Intraocular Inflammation in Diabetic Populations
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Abstract
Purpose of review
The purpose of this review is to determine the prevalence of uveitis in the diabetic population, the clinical features of the uveitis and diabetes when coexisting and pathophysiology of a possible correlation. We also aim to review the cases of diabetes and uveitis in the literature.
Recent findings
The basis of an association between uveitis and diabetes mellitus (DM) is the common pathophysiology of inflammation. There are several reports on a DM-related uveitis, defined as idiopathic anterior uveitis in the presence of poorly controlled DM, but causation has not been established.
Summary
There are conflicting results in the literature regarding an association between uveitis and DM. More studies are needed to determine if an association truly exists.
Keywords
Uveitis Diabetes mellitus Blood-retinal barrier Blood-aqueous barrier Panretinal photocoagulation Intraocular inflammationNotes
Compliance with Ethical Standards
Conflict of Interest
Wajiha J. Kheir, Huda A. Sheheitli, and Rola N. Hamam declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References
Papers of particular interest, published recently, have been highlighted as: •Of importance•• Of major importance
- 1.Castagna I, Fama F, Salmeri G. Anterior uveitis and diabetes mellitus: immunological study. Ophthalmologica. 1995;209(2):53–5.CrossRefPubMedGoogle Scholar
- 2.Herranz M, et al. Increased prevalence of NIDDM in anterior uveitis. Diabetes Care. 1997;20(11):1797.CrossRefPubMedGoogle Scholar
- 3.Oswal KS, et al. Clinical features of patients with diabetes mellitus presenting with their first episode of uveitis. Ocul Immunol Inflamm. 2009;17(6):390–3.CrossRefPubMedGoogle Scholar
- 4.Al-Halafi A, et al. The association of systemic disorders with Vogt-Koyanagi-Harada and sympathetic ophthalmia. Graefes Arch Clin Exp Ophthalmol. 2011;249(8):1229–33.CrossRefPubMedGoogle Scholar
- 5.Waite JH, Beetham WP. The visual mechanism in diabetes mellitus: a comparative study of 2002 diabetics, and 457 non-diabetics for control. N Engl J Med. 1935;212(9):367–79.CrossRefGoogle Scholar
- 6.Rothova A, et al. Uveitis and systemic disease. Br J Ophthalmol. 1992;76(3):137–41.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Noyes HD. Retinitis in glycosuria. Trans Am Ophthalmol Soc. 1868;1(4–5):71.PubMedPubMedCentralGoogle Scholar
- 8.Ojaimi E, et al. Vogt-Koyanagi-Harada disease, diabetes mellitus, and psoriasis in a child. Ocul Immunol Inflamm. 2012;20(1):56–8.CrossRefPubMedGoogle Scholar
- 9.Rottgers E, Holdeman NR. An unusual case of chorioretinitis in a diabetic patient. Clin Exp Optom. 2009;92(2):142–5.CrossRefPubMedGoogle Scholar
- 10.Sinha MK, Narayanan R, Chhablani JK. Hypopyon uveitis following panretinal photocoagulation in a diabetic patient. Semin Ophthalmol. 2014;29(3):166–8.CrossRefPubMedGoogle Scholar
- 11.Takahashi Y, et al. Severe anterior uveitis associated with idiopathic dacryoadenitis in diabetes mellitus patient. Clin Ophthalmol. 2011;5:619–21.PubMedPubMedCentralGoogle Scholar
- 12.• Tyagi M, Ambiya V, Rani PK. Hypopyon uveitis following panretinal photocoagulation. BMJ Case Rep. 2016; This case report is of a patient with DM and uveitis who develops recurrent ocular inflammation after panretinal photoagulation Google Scholar
- 13.Stanga P, Boyd S, Hamilton A. Ocular manifestations of diabetes mellitus. Curr Opin Ophthalmol. 1999;10(6):483–9.CrossRefPubMedGoogle Scholar
- 14.Liberman P, et al. Causes of uveitis in a tertiary center in Chile: a cross-sectional retrospective review. Ocul Immunol Inflamm. 2014:1–7.Google Scholar
- 15.Rothova A, et al. Uveitis and diabetes mellitus. Am J Ophthalmol. 1988;106(1):17–20.CrossRefPubMedGoogle Scholar
- 16.•• Oswal KS, et al. Clinical course and visual outcome in patients with diabetes mellitus and uveitis. BMC research notes. 2013;6(1):167. This retrospective study reported a greater complication rate, reduced vision and poor glycemic control in patients with DM who develop uveitis CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Chatzistefanou K, et al. Characteristics of uveitis presenting for the first time in the elderly. Ophthalmology. 1998;105(2):347–52.CrossRefPubMedGoogle Scholar
