Gayatree Mohanty1, Prasanta Padhan2, Sridivya Chilakamarthy3, Manmath Kumar Das4, Debendranath Bhuyan5
BACKGROUND
The nailfold capillaroscopy (NFC) has been used to analyse capillary microarchitecture
in diseases like Raynaud’s disease, scleroderma, and other collagen
disorders earlier but recently researchers have documented capillaroscopic
findings in diabetic patients which correspond to their ophthalmoscopic findings.
Every diabetic patient after ten years of the disease is at risk of diabetic retinopathy
and should thereby be referred to an ophthalmologist for screening. But for various
factors the referral to ophthalmologists is poor and the patients usually present to
the ophthalmologist when their vision is threatened. Our study intends to correlate
the nailfold capillaroscopic microvascular changes with duration of diabetes,
severity of diabetic retinopathy (DR), compare the changes of patients with DR
and without DR and determine its role as a screening tool.
METHODS
This was a hospital based cross-sectional study for over 18 months in patients (15
- 75 yrs. of age) with diabetes mellitus. Patients with other vascular disorders were
excluded. The study subjects were evaluated for diabetic retinopathy by indirect
ophthalmoscopy, fundus pictures and optical coherence tomography. The nailfold
capillaroscopy findings were recorded and co-related with fundus findings.
Statistical analysis was done by using the STATA software version 15.1.
RESULTS
Two hundred and fifty patients were recruited with 125 patients in each group,
patients with and without DR respectively. Poor glycaemic control was seen most
commonly in patients with proliferative diabetic retinopathy. The reduced capillary
density, tortuosity, microhaemorrhages, neoangiogenesis and avascular areas
were seen more frequently in proliferative diabetic retinopathy than nonproliferative
diabetic retinopathy and patients without DR. (P value 0.00).
CONCLUSIONS
Changes in nailfold capillaroscopy in diabetics have significant association with
severity of DR, duration of diabetes, and glycaemic control. It could be used as
screening and early diagnostic tool for non-ophthalmology medical fraternities to
refer to ophthalmologist for follow-up and treatment of diabetic retinopathy.
