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Diabetes aktuell 2008; 6(5): 201-206
DOI: 10.1055/s-0028-1103107
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© Georg Thieme Verlag Stuttgart · New York

Die diabetische Retinopathie und Makulopathie – Häufigste mikrovaskuläre Spätkomplikation des Diabetes mellitus

Diabetic nephropathy and maculopathyClaudia Jochmann1 , Eva Martinetz1 , Peter Wiedemann1
  • 1Klinik und Poliklinik für Augenheilkunde (Direktor: Prof. Dr. med. Peter Wiedemann) am Universitätsklinikum Leipzig
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Publication Date:
05 November 2008 (online)

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Weltweit ist bis zum Jahr 2030 mit einer Verdopplung der Prävalenz des Diabetes zu rechnen, dabei sollen junge Erwachsene am stärksten betroffen sein. Die hohe Prävalenz und Inzidenz von Netzhautkomplikationen verlangt verstärkte Bemühungen um die Optimierung der Versorgung. Die diabetische Retinopathie und die Makulopathie sind die häufigsten mikrovaskulären Spätkomplikationen bei Diabetes mellitus. Eine frühe Diagnostik und eine stadiengerechte Therapie kann Erblindungen vermeiden.

Man unterscheidet eine nicht proliferative und eine proliferative diabetische Retinopathie mit und ohne diabetisches Makulaödem. Durch den Hausarzt veranlasste Kontrolluntersuchungen bei einem Facharzt für Augenheilkunde sind erforderlich, um die oft symptomlos verlaufenden, aber schon therapiebedürftigen Stadien zu erkennen.

Vor allem bei der proliferativen diabetischen Retinopathie und dem diabetischen Makulaödem kann durch die Lasertherapie eine Sehverschlechterung aufgehalten werden. Mit der Vitrektomie steht außerdem ein operatives Verfahren zur Verfügung, welches auch bei weit fortgeschrittenen Stadien noch eine funktionelle Besserung bringen kann.

It is estimated, that worldwide the prevalence of diabetes mellitus will double by the year 2030. Mainly affected will be young adults. The high prevalence and incidence of complications of the retina requires stronger efforts in respect of a better care. Diabetic retinopathy and maculopathy are the most common microvascular late complications of diabetes mellitus. Early diagnosis and therapy according to the stage of the disease can prevent blindness.

Diabetic retinopathy is differentiated as proliferative or nonproliferative with or without diabetic macula edema. Check–ups by an ophthalmologist are required to detect early stages which are often not causing any symptoms.

Laser therapy can arrest a deterioration of sight especially in proliferative diabetic retinopathy and diabetic macula edema. Vitrectomy is a surgical procedure which can result in a functional amelioration even in late stages of the disease.

