|Year : 1982 | Volume
| Issue : 6 | Page : 603-604
The role of rheological and related factors in diabetic retinopathy
OP Kulshrestha, Madhu Mathur, PK Mathur
Dept. of Ophthalmology, S.M.S. Medical College, Jaipur, India
O P Kulshrestha
Upgraded Department of Ophthalmology, S.M.S. Medical College, Jaipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kulshrestha O P, Mathur M, Mathur P K. The role of rheological and related factors in diabetic retinopathy. Indian J Ophthalmol 1982;30:603-4
The basic pathology behind the production of diabetic retinopathy is obstruction to microcirculation in the retina producing hypoxia and secondlry production of neovascularisation, microaneurysms and haemorrhages. The obstruction is thought to be related to certain changes occuring in the blood i.e. the Rheological factors. These so called rheological factors include plasma protein fractions like albumin, Alpha-2 globulin and fibrinogen, erythrocyte and platelet aggregation and viscosity "of blood. Changes caused by these factors produce increased tendency of red blood cells and platelets to aggregate, increasing plasma viscosity and impairing the blood flow in the microcirculation with resulting hypoxia.
| Method material observation and discussion|| |
The present study included 40 diabetic patients and 10 normal healthy individuals to serve as controls. They were divided into 3 groups.
Group I : Non Diabetic healthy individuals- 10 cases
Group II : Diabetic patients without retinopathy-IO cases.
Group III A : Diabetic patients with simple retinopathy-20 cases.
Group III B : Diabetic patients with proliferative retinopathy 10 cases.
There was a significant fall in the average plasma levels of albumin in diabetics with retinopathy as compared to normal individuals. Albumin levels was 4.0 gms% in norma 1 healthy individuals (group I), 2.6 gms% in diabetics without retinopathy (Group II), 2.05 gm% in diabetics with simple retinopathy (Group III A) and 1.54 gm% in diabetics with proliferative retinopathy (Group III B).
There was progressive increase in level of Alpha-2 Globulin from healthy individual towards diabetics. The average for group I was 0.6 gm%, for group II 0.8 gm%, for group III A 1.0 gm% and for group III B 1.2 gm%, Albumin and globulin estimations were done by paper electrophoresis technique using Beckman Model "R" paper electrophoresis system.
In a similar way plasma Fibrinogen levels were affected to a much larger extent. The serum fibrinogen level was 223 mg% in normal individuals (I), 370 mg% in diabetic (II), 490 mg% in diabetics with simple retinopathy (III A) and 527 mg% in diabetics with; proliferative retinopathy. Fibrinogen is also one of the plasma proteins and estimation was done by modified technique of Kings.
An increase in the mean value of plasma viscosity was noted in diabetics and much more so in diabetics with retinopathy. The average plasma viscosity levels were Group I 1.60 opo, Group 11 1.86 cpo, Group 11I A 2.09 cpo and group III B 2.25 cpo. Taking the average for all cases with retinopathy. [Table - 1] (III A & III B) as 2.16 cpo, the serum viscosity increased by an average of 35% in these cases as compared to normal non-diabetic individuals. Viscosity measurement was done by modified ostwald capillary tube viscometer because it requires only 2.5 ml. of plasma and it was easy to wash [Table - 2]. The platelets and erythrocytes also showed an increased tendency to aggregate in diabetics with retinopathy. The mean value of platelet aggregation index in different groups I 0.43 O.D., Group II o.53 O.D., Group III A 0.68 O.D. and Group III B 0.85 O. D.
Mean value of red cell aggregation (as indirectly evidenced by erythrocyte Sedimentation rate) was group 1 12 mm./1st hour, Group 11 32 mm./ 1st hour, Group II I A 42 mm Ist hour and Group III B 46 mm./1st hour. This was statistically significant.
| Summary|| |
Blood studies were done in 40 diabetics and 10 normal subjects and estimations done for albumin, alpha-2 globulin fibrinogen, plasma viscosity, platelet aggregations and erythrocyte aggregations. There was reduction in plasma albumin in diabetics with retinopathy but increase in all other values as compared to normal individuals.
The probable role of these rheological factors is also discussed.
[Table - 1], [Table - 2]