Evaluation of Microvascular Complications in Kidney Recipients With Posttransplant Diabetes Mellitus.

CONTEXT: The paucity of data on microvascular complications in patients with posttransplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. OBJECTIVE: To evaluate diabetic microvascular complications in patients with long-standing PTDM. METHODS: In patients with ≥5-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM), diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument, the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy tests were performed using heart rate variability. Nephropathy screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy was evaluated by fundus examination and photography, and optical coherence tomography. RESULTS: This study included 41 patients with PTDM and 45 NDM patients. The median follow-up was 107.5 months in the PTDM group. Peripheral neuropathy was significantly higher in the PTDM group than in the NDM group (P = .02). In the PTDM patients with peripheral neuropathy, corneal nerve fiber density examined by CCM was significantly lower than in PTDM patients without neuropathy (P = .001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (P = .001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (P = .001). Retinopathy was observed in 19.5% of patients in the PTDM group and in none of the NDM patients (P < .001). Renal functions were similar between the study groups. CONCLUSION: Cardiac autonomic neuropathy and diabetic retinopathy can affect patients with PTDM at a high rate. Diabetic retinopathy is a threat to the vision of PTDM patients. Diabetic peripheral neuropathy can be detected early in PTDM patients by CCM.

Correlation of Ocular Biometric Parameters and Macular Ganglion Cell Layer in Normal Eyes.

PURPOSE: To determine the association between ocular biometric parameters and macular ganglion cell layer (MGCL) thickness in normal eyes. METHODS: This observational cohort study was conducted with 76 eyes of 76 healthy subjects. Keratometry, pachymetry, corneal volume, iridocorneal angle were measured with Sirius (CSO, Florence, Italy); axial length, anterior chamber depth, anterior chamber volume, corneal diameter were measured with IOL Master (Carl Zeiss Meditec, Dublin, California). For all participants, serial horizontal Spectralis Domain Optical Coherence Tomography (SD-OCT, Heidelberg Engineering, GmbH, Dossenheim, Germany) scans of the macula and peripapillary retinal nerve fiber layer (RNFL) analysis were obtained using SD-OCT. The relationship between numerical variables was given by Pearson correlation coefficient. RESULTS: The mean age of the subjects was 36.3 ± 11.9 years (between 19 and 70 y). Fifty-one patients were female (67.1%) and twenty-five patients were male (32.9%). MGCL was found to be correlated with anterior chamber depth, anterior chamber volume, iridocorneal angle, axial length and white to white (p = .015 r = 0.594, p = .002 r = 0.365, p = .013 r = 0.299, p = .004 r = 0.335, p = .013 r = 0.289, respectively). In addition, MGCL was correlated positively with the mean global and superotemporal RNFL (p ≤ 0.005). However, neither central corneal thickness nor keratometry values were found to be correlated with MGCL. CONCLUSION: The results of this study showed that MGCL thickness is affected by ocular biometric parameters. Therefore, these parameters should be taken into consideration when interpreting MGCL thickness measurements in the diagnosis of glaucoma.

Recurrence of a Totally Excised Cavernous Venous Malformation 25 Years Later.

Recurrence of cavernous venous malformation is exceedingly rare. In 1995, a 16-year-old woman was referred for left axial proptosis. Her left visual acuity was 20/200, and there were choroidal folds in the OS. MRI studies showed a well-circumscribed retrobulbar intraconal mass in the left orbit. The tumor was totally removed with intact capsule through a transconjunctival orbitotomy and proved to be a cavernous venous malformation. In 2020, at the age of 41 years and 25 years after the operation, she again presented with left proptosis. Imaging results were very similar to those at first presentation. This tumor was also extirpated in its entirety via an inferior forniceal orbitotomy with the histopathologic diagnosis of a cavernous venous malformation. Her final left visual acuity remained 20/50. Women with orbital cavernous venous malformations, especially those who undergo surgical removal at a relatively young age are advised to have long-term follow up complemented with occasional imaging studies.