Key words

diabetic retinopathy - diabetic macula edema - laser surgery - vitrectomy

Literatur

  • 1 EURODIAB IDDM Complications Study. . Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study.  Diabetologia. 1994;  37 278-285
    CrossrefGoogle Scholar
  • 2 Klein R, Klein BE, Moss SE. et al. . The Wisconsin epidemiologic study of diabetic retinopathy II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years.  Arch Ophthalmol. 1984;  102 520-526
    CrossrefPubMedGoogle Scholar
  • 3 Klein R, Klein BE, Moss SE. et al. . The Wisconsin epidemiologic study of diabetic retinopathy III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years.  Arch Ophthalmol. 1984;  102 527-532
    CrossrefGoogle Scholar
  • 4 Trautner C, Icks A, Haastert B, Plum F, Berger M.. Incidence of blindness in relation to diabetes. A population–based study.  Diab Care. 1997;  20
    Google Scholar
  • 5 Trautner C, Haastert B, Berger M, Willich SN.. Blindheit und Diabetes mellitus. Eine Fall–Kontroll–Studie.  Diab Stoffw. 1999;  8 245-249
    Google Scholar
  • 6 Keen H, Lee LT, Russell D, Miki E, Bennett PH, Lu M.. The appearance of retinopathy and progression to proliferative retinopathy: the WHO Multinational Study of Vascular Disease in Diabetes.  Diabetologia. 2001;  44
    Google Scholar
  • 7 UKPDS Group. . Intensive blood–glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.  Lancet. 1998;  352 837-853
    CrossrefGoogle Scholar
  • 8 Klein R, Klein BE, Moss SE, Cruickshanks KJ.. The Wisconsin Epidemiologic Study of Diabetic Retinopathy XV. The long–term incidence of macular edema.  Ophthalmology. 1995;  102 7-16
    Google Scholar
  • 9 Malone JI, Morrison AD, Pavan PR, Cuthbertson DD.. Prevalence and significance of retinopathy in subjects with type 1 diabetes of less than 5 years duration screened for the diabetic control and complications trial.  Diab Care. 2001;  24 522-526
    CrossrefGoogle Scholar
  • 10 DCCT Research Group. . The effect of intensive treatment of diabetes on the development and progression of long–term complications in insulin–dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group.  N Engl J Med. 1993;  329 977-986
    Google Scholar
  • 11 UKPDS Group. . Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.  BMJ. 1998;  317 703-713
    Google Scholar
  • 12 Janka HU, Warram JH, Rand LI, Krolewski AS.. Risk factors for progression of background retinopathy in long–standing IDDM.  Diabetes. 1989;  38 460-464
    CrossrefGoogle Scholar
  • 13 Klein R, Klein BE, Moss SE. et al. . Is blood pressure a predictor of the incidence or progression of diabetic retinopathy?.  Arch Intern Med. 1989;  149 2427-2432
    CrossrefPubMedGoogle Scholar
  • 14 Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38, UK Prospective Diabetes Study Group.  BMJ. 1998;  317
    Google Scholar
  • 15 Chew EY, Klein ML, Ferris FL. et al. . Association of elevated serum lipid levels with retinal hard exsudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22.  Arch Ophthalmol. 1996;  114 1079-1084
    Google Scholar
  • 16 Danne T, Kordonouri O, Hovener G, Weber B.. Diabetic angiopathy in children.  Diabet Med. 1997;  14 1012-1025
    CrossrefGoogle Scholar
  • 17 Bertram B, Wolf S, Schulte K. et al. . Retinal blood flow in diabetic children and adolescents.  Graefea Arch Clin Exp Ophthalmol. 1991;  229 336-340
    Google Scholar
  • 18 Klein BE, Moss SE, Klein R.. Effect of pregnancy on progression of diabetic retinopathy.  Diabetes Care. 1990;  13 34-40
    Google Scholar
  • 19 Sunnes JS.. The pregnant woman's eye.  Surv Ophthalmol. 1988;  32 219-238
    CrossrefGoogle Scholar
  • 20 Horvat M, Maclean H, Goldberg L, Crock GW.. Diabetic retinopathy in pregnancy: a 12–year prospective survey.  Br J Ophthalmol. 1980;  64 398-403
    CrossrefGoogle Scholar
  • 21 Muhlhauser I, Bender R, Bott U, Jorgens V. et al. . Cigarette smoking and progression of retinopathy and nephropathy in type 1 diabetes.  Diabet Med. 1996;  13 536-543
    CrossrefGoogle Scholar
  • 22 Muhlhauser I, Sawicki P, Berger M.. Cigarette–smoking as a risk factor for macroproteinuria and proliferative retinopathy in type 1 (insulin–dependent) diabetes.  Diabetologia. 1986;  29 500-502
    CrossrefGoogle Scholar
  • 23 Klein BE, Klein R, McBride PE, Cruickshanks KJ. et al. . Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy.  Arch Intern Med. 2004;  164 1917-1924
    CrossrefGoogle Scholar
  • 24 Klein R, Klein BE, Moss SE, Cruickshanks KJ.. Association of ocular disease and mortality in a diabetic population.  Arch Ophthalmol. 1999;  117 1487-1495
    Google Scholar
  • 25 Klein R, Klein BE, Moss SE, Cruickshanks KJ.. Association of ocular disease and mortality in a diabetes population.  Arch Ophthalmol. 1999;  117 1487-1495
    Google Scholar
  • 26 Fuller JH, Stevens LK, Wang SL.. Risk factors for cardiovascular mortality and morbidity: the WHO Multinational Study of vascular Disease in Diabetes.  Diabetologia. 2001;  44
    Google Scholar
  • 27 Bertram B.. Diabetikerbetreuung in deutschen Augenarztpraxen. Augenarzt 1998: 289-291
    Google Scholar
  • 28 Hauner H, von Ferber L, Köster I.. Ambulante Versorgung von Diabetikern. Eine Analyse von Krankenkassendaten der AOK Dortmund.  Dtsch Med Wschr. 1994;  119 129-134
    Google Scholar
  • 29 Javittt JC, Canner JK, Frank RG, Steinwachs DM, Sommer A.. Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model.  Ophthalmology. 1990;  97 483-494
    Google Scholar
  • 30 Javitt JC, Aiello LP, Chiang Y, Ferris FL, Canner JK, Greenfield S.. Preventive eye care in people with diabetes is cost–saving to the federal government. Implications for health–care reform.  Diabetes care. 1994;  17 909-917
    Google Scholar
  • 31 CDC. . The cost–effectiveness of screening for type 2 diabetes. CDC Diabetes Cost–Effectiveness Study Group. Centers for Diesease Control and Prevention.  JAMA. 1998;  280 1757-1763
    CrossrefGoogle Scholar
  • 32 Early Treatment Diabetic Retinopathy Study (ETDRS) Group. . Results and summary.  Ophthalmology. 1991;  5 739-840
    Google Scholar
  • 33 Global Diabetic Retinopathy Project Group. . Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.  Ophthalmology. 2003;  110 1677-1682
    CrossrefGoogle Scholar
  • 34 Lee CM, Olk RJ.. Modified grid laser photocoagulation for diffuse diabetic macular edema. Long–term visual results.  Ophthalmol. 1991;  998 1594-1602
    Google Scholar
  • 35 Diabetic Retinopathy Vitrectomy Study Research Group. . Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four–year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5.  Arch Ophthalmol. 1990;  108 958-964
    Google Scholar
  • 36 Otani T, Kishi.. A controlled study of vitrectomy for diabetic macular edema.  Am J Ophthalmol. 2002;  134 214-219
    CrossrefGoogle Scholar
  • 37 Recchia FM, Ruby AJ, Carvalho CA. Recchia. Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema.  Am J Ophthalmol. 2005;  139 447-454
    CrossrefGoogle Scholar

Korrespondenz

Dr. med. Claudia Jochmann
Eva Martinetz
Prof. Dr. med. Peter Wiedemann

Klinik und Poliklinik für Augenheilkunde Universitätsklinikum Leipzig AöR

Liebigstraße 10 – 14

04103 Leipzig

Email: Claudia.Jochmann@medizin.uni-leipzig.de