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  • Title: Bilateral diabetic papillopathy and metabolic control.
    Author: Ostri C, Lund-Andersen H, Sander B, Hvidt-Nielsen D, Larsen M.
    Journal: Ophthalmology; 2010 Nov; 117(11):2214-7. PubMed ID: 20557939.
    Abstract:
    OBJECTIVE: The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis. DESIGN: Retrospective case-control study. PARTICIPANTS: Two thousand sixty-six patients with type 1 diabetes. METHODS: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. MAIN OUTCOME MEASURES: Simultaneous, bilateral diabetic papillopathy. RESULTS: The mean follow-up was 4.9 years. During 10,020 patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A₁(c) (HbA₁(C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA₁(C) observed in the remainder of the study population (P<0.001). Photographs recorded before the onset of bilateral diabetic papillopathy showed that all 5 patients had small cup-to-disc diameter ratios in both eyes (P<0.001). CONCLUSIONS: Diabetic papillopathy was associated markedly with a drastic recent reduction in glycemia and a small cup-to-disc diameter ratio. This supports the hypothesis that diabetic papillopathy may be an early worsening phenomenon occurring in anatomically predisposed patients in response to a recent rapid decrease in glycemia. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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