Primary open-angle glaucoma in patients with diabetic retinopathy in type 2 diabetes

Author: 
Mogilevskyy S. Yu, Gudzenko K.A. and Ziablitsev S.V.

Background: The common mechanisms of diabetic retinopathy (DR) in type 2 diabetes mellitus (DM2) and glaucoma optic neuropathy (GON) in primary open-angle glaucoma (POAG) justify the need to study possible clinical variants of their combination. Objective: to study the clinical features of the combination of POAG and DR in diabetes mellitus2 and their mutual influence on the progression of diseases by stages. Material and Methods: 301 patients with diabetes mellitus 2 and POAG were examined, 164 patients who had diabetes mellitus2 and DR but did not have POAG; 81 patients who had POAG but no diabetes mellitus and 103 patients who had neither diabetes mellitus nor POAG. A total of 649 patients (649 eyes) were examined. The stage of DR was established according to the classification of the American Academy of Ophthalmology (2002); stage POAG – for the classification of perimetric changes by stages of glaucoma. MedStat and MedCalc v.15.1 (MedCalc Software bvba) were used for statistical research. Results. Among patients with a combination of DR and POAG, 42.9% initially developed diabetes mellitus, which was joined by POAG after 1-7 years. Another 57.1% of patients first developed POAG, and later (after 1-8 years) – diabetes mellitus2. The vast majority of patients with diabetes mellitus2 and POAG (79.1%) had stage II and III POAG. Stage IV POAG had 14.6% of patients who initially developed POAG with a disease duration of 10 to 30 years (average 20.5±0.8 years). Among patients with diabetes mellitus and POAG, the proportion of normotensive glaucoma (NTG) was 18.6%. All of these patients had stage II or III. The calculation of the progression index in relation to the stage of the disease to its duration showed, that the burden of POAG development of diabetes mellitus does not accelerate the progression of either GON or DR. With the development of POAG in patients with diabetes mellitus, the progression of GON significantly (2.8 times) accelerated. Conclusion. Thus, the clinical features of the combination of POAG and DR in diabetes mellitus and the phenomenon of mutual burdening of their course have been established.

Paper No: 
3540