Skip to main content

Advertisement

Log in

Intraocular Inflammation in Diabetic Populations

  • Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this review is to determine the prevalence of uveitis in the diabetic population, the clinical features of the uveitis and diabetes when coexisting and pathophysiology of a possible correlation. We also aim to review the cases of diabetes and uveitis in the literature.

Recent findings

The basis of an association between uveitis and diabetes mellitus (DM) is the common pathophysiology of inflammation. There are several reports on a DM-related uveitis, defined as idiopathic anterior uveitis in the presence of poorly controlled DM, but causation has not been established.

Summary

There are conflicting results in the literature regarding an association between uveitis and DM. More studies are needed to determine if an association truly exists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance•• Of major importance

  1. Castagna I, Fama F, Salmeri G. Anterior uveitis and diabetes mellitus: immunological study. Ophthalmologica. 1995;209(2):53–5.

    Article  CAS  PubMed  Google Scholar 

  2. Herranz M, et al. Increased prevalence of NIDDM in anterior uveitis. Diabetes Care. 1997;20(11):1797.

    Article  CAS  PubMed  Google Scholar 

  3. Oswal KS, et al. Clinical features of patients with diabetes mellitus presenting with their first episode of uveitis. Ocul Immunol Inflamm. 2009;17(6):390–3.

    Article  PubMed  Google Scholar 

  4. Al-Halafi A, et al. The association of systemic disorders with Vogt-Koyanagi-Harada and sympathetic ophthalmia. Graefes Arch Clin Exp Ophthalmol. 2011;249(8):1229–33.

    Article  PubMed  Google Scholar 

  5. Waite JH, Beetham WP. The visual mechanism in diabetes mellitus: a comparative study of 2002 diabetics, and 457 non-diabetics for control. N Engl J Med. 1935;212(9):367–79.

    Article  Google Scholar 

  6. Rothova A, et al. Uveitis and systemic disease. Br J Ophthalmol. 1992;76(3):137–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Noyes HD. Retinitis in glycosuria. Trans Am Ophthalmol Soc. 1868;1(4–5):71.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Ojaimi E, et al. Vogt-Koyanagi-Harada disease, diabetes mellitus, and psoriasis in a child. Ocul Immunol Inflamm. 2012;20(1):56–8.

    Article  PubMed  Google Scholar 

  9. Rottgers E, Holdeman NR. An unusual case of chorioretinitis in a diabetic patient. Clin Exp Optom. 2009;92(2):142–5.

    Article  PubMed  Google Scholar 

  10. Sinha MK, Narayanan R, Chhablani JK. Hypopyon uveitis following panretinal photocoagulation in a diabetic patient. Semin Ophthalmol. 2014;29(3):166–8.

    Article  PubMed  Google Scholar 

  11. Takahashi Y, et al. Severe anterior uveitis associated with idiopathic dacryoadenitis in diabetes mellitus patient. Clin Ophthalmol. 2011;5:619–21.

    PubMed  PubMed Central  Google Scholar 

  12. • Tyagi M, Ambiya V, Rani PK. Hypopyon uveitis following panretinal photocoagulation. BMJ Case Rep. 2016; This case report is of a patient with DM and uveitis who develops recurrent ocular inflammation after panretinal photoagulation

  13. Stanga P, Boyd S, Hamilton A. Ocular manifestations of diabetes mellitus. Curr Opin Ophthalmol. 1999;10(6):483–9.

    Article  CAS  PubMed  Google Scholar 

  14. Liberman P, et al. Causes of uveitis in a tertiary center in Chile: a cross-sectional retrospective review. Ocul Immunol Inflamm. 2014:1–7.

  15. Rothova A, et al. Uveitis and diabetes mellitus. Am J Ophthalmol. 1988;106(1):17–20.

    Article  CAS  PubMed  Google Scholar 

  16. •• Oswal KS, et al. Clinical course and visual outcome in patients with diabetes mellitus and uveitis. BMC research notes. 2013;6(1):167. This retrospective study reported a greater complication rate, reduced vision and poor glycemic control in patients with DM who develop uveitis

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chatzistefanou K, et al. Characteristics of uveitis presenting for the first time in the elderly. Ophthalmology. 1998;105(2):347–52.

    Article  CAS  PubMed  Google Scholar 

  18. Yawata N, et al. High incidence of glucose intolerance in Vogt–Koyanagi–Harada disease. Br J Ophthalmol. 1999;83(1):39–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Barton K, et al. Uveitis presenting de novo in the elderly. Eye (Lond). 1994;8(Pt 3):288–91.

    Article  Google Scholar 

  20. Nalcacioglu-Yuksekkaya P, et al. Clinical and demographic characteristics of patients with uveitis starting later in life. Ocul Immunol Inflamm. 2014:1–7.

  21. Martyn C, Young R, Ewing D. Is there a link between iritis and diabetic autonomic neuropathy? Br Med J (Clin Res Ed). 1986;292(6525):934.

    Article  CAS  Google Scholar 

  22. Gregoire MA, et al. Characteristics of uveitis presenting for the first time in the elderly: analysis of 91 patients in a tertiary center. Ocul Immunol Inflamm. 2011;19(4):219–26.

    Article  PubMed  Google Scholar 

  23. Hemidan A, Tabbara K, Althomali T. Vogt-Koyanagi-Harada associated with diabetes mellitus and celiac disease in a 3-year-old girl. Eur J Ophthalmol. 2006;16(1):173.

    PubMed  Google Scholar 

  24. Jaggarao N, Voth D, Jacobsen J. The Vogt-Koyanagi-Harada syndrome: association with hypothyroidism and diabetes mellitus. Postgrad Med J. 1989;65(766):587–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Maruyama Y, et al. A case of insulin dependent diabetes mellitus following systemic treatment with corticosteroids for Vogt-Koyanagi-Harada syndrome. Ophthalmic Surgery, Lasers and Imaging Retina. 2000;31(6):487–90.

    CAS  Google Scholar 

  26. Murray D, Sung V, Headon M. Asymmetric diabetic retinopathy associated with Fuchs’ heterochromic cyclitis. Br J Ophthalmol. 1999;83(8):987-987.

    Article  Google Scholar 

  27. Al Shehri FS. Uveitis in diabetic woman. International Journal of Diabetes Mellitus. 2009;1(1):59–60.

    Article  Google Scholar 

  28. Guy R, et al. Diabetic autonomic neuropathy and iritis: an association suggesting an immunological cause. Br Med J (Clin Res Ed). 1984;289(6441):343–5.

    Article  CAS  Google Scholar 

  29. Patel AK, et al. Risk of retinal neovascularization in cases of uveitis. Ophthalmology. 2016;123(3):646–54.

    Article  PubMed  Google Scholar 

  30. Joussen AM, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. FASEB J. 2004;18(12):1450–2.

    CAS  PubMed  Google Scholar 

  31. Joussen AM, et al. Leukocyte-mediated endothelial cell injury and death in the diabetic retina. Am J Pathol. 2001;158(1):147–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Fujikawa LS, et al. Retinal vascular endothelium expresses fibronectin and class II histocompatibility complex antigens in experimental autoimmune uveitis. Cell Immunol. 1987;106(1):139–50.

    Article  CAS  PubMed  Google Scholar 

  33. Tang J, Kern TS. Inflammation in diabetic retinopathy. Prog Retin Eye Res. 2011;30(5):343–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ongkosuwito JV, et al. Analysis of immunoregulatory cytokines in ocular fluid samples from patients with uveitis. Invest Ophthalmol Vis Sci. 1998;39(13):2659–65.

    CAS  PubMed  Google Scholar 

  35. Nussenblatt RB, et al. The immunological basis of degenerative diseases of the eye. Int Rev Immunol. 2013;32(1):97–112.

    Article  CAS  PubMed  Google Scholar 

  36. Adamis AP, Berman AJ. Immunological mechanisms in the pathogenesis of diabetic retinopathy. Semin Immunopathol. 2008;30(2):65–84.

    Article  CAS  PubMed  Google Scholar 

  37. Cantón A, et al. CD4-CD8 and CD28 expression in t cells infiltrating the vitreous fluidin patients with proliferative diabetic retinopathy: a flow cytometric analysis. Arch Ophthalmol. 2004;122(5):743–9.

    Article  PubMed  Google Scholar 

  38. Demircan N, et al. Determination of vitreous interleukin-1 (IL-1) and tumour necrosis factor (TNF) levels in proliferative diabetic retinopathy. Eye (Lond). 2006;20(12):1366–9.

    Article  CAS  Google Scholar 

  39. Elner SG, et al. Interferon-induced protein 10 and interleukin 8: CXC chemokines present in proliferative diabetic retinopathy. Arch Ophthalmol. 1998;116(12):1597–601.

