Verdaguer Juan, Zanolli Mario, Sepúlveda Gonzalo, García de Los Ríos Manuel, Domínguez Angélica
Fundación Oftalmológica Los Andes, Universidad de los Andes, Chile.
Rev Med Chil. 2009 Sep;137(9):1145-52.
Diabetic retinopathy is one of the most common causes of blindness among adults.
To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years.
Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control.
The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twenty three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient.
In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy.
糖尿病视网膜病变是成年人失明的最常见原因之一。
报告对平均随访18年的智利1型糖尿病患者糖尿病视网膜病变的自然病史。
回顾性分析1971年至2008年由同一位眼科医生诊治的39例年龄在26至70岁之间的1型糖尿病患者（20名女性，78只眼）的病历。向每位患者及其主治医生发送问卷，以获取有关疾病进展和代谢控制的信息。
24例患者（62%）和21名主治医生（54%）回复了问卷。25例患者（64%）观察到小的硬性玻璃膜疣。其中12例在任何类型的视网膜病变出现之前就检测到了玻璃膜疣。11名女性怀孕，其中4人视网膜病变进展。23例患者（59%）发生了增殖性糖尿病视网膜病变（PDR）。发生PDR的患者糖尿病病程明显更长，血糖控制更差。PDR组糖尿病肾病的发生率更高，但23例PDR患者中只有13例患有肾病。1例患者在成功进行肾胰腺移植两年后，视网膜病变进展为高危PDR。
在1型糖尿病患者中，小的硬性玻璃膜疣可能是糖尿病视网膜病变的初始表现。进展为PDR的危险因素是糖尿病病程和血糖控制不佳。肾病在PDR患者中更普遍，但相当一部分PDR患者没有明显的肾病。
