Abstract
• Background: The study was carried out to evaluate the correlation between blood-retinal barrier (BRB) permeability and the development of diabetic retinopathy (DR) and to assess the metabolic and clinical factors related to DR over a 4-year period by means of vitreous fluorophotometry (VF). • Methods: Thirty-five type I diabetics with no retinopathy, age 7–21 years (mean 14.32±2.1 years) were enrolled in this longitudinal study. Two visits including standard ophthalmological examination, fluorescein angiography and VF were performed, on entry into the study and 4 years later. The following risk factors in DR were analyzed: age, duration of diabetes, blood pressure, cholesterol, triglycerides, fasting blood glucose levels, glycosylated hemoglobin (HbA1c), insulin dose/kg body weight (IDBW), fructosamine and albuminuria. To estimate the BRB permeability we adopted the vitreous penetration ratio transmittance (VPRt) value. • Results: At 4-year follow-up the mean VPRt had significantly increased. During that time 13 patients developed DR and their final mean VPRt was significantly higher than that in non-DR patients. Additionally, the initial mean VPRt was higher but not significantly so, in patients that later developed DR than in non-DR subjects. A constant linear correlation was found between VPRt and duration of diabetes, HbA1c and microalbuminuria. • Conclusion: VF is a quantitative method that could measure and predict the breakdown of the BRB before angiographic retinopathy in type I diabetics. The major clinical and metabolic factors related to alterations in the BRB are duration of diabetes, HbA1c and microalbuminuria.
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References
Benitez del Castillo JM, Castillo A, Fernandez PC, Garcia J (1993) Clinical and metabolic factors associated with the blood retinal barrier permeability in insulin dependent diabetes mellitus without retinopathy. Doc Ophthalmol 84:127–133
Benitez del Castillo JM, Castillo A, Garcia J, Ruibal JL, Reverte F, Ibarra JM (1993) An 18-month vitreous fluorophotometric follow-up study in juvenile diabetics. Acta Ophthalmol 71:651–656
Chase HP, Garg SK, Jackson WW (1990) Blood pressure and retinopathy in type I diabetes. Ophthalmology 97:155–159
Conway BP (1985) Technical variables in vitreous fluorophotometry. Graefes Arch Clin Exp Ophthalmol 22:194–201
Cunha-Vaz JG, Fonseca JR, Abreu JF (1979) Detection of early changes in diabetes by vitreous fluorophotometry. Diabetes 28:16–19
Cunha-Vaz JG, Leite E, Castro Sousa J, Faria de Abreu JR (1993) Blood-retinal barrier permeability and its relation to progression of retinopathy in patients with type 2 diabetes: a fouryear follow-up study. Graefes Arch Clin Exp Ophthalmol 231:141–145
Cruickshanks KJ, Ritter LL, Klein R (1993) The association of microalbuminuria with diabetic retinopathy. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 100:862–867
Dalgaard P, Baker VA, Lund-Andersen H (1989) Spatial sensitivity of vitreous fluorophotometry. In: Cunha-Vaz J (ed) Ocular fluorophotometry. Kugler & Ghedini, Amsterdam, pp 115–117
Dalgaard P, Baker VA, Lund-Andersen H (1989) Vitreous fluorophotometry. Mathematical analysis of the effect of peripheral leakage on axial scans. Invest Ophthalmol Vis Sci 80:1522–1526
DCCT, The Diabetes Control and Complications Trial and Study Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New Engl J Med 329:977–986
Engler C, Krogsaa B, Lund-Andersen H (1991) Blood-retina barrier permeability and its relation to the progression of diabetic retinopathy in type I diabetics. An 8-year follow-up study. Graefes Arch Clin Exp Ophthalmol 229:442–446
Gordon B, Chang S, Kavanagh M (1991) The effects of lipid lowering on diabetic retinopathy. Am J Ophthalmol 112:385–391
Klein BEK, Moss SE, Klein R (1991) The Wisconsin epidemiologic study of diabetic retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology 98:1261–1265
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology 91:1464–1474
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1989) The Wisconsin epidemiologic study of diabetic retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 107:237–243
Krogsaa B, Lund-Andersen H, Mehlsen J, Sestoft L (1987) Blood-retinal barrier permeability versus diabetes duration and retinal morphology in insulin dependent diabetic patients. Acta Ophthalmol 65:686–692
Larsen M, Hommel E, Parving HH (1990) Protective effect of captopril on the blood-retina barrier in normotensive insulin-dependent diabetic patients with nephropathy and background retinopathy. Graefe's Arch Clin Exp Ophthalmol 228:505–509
Marshall G, Garg SK, Jackson WE (1993) Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus. Ophthalmology 100:1133–1139
Mota MC, Leite E (1985) Autofluorescencia e transmitancia do cristalinos em diabeticos insulino-dependentes. Exp Ophthalmol 11:28–32
Mota MC, Leite E, Faria de Abreu JR, Cunha-Vaz JG (1986) Contribuçoes para a metodologia da fluoresceina do vitreo. Exp Ophthalmol 12:1–5
Mota MC, Leite E, Faria de Abreu JR (1987) Plasma fluorescein decay, penetration ratio and duration of diabetes. In: Brancato R, Coscas G (eds) Ocular fluorophotometry. Kugler & Ghedini, Amsterdam, pp 23–25
National Heart, Lung, and Blood Institute (1987) Report of the second task force on blood pressure control in children, 1987. Pediatrics 79:1–25
Nuzzi G, Vanelli M, Venturini I, Bonacini M, Boselli E (1986) Vitreous fluorophotometry in juvenile di abetics after oral fluorescein. Arch Ophthalmol 104:1630–1631
Reichard P, Nilsson BY, Rosenquist U (1993) The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 329:304–309
Sander B, Larsen M, Engler C, Lund-Andersen H, Parving HH (1994) Early changes in diabetic retinopathy: Capillary loss and blood-retina barrier permeability in relation to metabolic control. Acta Ophthalmol 72:553–559
Van Best JA, Tsoi EW, Boot JP, Oosterhuis JA (1985) In vivo assesment of lens transmission for blue-green light by autofluorescence measurement. Ophthalmic Res 17:90–95
Waltman SR (1984) Sequential vitreous fluorophotometry in diabetes mellitus. A five year prospective study. Trans Am Ophthalmol Soc 82:827–849
Weber B, Burger W Hartmann R (1986) Risk factors for the development of retinopathy in children and adolescents with type I diabetes mellitus. Diabetologia 29:23–29
White NH, Waltman SR, Krupin T (1982) Reversal of abnormalities in ocular fluorophotometry in insulindependent diabetes after five to nine months of improved metabolic control. Diabetes 31:80–85
Winocour PH, Bhatnagar D, Kalsi P (1989) Relative clinical usefulness of glycosylated serum albumin and fructosamine during short-term changes in glycemic control IDDM. Diabetes Care 12:665–672
Yoshida A, Furukawa M, Delori FC, Bursell SE, Tremple CL, McMeel JW (1984) Effect of vitreous detachment on vitreous fluorophotometry. Arch Ophthalmol 101:1753–1756
Zeimer RC, Noth JM (1984) A new method of measuring in vivo lens transmittance. Ophthalmic Res 16:246–255
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Castillo, A., Benitez Del Castillo, J.M., Diaz, D. et al. Analysis of the blood-retinal barrier: its relation to clinical and metabolic factors and progression to retinopathy in juvenile diabetics. A 4-year follow-up study. Graefe's Arch Clin Exp Ophthalmol 234, 246–250 (1996). https://doi.org/10.1007/BF00430417
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DOI: https://doi.org/10.1007/BF00430417