DIABETIC-RETINOPATHY AND CONTROL OF DIABETES WITH SPECIAL REFERENCE TO BLOOD-GLUCOSE LEVELS

Data concerning diabetic retinopathy were collected prospectively in t he Diabetes Clinic of the Third Department of Internal Medicine, Unive rsity of Tokyo, from the beginning of the Clinic in 1957 until 1985. T hese data are analyzed here. The prevalence and severity of the retino pathy at the initial visit was strongly related to the duration of dia betes before examination. Pretreatment fasting blood glucose levels we re also significantly related. During follow-up, the incidence of reti nopathy was most strongly influenced by the degree of control of blood glucose, followed by other factors like blood pressure, age at diagno sis, etc. The effectiveness of sulfonylurea on retinopathy was not inf erior to insulin so long as good control was obtained. It was deduced from the analysis of the chain of events that dot hemorrhage is the in itial component of diabetic retinopathy, followed by hard exudate, blo t hemorrhage, soft exudate and proliferative retinopathy. A six-year f luorescein angiography follow-up of well-controlled non-insulin depend ent cases with mild retinopathy showed that microaneurysms disappear r apidly during the first year and more slowly thereafter. The avascular areas once formed seem to progress despite the degree of control exer ted here. The other Japanese results are discussed.