- 18.Yawata N, et al. High incidence of glucose intolerance in Vogt–Koyanagi–Harada disease. Br J Ophthalmol. 1999;83(1):39–42.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Barton K, et al. Uveitis presenting de novo in the elderly. Eye (Lond). 1994;8(Pt 3):288–91.CrossRefGoogle Scholar
- 20.Nalcacioglu-Yuksekkaya P, et al. Clinical and demographic characteristics of patients with uveitis starting later in life. Ocul Immunol Inflamm. 2014:1–7.Google Scholar
- 21.Martyn C, Young R, Ewing D. Is there a link between iritis and diabetic autonomic neuropathy? Br Med J (Clin Res Ed). 1986;292(6525):934.CrossRefGoogle Scholar
- 22.Gregoire MA, et al. Characteristics of uveitis presenting for the first time in the elderly: analysis of 91 patients in a tertiary center. Ocul Immunol Inflamm. 2011;19(4):219–26.CrossRefPubMedGoogle Scholar
- 23.Hemidan A, Tabbara K, Althomali T. Vogt-Koyanagi-Harada associated with diabetes mellitus and celiac disease in a 3-year-old girl. Eur J Ophthalmol. 2006;16(1):173.PubMedGoogle Scholar
- 24.Jaggarao N, Voth D, Jacobsen J. The Vogt-Koyanagi-Harada syndrome: association with hypothyroidism and diabetes mellitus. Postgrad Med J. 1989;65(766):587–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Maruyama Y, et al. A case of insulin dependent diabetes mellitus following systemic treatment with corticosteroids for Vogt-Koyanagi-Harada syndrome. Ophthalmic Surgery, Lasers and Imaging Retina. 2000;31(6):487–90.Google Scholar
- 26.Murray D, Sung V, Headon M. Asymmetric diabetic retinopathy associated with Fuchs’ heterochromic cyclitis. Br J Ophthalmol. 1999;83(8):987-987.CrossRefGoogle Scholar
- 27.Al Shehri FS. Uveitis in diabetic woman. International Journal of Diabetes Mellitus. 2009;1(1):59–60.CrossRefGoogle Scholar
- 28.Guy R, et al. Diabetic autonomic neuropathy and iritis: an association suggesting an immunological cause. Br Med J (Clin Res Ed). 1984;289(6441):343–5.CrossRefGoogle Scholar
- 29.Patel AK, et al. Risk of retinal neovascularization in cases of uveitis. Ophthalmology. 2016;123(3):646–54.CrossRefPubMedGoogle Scholar
- 30.Joussen AM, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. FASEB J. 2004;18(12):1450–2.PubMedGoogle Scholar
- 31.Joussen AM, et al. Leukocyte-mediated endothelial cell injury and death in the diabetic retina. Am J Pathol. 2001;158(1):147–52.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Fujikawa LS, et al. Retinal vascular endothelium expresses fibronectin and class II histocompatibility complex antigens in experimental autoimmune uveitis. Cell Immunol. 1987;106(1):139–50.CrossRefPubMedGoogle Scholar
- 33.Tang J, Kern TS. Inflammation in diabetic retinopathy. Prog Retin Eye Res. 2011;30(5):343–58.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Ongkosuwito JV, et al. Analysis of immunoregulatory cytokines in ocular fluid samples from patients with uveitis. Invest Ophthalmol Vis Sci. 1998;39(13):2659–65.PubMedGoogle Scholar
- 35.Nussenblatt RB, et al. The immunological basis of degenerative diseases of the eye. Int Rev Immunol. 2013;32(1):97–112.CrossRefPubMedGoogle Scholar
- 36.Adamis AP, Berman AJ. Immunological mechanisms in the pathogenesis of diabetic retinopathy. Semin Immunopathol. 2008;30(2):65–84.CrossRefPubMedGoogle Scholar
- 37.Cantón A, et al. CD4-CD8 and CD28 expression in t cells infiltrating the vitreous fluidin patients with proliferative diabetic retinopathy: a flow cytometric analysis. Arch Ophthalmol. 2004;122(5):743–9.CrossRefPubMedGoogle Scholar
- 38.Demircan N, et al. Determination of vitreous interleukin-1 (IL-1) and tumour necrosis factor (TNF) levels in proliferative diabetic retinopathy. Eye (Lond). 2006;20(12):1366–9.CrossRefGoogle Scholar
- 39.Elner SG, et al. Interferon-induced protein 10 and interleukin 8: CXC chemokines present in proliferative diabetic retinopathy. Arch Ophthalmol. 1998;116(12):1597–601.CrossRefPubMedGoogle Scholar
- 40.Adamiec-Mroczek J, Oficjalska-Mlynczak J, Misiuk-Hojlo M. Roles of endothelin-1 and selected proinflammatory cytokines in the pathogenesis of proliferative diabetic retinopathy: Analysis of vitreous samples. Cytokine. 2010;49(3):269–74.CrossRefPubMedGoogle Scholar
