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Early selective neuroretinal disorder in prepubertal type 1 (insulin-dependent) diabetic children without
A V Greco1, M A Di Leo, S Caputo
1Institute of Internal Medicine, Catholic University, Rome, Italy.
Insights
Early diabetes in children affects neural retina function before puberty, even without visible retinopathy. Focal electroretinography can detect these neurosensory changes, potentially identifying those at higher risk for future complications.
Area of Science:
- Ophthalmology
- Pediatrics
- Endocrinology
Background:
- Diabetes mellitus is a chronic condition affecting multiple organ systems.
- The impact of diabetes on the neural retina before puberty is not well understood.
- Vascular retinopathy is a known complication of diabetes, but earlier neural changes may occur.
Purpose of the Study:
- To investigate the effects of early-stage diabetes on macular function in prepubescent children.
- To determine if diabetes impacts retinal cellular elements prior to the development of vascular retinopathy.
- To assess the utility of focal electroretinography in detecting subclinical retinal dysfunction in diabetic children.
Main Methods:
- A cohort of 20 prepubescent children with diabetes was compared to 39 age- and sex-matched healthy controls.
- Macular function was assessed using steady-state focal electroretinography (fERG).
- Specific fERG parameters were analyzed to evaluate photoreceptor, inner retinal, and ganglion cell function.
Main Results:
- Diabetic children showed significantly reduced macular function compared to controls, indicating impaired retinal cellular elements.
- Ganglion cell function was significantly impaired in diabetic children.
- Photoreceptor function remained unaffected in the diabetic group.
- No correlation was found between metabolic control, disease duration, and the observed functional deficits.
Conclusions:
- Early-stage diabetes in prepubescent children can selectively affect the neural retina before microvascular changes are evident.
- Focal electroretinography is a valuable tool for identifying neurosensory retinal disorders in diabetic children.
- These findings suggest that children with early diabetes and subclinical retinal dysfunction may be at increased risk for developing microvascular retinopathy later.
Abstract:
The duration of diabetes before puberty is not considered relevant to the future development of complications. To evaluate the effects of diabetes on the neural retina, we analysed macular function by steady-state focal electroretinography in 20 prepubescent diabetic children without vascular retinopathy and in 39 sex- and age-matched normal children. The mean (+/- SD) response related to retinal cellular elements between the photoreceptors and ganglion cells was significantly lower in diabetic children than in the control group (0.38 +/- 0.12 vs. 0.51 +/- 0.13 microV; unpaired t-test = 3; P = 0.005). Similarly, ganglion cell function showed a significant impairment in diabetic children with respect to the control group (0.4 +/- 0.13 vs. 0.53 +/- 0.09 microV; unpaired t-test = 5.4; P = 0.0001), whereas the photoreceptors appeared unaffected. Metabolic control and disease duration were not correlated with functional deficits. Our results suggest that before puberty, early diabetes may have a selective effect on the neural retina prior to the appearance of microvascular changes. A focal electroretinogram could identify diabetic children with neurosensory disorders who may have a higher risk of developing microvascular retinopathy.