Bilateral Diabetic Papillopathy and Metabolic Control

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• 作者：Christoffer Ostri ; Henrik Lund-Andersen ; Birgit S ; er ; Ditte Hvidt-Nielsen ; Michael Larsen
• 刊名：Ophthalmology
• 出版年：2010
• 出版时间：November 2010
• 年：2010
• 卷：117
• 期：11
• 页码：2214-2217
• 全文大小：162 K

文摘

Objective

The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis.

Design

Retrospective case-control study.

Participants

Two thousand sixty-six patients with type 1 diabetes.

Methods

Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008.

Main Outcome Measures

Simultaneous, bilateral diabetic papillopathy.

Results

The mean follow-up was 4.9 years. During 10 020 patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A_1c (HbA_1C) at a maximum rate of –2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA_1C observed in the remainder of the study population (P<0.001). Photographs recorded before the onset of bilateral diabetic papillopathy showed that all 5 patients had small cup-to-disc diameter ratios in both eyes (P<0.001).

Conclusions

Diabetic papillopathy was associated markedly with a drastic recent reduction in glycemia and a small cup-to-disc diameter ratio. This supports the hypothesis that diabetic papillopathy may be an early worsening phenomenon occurring in anatomically predisposed patients in response to a recent rapid decrease in glycemia.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.