Diabetic retinopathy in childhood: Long-term follow-up by fluorescein angiography beginning in the first months of disease

Background: Little is known about minimal retinal lesions occurring in the first months of disease in children with type 1 diabetes mellitus (DM). Objective: To detect any early retinal change and to evaluate its progressi on in children diagnosed with type 1 DM. Patients: From 1979 to 1997 we examined by fluorescein angiography at diagn osis or within 15 months from the onset of DM 130 young patients with type 1 DM (mean age at diagnosis 10.08 +/- 2.62 yr). In 112 patients follow-up b y fluorescein angiography was performed every 1.26 years with a mean of 5.4 1 fluorescein angio graphies/patient. Methods: The stage of retinopathy was graded to detect minimal lesions. We also considered sex, pubertal stage, HLA, family history of DM, disease dur ation and HbA(1c) levels. Results: At first examination, 14 out of 127 (11%) readable angiographies s howed minimal retinal changes. There was no statistically significant diffe rence between the patients with or without lesions for all parameters consi dered. The 112 patients examined during follow-up were divided as follows: Group A: no retinopathy at first examination; Group Al: no retinopathy duri ng follow-up; Group A2: retinal changes during follow-up; Group B: retinal changes at the first examination. Mean HbA(1c) value evaluated during the w hole follow-up was lower in group Al than in group A2. HbA1, levels at onse t of the disease were significantly different in the three groups: in group Al it was lower than in group A2 and in group B. Conclusions: The presence of early lesions in the first year of disease in 11% of patients is probably due to the method of examination, which may det ect even minimal retinal changes. This may be correlated to the acute metab olic failure present at the onset of disease. The prolonged follow-up seems to demonstrate that the early changes are not necessarily a negative progn ostic factor in the evolution of diabetic retinopathy. We confirm that dura tion of DM and metabolic control are the main factors influencing the cours e of retinopathy in these young patients. Early fluorescein angiography is not particularly useful in the management of children with DM.