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| ARTICLE |
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| Year : 1969 | Volume
: 17
| Issue : 3 | Page : 91-94 |
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Intraocular pressure in young diabetics and its relationship with diabetic retinopathy
IS Jain1, M.M.S Gill1, GK Rastogi2
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 Publication | 10-Jan-2008 |
Correspondence Address:
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
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 |
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 | |  |
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 | | |
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 | | |
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 | | |
| 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.  |
| 2. | Armstrong, J. R.: The incidence of glaucoma in diabetes mellitus Amer. J. Ophth. 50, 55, 1960. |
| 3. | Bloodsworth, J. M . B.: Diabetic Retinopathy. Diabetes 11, 1, 1962. |
| 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. |
| 5. | Castreus, J. Pohjola, S.: Scleral rigidity at puberty. Acta Onh., 39, 1015, 1961. |
| 6. | Christiansson, J.: Intraocular pressure in diabetes mellitus Acta. Oph., 39, 155, 1961. |
| 7. | Christiansson, J.: Glaucoma simplex in diabetes mellitus. Acta Oph., 43, 224, 1965. |
| 8. | Jain, 1. S. and Lnthra, C. L.: Diabetic retinopathy, its relationship with intraocular pressure. Arch. Oph (Chicago) 78, 198, 1967. |
| 9. | Larsen, 11. NV. and Poulsen, J, E.: Intraocular tension and blood sugar fluctuations in diabetes. Acta Ophth., 40, 580, 1962. |
| 10. | Levene, R.: Tonometrv and Tonography in a group of health population. Arch. Oph. (Chicago), 66, 68, 1961. |
| 11. | Mooney, A. J,: Diabetic retinopathyA challenge. Brit. J. Oph., 47, 51:3, 1965. |
| 12. | Pines, N.: A clinical study of diabetic retinal angiopathy. Brit. J. Oph., 34, •303, 1950. |
| 13. | Poos, 1930 Quoted by Ashton, N. Diabetic retinopathy: A new approach. Lancet, ii 25, 625, 1959. |
| 14. | Safir, A., Paulson, E. P. and Klayman, J.: Elevated intraocular pressure io diabetic children Diabetes, 13, 161, 1964. |
| 15. | Safir, A.; Paulson. E. P.; Klaynmu, J., and Cerstenfeld, J.: Ocular abuornlalitics in juvenile diabetics. Arch. Oph. (Chicago), 76, 557, 1966. |
| 16. | Traisman, Il. S.; Alfano, J. E.; Andrew, J., and Gatti, R.; Intraocular pressure in juvenile diabetics. Amer. J. Oph., 64, 1149, 1967. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]
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