Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.

AIMS: To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. METHODS: Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. RESULTS: Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (P<0.001). Only 6% in the diabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; P<0.001), but time-to-proliferative diabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. CONCLUSIONS: In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to <10% in our matched control group. More advanced diabetic retinopathy was linked to worse visual acuity.

A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers.

Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.

Colour slides or digital photography in diabetes screening--a comparison.

PURPOSE: The aim of this study was to compare digital images with slides in detecting and grading diabetic retinopathy, and to assess the retinopathy screening performed by ophthalmic nurses. METHOD: 283 consecutive patients were examined using digital colour and redfree photography (Topcon Imagenet System 1.53) and 35 mm slides (Topcon TRC-50 VT fundus camera, Kodachrome 64 colour film). The images were graded by the worst eye according to the Wisconsin classification by an ophthalmologist and ophthalmic nurse independently. RESULTS: There was exact agreement between grades obtained from the colour slides and the digital colour images in 82% (weighted kappa 0.88; 95% CI 0.80-0.96), and in 85% when redfree images were used as an adjunct to the digital colour images There was a tendency towards undergrading of the digital colour images and overgrading of the digital redfree images, compared with the colour slides. Inter- and intragrader agreement (weighted kappa) varied between 0.77 and 0.84 for digital photography and between 0.88 and 0.90 for colour slides CONCLUSION: Good to excellent agreement was found between the grading of colour slides and digital colour images, the latter, however, associated with a slightly lower reliability. The adjunct of redfree images seemed to facilitate the detection of retinopathic lesions.

Progression to proliferative retinopathy and macular oedema requiring treatment. Assessment of the alternative classification of the Wisconsin Study.

PURPOSE: To study the ability of the alternative classification of the Wisconsin Study to predict progression to retinopathy requiring laser treatment in patients with diabetes. METHODS: A total of 1585 diabetic patients were included in the study. Of them, 294 (19%) were diagnosed with diabetes before and 1291 (81%) after age 30 years. Retinopathy was diagnosed on fundus photographs using a modification of the Wisconsin scale, and graded into 6 levels according to the worse eye. The first visit during the study period was used to represent baseline examination. The time points for detection of proliferative retinopathy (PDR) and clinically significant macular oedema (CSME) were recorded during a mean follow-up time of 2.9 years. RESULTS: Progression to PDR and/or CSME was significantly related to increasing severity of retinopathy at baseline (p<0.001; test for trend). Fifty per cent of patients with severe non-proliferative retinopathy (NPDR) (level 51) at entry progressed within one year to PDR and/or CSME; the 3-year risk for such progression in patients with mild (level 31) and moderate NPDR (level 41) was 25 and 60%, respectively. The incidence of progression to PDR and to CSME was 0.95 and 2.3/100 person-years, respectively. Progression to PDR and/or CSME was furthermore associated with a higher level of glycosylated haemoglobin, longer duration of the diabetes and use of antihypertensive treatment. CONCLUSION: Increasing severity of retinopathy as recorded by this modification of the alternative classification of the Wisconsin Study was significantly associated with increased risk of progression to retinopathy requiring treatment.

Activated protein C resistance in patients with central retinal vein occlusion.

AIM/BACKGROUND: A new defect in the anticoagulant system has recently been discovered--activated protein C resistance. The frequency of this disorder has been shown to be increased in young patients (< 50 years of age) with central retinal vein occlusion. This study was carried out to determine if there was any overrepresentation of activated protein C resistance in patients > 50 years of age with central retinal vein occlusion. METHODS: Blood samples were obtained from 83 patients > 50 years of age and with a history of central retinal vein occlusion. The blood samples were analysed for activated protein C resistance with standard clinical laboratory methods. RESULTS: In this material 11% of the patients were resistant to activated protein C. The normal incidence of activated protein C resistance in the same geographical area is 10-11%. CONCLUSION: Activated protein C resistance does not seem to be a cause of central retinal vein occlusion in people older than 50 years.