THE BLOOD-RETINAL BARRIER IN DIABETES DURING PUBERTY

Objective: To assess the alteration of the blood-retinal barrier in pa tients with type I diabetes during puberty. Design: A 7-year prospecti ve study evaluated retinal changes occurring in diabetic children duri ng puberty. Patients between-the ages of 10 and 20 years underwent ann ual ophthalmologic examinations that included fluorescein angiography and vitreous fluorophotometry. Setting: Clinical research facility. Pa tients: Fifty-seven diabetic children met preset eligibility criteria. During the study, 241 ophthalmologic examinations were scheduled and 210 (87.1%) were performed. Main Outcome Measure: Vitreous fluorophoto metry penetration ratio (VFPR) was used to indicate blood-retinal barr ier permeability. Results: No sign of retinopathy was detected before puberty (age 13 years for boys and 11 or 12 years for girls). The prev alence of retinopathy in the 4 years immediately after puberty was 6%. In the next 4 years, the prevalence was 29.6% (P=.0003). When all VFP Rs were correlated with age, and data for male and female patients wer e analyzed separately, we found that the lowest VFPRs occurred at the expected time of puberty. When patients were paired by gender and dura tion of diabetes, there was a significant difference between VFPR valu es before and after puberty (P=.03). Also, a progressive deterioration of the blood-retinal barrier became apparent when only VFPR values af ter puberty were considered. Conclusions: These results support the vi ew that the blood-retinal barrier remains stable until puberty, achiev ing a maximum of efficiency and protection. A progressive decline then begins, suggesting that this period of growth is associated with fact ors that, under the influence of diabetes, contribute to the progressi ve damage of the blood-retinal barrier.