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L.G. Duarte, R.C. Bernardes, M.A. Soares, C.L. Lobo, J.F. Abreu, J.G. Cunha–Vaz; Retinopathy Phenotypes in Diabetes type 2. Patterns of retinopathy progression in a two year follow–up. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4147.
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© ARVO (1962-2015); The Authors (2016-present)
Objective: To characterize retinopathy progression in the initial stages of retinal disease in diabetes type 2. Methods: We classified 57 eyes of 57 patients with type 2 diabetes mellitus and mild nonproliferative retinopathy by 7 field stereoscopic fundus photography (levels 10, 20 and 35 of Wisconsing grading). They were examined 5 times at six–month intervals by fundus photography (FP), fluorescein angiography (FA), vitreous fluorometry (VF), retinal leakage analyzer (RLA) and retinal thickness analyzer (RTA). Results: Red dots (microaneurysms and hemorrhages), increased fluorescein leakage and increased retinal thickness were present at some time during the follow–up in every eye findings. Capillary closure in the foveal avascular zone (FAZ) developed in only 8 eyes (14%). Three different patterns of progression of retinopathy were identified. Pattern A, involving 63% of the eyes, is characterized by slow increases in the rate of red dot accumulation (<3/year) and low fluorescein leakage (< 4mg/ml, VF). Pattern B, involving 23% of the eyes, is characterized by marked increases in the rate of red dot accumulation and in fluorescein leakage, defining a "wet" type of retinopathy. Pattern C, involving 14% of the eyes, is characterized by increased red dot accumulation associated with capillary closure in the FAZ, identifying an "ischemic" type of retinopathy. Conclusions: Three major evolutive patterns of retinopathy progression in diabetes type 2 were identified in a two year follow–up study, by combining different imaging techniques. They may characterise three different retinopathy phenotypes: one, more frequent, showing slow progression, and the other two, less frequent, which may be called "wet" and "ischemic" phenotypes.
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