|Year : 1969 | Volume
| Issue : 2 | Page : 37-40
Serum lipids in relation to diabetic retinopathy
K Rajyashree, KS Mehra, JS Mathur
Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Varanasi-5, India
|Date of Web Publication||8-Jan-2008|
Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Varanasi-5
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rajyashree K, Mehra K S, Mathur J S. Serum lipids in relation to diabetic retinopathy. Indian J Ophthalmol 1969;17:37-40
|How to cite this URL:|
Rajyashree K, Mehra K S, Mathur J S. Serum lipids in relation to diabetic retinopathy. Indian J Ophthalmol [serial online] 1969 [cited 2019 Jun 25];17:37-40. Available from: http://www.ijo.in/text.asp?1969/17/2/37/38418
Diabetes is characterised by not just one but by a spectrum of biochemical derangements involving numerous aspects of cellular metabolism e.g. carbohydrate, protein and lipid metabolism, the latter one being the most notorious. The relative freedom of juvenile Diabetes from retinopathy in whom the serum lipid levels can be controlled with a good control of blood sugar levels, as contrasted to diabetes in older groups, opens the possibility that diabetic retinopathy might be produced by elevated serum lipid levels.
As the available knowledge concerning complete serum lipid fractions in diabetic retinopathy is very limited, this study was undertaken to find out exactly which of the lipid fractions may be responsible for the causation or precipitation of diabetic retinopathy.
The study was carried out in 150 cases whose ages ranged from 40-60 years. They comprised of 3 equal groups as follows:
Group A (Control) with 50 normal cases, Group B with 50 cases of diabetes without retinopathy and Group C with 50 cases of diabetes with retinopathy. Diabetes was labeled if the fasting blood sugar level was above 120 mgm % or the postprandial blood sugar level was above 180 mgs %. There were a few known diabetic cases whose blood sugar levels were normal. They were taken as cases of diabetes under control.
History of duration of diabetes, the treatment taken and the presence of hypertension was also taken into consideration. A careful and detailed fundus examination after mydriasis was done. The changes were noted according to Ballantyne's 1946 classification.
Estimation of serum cholesterol (Direct micro determination method), of serum phospholipids (modified Young-burg's method), of serum fatty acids (modified Man and Gilder's method) and of serum total lipids (Adam's method) were done.
It has been found that serum cholesterol and serum phospholipid levels were higher in groups B and C in comparison to Group A. There was however, no significant difference between these levels in groups B and C. The serum fatty acids and serum total lipids level were higher in Group C than in Group B [Table - 1].
There were 11 female cases in Group A, 15 female cases in Group B and 8 female cases in Group C. Blood sample was never collected during menstruation as it might give increased lipid levels during this period. No difference was found in the levels of various lipid fractions in the 2 sexes [Table - 2].
Further, it was noted that the serum lipid levels were almost the same irrespective of the control of diabetes in both group B and Group C. [Table - 3].
As regards the duration of diabetes, there was no difference in the levels of serum fatty acids and serum total lipids in the Group B. [Table - 4].
The levels of serum fatty acids in Group C were found to be higher in all grades of retinopathy irrespective of the duration of diabetes but in ascending order in relation to the duration as well as the grades of retinopathy. [Table - 5].
Similar had been our findings regarding Serum total lipid fractions [Table - 6].
It has been thus observed that the rise in serum cholesterol levels is insignificant in cases of diabetes with retinopathy as also reported by Christini and Roversi Aldersberg, Wang, Rifkin, Birkman, Ross and Weinstein and Agarwal, Chabra and Bhatia. But a few workers like Joslin (1946) and Babel and Rillet found these levels higher in cases of diabetes with retinopathy. The serum phospholipid levels are almost equal in the groups B and C. This is in contrast to the findings of a few workers e.g. Pomeranze and Kunkel and Schrade, Bochle, Biegler and Harmuth and in agreement with the findings of lannacone and Kornerup Aldersberg et al.
The increased levels of serum fatty acids and serum total lipids in cases of diabetics with retinopathy as against group B i.e. diabetes without retinopathy and the fact that the values are higher in higher grades of retinopathy have led us to the conclusion that these fractions of serum lipids may be playing an important role in the causation of diabetic retinopathy. Pope opined that this leads to destruction of capillaries specially at the venous end and causes weakening of the wall finally leading to micro-aneurysms. However, there must also be some local factor, as suggested by Ashton responsible for these changes. The disappearance of retinal exudates on lowering plasma lipid levels, by either heparin therapy, or by P.A.S. administration, further proves that serum lipids may be partly responsible for the pathogenesis of diabetic retinopathy.
We could not get any co-relation between the various grades of retinopathy and the control of diabetes.
| References|| |
Adam's method for estimation of fat in milk (1955) Extra. Pharm,acopeia, Martindale Vol. II, 23rd Ed. p. 579.
Aldersberg, D. Wang, C., Rifkin, H. Berkman, J., Ross, G. and Weinstein, C. (1956)-Serum Lipids and Polysaccharides in Diabetes Mellitus. Diabetes. 5: 116.
Agarwal, L. P., Chabbra, H. N. and Bhatta R. K. (1967) Pathogenesis of Diabetic Retinopathy, Orient. Arch. Opth., 5: 105-114.
Ashton, N. (1959), Diabetic Retinopathy, A new approach, Lancet, 2: 625-630.
Babel, J. and Billet, B. (1958), Diabetic Retinopathy, Clin. Ophth. Ophthahnologica (Basel), 135-56: 471-529.
Christini G. and Roversi, L. (1949) Acta Ophthal., 27: 563.
Iannacone A and Kornerup, T (1954) Plasma lipids and Diabetic Retinopathy Acta Medica Scand. CXLVIII, Fasc VI.
Joslin, E. P. (,1946), The treatment of Diabetes Mellitus 8th Ed., Lea & Febiger, Philadephia.
Pomeranze, J. and Kunkel, H. G. (1950): Serum lipids in diabetes, Proc. Amer. Diabetic Assoc., 10: 217-31.
Pope, C. 11. (1955) - Retinal capillary microaneurysms. Diabetes, 4:24.
Schrade, W. Boehle, E. Biegler, R., and Harmuth, E. (1963) - Fatty acid Composition of lipid fraction diabetic Serum. Lancet 1:285.
Total Cholesterol Direct Micro-determination (1947) Sols. Rev. Esp. Fisciol., 3: 275.
Youngburg, G. E. and Youngburg, M. V. (1930) - Modified Youngburg method for estimation of phospholipids. J. Lab. Clin. Med., 16: 158.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]