Correlation of diabetic maculopathy and level of diabetic retinopathy.
One of the retinal changes during diabetic disease is appearance of diabetic maculopathy, which main characteristic is development of edema in the area of m.lutea. It is the main cause of decrease in vision and is found in about 10% of diabetic patients. The aim of this paper is to determine the frequency of diabetic maculopathy, prevalence of the found type of maculopathy and correlation with retinopathy level.


METHODS
the study comprised consecutive type 2 diabetic patients referred to the Unit for Laser Photocoagulation of the Clinic for Eye Diseases by ophthalmologists from other health centers. A total number of 86 patients were recruited in the study. Both ophthalmoscopic and biomicroscopic examinations of eye fundus as well as fluorescein angiography were performed. Grading of severity and level of both maculopathy and retinopathy has been done according to International Classification.


RESULTS
A high presence of maculopathy in the examined patients (89.5%) was found as a result of previous high selection of diabetic patients by their ophthalmologists. The high selection has also an impact on correlation of diabetic maculopathy onset and disease duration, where parallelism with its appearance was registered, but this could also suggest that retinal microvascular changes appear very early, prior to clinical manifestation of diabetes. Diabetic maculopathy was most frequently found in preproliferative and proliferative diabetic retinopathy (93.6% and 95.3%). Severe forms of diabetic maculopathy with huge edema, numerous hard exudates and significant zones of capillary "drop out" of foveal capillary net are also associated with preproliferative and proliferative diabetic retinopathy. The most frequent type of diabetic maculopahty was the mixed one, where in addition to exudative characteristics, elements of ischemia and diffuse leakage were also found in 56% of the cases.


CONCLUSIONS
Diabetic maculopathy is only one of the manifestations of diabetic disease and it is the main cause of visual acuity impairment in diabetic patients. It is a reflection of already existing more significant and advanced biochemical and pathophysiological processes on the level of retinal microcirculation. The mixed type of diabetic maculopathy was predominant and its onset and severity was in correlation with concurrent diabetic retinopathy. Prevention of retinal changes and sight preservation in these patients, in addition to timely and adequate ophthalmologic treatment, induces multidisciplinary approach since the principal cause of microvascular complications is hyperglycemia in correlation with many risk factors, such as hypertension and dyslipidemia.
Golubovic-Arsovska
M
M
Clinic for Eye Diseases, Clinical Centre, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia. golubovikarsovska@hotmail.com
D000368:Aged; D003930:Diabetic Retinopathy / Q000473:pathology*; D004487:Edema / Q000473:pathology; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged