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Kay T. Khine, Abhilash Guduru, Pratap Challa, David Fleischman; The influence of intraocular pressure on the severity of diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):66.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the influence of intraocular pressure (IOP) and prostaglandin analog use (PGA) on the severity of diabetic retinopathy (DR) and the presence of macular edema (DME) in diabetic patients.
This was a retrospective chart review of patients seen at University of North Carolina Kittner Eye Center from 2000 to 2015 with ICD-9 codes of no diabetic retinopathy, mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR). Both eyes of all patients were included. Exclusion criteria included not having all study data (three IOP measurements, three blood pressure measurements, three hemoglobin A1c [HbA1c] measurements, body mass index, sex, race, age, duration of diabetes), presence of neovascular glaucoma and IOP above 29. A generalized estimating equation model was created to identify the role of IOP on severity of DR and presence of DME after controlling for all variables. Odds ratios (OR) were calculated for a 10-unit increase in pressure variables and age. We analyzed the relationship of PGA use in presence of DME and severity of DR.
Of 1058 patients who met inclusion criteria, 1269 eyes had complete data; 212 eyes had no retinopathy (16.7%), 244 eyes had mild NPDR (19.2%), 223 eyes had moderate NPDR (17.6%), 112 eyes had severe NPDR (8.8%), and 478 eyes had PDR (37.7%). Increase in IOP did not increase risk of more severe DR (OR, 1.19; 95% confidence interval [CI], 0.76-1.84; p=0.45). Increase in systolic blood pressure (SBP) increased severity of DR (OR, 1.28; 95% CI, 1.16-1.40; p<0.0001), while increase in diastolic blood pressure (DBP) was not associated with an increase in DR severity (OR, 0.79; 95% CI, 0.68-0.92; p=0.0029). Longer duration of diabetes increased risk of more advanced DR (OR, 1.68; 95% CI, 1.44-1.97; p<0.0001). Older age was found to decrease severity of DR (OR, 0.52; 95% CI, 0.44-0.60; p<0.0001). IOP had no influence on presence or absence of DME (Chi-square 0.52, p=0.47). Use of PGA had no impact on the severity of DR or on the presence or absence of DME (OR, 0.66; 95% CI, 0.36-1.20; p=0.17).
IOP and usage of PGA did not have an influence on severity indices of DR or presence of DME. Increased duration of diabetes and higher SBP were the only variables associated with worsening DR severity indices, while higher DBP and older age were associated with lower DR severity.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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