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      Ocular Blood Flow Velocity Determined by Color Doppler Imaging in Diabetic Retinopathy

      Ophthalmologica

      S. Karger AG

      Ocular blood flow velocity, Color Doppler imaging, Diabetic retinopathy

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          Abstract

          Purpose: To measure and investigate changes of blood flow velocity by color Doppler imaging in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) in diabetic retinopathy (DR) and to compare the results with those in healthy control subjects. Methods: In this investigation we included 44 eyes of 44 diabetic patients with different stages of DR forming group NPDR (11 eyes with mild and 11 eyes with moderate nonproliferative DR) and group SNPDR/PDR (19 eyes with severe nonproliferative and 3 eyes with proliferative DR) and 22 eyes of 22 healthy age- and sex-matched subjects forming control group HC. With color Doppler imaging we measured the peak systolic velocity (PSV, cm/s) and end-diastolic velocity (EDV, cm/s) of blood flow in the OA, CRA and PCA. The resistance index of each vessel was then calculated. Statistical analysis comparing the results of groups NPDR, SNPDR/PDR and HC was carried out. Statistical significance was set at p < 0.05. Results: There was a statistically significant increase in PSV in the OA in group SNPDR/PDR compared with group HC (35.71 ± 6.90 vs. 31.45 ± 4.32 cm/s; mean ± SD). There was a statistically significant decrease in PSV in the CRA in group NPDR compared with group HC (8.50 ± 1.62 vs. 10.61 ± 1.75 cm/s; mean ± SD) and in group SNPDR/PDR compared with group HC (7.34 ± 1.78 vs. 10.61 ± 1.75 cm/s; mean ± SD), also there was a statistically significant decrease in EDV in group SNPDR/PDR compared with group HC (2.05 ± 0.53 vs. 3.00 ± 0.81 cm/s; mean ± SD). A statistically significant decrease in EDV in the PCA in group SNPDR/PDR compared with group HC (2.95 ± 1.04 vs. 3.95 ± 0.98 cm/s; mean ± SD) was found, also there was a statistically significant increase in the resistance index in group SNPDR/PDR compared with group NPDR (0.72 ± 0.05 vs. 0.67 ± 0.07; mean ± SD) and in group SNPDR/PDR compared with group HC (0.72 ± 0.05 vs. 0.67 ± 0.05; mean ± SD). Conclusions: In this investigation, color Doppler imaging was used to determine significant changes of blood flow velocity in the OA, CRA and PCA in DR compared with healthy control subjects and the changes of blood flow velocity become further significant considering the progression of DR. This points to the presence of circulatory changes in the OA, CRA and PCA in diabetic patients with DR.

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          Most cited references 10

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          The 14-year incidence of visual loss in a diabetic population.

          The purpose of the study was to estimate the 14-year incidence of visual loss in a diabetic population and to examine its relationship to potential risk factors. Cohort study. A population-based sample of younger onset diabetic persons diagnosed younger than 30 years of age and taking insulin (n = 880) were examined at baseline, 4 years, 10 years, and 14 years. Visual acuity (VA) as measured by the Early Treatment Diabetic Retinopathy Study protocol was performed. Visual impairment (VI), defined as a VA of 20/40 or worse in the better eye; blindness, defined as a VA of 20/200 or worse in the better eye; and doubling of the visual angle were measured. Cumulative 14-year incidences of VI, doubling of the visual angle, and blindness were 12.7%, 14.2%, and 2.4%, respectively. In univariate analyses, loss of vision as measured by doubling of the visual angle is associated with older age, longer duration of diabetes, higher glycosylated hemoglobin, higher systolic and diastolic blood pressure, presence of proteinuria, more pack-years smoked, presence of macular edema, and more severe retinopathy. In logistic regression analyses, incidence of doubling of the visual angle is associated independently with retinopathy (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03, 1.11 for each level), glycosylated hemoglobin (OR, 1.46; 95% CI, 1.28, 1.66 for each 1%), proteinuria (OR, 2.32; 95% CI, 1.39, 3.88 for presence), and age (OR, 1.45; 95% CI, 1.20, 1.75 for 10 years). In addition, a change in glycosylated hemoglobin from baseline to the 4-year examination is associated with loss of vision (OR, 1.15; 95% CI, 1.02, 1.30 for a 1% increase). Loss of vision continues to be significant in persons with diabetes. These results suggest that prevention of retinopathy through control of glycemia will have a beneficial effect on visual outcome.
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            Color Doppler ultrasound imaging of theeye and orbit

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              Impaired retinal artery blood flow in IDDM patients before clinical manifestations of diabetic retinopathy.

              To determine whether hemodynamic changes in retinal arteries precede clinical manifestations of diabetic retinopathy and to examine the effects of control of hyperglycemia on retinal artery blood flow. We assessed blood flow in bilateral central retinal arteries in 50 insulin-dependent diabetes mellitus (IDDM) patients without retinopathy and 20 sex- and age-matched control subjects using duplex Doppler sonography. We determined the peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged velocity (TAV), resistance index (RI), and pulsatility index (PI). PSV, EDV, and TAV were significantly lower in IDDM patients than in control subjects (P < 0.05, P < 0.01, and P < 0.01, respectively). The RI was significantly higher in IDDM patients than in control subjects (P < 0.01) and was significantly correlated with plasma levels of glucose in IDDM patients (r = 0.0.310, P = 0.0248). Multiple regression analysis identified the plasma levels of glucose as a significant determination of RI in IDDM patients. After 14 days of intensive insulin therapy in 7 IDDM patients, the RI and plasma levels of glucose showed significant decreases (P = 0.018, P = 0.001, respectively). Our results showed that changes in retinal hemodynamics were present before the clinical detection of overt diabetic retinopathy and suggest that the presence of short-term hyperglycemia partly contributes to impaired retinal circulation.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2004
                August 2004
                06 July 2004
                : 218
                : 4
                : 237-242
                Affiliations
                Department of Ophthalmology, Maribor Teaching Hospital, Maribor, Slovenia
                Article
                78613 Ophthalmologica 2004;218:237–242
                10.1159/000078613
                15258411
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 4, References: 27, Pages: 6
                Categories
                Original Paper

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