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3 . 2022

The effect of simultaneous pancreatic and kidney transplantation on the state of the retina in diabetes mellitus

Abstract

Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM), observed in every third patient with DM, and in every tenth is the cause of vision loss. It has been previously reported that the presence of DR increases the risk of diabetic nephropathy (DN). DN is the greatest threat to the life of patients with type 1 DM. Simultaneous pancreas and kidney transplantation (SPK) is the most effective treatment for patients with type 1 DM and end-stage renal disease (ESRD), normalizing carbohydrate metabolism and renal excretory function.

The aim of the study was to analyze the morphofunctional state and hemodynamics of the retina in patients with type 1 DM and DR before and after SPK.

Material and methods. The study included 45 patients (68 eyes). Patients were divided into 3 groups: A – patients with type 1 diabetes and ESRD after SPK; B – patients with type 1 DM and ESRD receiving courses of long-term hemodialysis (LTH); С – patients without ocular and systemic pathologies. All patients underwent a standard ophthalmological examination with measurement of the central retinal thickness (CRT) and retinal perfusion density in the superficial (SCP) and deep (DCP) capillary plexus of the retina, as well as the determination of the retinal photosensitivity threshold. In patients after SPK there was a significant decrease in CRT (p<0.05), an increase in the average retinal perfusion density (p<0.05), visual acuity (p<0.05) and macular photosensitivity threshold (p<0.05) compared with patients on LTH. Patients in the preoperative period of SPK needed more active ophthalmic tactics by way of laser photocoagulation of the retina, anti-angiogenic therapy and vitrectomy than after organ transplantation.

Conclusion. This study demonstrates an improvement in hemoperfusion and morphofunctional status of the retina in patients with preserved macular blood flow and central vision functions in the SPK post-transplant period in comparison with patients awaiting transplantation. Normalization of glycemia and reduction of uremia achieved with SPK stabilize the progress of DR, which is characterized by a decrease in the proliferation activity and the incidence of diabetic macular edema, requiring active ophthalmic tactics.

Keywords:type 1 diabetes mellitus; diabetic retinopathy; diabetic nephropathy; simultaneous transplantation of the pancreas and kidney

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Bulava E.V., Vorobyeva I.V., Moshetova L.K., Pinchuk A.V. The effect of simultaneous pancreatic and kidney transplantation on the state of the retina in diabetes mellitus. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (3): 90–4. DOI: https://doi.org/10.33029/2304-9529-2022-11-3-90-94 (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
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