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C. Hudson, K. Guan, T. Wong, M. Kisilevsky, R.K. Nrusimhadevara, W.C. Lam, M. Mandelcorn, R.G. Devenyi, J.G. Flanagan; One–Year Follow–Up of Retinal Arteriolar Hemodynamics in Patients at Risk for the Development of Clinically Significant Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):392.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine change of retinal hemodynamics in stratified groups of diabetic patients at increasing risk for the development of clinically significant diabetic macular edema (CSDME) after 1 year of follow–up. Methods: Group 1: 32 normal control subjects. Group 2: 41 diabetic patients without retinopathy. Group 3: 22 diabetic patients with micro–aneurysms and / or hard exudates within 2 disc diameters of the fovea. Group 4: 32 patients with pre–treatable DME. Retinal hemodynamics (diameter, velocity, max:min velocity ratio and flow) were assessed in a superior retinal arteriole using the Canon Laser Blood Flowmeter (CLBF), at baseline and at 1–year follow–up. Care was taken to ensure the measurement site was situated in a straight vessel segment distant from a bifurcation. The identical measurement site was assessed across the two visits using the intrinsic fixation target of the CLBF and was cross–checked by reference to fundus images showing the baseline measurement site. Diabetic patients were assessed for retinopathy status by retinal specialists at each visit. Progression was defined as advancement from a lower to a higher diabetic group or enlargement of the area of DME. Intraocular pressure, blood pressure and standard blood tests were also assessed. Results: No significant changes were found in any of the diabetic patient groups for diameter, velocity, max:min velocity ratio or flow at 1–year follow–up relative to baseline. Over the 1–year period of follow–up, 21 diabetic patients showed progression of retinopathy status. For the diabetic patients who demonstrated progression of retinopathy status, the max:min velocity ratio at baseline was 3.54 (SD 0.99) and increased significantly (p=0.034, two–tailed, paired t–test) to 4.28 (SD 1.88) at 1–year follow–up. Diameter, velocity or flow did not change significantly for the progressing diabetic patients. Conclusions: The 1–year follow–up results demonstrated that the most prominent retinal hemodynamic change in diabetic patients progressing to CSDME is an increase of max:min velocity ratio. These results confirm our baseline cross–sectional findings (presented at ARVO 2004) and implicate a change in the compliance of the retinal arterioles, or up–stream arteries, in the pathogenesis of DME.
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