Doppler ultrasound features of ophthalmic artery in diabetic retinopathy in a Nigerian Teaching Hospital
Keywords:Diabetic retinopathy, Doppler ultrasound, Resistivity index, Ophthalmic artery
Background: Diabetes mellitus is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion, insulin action or both with diabetic retinopathy being the most common microangiopathic complication. A comparative, cross- sectional study aimed at evaluating Doppler blood flow indices in the ophthalmic artery in diabetic retinopathy and non-retinopathy patients when compared to normal controls in a Nigerian tertiary hospital.
Methods: Data were collected over 7 months (April 2017-October 2017) in Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria. Sixty-five diabetic retinopathy patients, 65 diabetic patients without retinopathy and 65 non-diabetic controls had their ophthalmic artery Doppler indices assessed for comparison.
Results: The end diastolic velocity (EDV) of the ophthalmic arteries in the diabetic patients were significantly lower than those of control group (EDV=5.84±2.59 cm/s, p<0.001 bilaterally). In diabetic patients with retinopathy, the end diastolic velocity of the ophthalmic arteries was significantly lower than those of diabetic patients without retinopathy (EDV=5.84±2.59 cm/s right eye, EDV=5.75±2.39 left eye, p<0.001 bilaterally). The resistivity index (RI) of the ophthalmic arteries was significantly higher in both diabetic patients with retinopathy and those without retinopathy compared to control group (RI=0.92±0.07 right eye, p=0.044 right eye, p<0.001 left eye) with resistivity index of diabetic retinopathy respondents significantly higher than the diabetic patients with no retinopathy.
Conclusions: The study showed that Doppler is a useful screening parameter in identifying eyes at risk of developing sight threatening proliferative disease in diabetic patients. Significant differences exist in ophthalmic artery Doppler flow indices of diabetics with retinopathy compared to the healthy controls.
Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association. Diabetes Care. 2009;32(1):62-7.
Gospin R, Zonszein J. Diagnostic Criteria and Classification of Diabetes. Principles of Diabetes Mellitus. 2016;1-16.
Kyari F, Tafida A, Sivasubramaniam S, Murthy G, Peto T, Gilbert C. Prevalence and risk factors for diabetes and diabetic retinopathy: results from the Nigeria national blindness and visual impairment survey. BMC Public Health. 2014;14:1299-306.
Okeoghene-Ogbera A, Ekpebegh C. Diabetes Mellitus in Nigeria: The past, present and future. World J Diabetes. 2014;5(6):905-11.
Rosberger DF. Diabetic Retinopathy: Current Concepts and Emerging Therapy. Endocrinol Metabol Clin North Am. 2013;42(4):721-45.
Romero-Aroca P. Managing diabetic macular edema: The leading cause of diabetes blindness. World J Diabetes. 2011;2(6):98-104.
Evans J, Rooney C, Ashwood F, Dattani N, Wormald RPL. Blindness and partial sight in England and Wales. Health Trends. 1996;28:5-12.
Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Rev Endocrinol. 2012;228-36.
Varma R, Torres M, Pena F, Klein R, Azen SP. Prevalence of diabetic retinopathy in adult Latinos: the Los Angeles Latino eye study. Ophthalmology. 2004;111:1298-306.
Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, Lim SC, Tai ES, Mitchell P. Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology. 2008;15:1869-75.
Zheng Y, Lamoureux EL, Lavanya R, Wu R, Ikram MK, Wang JJ, et al. Prevalence and risk factors of diabetic retinopathy in migrant Indians in an urbanized society in Asia: the Singapore Indian eye study. Ophthalmology. 2012;119:2119-24.
Wang FH, Liang YB, Zhang F, Wang JJ, Wei WB, Tao QS, et al. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology. 2009;116:461-7.
Al Ghamdi AH, Rabiu M, Hajar S, Yorston D, Kuper H, Polack S. Rapid assessment of avoidable blindness and diabetic retinopathy in Taif, Saudi Arabia. Br J Ophthalmol. 2012;96:1168-72.
Polack S, Yorston D, Lopez-Ramos A, Lepe-Orta S, Baia RM, Alves L, Grau-Alvidrez C, Gomez-Bastar P, Kuper H. Rapid assessment of avoidable blindness and diabetic retinopathy in Chiapas, Mexico. Ophthalmology. 2012;119:1033-40.
Noubiap JJN, Naidoo J, Kengne AP. Diabetic nephropathy in Africa: A systematic review. World J Diabetes. 2015;6(5):759-73.
Nwosu SNN. Prevalence and pattern of retinal disease at the Guinness Eye Hospital, Onitsha, Nigeria. Ophthalmic Epidemiol. 2000;7:41-8.
