Acta Diabetologica

, Volume 31, Issue 2, pp 98–102 | Cite as

Early selective neuroretinal disorder in prepubertal type 1 (insulin-dependent) diabetic children without microvascular abnormalities

  • A. V. Greco
  • M. A. S. Di Leo
  • S. Caputo
  • B. Falsini
  • V. Porciatti
  • G. Marietti
  • G. Ghirlanda
Originals

Abstract

The duration of diabetes before puberty is not considered relevant to the future development of complications. To evaluate the effects of diabetes on the neural retina, we analysed macular function by steady-state focal electroretinography in 20 prepubescent diabetic children without vascular retinopathy and in 39 sex- and age-matched normal children. The mean (±SD) response related to retinal cellular elements between the photoreceptors and ganglion cells was significantly lower in diabetic children than in the control group (0.38±0.12 vs. 0.51±0.13 μV; unpairedt-test=3;P=0.005). Similarly, ganglion cell function showed a significant impairment in diabetic children with respect to the control group (0.4±0.13 vs. 0.53±0.09 μV; unpairedt-test=5.4;P=0.0001), whereas the photoreceptors appeared unaffected. Metabolic control and disease duration were not correlated with functional deficits. Our results suggest that before puberty, early diabetes may have a selective effect on the neural retina prior to the appearance of microvascular changes. A focal electroretinogram could identify diabetic children with neurosensory disorders who may have a higher risk of developing microvascular retinopathy.

