Korean J Ophthalmol.  2019 Feb;33(1):46-53. 10.3341/kjo.2018.0034.

Diabetic Nephropathy in Type 2 Diabetic Retinopathy Requiring Panretinal Photocoagulation

• Ha M
• Choi SY
• Kim M
• Na JK
• Park YH

• KMID: 2434304
• DOI: http://doi.org/10.3341/kjo.2018.0034

Abstract

PURPOSE
To investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis.
METHODS
A retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated.
RESULTS
The mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy.
CONCLUSIONS
In the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.

Keyword

Diabetic nephropathies; Diabetic retinopathy; Panretinal photocoagulation

MeSH Terms

Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diabetic Nephropathies*
Diabetic Retinopathy*
Diagnosis
Electronic Health Records
Female
Hemoglobin A, Glycosylated
Humans
Incidence
Light Coagulation*
Male
Prognosis
Retinal Diseases
Retrospective Studies
Risk Factors
Seoul
Visual Acuity
Vitreous Hemorrhage

Figure

• 

  Fig. 1 Distribution of patients by time-taken for diagnosis of nephropathy after panretinal photocoagulation (PRP). In the microalbuminuria group and advanced nephropathy group, one and three patients, respectively, were diagnosed as diabetic nephropathy at or before the time of PRP. In 58 patients with diabetic nephropathy, 27 were diagnosed nephropathy 6 to 10 years after PRP.

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