Diabetische Retinopathie und diabetisches Fußsyndrom bei Diabetikern in Kinshasa (Demokratische Republik Kongo)

Zusammenfassung

Einleitung: Weltweit, aber hauptsächlich in den Entwicklungsländern ist ein stetiger Anstieg der Prävalenz des Diabetes mellitus zu beobachten. Diabetische Komplikationen wie Retinopathie und diabetisches Fußsyndrom werden durch eine Neuropathie, Mikro- oder Makroangiopathie verursacht. In Ländern der Subsahara-Region zählt die diabetische Retinopathie/Makulopathie zu einer führenden Ursache für irreversible Erblindungen im Erwachsenenalter. Patienten mit diabetischem Fußsyndrom haben im Vergleich zur gesunden Bevölkerung ein 15–40-fach erhöhtes Risiko einer Amputation im Bereich der distalen Gliedmaßen.

Methode: Wir untersuchten 41 Diabetiker (26 Männer, 15 Frauen) mit einem diabetischen Fußsyndrom im Hinblick auf den Schweregrad der diabetischen Retinopathie. Neben der Visusbestimmung erfolgte eine Untersuchung der vorderen und hinteren Augenabschnitte. Die Inzidenz und das Erkrankungsstadium der diabetischen Retinopathie wurden evaluiert und mittels Fundusfoto dokumentiert.

Ergebnisse: Insgesamt wurden 82 Augen ophthalmologisch analysiert. Keine Anzeichen einer diabetischen Retinopathie wiesen 27 Augen auf. Als nicht proliferative diabetische Retinopathie diagnostizierten wir 47 Augen (16 milde, 16 mäßige, 15 schwere). Sieben Augen zeigten Veränderungen im Sinne einer proliferativen diabetischen Retinopathie. Bei einer Patientin wurde unilateral ein Zentralvenenverschluss diagnostiziert. Hier ließ sich aufgrund ausgeprägter retinaler Blutungen keine Klassifizierung der Retinopathie vornehmen.

Diskussion: Auffällig war eine vorherrschende Diskrepanz zwischen teilweise schwerwiegenden diabetischen Fußveränderungen und nur milden bis mäßigen retinalen Veränderungen. Unsere Beobachtungen deuteten darauf hin, dass die Pathogenese der durch diabetische Neuropathie und der diabetischen Retinopathie induzierenden Mikroangiopathie nur locker miteinander korrelieren. Zusätzlich scheinen lokale Risikofaktoren in Ländern der Subsahara-Region verglichen mit Ländern Europas eine wesentliche Rolle für diese Diskrepanz zu spielen.

Abstract

Purpose: The prevalence of diabetes mellitus is increasing worldwide especially in developing countries. Foot ulcerations in patients with diabetic neuropathy have a high impact in the overall amputation rate. In the present study we looked for the severity of diabetic retinopathy in patients with diabetic foot syndrome in a diabetic care unit in a sub-Sahara megacity (Kinshasa, Democratic Republic of Congo).

Method: Forty-one patients with diabetes-related foot ulcerations (26 male, 15 female, mean age 45.6 years) were enrolled in the study. All patients underwent visual acuity evaluation and slit lamp biomicroscopy. Incidence and stage of retinopathy were evaluated by retinal funduscopy and documented by fundus photography.

Results: Twenty-seven eyes showed no signs of diabetic retinopathy. Forty-seven eyes were diagnosed as non-proliferative diabetic retinopathy (16 mild, 16 moderate, 15 severe). Seven eyes showed proliferative diabetic retinopathy. One patient had a unilateral central venous occlusion. In this case the classification of diabetic retinopathy was not possible because of the massive retinal bleedings.

Conclusion: It was evident that there is a considerable discrepancy between partly extensive foot ulcerations and only mild to moderate diabetic retinopathy in most of the patients. This indicates that neuropathy-induced foot problems and microangiopathy-induced diabetic retinopathy are diabetic complications whose formal pathogenesis is only loosely correlated. Additional risk factors in local African conditions compared to Europe may play a major role in this discrepancy.

Schlüsselwörter

Diabetes mellitus - diabetische Neuropathie - diabetische Retinopathie - Kinshasa (Demokratische Republik Kongo)

Key words

diabetes mellitus - diabetic neuropathy - diabetic retinopathy - Kinshasa (Democratic Republic of Congo)

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