İnsüline Bağımlı Diyabet Mellituslu Çocuk Ve Ergenlerde Diyabetik Retinopatinin Erken Evrede Tanısı Ve İzlemi
Abstract
Erken retinal değişikliği saptamak ve ilerleyişini değerlendirmek için insüline bağımlı diyabet mellituslu (İBDM) 20 çocuk ve ergen hasta (8 kız / 12 erkek; ortalama yaşları 13.1 ± 3.9 yıl, ortalama diyabet süreleri 4.9 ± 3.1 yıl) direkt oftalmoskopi ve fluoresan fundus anjiografisi (FFA) ile çalışma başlangıcında ve 2 yıllık izlem süresinin sonunda incelendi. Diyabetik retinopatinin (DR) derecesi Airlie House Diyabetik Retinopati değerlendirmesinin Madison modifikasyonuna uygun olarak 6 evrede yapıldı. Hastanın yaşı, ergenlik durumu, diyabet süresi, arteriyel kan basıncı, idrarda mikroalbümin varlığı ve HbA1c düzeyleri de değerlendirmeye alındı. Direkt oftalmoskopi ile 2 (% 15) hastada, FFA ile altı (% 30) hastada değişik düzeylerde retinopati saptandı. Retinopati ile hastanın yaşı arasında istatistiksel olarak anlamlı bir ilişki vardı. Diyabet süresi 5 yılı geçen hastaların % 60' ında DR saptandı. Bu hastaların 2 yıllık takibinde 3 hastada gerileme gözlendi, iki hastada FFA ile evre 2 ve 3 ile uyumlu yeni retinal değişiklikler ortaya çıktı, HbA1c ve mikro-albüminüri ile retinal değişiklikler arasında önemli bir pozitif korelasyon saptandı. Ergenliğe girmemiş hastalarda DR gözlenmedi. Sonuç olarak diyabetik retinopati başlangıç döneminde herhangi bir belirti vermediği için, göz muayeneleri düzenli olarak yapılmalıdır. Retinopatinin erken evrede tanınabilmesini sağlayan FFA yöntemi direkt oftalmoskopi yöntemine göre daha duyarlı bir yöntemdir. İyi metabolik kontrol ile DR ilerlemesi kontrol altına alınabilir.
References
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- DCCT Research Group. Effect of intensive diabetes treatment on The development and progression on long term complications in
- Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent diabetes. N Engl J Med 1984; 311: 89-93.
- Tümer N, Yalçinkaya F, İnce E,Ekim M, Köse K, Cakar N, Kara N, Ozkaya, Ensari C, Onder S.Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol 1999; 13: 438-443.
- Dorothy B. Complications of insulin-dependent diabetes mellitus in childhood and adolescence. In Lifshitz F (ed). Pediatric Endocri
- Salardi S, Rubbi F, Puglioli R, Brancaleoni A, Bacchi-Reggiani L, Ragni L, Cacciari E. Diabetic retinopathy in childhood: Long-term
- Early Treatment Diabetic Retinopathy Study Research Group. Gra- ding diabetic retinopathy from stereoscopic color fundus photog
- Chaturvedi N, Sjoelie AK, Porta M, Aldington SJ, Fuller JH, Songini M, Kohner EM, Markers of insulin resistance are strong risk factors
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- nephropathy in type 1 diabetes. Diabetes 1998; 47: 1341-1346.
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- background retinopathy in adolescent with diabetes. Diabetes Care 1994; 17: 1390 1396.
EARLY STAGE DIAGNOSIS AND FOLLOW-UP OF THE DIABETIC RETINOPATHY IN CHILDREN AND ADOLESCENTS WITH INSULIN DEPENDENT DIABETES MELLITUS
Abstract
Early retinal change and evaluate its progression in children and adolescents diagnosed with insulin dependent diabetes mellitus we examined in 20 Turkish children (8 female, 12 male ). Thein mean age was 13.1 ± 3.9 years with mean diabetes duration of 4.9 ± 3.1 years. Direct ophtalmoscopy and fluorescein fundus angiography (FFA) were performed at the beginning and at and the end of two years follow-up period. The stage of diabetic retinopathy (DR) was evaluated in six stages according to ''Madison modification of Airlie House Classification of Diabetic Retinopathy”. We also considered age, pubertal stage, disease duration, arterial blood pressure, microalbuminuria and HbA1c levels. Retinopathy of varying stage was detected with direct ophtalmoscopy in 2 cases (15 %) and FFA in 6 cases (30 %) respectively. A significant statistical relationship was present between the stage of the DR and patient age. DR was present in 60 % of the patients with a disease duration exceeding 5 years. In the two years follow-up of these patients, regression was noted in 3, new retinal changes consistent with stage 2 and 3 appeared in two patients. A significant positive correlation was present between HbA1c and retinal changes; microalbuminuria and retinal changes. No DR was noted in prepubertal cases. Conclusion: Because DR may give no symptom early in disease course, routine eye examination must be done regularly in diabetic patients. In early stages; FFA is more sensitive than direct ophtalmoscopy. Regression changes are possible with close follow-up of these cases and the maintenance of good metabolic control of the retinal
References
- Watkins PJ . Retinopathy. BMJ 2003; 326: 924-926.
- DCCT Research Group. Effect of intensive diabetes treatment on The development and progression on long term complications in
- Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent diabetes. N Engl J Med 1984; 311: 89-93.
- Tümer N, Yalçinkaya F, İnce E,Ekim M, Köse K, Cakar N, Kara N, Ozkaya, Ensari C, Onder S.Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol 1999; 13: 438-443.
- Dorothy B. Complications of insulin-dependent diabetes mellitus in childhood and adolescence. In Lifshitz F (ed). Pediatric Endocri
- Salardi S, Rubbi F, Puglioli R, Brancaleoni A, Bacchi-Reggiani L, Ragni L, Cacciari E. Diabetic retinopathy in childhood: Long-term
- Early Treatment Diabetic Retinopathy Study Research Group. Gra- ding diabetic retinopathy from stereoscopic color fundus photog
- Chaturvedi N, Sjoelie AK, Porta M, Aldington SJ, Fuller JH, Songini M, Kohner EM, Markers of insulin resistance are strong risk factors
- Cummings EA, Sochet EB, Dekker MG,Lawson ML, Daneman D. Contribution of growth hormone and IGF-1 to early diabetic
- nephropathy in type 1 diabetes. Diabetes 1998; 47: 1341-1346.
- Danne T, Weber B, Hartman R, Enders I, Burger W, Hovener G. Long term glycemic control has a non-linear association to the frequency of
- background retinopathy in adolescent with diabetes. Diabetes Care 1994; 17: 1390 1396.
Details
| Other ID | JA75TK78CJ |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 1, 2008 |
| Submission Date | August 1, 2008 |
| Published in Issue | Year 2008 Volume: 2 Issue: 1 |
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