[Endothelial dysfunction of central retinal vessels: a prognostic parameter for diabetic retinopathy?].
BACKGROUND
Endothelial dysfunction as a possible prognostic parameter seems to play a role in the course of diabetic retinopathy. Flicker-induced endothelial NO release may be used as an indicator for endothelial functionality of the central retinal vessels.


METHODS
Flicker-induced arterial vasodilation as well as complete internal medicine status were determined in 65 type 1 and 170 type 2 diabetics. Diabetic retinopathy was classified according ETDRS criteria. Furthermore, a group of 55 healthy subjects was used as control group.


RESULTS
Diabetic subjects showed with 2.1+/-2.2 (type 1) and 2.2+/-2.4 (type 2) a significantly decreased percent arterial vasodilation in comparison to healthy subjects (3.6+/-2.1; p<or=0.001). With increasing stage of the diabetic retinopathy dilation of the retinal arterioles decreased significantly (p=0.002) while static arterial measurements before flicker testing did not show significant differences in the different stages of diabetic retinopathy. Diabetic patients without retinopathy already showed a noticeably reduced arterial dilation in comparison to healthy controls. These changes could be seen both in type 1 and type 2 diabetics. Patients with type 1 diabetes with proliferative diabetic retinopathy showed a mean percent dilation of 1.80+/-2.11, while these reactions had nearly disappeared in patients with type 2 diabetes (0.31+/-1.08).


CONCLUSIONS
Both type 1 and type 2 diabetics showed significantly decreased flicker-induced arterial dilation as a sign of endothelial dysfunction in comparison to healthy controls. With increasing stage of the diabetic retinopathy dilation of the retinal arterioles decreased significantly. Diabetics without retinopathy already showed decreased flicker-induced reactions in comparison to healthy controls. Measurement of arterial flicker response may be useful for prognostic approaches in the case diabetes care.
Dawczynski
J
J
Universitäts-Augenklinik, Klinikum der FSU-Jena. Jens.Dawczynski@med.uni-jena.de
Mandecka
A
A
Blum
M
M
Müller
U A
UA
Ach
T
T
Strobel
J
J
D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology*; D003941:Diagnostic Techniques, Ophthalmological; D004730:Endothelium, Vascular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012161:Retinal Artery / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D014661:Vasoconstriction