Radionuclide detection of blood-retinal barrier disruption in diabetes mellitus

Diabetic retinopathy is one of the leading causes of blindness in the United States today. Because early treatment of proliferative retinopathy offers the best chance for visual salvation, there is an essential need for methods of identifying eyes at high risk. Recent research has shown that subclinical leakage from retinal blood vessels is one of the earliest signs of retinopathy. The feasibility of using radionuclide techniques to quantitate blood-retinal barrier disruption is demonstrated by a study in which 23 diabetics and 7 nondiabetics were imaged with an Anger camera in the anterior Waters projection at 2 hours after the administration of Tc-99m DTPA. In the digitized images, regions of interest were placed over each orbit and over one of the cerebral hemispheres. Orbital counts were then compared to cerebral counts on a per pixel basis. Eye to brain ratios were found to be lowest for nondiabetics and highest for patients with proliferative retinopathy. Additionally, the dynamic analysis of the same radiopharmaceutical may allow investigators to further study the pathophysiology of the diabetic eye.