First Author: N.Marques PORTUGAL
Co Author(s): S. Barros A. Cardoso J. Cardoso A. Miranda N. Donaire N. Campos 0 0 0 0 0 0 0 0 0
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To elucidate the importance of metabolic changes in diabetic patients and the risk for sistemic vascular events.
Centro de Responsabilidade de Oftalmologia do Hospital Garcia de Orta
The Diabetes is a micro- and macroangiopathy that affects 100 million people worldwide and is associated with higher risk of cardiovascular events. Glucose intolerance is associated with altered endothelial and smooth muscle function, vasoconstriction due to higher levels of endothelin, and lower levels of nitric oxid, vascular inflammation and thrombosis risk due to plaquelet activation and due to increased plasma coagulation factors (factor VII, thrombin, fibrinogen) and homocistein. Higher levels of homocistein in diabetics are associated with a higher risk of cardiovascular events.
37 years old patient, with Diabetes mellitus type 1, hypertension and dyslipidemia, was referred to our hospital with amaurosis of right eye (RE) with 3 days of evolution. At clinical examination, the patient presented a RE visual acuity of counting fingers at 20 cm and 5/10 in left eye (LE). At biomicroscopy, he had bilateral corticonuclear cataracts without rubeosis iridis. The fundoscopy showed a bilateral proliferative retinopathy with panphotocoagulation and a central arterial retinal occlusion of RE. The final RE visual acuity was counting fingers at 2 m after ocular massage and oral acetazolamide. The patient was also treated with more photocoagulation and aspirin 150 mg/day. The analytic exams showed: an elevated sedimentation velocity (91mm), a lower protrombin time and aPTT, higher glycosylated hemoglobin (11,9%), hyperhomocysteinemia (19,1 umol/L) and higher fibrinogen ( 632mg/dL).
The Diabetes is a pathology that involves multiple metabolic changes which contribute to cardiovascular events. Such alterations like hyperhomocysteinemia, higher coagulation factor levels and higher VS could contribute to identify the diabetics in higher risk of developing vascular events (for example, cardiac infarction, central arterial retinal occlusion).