- 41.Murugeswari P, et al. Proinflammatory cytokines and angiogenic and anti-angiogenic factors in vitreous of patients with proliferative diabetic retinopathy and Eales’ disease. Retina. 2008;28(6):817–24.CrossRefPubMedGoogle Scholar
- 42.Zhou J, Wang S, Xia X. Role of intravitreal inflammatory cytokines and angiogenic factors in proliferative diabetic retinopathy. Curr Eye Res. 2012;37(5):416–20.CrossRefPubMedGoogle Scholar
- 43.Bromberg-White JL, et al. Identification of VEGF-independent cytokines in proliferative diabetic retinopathy vitreous. Invest Ophthalmol Vis Sci. 2013;54(10):6472–80.CrossRefPubMedGoogle Scholar
- 44.Takeuchi M, et al. Elevated levels of cytokines associated with Th2 and Th17 cells in vitreous fluid of proliferative diabetic retinopathy patients. PLoS One. 2015;10(9):e0137358.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Doganay S, et al. Comparison of serum NO, TNF-α, IL-1β, sIL-2R, IL-6 and IL-8 levels with grades of retinopathy in patients with diabetes mellitus. Eye. 2002;16(2):163–70.CrossRefPubMedGoogle Scholar
- 46.Funatsu H, et al. Aqueous humor levels of cytokines are related to vitreous levels and progression of diabetic retinopathy in diabetic patients. Graefes Arch Clin Exp Ophthalmol. 2005;243(1):3–8.CrossRefPubMedGoogle Scholar
- 47.Gerl VB, et al. Extensive deposits of complement C3d and C5b-9 in the choriocapillaris of eyes of patients with diabetic retinopathy. Invest Ophthalmol Vis Sci. 2002;43(4):1104–8.PubMedGoogle Scholar
- 48.Cunha-Vaz J, De Abreu JF, Campos A. Early breakdown of the blood-retinal barrier in diabetes. Br J Ophthalmol. 1975;59(11):649–56.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Jandrasits K, Krepler K, Wedrich A. Aqueous flare and macular edema in eyes with diabetic retinopathy. Ophthalmologica. 2003;217(1):49–52.CrossRefPubMedGoogle Scholar
- 50.Ino-ue M, et al. Laser flare intensity in diabetics: correlation with retinopathy and aqueous protein concentration. Br J Ophthalmol. 1994;78(9):694–7.CrossRefPubMedPubMedCentralGoogle Scholar
- 51.Moriarty A, et al. Studies of the blood-aqueous barrier in diabetes mellitus. Am J Ophthalmol. 1994;117(6):768–71.CrossRefPubMedGoogle Scholar
- 52.Nguyen N, Schönherr U, Küchle M. Aqueous flare and retinal capillary changes in eyes with diabetic retinopathy. Ophthalmologica. 1995;209(3):145–8.CrossRefPubMedGoogle Scholar
- 53.Moriarty AP, et al. Breakdown of the blood-aqueous barrier after argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1996;103(5):833–8.CrossRefPubMedGoogle Scholar
- 54.Baudouin C, et al. MHC class II antigen expression by ocular cells in proliferative diabetic retinopathy. Fundamental & clinical pharmacology. 1993;7(9):523–30.CrossRefGoogle Scholar
- 55.Udoetuk JD, et al. Risk of corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. Ophthalmology. 2012;119(8):1569–74.CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Savin J. Diabetes mellitus, sarcoidosis,? necrobiosis lipoidica. Proceedings of the Royal Society of Medicine. 1969;62(4):350.PubMedPubMedCentralGoogle Scholar
- 57.Gordon D, Browne B. Macular oedema with associated uveitis and cataract following presentation of type 1 diabetes mellitus in severe ketoacidosis. Diabet Med. 2000;17(4):326–8.CrossRefPubMedGoogle Scholar
- 58.Yamamoto J, et al. Severe bilateral necrotising retinitis caused by toxoplasma gondii in a patient with systemic lupus erythematosus and diabetes mellitus. Br J Ophthalmol. 2003;87(5):651–2.CrossRefPubMedPubMedCentralGoogle Scholar
- 59.Knol JA, et al. Rapid progression of diabetic retinopathy in eyes with posterior uveitis. Am J Ophthalmol. 2006;141(2):409–12.CrossRefPubMedGoogle Scholar
- 60.Suzuki H, Isaka M, Suzuki S. Type 1 diabetes mellitus associated with Graves’ disease and Vogt-Koyanagi-Harada syndrome. Intern Med. 2008;47(13):1241–4.CrossRefPubMedGoogle Scholar
- 61.Krifa F, et al. Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1. Gastroenterol Clin Biol. 2010;34(4–5):319–20.CrossRefPubMedGoogle Scholar
- 62.Talat L, et al. The influence of diabetes mellitus on the management and visual outcome of patients with uveitis. Acta Ophthalmol. 2014;92(4):e329–30.CrossRefPubMedGoogle Scholar