RELATIONSHIP BETWEEN PERINDONTAL DISEASE AND DIABETIC RETINOPATHY

Abstract

Abstract: : Purpose: To investigate the relationship between periodontal disease and diabetic retinopathy (DR). Methods: The study was based on a prospective review of 73 eyes in 73 consecutive patients with diabetes mellitus (DM). The mean duration of diabetes was 14.3 ± 7.1 years. The mean hemoglobin A_1c (HbA_1c) was 7.5 ±1.6 %. Interleukin–6 (IL–6) and tumor necrosis factor–α (TNF–α) levels in the vitreous fluid samples from 32 eyes obtained during vitrectomy and in paired plasma samples were measured by enzyme linked immunosorbent assay. Non–DM patients included 10 with macular hole and 2 with epiretinal membrane. The institutional ethics committee approval was obtained, and all participants gave informed consent. The severity of DR was quantified according to the modified Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy severity scale. The severity of periodontal disease was quantified according to bone loss, then graded and evaluated. Patients with periodontal disease were classified as + or – based on median values. DM Patients were classified as having non–proliferative DR (NPDR)or proliferative DR (PDR). To determine the relationship between the severity of periodontal disease and ETDRS retinopathy severity or angiogenic factors, Spearman^,s rank–order correlation coefficient was applied. Results: The severity of periodontal disease was significantly correlated with the severity of DR (p=0.0012), and the risk of PDR was significantly higher in the presence of periodontal disease (odds ratio=2.80, p=0.036). The vitreous fluid level of IL–6 (mean 154.2 ± 164.6 pg/ml) was significantly elevated in patients with DR compared with that in non–DM patients (mean 1.34 ± 0.91 pg/ml) (p<0.0001). Furthermore, the vitreous fluid level of IL–6 was significantly correlated with the severity of periodontal disease (p=0.012). In contrast, the vitreous fluid level of TNF–α was not significantly correlated with the severity of periodontal disease. The IL–6 concentration in vitreous fluid (mean 154.2 ± 164.6 pg/ml) was significantly higher than that in plasma (mean 1.89 ± 3.47 pg/ml) (p<0.0001). Conclusions: There was a significant relationship between periodontal disease and severity of DR, but it was unclear whether periodontal disease directly affects the progression of DR.

Keywords: diabetic retinopathy • cytokines/chemokines