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   Table of Contents      
ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 3  |  Page : 91-94

Intraocular pressure in young diabetics and its relationship with diabetic retinopathy


1 Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication10-Jan-2008

Correspondence Address:
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Jain I S, Gill M, Rastogi G K. Intraocular pressure in young diabetics and its relationship with diabetic retinopathy. Indian J Ophthalmol 1969;17:91-4

How to cite this URL:
Jain I S, Gill M, Rastogi G K. Intraocular pressure in young diabetics and its relationship with diabetic retinopathy. Indian J Ophthalmol [serial online] 1969 [cited 2019 Aug 23];17:91-4. Available from: http://www.ijo.in/text.asp?1969/17/3/91/38519

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Table 1

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Table 1

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Safir, Panlsen and Klayman [14] for the first time observed elevated intraocu­lar pressure (I.O.P.) in diabetic children. Subsequently Becker, Bros­nick Chiverette, Kolker, Daks and Cibis Andrea, [4] Safir, Poulsen, Klay­man and Cerstenfeld, [15] also reported a higher incidence of raised intraocu­lar pressure in juvenile diabetics.

Armstrong [2] reported higher inci­dence of glaucoma in diabetics. Jain and Luthra, [8] reported that mean in­traocular pressure in diabetic eyes is slightly higher than nondiabetic eyes.

The importance of intraocular pres­sure in the development of retinopathy was realized as early as 1930 (Poos) [13] , but only recently stressed by Larson and Poulsen, [9] Christlansson, [6] and others [11],[8],[4] .

Since no such study in young dia­betics has been reported from India, the authors undertook to study the level of intraocular pressure and its possible relationship with diabetic retinopathy.


  Methods and Material Top


This work is based on a study of 50 selected young diabetics, which in­clude juvenile diabetics and patients developing diabetes before the age of 35 years, and those who require insu­lin for the control of diabetes.

This is done so that most of the diabetics in the age group of 15-40 years have an onset and course like that of juvenile diabetics and only a few have like that of the type asso­ciated with middle-age and over. These patients were referred from the Diabetic Clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh, to the Fundus Clinic of the Eye Department, in a routine manner and had no prior eye examination before reference.

Ages ranged between 11 to 63 years. Seven were below 20 years, 22 were between 21-30 years, 13 bet­ween 31-40 years i.e. 42 cases were under 40 years and only 8 cases were over 40 years. 31 were males and 19 females. A full record of the diabetic status and history was kept.

Eye check-up

Each case was subjected to the fol­lowing schedule for eye examination. First the visual acuity was noted with and without glasses, and then the intraocular pressure was recorded with a Schiotz tonometer using 5.5 and 10 gm weights and the corrected P0 value was noted from the tables based on Friedenwald's nomogram of 1955. A repeat check up of the intra­ocular pressure was done the follow­ing day and the mean of the two readings was taken. Pupils were then dilated and refraction was done in each case, followed by fundus exa­mination. Grading of retinopathy was done according to Scott's classi­fication. Finally a slit lamp examina­tion was carried out to note any evidence of rubeosis iridis or lenticu­lar changes. Gonioscopy was not done as a routine and was reserved for those cases only which showed evi­dence of rubeosis. In this study no case was found to have any rubeosis.

Subsequently these patients were given Betamethasone eye drops 0.1 to be instilled three times a day for 4 weeks, and the intraocular pressure was checked after 2 and 4 weeks. The results of the steroid response will be reported in a subsequent paper.

Study of controls

For the purpose of control, intra­ocular pressure was measured in 60 non-diabetic eyes of comparable age groups. The same Schiotz tonometer was used with 5.5 gm and 10 gm weights and Pp was noted from tables based on Friedenwald's nomograms of 1955.


  Observations and Comments Top


Several investigators have reported intraocular pressure studies in a nor­mal population of younger age groups, and the results of the present study are quite comparable [10],[5],[15] . How­ ever, the mean intraocular pressure in diabetics was found to be higher (17.28 mm of Hg) in the present series as compared to the nondiabe­tics of comparable ages (mean 14.9 mm of Hg.).-[Table - 1],[Table - 2],[Table - 3].

Sixteen (16.16% ) out of 99 eyes, had tension greater than 20 mm and only two eyes (2.02%) had tension greater than 23 mm. Whereas Becker et al. [4] reported intraocular pressure greater than 20 mm of Hg in 21 and greater than 23 mm of Hg in 8% out of a study of 52 juvenile diabetics. Safir and associates [15] reported pres­sure of over 22 mm of Hg in 29.7% and between 20-22 in 20.3% from a study of 64 patients.

The duration of diabetes appeared to have some influence on the intra­ocular pressure as shown in [Table - 2]. In cases having diabetes of over 10 years duration, the mean pressure was found to be higher as compared to those whose duration was less than 10 years. This observation of ours is nearly in agreement with that of Armaly and Baloglan [1] but is contrary to the one made by Becker et. al. [4]

The refractive error did not seem to have any influence over the level of intraocular pressure as shown in [Table - 3]. However, no such correlation with the errors of refraction has ever been reported in the literature so far.

