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Choi, Kim, and Park: Clinical Analysis of Newly Diagnosed Diabetes Mellitus Patients by Abnormal Fundus Examination
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(9): 1050-1057.

Published online: 18 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.9.1050

Clinical Analysis of Newly Diagnosed Diabetes Mellitus Patients by Abnormal Fundus Examination

Hwa Su Choi, MD, Sung Jin Kim, MD, Jong Seok Park, MD, PhD

Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.

Address reprint requests to: Jong Seok Park, MD, PhD. Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University, #68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea. Tel: 82-2-970-8269, Fax: 82-2-970-8272, pjs4106@eulji.ac.kr

Received 29 June 2017       Revised 18 August 2017       Accepted 5 September 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical analysis of newly diagnosed diabetes mellitus (NDM) patients with abnormal fundus examination at the first visit.

Methods

This retrospective study utilized the first visit medical records of 15 patients (30 eyes) who were diagnosed with NDM from February 2011 to October 2016.

Results

Patients were divided into 3 groups: 1) diabetic retinopathy group including proliferative diabetic retinopathy (PDR) (3) and severe non-proliferative diabetic retinopathy (NPDR) (1); 2) retinal vascular disease group including central retinal vein occlusion (CRVO) (1), branch retinal vein occlusion (1), vitreous hemorrhage with CRVO (1) and macular edema (1); and 3) other retinal disease group including vitreous hemorrhage due to choroidal neovascular rupture (1), exudative age-related macular degeneration (3), central serous chorioretinopathy (2), and macular hole (1). All 3 PDR patients had latent autoimmune diabetes in adults (type 1.5 diabetes). The remaining 12 patients had type 2 diabetes. Three patients showed mild NPDR in the opposite eye and the other 9 patients did not have diabetic retinopathy in the opposite eye. Onset age, HbA1C and proteinuria were significantly different between the diabetic retinopathy group and the other retinal disease group (p = 0.006, p = 0.012 and p = 0.006, Mann-Whitney test).

Conclusions

In patients with various retinal diseases, early detection of NDM could be achieved by performing fundoscopic imaging and systemic examination as well as basic ophthalmologic examination. In addition, patients with diabetic retinopathy should be treated promptly through ophthalmology and internal medicine consultation. For the retinal vascular disease and other retinal disease groups, not only treatment for ophthalmic diseases, but also education about diabetes treatment are important.

Keywords: Diabetic retinopathy, HbA1C, Latent autoimmune diabetes in adults, Newly diagnosed diabetes mellitus

Figures and Tables

Figure 1

Fundus photography of a patient who was diagnosed with proliferative diabetic retinopathy and latent autoimmune diabetes in adult. A 39-year-old female patient (Patient No.1) presented with decreased visual acuity in the right eye. (A) The patient underwent pars plana vitrectomy due to vitreous hemorrhage and subhyaloid hemorrhage in the right eye. (B) Neovascularization (at the disc and elsewhere) and hard exudate were observed in the opposite eye.

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Figure 2

A case of central retinal vein occlusion (CRVO) in the right eye (Patient No. 5). Fundus photography and fluorescein angiography of a 46-year-old woman who presented with decreased visual acuity in the right eye. (A) In the fundus photograph, the right eye showed diffuse flame-shaped retinal hemorrhages and cotton wool patches of CRVO. And there was one flame-shaped retinal hemorrhage (black arrow) with cotton wool patch in the left eye and no microaneurysms. (B) However, two microaneurysms (white arrow) are observed in the left eye in the fluorescein angiography.

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Table 1

Clinical features and characteristics of newly diagnosed diabetes mellitus patients, classified into 3 groups

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HTN = hypertension; DM = diabetes mellitus; F = female; M = male; PDR = proliferative diabetic retinopathy; LADA = latent autoimmune diabetes in adults; NPDR = non-proliferative diabetic retinopathy; CRVO = central retinal vein occlusion; BRVO = branch retinal vein occlusion; CNV = choroidal neovascularization; AMD = age-related macular degeneration; CSC = central serous chorioretinopathy; MH = macular hole.

Table 2

Comparison of diagnosis between both eyes

jkos-58-1050-i002

PDR = proliferative diabetic retinopathy; NPDR = non-proliferative diabetic retinopathy; RRD = rhegmatogenous retinal detachment; CRVO = central retinal vein occlusion; BRVO = branch retinal vein occlusion; DR = diabetic retinopathy; RPE = retinal pigment epithelium; CNV = choroidal neovascularization; AMD = age-related macular degeneration; CSC = central serous chorioretinopathy; MH = macular hole.

Table 3

Diabetic status, lipid profile and renal function test results of the patients

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HbA1C = hemoglobin A1C; LDL = low density lipoprotein; TG = triglyceride; Cr = creatinine; GFR = glomerular filtration rate.

*It was measured in the fasting state; †Although HbA1C did not meet the standard of 5.9%, random glucose measured as 205 mg/dL and diagnosed as newly diagnosed diabetes mellitus.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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