Arun Kumar B. Desai1, Srinivas Badageri2, S. Pandu3
To evaluate the association of elevated serum lipids with retinal hard exudates in type 2 diabetic patients in rural Karnataka. MATERIAL AND METHODS: Hospital based cross sectional study which included 60 (n=60) type 2 diabetic patients (60 eyes) fulfilling the inclusion criteria. Patients were subjected to detailed ocular examination, fundus examination done under full dilatation using indirect ophthalmoscope with 20D lens and slit lamp biomicroscope with 90D lens. Fundus photographs were obtained using fundus camera. Grading of retinal hard exudates performed by utilizing modified Airlie House classification. The modified Airlie House Classification used is as follows: Grade 0 - No evidence of hard exudates; Grade 1: Questionable hard exudates present; Grade 2: Hard exudates less than standard photograph 3; Grade 3: Hard exudates greater than or equal to standard photograph 3, but less than standard photograph 5; Grade 4: Hard exudates greater than or equal to standard photograph 5, but less than standard photograph 4 and Grade 5: Hard exudates greater than or equal to standard photograph 4. These grades were further divided into three groups of patient severity as follows: Group 1 (absent or minimal hard exudates) included patients with Grade 0, 1 or 2 hard exudates; Group 2 (hard exudates present) included patients with Grade 3 or 4 hard exudates and Group 3 (prominent hard exudates) included patients with Grade 5 hard exudates. Fasting lipid profile including serum total cholesterol, low density lipoproteins, very low density lipoproteins, high density lipoproteins and triglycerides was obtained. Association of dyslipidemia with retinal hard exudates was analysed using one way ANOVA test. RESULTS: On statistical analysis with ANOVA test retinal hard exudates were significantly associated with elevated total cholesterol (p= .0001), triglycerides (p= .0001), serum LDL (p=.008), serum VLDL (p=.012), and negative correlation was found with serum HDL (p=.0001). CONCLUSION: Dyslipidemia was significantly associated with retinal hard exudates formation in type 2 diabetic patients. This study suggests treating ophthalmologist should get a fasting lipid profile done if patient has significant hard exudates on fundus examination. Study also recommends need of lipid lowering drugs due to high incidence of dyslipidemia in these patients.
