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R. R. Sivaraj, K. Oswal, P. Stavrou, P. I. Murray; Diabetes Mellitus and Uveitis: A Longitudinal Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):296.
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There is limited information about the characteristics of uveitis and diabetic eye disease when they coexist. We report the clinical course of uveitis and diabetic retinopathy in diabetic patients and its relation to glycaemic control.
Longitudinal, retrospective case notes analysis of patients with pre-existing diabetes who developed uveitis.
A total of 31 patients (M/F: 14/17, 49 eyes) were included. Mean age of onset of diabetes was 49 years and uveitis 57 years. All patients except one had type 2 diabetes; the majority (20) taking oral hypoglycaemics. Uveitis was bilateral in 18 (58%) patients. 15 had anterior uveitis, 11 panuveitis, and 5 intermediate uveitis. Uveitis was idiopathic in 19, 3 had Fuchs’ heterochromic cyclitis, 2 had sarcoidosis, 2 had HLA-B27 related uveitis, and 1 had rheumatoid arthritis. In 4 patients there was an infectious cause. 13 pts had acute, 9 recurrent and 9 chronic uveitis. Mean follow-up was 4.7 yrs (range 1-18 yrs). Mean number of recurrences of uveitis was 3 (range 1-7). At some stage during follow-up all patients required topical corticosteroids, 6 needed subconjunctival/periocular corticosteroids, 8 oral corticosteroids and 2 systemic immunosuppression. Cataract occurred in 19 eyes (17 required surgery), glaucoma 15 eyes, and cystoid macular oedema 10 eyes. Diabetic retinopathy occurred in 32 (65%) eyes (non-proliferative 26 eyes including 6 with clinically significant macular oedema; proliferative 6 eyes including 3 with vitreous haemorrhage). In 6 patients with active disease the mean HbA1c was 8.7%, (range 6.6-10.8%) and 7.7% (range 6.4-9.4%) when the uveitis was quiescent, p = 0.011. Mean HbA1c value was 8.06% in 14 pts with active uveitis and 7.34% in 16 pts with inactive disease. Diabetic treatment was changed in 7 patients to obtain better glycaemic control during episodes of uveitis. A poor visual outcome with acuity 6/18 or worse in 16/49 (33%) eyes was related to the uveitis in 8 eyes and to the diabetes in 4 eyes
Uveitis in patients with pre-existing diabetes is associated with a high complications rate and poor glycaemic control. Reduced visual outcome was more often related to the uveitis than the diabetes.
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