The differences in intraocular pres­sure becomes however, more signifi­cant in diabetic eyes with retinopathy as compared to those without retino­pathy [Table - 4]. Eyes having tension less than 15 mm of Hg showed greater percentage of retinopathy 33.33 than without retinopathy 17.4%. The percentage of eyes having retinopathy showed a linear fall as the tension became higher and higher. No eye was found to have retinopathy having tension more than 23 mm of Hg. This observation finds support from Mooney, [11] Jain and Luthra. [8]

The differences in intraocular pres­sure between proliferative and non-­proliferative group becomes still more striking [Table - 5]. However no definite conclusions could be drawn from the present study as the number of cases was rather small but it is supported by Christiansson. [7]

This relationship between retinopa­thy and intraocular pressure can only be explained on mechanical grounds. Pines [12] laid stress on the fact that blood vessels of the eye including the retina lie between the non-elastic sclera and non-elastic gel of vitreous body and are constantly subjected to outside pressure of 15 to 18 mm of Hg. Supported continuously by a very considerable pressure from outside, they have no need to develop powerful vascular walls and therefore, are more prone to changes as compared to ves­sels in the other parts of the body. Bloodsworth [3] emphasized the degene­ration of neurons whereby capillaries lose their support and thus periods of low intraocular pressure could aggra­vate retinopathic changes. This may also explain in part the variability in the manifestation of diabetic retino­pathy resulting from day to day varia­tion in intraocular pressure. However, it is not yet definitely known as to how diabetes affects intraocular pres­sure. Changes in blood glucose level may be one such factor. (Traisman, Alfano, Andrew and Gatti [16] )

Perhaps the pattern of intraocular pressure including its variability or responsiveness to different stimuli may be determined genetically and in­fluence the retinopathy thereby.


  Summary Top


Intraocular pressure was studied in 50 young diabetics and 30 normal con­trols of comparable age groups. A higher mean intraocular pressure of 17.28 mm of Hg was recorded in dia­betic eyes as compared to the mean of 14.9 mm of Hg in control eyes.

The difference in intraocular pres­sure becomes however, more signifi­cant in diabetic eyes with retinopathy as compared to those without retino­pathy. The percentage of eyes having retinopathy showed a linear fall as the tension became higher and higher. No eye with retinopathy was found to have tension more than 23 mm of Hg.

The variability and the pattern of intraocular pressure may perhaps be determined genetically and influence the retinopathy thereby.

 
  References Top

1.
Arm,aly, M. F. and Baloglan, P. T.: Diabetes mellitus and the eye. II. In­traocular pressure and out-flow facility. Arch. Oph. (Chicago), 77, -193, 1967.  Back to cited text no. 1
    
2.
Armstrong, J. R.: The incidence of glaucoma in diabetes mellitus Amer. J. Ophth. 50, 55, 1960.  Back to cited text no. 2
    
3.
Bloodsworth, J. M . B.: Diabetic Re­tinopathy. Diabetes 11, 1, 1962.  Back to cited text no. 3
    
4.
Becker, B.; Bresnick, G.; Cheverette, L.: Kolker, A. E. Daks, M. C. and Cibis, Andrea: Intraocular pressure and its response to topical corticoids in diabetes. Arch. Oph. (Chicago), 76, 477, 1966.  Back to cited text no. 4
    
5.
Castreus, J. Pohjola, S.: Scleral rigidity at puberty. Acta Onh., 39, 1015, 1961.  Back to cited text no. 5
    
6.
Christiansson, J.: Intraocular pressure in diabetes mellitus Acta. Oph., 39, 155, 1961.  Back to cited text no. 6
    
7.
Christiansson, J.: Glaucoma simplex in diabetes mellitus. Acta Oph., 43, 224, 1965.  Back to cited text no. 7
    
8.
Jain, 1. S. and Lnthra, C. L.: Diabetic retinopathy, its relationship with in­traocular pressure. Arch. Oph (Chica­go) 78, 198, 1967.  Back to cited text no. 8
    
9.
Larsen, 11. NV. and Poulsen, J, E.: In­traocular tension and blood sugar fluc­tuations in diabetes. Acta Ophth., 40, 580, 1962.  Back to cited text no. 9
    
10.
Levene, R.: Tonometrv and Tonogra­phy in a group of health population. Arch. Oph. (Chicago), 66, 68, 1961.  Back to cited text no. 10
    
11.
Mooney, A. J,: Diabetic retinopathy­A challenge. Brit. J. Oph., 47, 51:3, 1965.  Back to cited text no. 11
    
12.
Pines, N.: A clinical study of diabe­tic retinal angiopathy. Brit. J. Oph., 34, •303, 1950.  Back to cited text no. 12
    
13.
Poos, 1930 Quoted by Ashton, N. Dia­betic retinopathy: A new approach. Lancet, ii 25, 625, 1959.  Back to cited text no. 13
    
14.
Safir, A., Paulson, E. P. and Klayman, J.: Elevated intraocular pressure io dia­betic children Diabetes, 13, 161, 1964.  Back to cited text no. 14
    
15.
Safir, A.; Paulson. E. P.; Klaynmu, J., and Cerstenfeld, J.: Ocular abuornla­litics in juvenile diabetics. Arch. Oph. (Chicago), 76, 557, 1966.  Back to cited text no. 15
    
16.
Traisman, Il. S.; Alfano, J. E.; An­drew, J., and Gatti, R.; Intraocular pressure in juvenile diabetics. Amer. J. Oph., 64, 1149, 1967.  Back to cited text no. 16
    



 
 
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  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]



 

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