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Ophthalmology. 2010 Nov;117(11):2214-7. doi: 10.1016/j.ophtha.2010.03.006. Epub 2010 Jun 16.

Bilateral diabetic papillopathy and metabolic control.

Author information

1
Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark. oejenforsk@glo.regionh.dk

Abstract

OBJECTIVE:

The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis.

DESIGN:

Retrospective case-control study.

PARTICIPANTS:

Two thousand sixty-six patients with type 1 diabetes.

METHODS:

Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008.

MAIN OUTCOME MEASURES:

Simultaneous, bilateral diabetic papillopathy.

RESULTS:

The mean follow-up was 4.9 years. During 10,020 patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A₁(c) (HbA₁(C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA₁(C) observed in the remainder of the study population (P<0.001). Photographs recorded before the onset of bilateral diabetic papillopathy showed that all 5 patients had small cup-to-disc diameter ratios in both eyes (P<0.001).

CONCLUSIONS:

Diabetic papillopathy was associated markedly with a drastic recent reduction in glycemia and a small cup-to-disc diameter ratio. This supports the hypothesis that diabetic papillopathy may be an early worsening phenomenon occurring in anatomically predisposed patients in response to a recent rapid decrease in glycemia.

FINANCIAL DISCLOSURE(S):

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

PMID:
20557939
DOI:
10.1016/j.ophtha.2010.03.006
[Indexed for MEDLINE]

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