Hans-Walther Larsen

EFFECT OF 1 YEAR OF NEAR-NORMAL BLOOD GLUCOSE LEVELS ON RETINOPATHY IN INSULIN-DEPENDENT DIABETICS

30 insulin-dependent diabetic patients with background retinopathy were randomised to conventional treatment (UCT) or treatment with continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 1 year with fortnightly seven-sample home blood glucose measurements and retinal examinations every 6 months. Mean blood glucose and stable haemoglobin A1c during months 3-12 were significantly lower in the CSII than the UCT group. Retinal morphology deteriorated during the year with no significant differences between UCT and CSII groups. The frequency of deterioration was highest in the CSII group, especially among the 10 patients with best glycaemic control. Proliferative retinopathy developed in 3 patients--2 of these were CSII treated. Retinal function (oscillatory potential, macular recovery time, and posterior vitreous fluorophotometry) improved significantly with CSII treatment and deteriorated significantly with UCT. Changes in retinal function were most pronounced in patients with the best and the poorest regulated glycaemic control.

Oscillatory potential and nyctometry in insulin-dependent diabetics.

The study draws a comparison between the oscillatory potential of the electroretinogram and the initial dark‐adaptation measured by nyctometry, with the aim of assessing the predictive value of nyctometry in juvenile diabetics. The study included 61 insulin‐dependent juvenile diabetics, aged 18–49 years, with a disease duration of more than five years. A statistically highly significant correlation could be demonstrated between alterations in the oscillatory potential and the initial dark‐adaptation. The results justify the assumption that nyctometry can be used as an easily handled clinical tool in selecting those at risk of developing proliferative retinopathy in their subsequent 6–8 years.

Macular recovery time recorded by nyctometry--a screening method for selection of patients who are at risk of developing proliferative diabetic retinopathy. Results of a 5-year follow-up.

Abstract a 5‐year study on the predictive value of the macular recovery time, as recorded by nyctometry, in the development of proliferative diabetic retinopathy in insulin‐dependent diabetes mellitus has been completed. Seventyseven patients with a median age of 30,8 years and a median duration of the disease of 15,8 years participated. In the follow‐up period, 16 out of 20 patients initially showing abnormally prolonged macular recovery time had developed proliferative diabetic retinopathy the median duration from the initial investigation to the diagnosis of retinal neovascularization being 34 months. Contrary to this finding, only 4 out of 57 patients initially showing normal macular recovery had advanced into proliferative retinopathy, and the median duration until diagnosis of this condition was 45 months. It is concluded that nyctometry can serve as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.

FLUORESCEIN ANGIOGRAPHY IN DIABETIC CHILDREN

In 63 diabetic children, aged 10–14 years, with normal ophthalmoscopy, fluorescein angiography revealed slight diabetic retinopathy in maximally three, aged 12–14 years. These findings are discussed in relation to the controversial results published in a few other fluorescein angiographic studies on diabetic children.

NYCTOMETRY ‐ A NEW SCREENING METHOD FOR SELECTION OF PATIENTS WITH SIMPLE DIABETIC RETINOPATHY WHO ARE AT RISK OF DEVELOPING PROLIFERATIVE RETINOPATHY: Results of a 3‐year Follow‐up

A prospective long‐term study on the predictive value of nyctometry in the development of proliferative diabetic retinopathy in insulin‐dependent diabetes mellitus is in progress. Sixty‐one patients participated. At a follow‐up 3 years after the initial investigation, none of the patients initially showing results above the lower normal limit had developed proliferative retinopathy, whereas 6 out of 16 eyes initially displaying reduced values of nyctometry had advanced into proliferative retinopathy. It is concluded that nyctometry is valuable as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.

