de Abreu J R, Silva R, Cunha-Vaz J G
Department of Ophthalmology, Coimbra University Hospital, Portugal.
Arch Ophthalmol. 1994 Oct;112(10):1334-8. doi: 10.1001/archopht.1994.01090220084027.
To assess the alteration of the blood-retinal barrier in patients with type I diabetes during puberty.
A 7-year prospective study evaluated retinal changes occurring in diabetic children during puberty. Patients between the ages of 10 and 20 years underwent annual ophthalmologic examinations that included fluorescein angiography and vitreous fluorophotometry.
Clinical research facility.
Fifty-seven diabetic children met preset eligibility criteria. During the study, 241 ophthalmologic examinations were scheduled and 210 (87.1%) were performed.
Vitreous fluorophotometry penetration ratio (VFPR) was used to indicate blood-retinal barrier permeability.
No sign of retinopathy was detected before puberty (age 13 years for boys and 11 or 12 years for girls). The prevalence of retinopathy in the 4 years immediately after puberty was 6%. In the next 4 years, the prevalence was 29.6% (P = .0003). When all VFPRs were correlated with age, and data for male and female patients were analyzed separately, we found that the lowest VFPRs occurred at the expected time of puberty. When patients were paired by gender and duration of diabetes, there was a significant difference between VFPR values before and after puberty (P = .03). Also, a progressive deterioration of the blood-retinal barrier became apparent when only VFPR values after puberty were considered.
These results support the view that the blood-retinal barrier remains stable until puberty, achieving a maximum of efficiency and protection. A progressive decline then begins, suggesting that this period of growth is associated with factors that, under the influence of diabetes, contribute to the progressive damage of the blood-retinal barrier.
评估青春期I型糖尿病患者血视网膜屏障的改变。
一项为期7年的前瞻性研究，评估糖尿病儿童在青春期发生的视网膜变化。年龄在10至20岁之间的患者每年接受眼科检查，包括荧光素血管造影和玻璃体荧光光度测定。
临床研究机构。
57名糖尿病儿童符合预设的入选标准。在研究期间，安排了241次眼科检查，其中210次（87.1%）得以进行。
玻璃体荧光光度测定渗透比（VFPR）用于指示血视网膜屏障的通透性。
青春期前（男孩13岁，女孩11或12岁）未检测到视网膜病变迹象。青春期后紧接着的4年中，视网膜病变患病率为6%。在接下来的4年中，患病率为29.6%（P = .0003）。当所有VFPR与年龄相关，并分别分析男性和女性患者的数据时，我们发现最低的VFPR出现在预期的青春期时间。当按性别和糖尿病病程对患者进行配对时，青春期前后的VFPR值存在显著差异（P = .03）。此外，仅考虑青春期后的VFPR值时，血视网膜屏障的逐渐恶化变得明显。
这些结果支持这样的观点，即血视网膜屏障在青春期前保持稳定，达到最大的效率和保护作用。随后开始逐渐下降，这表明这个生长时期与一些因素有关，在糖尿病的影响下，这些因素会导致血视网膜屏障的逐渐损害。
