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Correlation of Diabetic Retinopathy Grading with Peripheral Neuropathy

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Author(s): Mehak Nagpal | Malavika Krishnaswamy

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 269;
Date: 2011;
Original page

Keywords: Nerve conduction study | diabetic retinopathy | correlation

ABSTRACT
Background: Awareness about the course and progression of related complications of the disease isimportant due to sub clinical progression and varied presentations. Objective assessment of thesecomplications is needed for detection at a primary screening level. Hence grading will help correlateseverity of complications that may not be clinically apparent.Aims and objective:1. Detection and grading of retinal changes in diabetics (with or without symptomatic peripheralneuropathy)2. Correlation of the grading with results of nerve conduction studies.Design: Cross sectional study: 60 Type 2 Diabetes Mellitus patients were randomly recruited andfundoscopic examination was done and retinal picture graded according to ETDRS classification. Dataregarding age, duration of diabetes was collected. Nerve conduction velocity of sural nerve wasdocumented. Statistical analysis done using spearman correlationResults: Out of 120 eyes screened 97.5% of the eyes had presence of diabetic retinopathic changes(16.66% mild; 33.33% moderate; 22.5% severe; 20% very severe DR and 5% had PDR). Out of 60patients undergoing nerve conduction study only 45 % were clinically symptomatic with distal sensoryimpairment. Significant Negative correlation was seen between presence of retinopathy and nerveconduction velocity (NCV). Coefficient of determination relating neuropathy and presence of retinopathywas ρ2= 0.44 (44%).Significant positive relation at level 0.01 was seen between duration of diabetes andboth factors i.e. presence of retinopathy (ρ= -0.667) & average NCV (ρ= 0.613). No significantcorrelation was found between retinopathy and HbA1c levels.Study Limitation: More extensive study involving larger sample size and wide geographical area isnecessary. Longitudinal study would confirm the above results.Conclusion: Advancement of retinopathy and peripheral neuropathy was seen with increasing duration ofdiabetes at a similar rate regardless of clinical onset of symptoms. Progression of retinopathy indicatesnerve pathology and decrease in NCV. This indicates that in the presence of diabetic changes in the retinaan objective assessment of the peripheral nerves should be done as it is a more accurate indicator thanclinical presentation. Risk stratification of patients will thus institute a modified approach to screeningand patient education
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