INTRAOCULAR TENSION AND BLOOD-SUGAR FLUCTUATIONS IN DIABETICS

Ever since Heine (1903) and Krause (1904) reported hypotonia of the eye in diabetic coma, it has generally been accepted that severe hypotonia of the eye often is seen during diabetic coma (Bannes 1932). It is also known that when the diabetic coma is treated with insulin, normal intraocular pressure is restored. In diabetics, a fall in intraocular tension during hypoglycaemia has been reported by Richter (1926), Wiechmann & Koch (1927) and Wiechmann (1930). According to Schmidt (1938), T6th (1938) and C h k a (1939) the intraocular tension in non-diabetics is not lowered during induced hypoglycaemia. Investigations on the intraocular pressure in diabetics and the possible correlation between the intraocular tension and the state of diabetic retinopathy have not shown conclusive results (Gray 1933, Vila Ortiz 1947, Weinstein 1949, 1951, Cristiansson 1961). These papers do not mention any correlation between the intraocular pressure and the blood-sugar fluctations. On theoretical grounds Philps (1946), Vila Ortiz (1947), Weinstein (1949, 1951), Martin (1951), Krause (1953), Ashton (1958), Poulsen (1958), and Larsen (1960) all stressed how the development of diabetic retinopathy might be favoured by a changing or a low intraocular pressure. Martin (1951) found the variations in intraocular pressure over twenty-four hour periods larger and more irregular in diabetics than in non-diabetics, but he was unable to correlate these variations with fluctuations in the blood sugar levels. In a single diabetic, Poos (1930) was able to correlate such variations in intraocular pressure with fluctuations in blood-sugar values. The aim of the present investigation on diabetic subjects was to correlate

THE VALUE OF OCULAR FINDINGS IN THE DIAGNOSIS OF ANGIOKERATOMA CORPORIS DIFFUSUM (FABRY'S DISEASE)

In the past decades, the so-called inborn errors of metabolism have attracted great interest. As a result, our understanding of the underlying metabolic mechanisms have made great advances. Still, however, a rational therapy has ensued in only a few diseases. In the majority of metabolic diseases the physician has to content himself with making the diagnosis and giving genetic councelling. Early diagnosis and genetic councelling are of particular importance in Fabrys disease as it is an X-linked recessive disorder with variable expressivity (Ofiitr et al., 1965), in which affected family members can in most cases reproduce. The first case reports on angiokeratoma corporis diffusum appeared in 1898 (Fabry, Anderson) . Although the disease has been known since then it was not until 1958 that the first report of an affected woman appeared in the literature (Wallace) . Our increased knowledge of the clinical manifestations and the genetic, biochemical and pathological mechanisms has resulted in the disease now being diagnosed more frequently. U p to 1960 only about 50 cases were reported, but since then more than 50 additional cases have been described. The disease is not as rare as the litterature might suggest, since during the last few years, /ensen and Christensen Lou, 1966, and Christensen Lou, 1970, found 24 cases in 4 families originating in the Copenhagen area.

Congenital glaucoma (buphthalmia). A long-term follow-up of an operative material (1943-1963).

The treatment of congenital glaucoma has been a topic of vivid discussion for nearly one century. It is generally accepted that the treatment is operative, but which operation is the best one is not finally settled. Iridectomy, iridencleisis, Elliot’s operation, sclerotomy, cyclydialysis and cyclodiathermy have been the most common operations for congenital glaucoma for a very long period. The operative results, however, have been very conflicting and difficult to evaluate, not only because the buphthalmic eye often has undergone more than one operation, but also because the follow-up periods usually have been short, ranging from 2 to 6 years in average. Only a few references can be mentioned from the comprehensive literature: Seefelder (1906), Jaensch (1927), Anderson (1939) , Dalsgaard-Nielsen (1945), Kluyskens (1950), Scheie (1955, 1963, 1964). Extensive references are listed in these papers. Goniotomy was introduced in the treatment of congenital glaucoma by Barkan (1942) and goniopuncture by Scheie ( 1950). Both reported favorable results from their operations (Barkan 1948, 1953, Scheie 1961), results which were by far better than those reported in the above-mentioned operations. During the last 20 years, therefore, goniotomy, goniopuncture or a combination of goniotomy and goniopuncture have become more and more common in the treatment of congenital glaucoma. Favorable results have also been reported by Haas (1955) and Worst ( 1966), among many others. Unfortunately, however, a really adequate long-term follow-up of goniotomy, goniopuncture and combined goniotomy-goniopuncture has still not been presented. The genetic aspects in congenital glaucoma have been evaluated by Westerlund (1947) among others, and Jensen (1960) has presented the longterm prognosis, specially with reference to the occupational prognosis. We still lack sufficient information on the long-term prognosis of the opera-

Senile macular degeneration. Results of laser treatment. A preliminary report.

Abstract A preliminary report on laser treatment of senile macular degeneration is presented. Over a one year period 234 patients with symptoms and signs of macular degeneration were examined with flourescein angiography. 32 patients (14%) showed neovascular membranes accessible to treatment with blue/green argon laser. At the end of the observation period (mean 8.7 months) one half of the treated group had unchanged or better visual acuity, whereas the other half showed deterioration of the visual acuity. It is not known whether this result differs from the average spontaneous course. A controlled trial is necessary in order to evaluate the possible beneficial effect of laser treatment of senile macular degeneration in our population.