. All subjects were subjected to a meal tolerance test and underwent assessment of hemoglobin levels, fasting and postprandial beta-cell responsiveness, and microvascular complications. RESULTS: Patients with lower hemoglobin concentrations had a longer duration of diabetes, a lower body mass index, and lower concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. They also had lower levels of postprandial C-peptide, Delta C-peptide, and postprandial beta-cell responsiveness. They had a higher prevalence of retinopathy and nephropathy. In multivariate analyses, there was a significant association between nephropathy and hemoglobin concentration. Also, hemoglobin concentrations were independently associated with Delta C-peptide levels and postprandial beta-cell responsiveness. CONCLUSIONS: Hemoglobin concentrations are associated with postprandial C-peptide responses and diabetic nephropathy in patients with type 2 diabetes.
Aged ; Biological Markers/blood ; Blood Glucose/metabolism ; C-Peptide/blood ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/*blood/diagnosis/epidemiology ; Diabetic Nephropathies/*blood/diagnosis/epidemiology ; Diabetic Retinopathy/*blood/diagnosis/epidemiology ; Hemoglobins/*metabolism ; Humans ; Insulin-Secreting Cells/metabolism ; Linear Models ; Lipids/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postprandial Period ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors

Patients with diabetes mellitus (DM) are associated with an increased risk of thrombosis, and are susceptible to a series of complications including nephropathy. It has also been known that plasma tissue factor (TF) antigen levels increase significantly in certain disease states. To investigate the clinical significance of an association with the various complications in patients with type 2 non-insulin-dependent DM (NIDDM), we measured the plasma levels of TF antigen in 63 patients (35 males and 28 females, mean age 60.8 yrs) with NIDDM and in 22 normal subjects (14 males and 8 females, mean age 56.0 yrs). The mean concentrations of TF were higher for patients with NIDDM (253.7 +/- 144.9 pg/ml) than in normal subjects (187.3 +/- 108.7 pg/ml with marginal statistical significance (p= 0.0530). The TF levels were higher for patients with a nephropathy than for patients without a nephropathy (p=0.0402). There was a significant positive correlation between levels of TF and BUN (r=0.84, p < 0.0001) or creatinine (r=0.93, p < 0.0001). However, TF levels were found to be similar for both groups with and without thrombosis, neuropathy, retinopathy, or infection. These results suggest that plasma TF antigen levels may be associated with nephropathy and they may reflect a renal dysfunction in NIDDM.
Biological Markers ; Diabetes Mellitus, Type II/*blood/*diagnosis ; Diabetic Nephropathies/blood/diagnosis ; Diabetic Retinopathy/blood/diagnosis ; Female ; Human ; Infection/blood/diagnosis ; Male ; Middle Aged ; Support, Non-U.S. Gov't ; Thromboplastin/*metabolism ; Thrombosis/blood/diagnosis

PURPOSE: Prepapillary vascular loops are blood vessels that project from the optic disc into the vitreous cavity and then return to the disc to continue their natural cource. Ninety percent are arterial in origin and usually congenital anomaly. We report four cases of prepapillary vascular loops associated with retinal and choroidal disorders. METHODS: Prepapillary vascular channel which showed twisted or ringlike appearance without leakage on fluorescein angiogram constituted the diagnosis. However, there may be a sector delay in filling of the optic disc or retina supplied by the loop due to the increased distance that blood must travel through the loop. RESULTS: These cases are not associated with vision-threatening diseases. The associated retinal diseases are diabetic retinopathy in one case, retinitis pigmentosa in one case, contralateral posterior uveitis in two cases. They are arterial loops. In two eyes were observed multiple prepapillary vascular loops. The vessels may appear as simple hairpin loops, spiral, or corkscrew configuration. In our cases, the presence of a cilioretinal artery and retinal artery obstruction could not be determined; other complication associated with prepapillary vascular loops were not observed. CONCLUSIONS: We assume that prepapillary vascular loops may occur acquiredly associated with other ocular diseases.
Arteries ; Blood Vessels ; Choroid ; Diabetic Retinopathy ; Diagnosis ; Fluorescein ; Retina ; Retinal Artery ; Retinal Diseases* ; Retinaldehyde* ; Retinitis Pigmentosa ; Uveitis, Posterior

We performed a epidemiologic study to find a prevalence and risk factors of diabetic retinopathy. We reviewed 130 diabetic patients who had been performed the fundus examination for the first time for retinopathy at the ophthalmic department of Chung Ang university hospital from March 1993 to December 1993. We studied epidemiologic work-up sheet and performed ophthalmic and laboratory examination. The patients' ages ranged from 25 to 81 years, with an average age of 58.9 years. The age, sex, intraocular pressure, fasting blood sugar, post cibos 2 hours (Pc2hrs), age of onset, residence, smoking, alcohol drinking, diet pattern, blood type, treatment method and menstruation status were not significantly correlated with prevalence of diabetic retinopathy statistically(p>0.05). But the duration of diabetes(p<0.01), glycosylated hemoglobin(HbA1C) and cataract operation(p<0.05) were significantly correlated with diabetic retinopathy statisically. The prevalence of diabetic retinopathy was 28.5%(background changes in 21.5%, preproliferative changes in 4.6% and proliferative change in 2.4%). The mean interval between diagnosis of diabetes and the first examination of retinopathy was 6.62 years.
Age of Onset ; Alcohol Drinking ; Blood Glucose ; Cataract ; Diabetic Retinopathy* ; Diagnosis ; Diet ; Epidemiologic Studies ; Fasting ; Female ; Hemoglobin A, Glycosylated ; Humans ; Intraocular Pressure ; Menstruation ; Prevalence* ; Risk Factors* ; Smoke ; Smoking