96th DOG Annual Meeting, 1998


Level of generalized microangiopathy in patients with isolated diabetic maculopathy (DMP) and patients with proliferative diabetic retinopathy (PDRP)

M. Opitz1, C. Moschner2, A. Vieregge2, M. Heide2, U. Schmidt-Erfurth1

Background: Diabetic microangiopathy induces two characteristic manifestations at the retina: Exudative vascular reactions within the macular area (DMP) or occlusive-ischemic mechanisms with formation of neovascularization within the mid and outer periphery (PDRP). PDRP is known to be tightly correlated with diabetic polyneuropathy (PNP) and is being judged as a symptom of advanced generalized microangiopathy. In DMP the level of systemic microvascular disease has not been evaluated.

Patients and method: A prospective study in patients with either isolated DMP or PDRP and long- standing diabetes was conducted. Retinal angiopathy was classified clinically and angiographically. The level of generalized microangiopathy was documented by grading of the level of PNP including clinical neurological examination, electroneuro- (ENG) and electromyography (EMG).

Results: The mean age of patients was 61,3 years in the DMP group (n=26) and 53,8 years in the PDRP group (n= 20). In 53,8% of patients with DMP and 70% of the PDRP patients both clinically and electrophysically (EMG/ENG) significant PNP was documented. Clinically both groups invariably demonstrated changes consistent with a distal-symmetrical type of PNP. Neurographically a pathologic reduction in nerve conduction velocity was regularly present as found by ENG, while signs of denervation by EMG were seen in 20% of DMP patients only, but 50% of PDRP patients.

Conclusion: The majority of patients with PDRP, but also half of all patients with isolated DMP demonstrate a significant PNP as result of a generalized microangiopathy. This observation indicates that also DMP patients carry a significant risk for systemic disease. Signs of chronic neurogenic decomposition by EMG were more frequent in PDRP consistent with a more advanced stage of angiopathy in this group.

1 University Eye Clinic Lübeck, Ratzeburger Allee 160, D-23538 Lübeck

2 University Neurology Clinic Lübeck, Ratzeburger Allee 160, D-23538 Lübeck