Maiyaki MB, Garbati MA. The burden of non-communicable diseases in Nigeria; in the context of globalization. 2014;13(1):1-10.
Ashaye. A, Arijea, Kuti M, Olusanya B, Ayeni E, Fasanmade A, Akinlade K, Obajimi M, Adeleye J. Retinopathy among type 2 diabetic patients seen at a tertiary hospital in Nigeria: a preliminary report. Clinic Ophthalmol. 2008;2(1):103-8.
Jimenez-Aragon F. Role of Color Doppler Imaging in Early Diagnosis and Prediction of Progression in Glaucoma. BioMed Res Int. 2013;1-11.
Diliz AL, Moron AF, Santos MC, Sass N. Color Doppler velocimetry of orbital vessels: technique and normal vascular anatomy. Radiol Bras. 2004;37:287-90.
Baydar S, Adapinar B, Kebapci N, Bal C, Topbas S. Colour Doppler ultrasound evaluation of orbital vessels in diabetic retinopathy. Australas Radiol. 2007;51:230-5.
Wilkinson CP, Ferris FL, Klein RE. Global Diabetic Retinopathy Project Group Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110:1677-82.
Kirkwood BR, Sterne JAC. Essential Medical Statistics 2003. Oxford. Blackwell Scientific. 2003;417-8.
Lorenzi M, Gerhardinger C. Early cellular and molecular changes induced by diabetes in the retina. Diabetologia. 2001;44:791-804.
Kroll P, Rodrigues EB, Hoerle S. Pathogenesis and classification of proliferative diabetic vitreoretinopathy. Ophthalmologica. 2007;221:78-9.
Arai T, Numata K, Tanaka K, Kiba T, Kawasaki S, Saito T, et al. Ocular arterial flow hemodynamics in patients with diabetes mellitus. J Ultrasound Med. 1998;17:675-81.
MacKinnon JR, McKillop G, O'Brien C, Swa K, Butt Z, Nelson P. Colour Doppler imaging of the ocular circulation in diabetic retinopathy. Acta Ophthalmol Scand. 2000;78:386-9.
Dimitrova G, Kato S, Tamaki Y, Sakurai M, Kitano S, Fukushima H. Choroidal circulation in diabetic patients. Eye. 2001;15:602-7.
Karami M, Janghorbani M, Dehghani A, Khaksar K, Kaviani A. Orbital Doppler Evaluation of Blood Flow Velocities in Patients with Diabetic Retinopathy. Rev Diabetic Stud. 2012;9(2-3):104-11.
Ino-ue M, Azumi A, Yamamoto M. Ophthalmic artery blood flow velocity changes in diabetic patients as a manifestation of macroangiopathy. Acta Ophthalmol Scand. 2000;78:173-6.
Garner A, Ashton N. Ophthalmic artery stenosis and diabetic retinopathy. Trans Ophthalmol Soe U K. 1972;92:101-10.
Gracner T. Ocular blood flow velocity determined by color Doppler imaging in diabetic retinopathy. Ophthalmologica. 2004;218:237-42.
Kraśnicki P, Mariak Z, Ustymowicz A, Proniewska-Skretek E. Assessment of blood flow in the ocular circulation in type 2 diabetes patients with Color Doppler imaging. Klin Oczna. 2006;108:294-8.
Friedman E, Krupsky S, Lane AM, Oak S. Friedman E, Egan K, et al. Ocular blood flow velocity in age-related macular degeneration. Ophthalmology. 1995;102:640-6.
Harris AG, Skalak R, Hatchell DL. Leukocyte capillary plugging and network resistances increased in skeletal muscle of rats with streptozotocin-induced hyperglycemia. Int J Microcirc Clin Exp. 1994;14:159-66.
Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Risk factors for diabetic retinopathy in a South Indian Type 2 diabetic population-the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabetes Med. 2008;25:536-42.
Magulike NO, Chuka-Okosa CM, Oli JM. Diabetic eye disease in Enugu South-Eastern Nigeria – a preliminary report. Nig J Ophthalmol. 2003;11:30-3.
Klein BE, Klein R, Moss SE. Incidence of cataract surgery in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Am J Ophthalmol. 1995;119:295-300.
Kato S, Shiokawa A, Fukushima H, Numaga J, Kitano S, Hori S, et al. Glycemic control and lens transparency in patients with type 1 diabetes mellitus. Am J Ophthalmol. 2001;131:301-4.
Vishali G, Fernando Arevalo J. Surgical Management of Diabetic Retinopathy. Middle East Afr J Ophthalmol. 2013;20(4):283-92.