[Clinical management of diabetic retinopathy]

Factors to be checked concerning local and systemic condition were studied statistically in order to clarify the methodology for clinical management of diabetic retinopathy. NIDDM (n = 1517) and IDDM (n = 30) persons participating in baseline and follow-up examinations were included. The vitreous fluorophotometric values were selected for local check factors. Glycosylated hemoglobin was selected for systemic check factors. To determine the retinopathy status at both the baseline and follow-up examinations, all fundus photographs were graded in a masked fashion, using the author's classification scheme (1983) which specified six levels of retinopathy for each excepted from the interrupted proliferative retinopathy. Level 0: no retinopathy, Level 1: microaneurysms only (AI), Level 2: microaneurysms and retinal hemorrhages (AII), Level 3: preproliferative retinopathy (soft exudates, increased capillary occlusion and intraretinal microvascular abnormalities) (BI), Level 4: neovascularization elsewhere (BII), Level 5: neovascularization of the disc (BIII), Level 6: vitreous hemorrhages or proliferative tissue (BIV, V). A positive correlation between the progression of retinopathy and glycosylated hemoglobin or vitreous fluorophotometric values were observed. The coefficient of correlation was 0.67 between posterior vitreous fluorophotometric values and levels (scores) of retinopathy. The coefficient of correlation was 0.41 between glycosylated hemoglobin and levels of retinopathy. These data suggest that these two factors can predict the progression of diabetic retinopathy.