Visual Morbidity in Diabetic Retinopathy Associated with Diabetic Nephropathy - Our Experience in a Multispecialty Tertiary Hospital in Chennai, India

Abstract

BACKGROUND The increased prevalence of diabetes mellitus (DM) worldwide has resulted in worsening diabetic retinopathy (DR) and nephropathy. The pathophysiological changes that occur at a cellular and anatomical level are similar in DR and DN. The risk factors for DR and DN are common hence investigating both is paramount to reduce morbidity. We wanted to study the association of diabetic retinopathy and diabetic nephropathy, their ophthalmic features, patterns of vision loss and extent of ocular morbidity. METHODS This is a retrospective observational study performed on 100 diabetic patients over 2 years. Patients with a confirmed diagnosis of DN based on clinical evaluation and laboratory tests were included. Ophthalmic evaluation and investigations were done and DR was classified based on early treatment diabetic retinopathy study (ETDRS). RESULTS Mild non-proliferative diabetic retinopathy (NPDR) occurred in 60 %, moderate to severe NPDR in 9 %, proliferative diabetic retinopathy (PDR) in 4 % and no diabetic retinopathy in 27 %. Macula was involved in 48 % with clinically significant macular edema (CSME) in 33 % and ischemic maculopathy in 5 %. Retinopathy occurred in 3 % after 5 years and in 40 % after 20 years of DM. The incidence of DN +DR was 65 % and statistical significance was noted with longer duration of diabetes, higher serum creatinine, proteinuria, lower haemoglobin, decreased GFR, higher age and higher lipid levels (P = 0.04). Improvement in vision was seen in 63 % after blood sugar control with laser photocoagulation, 27 % with laser alone and 7 % of patients with intravitreal anti-VEGF CONCLUSIONS DR and DN have an overlapping significant association and all patients have to be screened for both to prevent ocular morbidity. KEY WORDS Diabetic Retinopathy, Diabetic Nephropathy, Vision, Glomerular Filtration Rate, Macular Edema.