Mafrici Marco, Toscani Laura, Lorenzi Umberto
Department of Ophthalmology, Ales-Cevennes Hospital, Ales, France.
Department of Anesthesiology and Intensive Care, Santa Maria Goretti Hospital, Latina, Italy.
Eur J Ophthalmol. 2020 Dec 22:1120672120984383. doi: 10.1177/1120672120984383.
Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy.
Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed.
We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.
糖尿病性视乳头病变是糖尿病的一种并发症。其表现为视乳头水肿，可为单侧或双侧，同时伴有视神经前部的血管改变。这种并发症常见于患有严重糖尿病视网膜病变的患者，但以孤立形式出现的情况很少见。一些作者认为糖尿病性视乳头炎是非动脉炎性前部缺血性视神经病变（NAION）的一种特殊形式。但有重要证据表明糖尿病性视乳头病变存在炎症成分。我们在本研究中报告了1例罕见的孤立性急性双侧糖尿病性视乳头病变病例，该病例发生在1例糖尿病患者口服降糖治疗加用胰岛素之后。
男性患者，49岁，2型糖尿病，随访期间血糖异常，过去2年糖化血红蛋白（HbA1c）为8%至12%，口服降糖治疗10年。他既往无糖尿病视网膜病变病史。在最近一次检查时，该患者出现双侧视乳头病变，双侧视力未下降。患者自述在医生指导下，于胰岛素治疗前10天在口服降糖治疗基础上加用了胰岛素。进行了血液生化和血清学检查，排除了炎症和感染性疾病。钆增强脑磁共振成像（MRI）排除了视神经炎或颅内高压的可能性。心血管检查正常。荧光素血管造影检查和光学相干断层扫描（OCT）证实双侧视乳头水肿及视神经增厚，无其他视网膜损伤。因此，他被诊断为双侧糖尿病性视乳头病变。随后，糖尿病专科医生在口服降糖治疗基础上加用胰岛素泵治疗。2个月后，他的血糖水平和HbA1c改善，视乳头病变消退。
我们报告了1例罕见的双侧急性糖尿病性视乳头病变病例，该病例与口服降糖治疗加用胰岛素有关。对糖尿病患者进行随机对照研究，将有助于验证在向胰岛素治疗的微妙转变过程中视神经可能受到的损伤。
