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Laurence S. Lim, E Shyong Tai, Lieng Hsi Ling, Wallace Foulds, Edmund Wong, Shu Yen Lee, Gemmy Cheung, Tien Y. Wong; Diabetic Retinopathy And Systemic Endothelial Function. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5276.
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To determine the associations between diabetic retinopathy (DR) and systemic vascular endothelial function measured using reactive hyperemia peripheral arterial tonometry.
This was a prospective observational clinical study. Subjects with diabetes were recruited and DR was graded from retinal photographs. A retinopathy severity score was assigned according to a scale modified from the Airlie House classification system. Retinopathy severity was categorized as minimal nonproliferative diabetic retinopathy (NPDR; Early Treatment Diabetic Retinopathy Study (ETDRS) levels 15 through 20), mild NPDR (level 35), moderateNPDR (levels 43 through 47), severe NPDR (level 53), and proliferative retinopathy (level more than 60). Vision-threatening retinopathy was defined as severe non-proliferative retinopathy (NPDR), proliferative DR, or clinically significant macular edema (CSME). Systemic endothelial function was measured using reactive hyperemia peripheral arterial tonometry (EndoPAT) and expressed as the Reactive Hyperemia Index (RHI).
Fourty-one subjects were included in the analyses. The mean age was 60.6±7.9 years, 32 (78%) were male, and the mean HbA1c level and mean duration of diabetes were 7.7±1.4% and 10.8±9.6 years respectively. In age-gender adjusted analyses, RHI responses were largest in subjects with the highest grade of DR compared to the lowest (adjusted mean (95% confidence interval(CI)): 3.42(2.87-3.97) versus 1.71(1.57-1.85); p for trend <0.001). In multivariate analyses adjusting further for smoking, hypertension, hyperlipidemia, duration of diabetes and HbA1c, the relationship persisted (adjusted mean (95% CI): 3.42 (2.89-3.95) for highest grade of DR versus 1.72 (1.57-1.88) for lowest; p <0.001). Subjects with vision threatening DR had higher mean RHI values than subjects without (p<0.001).
Subjects with more severe DR demonstrate higher peripheral reactive hyperemic responses. Our findings suggest that the severity of DR is correlated with measurable differences in systemic endothelial function, supporting a role for the latter in the pathogenesis of DR.
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