Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark.
Ophthalmology. 2010 Nov;117(11):2214-7. doi: 10.1016/j.ophtha.2010.03.006. Epub 2010 Jun 16.
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.
Retrospective case-control study.
Two thousand sixty-six patients with type 1 diabetes.
Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008.
Simultaneous, bilateral diabetic papillopathy.
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 A₁(c) (HbA₁(C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA₁(C) 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).
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.
糖尿病性视乳头病变的发病机制尚不清楚，但病例报告表明，它可能是在代谢控制迅速改善后发生的。本研究旨在对此假说进行探讨。
回顾性病例对照研究。
2066 例 1 型糖尿病患者。
对 2001 年至 2008 年期间一家大型糖尿病和眼科单位的临床、照相和临床化学记录进行了回顾。
同时性、双侧性糖尿病性视乳头病变。
平均随访时间为 4.9 年。在 10020 患者年的观察期间，5 例患者发生双侧糖尿病性视乳头病变。在这一事件发生前的 1 年中，所有 5 例患者的糖化血红蛋白 A₁(c)（HbA₁(C)）以最大 2.5%（平均）每季度的速度下降，与研究人群中其余患者的 HbA₁(C)变化明显不同（P<0.001）。在双侧糖尿病性视乳头病变发病前拍摄的照片显示，所有 5 例患者双眼的杯盘直径比均较小（P<0.001）。
糖尿病性视乳头病变与血糖急剧近期降低和杯盘直径比小显著相关。这支持了糖尿病性视乳头病变可能是一种解剖学上易患患者对近期血糖快速下降的反应的早期恶化现象的假说。
作者在本文讨论的任何材料中均无专有权或商业利益。
