The dissertation is devoted to solving of the current task of modern ophthalmology - to improve the early diagnosis of the development and progression of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) based on the correlation analysis of the connection between damage to the organ of vision and damage to other target organs.
Scientific novelty of the obtained results.
The epidemiological situation of visual disability caused by diabetes was analyzed, the prevalence, dynamics, and trends of disability due to diabetic retinopathy were studied. Over the 15-year period of observation, there is a fluctuation of the intensive indicator were noted in the range from 0.13 per 10 thousand in 2006 and 2008 to 0.22 in 2010 and 0.20 in 2015 with a general tendency to maintain the indicator at the level of 0.17 (0, 16 – 0.19) per 10,000 adult population. There is a significant increase in the level of accumulated disability due to diabetic retinopathy over 15 years of observation, almost 2.5 times. It was determined that the specific weight of the blind and partially sighted due to diabetic retinopathy (persons with disabilities of the first and second groups) is higher than in the general population of patients who were diagnosed with visual disability for the first time, which indicates the severity of the studied pathology.
The theoretical knowledge about the features of the pathogenesis of complications of the type 2 diabetes mellitus has been supplemented. According to the results of the correlation analysis, ROC-analysis and odds ratio analysis between the presence of diabetic retinopathy and lesions of other target organs of diabetes it was established that the most characteristic and significant risk factors for this eye complication are the presence of a severe form of diabetes, the need for insulin therapy, and the presence of diabetic nephropathy of the 3-5th degree, chronic renal failure of any stage, angiopathy of the lower extremities of the 2nd-3rd degree, and the duration of diabetes over 8 years. A weak positive correlation was found between the development of diabetic retinopathy and coronary heart disease and hypertension. With regard to the probability of progression of the non-proliferative form of diabetic retinopathy to the proliferative form, the presence of a severe form of diabetes and severe kidney damage in the form of diabetic nephropathy of the 3-5th degree and chronic renal failure in the patient constituted a significant threat.
Scientific data on the peculiarities of the local hemodynamics of the eye and orbit of patients with type 2 diabetes mellitus have been clarified: during the examination by the ultrasound method, a slowing of the linear velocity of blood flow in the ophthalmic artery, central retinal artery, and posterior short ciliary arteries and an increase in the pulse index and vascular resistance index in patients with diabetes have been determined retinopathy, with maximum changes in the proliferative stage.
Practical significance of the obtained results.
As a result of the study, the most significant general somatic risk factors for the development of diabetic retinopathy in patients with type 2 diabetes were determined: the presence of a severe form of diabetes (OR = 5.79, 95% CI 3.26-10.25), the need for insulin therapy (OR 6.1; 95% SI 3.40-10.93), the presence of diabetic nephropathy 3-5 stage (OR 17.34; 95% CI 4.94-60.83), chronic renal failure of any stage (OR 6.88; 95% CI 3.66-12.94), angiopathy of lower extremities 2-3 stage, and the duration of diabetes over 7 years.
According the examination of the local hemodynamics of the eye and orbit, a slowing of the linear velocity of blood flow in the ophthalmic artery, central retinal artery, and posterior short ciliary arteries and an increase in the pulse index and vascular resistance index were found in patients with diabetic retinopathy with maximal changes in the proliferative stage.
Based on the received data, additions to the current protocol for the examination and treatment of patients with type 2 diabetes (Order of the Ministry of Health of Ukraine No. 1118 of 12.21.2011) are proposed, namely, according to the presence of the specified risk factors, the indications for the consultation of an ophthalmologist, the expansion of the volume of instrumental examinations of the organ vision.
