Becker Daniel, Larsen Michael, Lund-Andersen Henrik, Hamann Steffen
Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur J Ophthalmol. 2023 Jul;33(4):NP129-NP132. doi: 10.1177/11206721221100901. Epub 2022 May 15.
To describe two cases of severe acute bilateral optic disc edema that occurred in patients with diabetes mellitus shortly after the initiation of intensified antihyperglycemic therapy.
Retrospective observational case report.
Two patients with type 1 diabetes presented for routine retinopathy screening with asymptomatic optic disc edema. One case was bilateral, the other unilateral. Neither patient had visual complaints. Both patients' glycemia history was characterized by a recent bout of poor regulation and both had optic disc edema consistent with diabetic papillopathy in combination with prominent Optic disc drusen (ODD). The swelling that appeared to constitute the edematous diabetes-related component of the disease resolved within 10-12 weeks during which diabetes therapy was optimized. Visual field deficits were seen early on in both patients and had resolved to some extent in one patient after 9 months but persisted in the one affected eye in the other patient up to at least 30 months.
Two cases of ODD-associated diabetic papillopathy were observed: One with classic, bilateral disc edema and minor visual field defects, the other with unilateral disc edema, severe visual field defects and a phenotype that resembled non-arteritic anterior ischemic optic neuropathy. The cases suggest that ODD may increase the risk of diabetic papillopathy, a condition that is associated with rapid glycemia reduction and crowded optic discs, which may combine to produce nerve fiber swelling and hypoperfusion with venous congestion in a compartment with limited room for expansion.
描述两例糖尿病患者在强化降糖治疗开始后不久出现的严重急性双侧视盘水肿病例。
回顾性观察病例报告。
两名1型糖尿病患者因无症状性视盘水肿前来进行常规视网膜病变筛查。一例为双侧，另一例为单侧。两名患者均无视力主诉。两名患者的血糖病史均表现为近期血糖控制不佳，且视盘水肿均符合糖尿病性视乳头病变，并伴有明显的视盘小疣（ODD）。在优化糖尿病治疗的10 - 12周内，似乎构成该疾病与水肿相关的糖尿病性成分的肿胀消退。两名患者早期均出现视野缺损，其中一名患者在9个月后部分视野缺损得到缓解，但另一名患者患眼的视野缺损至少持续了30个月。
观察到两例与ODD相关的糖尿病性视乳头病变：一例为典型的双侧视盘水肿和轻度视野缺损，另一例为单侧视盘水肿、严重视野缺损且表型类似非动脉炎性前部缺血性视神经病变。这些病例表明，ODD可能增加糖尿病性视乳头病变的风险，这种情况与血糖快速降低和视盘拥挤有关，可能共同导致神经纤维肿胀、灌注不足以及有限空间内静脉充血的眼内环境。
