The general practitioner and the diabetic eye - abstract

Diabetic patients are 25 times more likely to suffer blindness than non-diabetics. General practitioners form the first link in the clinical care of diabetic patients, and their role as screeners is extremely important. An early detection and a prompt control of the disease can greatly minimize the disabilities and the associated psychological and social consequences. The aim of the therapy is to prevent the development, or at least to reduce the severity, of retinopathy, nephropathy, neuropathy and macro-vascular disease. It may not be possible to adequately control this non-specific vascular disease, but the risk factors like hypertension, hyperlipidaemia and obesity can be fully controlled by using simple measures to reduce the morbidity. A good control of diabetes mellitus certainly decreases the incidence as well as the severity of retinopathy. It is well accepted now that the lower the mean blood glucose level, the lower are the micro-vascular complications, and the younger the patient the tighter should be the glycaemic control. The quality of glycaemic control can be assessed more accurately nowadays by the levels of glycated haemoglobin. Primary care physicians must be particularly thorough when examining these patients and look for abnormalities in other systems also. The rising incidence of morbidity is related to increased longevity and an inability to detect and prevent the various complications. A regular observation for an early recognition of retinal complications is essential. Non-insulin-dependent diabetics should be examined by an opthalmologist at the time of diagnosis and insulin-dependent diabetics should be seen once every year. A diabetic patient should be encouraged to actively participate in the self-management of the disease with proper education and motivation with a frequent review of compliance. A general practitioner may not have sufficient experience in recognizing the ocular complications of diabetes mellitus. Their screening performance can be greatly improved by short courses of instruction in opthalmology departments at various institutions (AU)

Diabetic retinopathy in pregnancy - abstract

Diabetic retinopathy is the leading cause of blindness between the ages of 24 and 64 years. The first half of this period corresponds to the childbearing age in women. The effects of pregnancy on diabetic retinopathy (DR) are unclear. However, the concensus is that pregnancy is an independent risk factor accelerating DR. Co-existing hypertension also potentiates this condition. The duration of diabetes mellitus and the status of the retina prior to pregnancy influence the rate of acceleration of retinopathy. Rapid normalization of blood glucose recommended for optimal obstetric outcome leads to worsening of DR. A baseline opthamological evaluation is recommended at the beginning of each pregnancy and follow-up in each trimester as well as three months post-partum. If there is no, or minimal, non-proliferative diabetic retinopathy (NPDR) at the initial examination, deterioration is unlikely. However, 50 per cent of women with severe NPDR or proliferative diabetic retinopathy (PDR) will worsen during pregnancy. PDR that has been adequately treated by laser photocoagulation prior to pregnancy does not deteriorate and as such it is no longer a contraindication to childbearing. Female diabetic patients ideally should have a planned pregnancy. A team approach has shown significant improvements in maternal and foetal outcome. By the inclusion of the opthalmologist in the team, the effects of pregnancy on DR. can be monitored (AU)

Electrical injury and cataracts: an unusual case

A 24 year-old male Jamaican building worker developed cataracts four months after electrical injury from a high tension cable. His visual acuity fell to perception of hand movements at 1 metre. Extracapsular cataract extraction and intraocular lens implantation restored his visual acuity to 20/25 (6/7.5). Mechanisms for this unusual complication of electrical injury are discussed (AU)

Diabetic retinopathy and visual loss in a Jamaican population

Opthalmic assessment was performed on a random sample of 178 black Jamaican diabetics. Retinopathy was present in 69 percent. Severe visual loss (V.A.<5/200or

Segmental dilation of the colon and the Stilling-Turk-Duane retraction syndrome

A case of a 3-year and 9-month-old girl with segmental dilation of the colon and the Duane Retraction Syndrome is reported. The dilated hypertrophied segment of the colon had no taenia coli. Dysfunction of this segment was demonstrated both radiologically and clinically by a non-functioning clostomy placed at the apparent distal transition zone. The proximal and distal colonic segments were normal and a resection of the dilated segment was curative. The relevant literature is reviewed (AU)