Key words

Diabetic retinopathy Retinal function Children Electroretinogram Puberty 

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References

  1. 1.
    Davis MD, Diabetic retinopathy a clinical overview. Diabetes Metab Rev 4: 291–322, 1988Google Scholar
  2. 2.
    Bresnick GH, Diabetic retinopathy viewed as a neurosensory disorder. Arch Ophthalnol 104: 989–990, 1986Google Scholar
  3. 3.
    Juen S, Kieselbach GF, Electrophysiological changes in juvenile diabetics without retinopathy. Arch Ophthalmol 108: 372–375, 1990Google Scholar
  4. 4.
    Caputo S, Di Leo MAS, Falsini B, Ghirlanda G, Porciatti V, Greco AV, Evidence for early impairment of macular function with pattern electroretinogram in type I diabetic patients. Diabetes Care 13: 412–418, 1990Google Scholar
  5. 5.
    Di Leo MAS, Falsini B, Caputo S, Ghirlanda G, Porciatti V, Greco AV, Spatial frequency-selective losses with pattern electroretinogram in Type 1 (insulin-dependent) diabetic patients without retinopathy. Diabetologia 33: 726–730, 1990Google Scholar
  6. 6.
    Frank RN, Hoffman WH, Podgor MJ, Joondeph HC, Lewis RA, Margherio RR, Machazel DP Jr, Weiss H, Christopherson RW, Cronin MA, Retinopathy in juvenile-onset type I diabetes of short duration. Diabetes 31: 874–882, 1982Google Scholar
  7. 7.
    Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL, Retinopathy in young-onset diabetic patients. Diabetes Care 8: 311–315, 1985Google Scholar
  8. 8.
    Weber B, Burger W, Hartmann R, Hövener G, Malchus R, Oberdisse U, Risk factors for the development of retinopathy in children and adolescents with Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 29: 23–29, 1986Google Scholar
  9. 9.
    Murphy RP, Nanda M, Plotnick L, Enger C, Vitale S, Patz A, The relationship of puberty to diabetic retinopathy. Arch Ophthalmol 108: 215–218, 1990Google Scholar
  10. 10.
    Porciatti V, Non-linearities in the focal ERG evoked by pattern and uniform-field stimulation. Their variation in retinal and optic nerve dysfunction. Invest Ophthalmol Vis Sci 28: 1306–1313, 1987Google Scholar
  11. 11.
    Baker CL, Hess RF, Olsen BT, Zrenner E, Current source density analysis of linear and non-linear components of the primate electroretinogram. J Physiol 407: 155–176, 1988Google Scholar
  12. 12.
    Porciatti V, Falsini B, Fadda A, Bolzani R, Steady-state analysis of the focal ERG to pattern and flicker: relationship between ERG components and retinal pathology. Clin Vision Sci 4: 323–332, 1989Google Scholar
  13. 13.
    Maffei L, Fiorentini A, Generator sources of the pattern ERG in man and animals. In: Cracco RQ, Bodis-Wollner I (eds) Frontiers in clinical neuroscience, Vol. III. Liss, New York, pp 101–116, 1986Google Scholar
  14. 14.
    Porciatti V, Falsini B, Scalia G, Fadda A, Fontanesi G, The pattern electroretinogram by skin electrodes: effect of spatial frequency and age. Doc Ophthalmol 70: 117–122, 1988Google Scholar
  15. 15.
    Baker WS, Hess RF, Linear and non-linear components of the human electroretinogram. J Neurophysiol 51: 952–967, 1984Google Scholar
  16. 16.
    Brindley GS, Westheimer G, The spatial properties of the human electroretinogram. J Physiol 119: 518–537, 1965Google Scholar
  17. 17.
    Fiorentini A, Maffei G, Pirchio M, Spinelli D, Porciatti V, The ERG in response to alternating gratings in patients with diseases of the peripheral visual pathways. Invest Ophthalmol Vis Sci 21: 490–493, 1981Google Scholar
  18. 18.
    Fadda A, Falsini B, Neroni M, Porciatti V, Development of a personal computer software for a visual electrophysiology laboratory. Comput Methods Programs Biomed 28:45–50, 1989Google Scholar
  19. 19.
    Arden GB, Hamilton AMP, Wilson-Holt J, Ryan S, Yudkin JS, Kurlz A, Pattern electroretinogram becomes abnormal when background diabetic retinopathy deteriorates to a preproliferative stage: possible use as a screening test. Br J Ophthalmol 70: 330–335, 1986Google Scholar
  20. 20.
    Coupland SG, A comparison of oscillatory potential and pattern electroretinogram measures in diabetic retinopathy. Doc Ophthalmol 66: 207–218, 1987Google Scholar
  21. 21.
    Porciatti V, Von Berger GP, Pattern electroretinogram and visual evoked potential in optic nerve disease: early diagnosis and prognosis. Doc Ophthalmol Proc Ser 40: 117–126, 1984Google Scholar
  22. 22.
    Seiple WH, Siegel IM, Carr RE, Mayron C, Evaluating macular function using the focal ERG. Invest Ophthalmol Vis Sci 27: 1123–1130, 1986Google Scholar
  23. 23.
    Maffei L, Fiorentini A, Electroretinographic responses alternating gratings before and after section of the optic nerve. Science 211: 953–955, 1981Google Scholar
  24. 24.
    Marano CW, Matschinsky FM, Biochemical manifestations of diabetes mellitus in microscopic layers of the cornea and retina. Diabetes Metab Rev 5: 1–15, 1989Google Scholar
  25. 25.
    MacGregor LC, Rosecan LR, Laties AM, Matschinsky FM, Altered retinal metabolism in diabetes. I. Microanalysis of lipid, glucose, sorbitol, and myo-inositol in the choroid and in the individual layers of the rabbit retina. J Biol Chem 261: 4046–4051, 1986Google Scholar
  26. 26.
    Sima AAF, Zhang WH, Cherian PV, Chakrabarti S, Impaired visual evoked potential and primary axonopathy of the optic nerve in the diabetic BB/W-rat. Diabetologia 35: 602–607, 1992Google Scholar
  27. 27.
    Cryer PE, Gerich JE, Glucose counterregulation, hypoglycaemia and intensive insulin therapy in diabetes mellitus. N Engl J Med 313: 232–241, 1985Google Scholar
  28. 28.
    Tallroth G, Lingren M, Stenberg G, Rosen I, Agarth C-D, Neurophysiological changes during insulin-induced hypoglycaemia and in the recovery period following glucose infusion in Type 1 (insulin-dependent) diabetes mellitus and in normal man. Diabetologia 33: 319–323, 1990Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • A. V. Greco
    • 1
  • M. A. S. Di Leo
    • 1
  • S. Caputo
    • 1
  • B. Falsini
    • 2
  • V. Porciatti
    • 3
  • G. Marietti
    • 4
  • G. Ghirlanda
    • 1
  1. 1.Institute of Internal MedicineCatholic UniversityRomeItaly
  2. 2.Institute of OphthalmologyCatholic UniversityRomeItaly
  3. 3.Institute of NeurophysiologyNational Council of ResearchPisaItaly
  4. 4.Institute of PediatricsCatholic UniversityRomeItaly

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