J Korean Ophthalmol Soc.  2017 Sep;58(9):1050-1057. 10.3341/jkos.2017.58.9.1050.

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

• Choi HS
• Kim SJ
• Park JS

• KMID: 2390068
• DOI: http://doi.org/10.3341/jkos.2017.58.9.1050

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.

Keyword

Diabetic retinopathy; HbA1C; Latent autoimmune diabetes in adults; Newly diagnosed diabetes mellitus

MeSH Terms

Adult
Age of Onset
Central Serous Chorioretinopathy
Choroid
Diabetes Mellitus*
Diabetes Mellitus, Type 1
Diabetic Retinopathy
Education
Humans
Internal Medicine
Macular Degeneration
Macular Edema
Medical Records
Ophthalmology
Proteinuria
Retinal Diseases
Retinal Perforations
Retinal Vein
Retinal Vein Occlusion
Retinaldehyde
Retrospective Studies
Rupture
Vascular Diseases
Vitreous Hemorrhage
Retinaldehyde

Figure

• 

  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.

• 

  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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