Effect of recombinant erythropoietin on progression of diabetic retinopathy and diabetic macular edema in diabetic patients with a kidney disease
DOI:
https://doi.org/10.31288/oftalmolzh2014448Keywords:
diabetic retinopathy, diabetic maculopathy, recombinant erytropoietinAbstract
Importance. Diabetes is a common disease that affects about 5 % of the European population. Various epidemiological studies have shown that the detection of frequency of diabetic retinopathy (DR) depends on the duration of the disease and compensation of carbohydrate disturbances quality during the illness. A serious complication of DR that may occur at any stage is maculopathy leading to a decrease in the central vision. Diabetes mellitus is a major cause of renal anemia. Anemia in diabetic patients is associated with an increased risk of vascular complications of diabetes, including retinopathy, nephropathy and neuropathy. Deficiency of erythropoietin — glycoprotein plays the leading role in the development of anemia. Erythropoietin — glycoprotein regulates the production of red blood cells and is synthesized by peritubular fibroblasts of the renal cortical layer. Purpose. To investigate the effect of recombinant erythropoietin on the progress of diabetic retinopathy and diabetic macular edema in diabetic patients with a kidney disease.
Materials and Methods: The paper presents the prospective study of 34patients (68 eyes) who were treated in the period from 2012 to 2014 in SI «The Filatov Institute of Eye Diseases and Tissue Therapy of NAMS of Ukraine». All patients were divided into two groups, depending on giving additional treatment with recombinant erythropoietin. The first group consisted of 13 patients (26 eyes). The second group consisted of 21 patients (42 eyes). DR and DME progress was assessed by the presence of DR complications, dynamics of visual acuity changes and OCT data. Improvement was considered in an increase of visual acuity (VA) by one or more rows in the Golovin — Sivtseva table, stabilization — preservation of the original visual acuity. Outcome of diabetic macular edema was evaluated according to the classification developed by Pasechnikova N. V. and Naumenko V. A. Results. It was established that DR complications, namely hemophthalmus and detachment of the retina were observed in the control group more frequently (15.3 %), whereas in the main group hemophthalmus and detachment of the retina developed only in 4.8 % of cases. According to the OCT, we found that positive dynamics of diabetic macular edema was not observed after 8 months in patients of the control group while in 70.7 % of patients in the main group there was a positive dynamics, i.e. regression of diabetic macular edema. During 8 months of the investigation it was found that visual acuity decreased in 69.2 % of patients in the control group. While in the main group of patients there was an increase and stabilization of visual acuity in 75.5 %, and a decrease of visual acuity occurred only in 24.4 % of patients. This study suggests that recombinant EPO not only slows the progress of diabetic retinopathy, but also leads to a reduction of diabetic macular edema.
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