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Simona Degli Esposti, Tunde Peto, Irene Leung, Ferenc Sallo, Catherine Egan, MacTel Study Group; Severity And Progression Of Diabetic Retinopathy In Type 2 Macular Telangiectasia (MacTel). Invest. Ophthalmol. Vis. Sci. 2013;54(15):1531.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the impact of diabetes on the characteristics of Type 2 Macular Telangiectasia (MacTel).
Data from patients enrolled in the MacTel Natural History Observation Study were analysed. Out of 409 patients, 145 had documented evidence of diabetes at enrolment. Colour fundus images, fluorescein angiography and OCT images were obtained from all diabetic patients and were graded on the ETDRS scale for severity of retinopathy and maculopathy. MacTel was graded for disease characteristics. Diabetes status of 30 patients from a single centre was analysed in detail. Diabetes was defined as uncontrolled when HbA1C was more than 7%.
MacTel patients with diabetes with early stages of MacTel had worse visual acuity than those without diabetes (Stage 1: no diabetes: 76.44±2.04, diabetes: 67.71±4.84, p=0.096; Stage 2: no diabetes: 74.71±1.46, diabetes: 70.71±2.06, p=0.073, Stage 3: no diabetes: 74.04±0.73, diabetes: 70.26±1.35, p=0.014; no difference in Stage 4-5 MacTel). After adjustment for length of MacTel and staging, patients with uncontrolled diabetes had significantly lower visual acuity when entering the study compared to patients with no history of diabetes despite having no difference in the severity of diabetic retinopathy or maculopathy with the patients with controlled diabetes (No diabetes 68.3±0.8 letters; diabetes controlled 66.3±1.3, p=0.142; diabetes uncontrolled 64.3±1.6, p=0.018). During the up to 5-year follow-up, no patient developed proliferative diabetic retinopathy; one patient (3.3%) developed maculopathy. Mean age of the sub-cohort of 30 MacTel patients was 66.7±8.5 years. Mean duration of diabetes was 11.6±6.7 years and mean HbA1c was 7.07±1.35%. Eighteen patients (60%) had family history of diabetes. Thirteen patients (43.3%) used a single oral hypoglycaemic medication, only 3 patients (10%) used insulin. Mean body mass index (BMI) was 30.1±5.9.
There seems to be a relationship between MacTel and diabetes. Diabetes mellitus seems to have a clinically meaningful impact on visual acuity and progression of MacTel, especially in early stages of the disease. On the other hand, patients with MacTel and diabetes do not seem to develop treatable diabetic retinopathy or maculopathy with the same rate as general diabetic population. Patients usually have good glycaemic control with need of relatively few medications.
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