Sequential vitreous fluorophotometry in diabetes mellitus: a five-year prospective study

Fifty-nine patients with juvenile-onset, insulin-dependent diabetes mellitus were followed for 5 years with sequential retinal photographs and ocular fluorophotometry. Very good metabolic control with a mean hemoglobin A1C level of 8.8% was maintained with conventional twice daily insulin injections. The incidence of retinopathy during the initial 10 years of the disease was considerably lower than that in previously reported series. The incidence of the development of retinopathy within the first 5 to 7 years of diabetes was 0 compared to a previous predicted incidence of 44%. It was possible to separate patients with diabetes mellitus without visible retinopathy from a group of normal control subjects. In this group of patients high hemoglobin A1C levels and thickened capillary basement membranes were not predictive of the development of progression of retinopathy. High vitreous fluorescein values and simultaneously high aqueous and vitreous fluorescein values were indicative of the presence of retinopathy or were harbingers of the development or progression of retinopathy. Disease duration was the single most important factor in determining the prevalence of retinopathy.