    Article  CAS  PubMed  Google Scholar 

  40. Adamiec-Mroczek J, Oficjalska-Mlynczak J, Misiuk-Hojlo M. Roles of endothelin-1 and selected proinflammatory cytokines in the pathogenesis of proliferative diabetic retinopathy: Analysis of vitreous samples. Cytokine. 2010;49(3):269–74.

    Article  CAS  PubMed  Google Scholar 

  41. Murugeswari P, et al. Proinflammatory cytokines and angiogenic and anti-angiogenic factors in vitreous of patients with proliferative diabetic retinopathy and Eales’ disease. Retina. 2008;28(6):817–24.

    Article  PubMed  Google Scholar 

  42. Zhou J, Wang S, Xia X. Role of intravitreal inflammatory cytokines and angiogenic factors in proliferative diabetic retinopathy. Curr Eye Res. 2012;37(5):416–20.

    Article  CAS  PubMed  Google Scholar 

  43. Bromberg-White JL, et al. Identification of VEGF-independent cytokines in proliferative diabetic retinopathy vitreous. Invest Ophthalmol Vis Sci. 2013;54(10):6472–80.

    Article  CAS  PubMed  Google Scholar 

  44. Takeuchi M, et al. Elevated levels of cytokines associated with Th2 and Th17 cells in vitreous fluid of proliferative diabetic retinopathy patients. PLoS One. 2015;10(9):e0137358.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Doganay S, et al. Comparison of serum NO, TNF-α, IL-1β, sIL-2R, IL-6 and IL-8 levels with grades of retinopathy in patients with diabetes mellitus. Eye. 2002;16(2):163–70.

    Article  CAS  PubMed  Google Scholar 

  46. Funatsu H, et al. Aqueous humor levels of cytokines are related to vitreous levels and progression of diabetic retinopathy in diabetic patients. Graefes Arch Clin Exp Ophthalmol. 2005;243(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  47. Gerl VB, et al. Extensive deposits of complement C3d and C5b-9 in the choriocapillaris of eyes of patients with diabetic retinopathy. Invest Ophthalmol Vis Sci. 2002;43(4):1104–8.

    PubMed  Google Scholar 

  48. Cunha-Vaz J, De Abreu JF, Campos A. Early breakdown of the blood-retinal barrier in diabetes. Br J Ophthalmol. 1975;59(11):649–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Jandrasits K, Krepler K, Wedrich A. Aqueous flare and macular edema in eyes with diabetic retinopathy. Ophthalmologica. 2003;217(1):49–52.

    Article  PubMed  Google Scholar 

  50. Ino-ue M, et al. Laser flare intensity in diabetics: correlation with retinopathy and aqueous protein concentration. Br J Ophthalmol. 1994;78(9):694–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Moriarty A, et al. Studies of the blood-aqueous barrier in diabetes mellitus. Am J Ophthalmol. 1994;117(6):768–71.

    Article  CAS  PubMed  Google Scholar 

  52. Nguyen N, Schönherr U, Küchle M. Aqueous flare and retinal capillary changes in eyes with diabetic retinopathy. Ophthalmologica. 1995;209(3):145–8.

    Article  CAS  PubMed  Google Scholar 

  53. Moriarty AP, et al. Breakdown of the blood-aqueous barrier after argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1996;103(5):833–8.

    Article  CAS  PubMed  Google Scholar 

  54. Baudouin C, et al. MHC class II antigen expression by ocular cells in proliferative diabetic retinopathy. Fundamental & clinical pharmacology. 1993;7(9):523–30.

    Article  CAS  Google Scholar 

  55. Udoetuk JD, et al. Risk of corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. Ophthalmology. 2012;119(8):1569–74.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Savin J. Diabetes mellitus, sarcoidosis,? necrobiosis lipoidica. Proceedings of the Royal Society of Medicine. 1969;62(4):350.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Gordon D, Browne B. Macular oedema with associated uveitis and cataract following presentation of type 1 diabetes mellitus in severe ketoacidosis. Diabet Med. 2000;17(4):326–8.

    Article  CAS  PubMed  Google Scholar 

  58. Yamamoto J, et al. Severe bilateral necrotising retinitis caused by toxoplasma gondii in a patient with systemic lupus erythematosus and diabetes mellitus. Br J Ophthalmol. 2003;87(5):651–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Knol JA, et al. Rapid progression of diabetic retinopathy in eyes with posterior uveitis. Am J Ophthalmol. 2006;141(2):409–12.

    Article  PubMed  Google Scholar 

  60. Suzuki H, Isaka M, Suzuki S. Type 1 diabetes mellitus associated with Graves’ disease and Vogt-Koyanagi-Harada syndrome. Intern Med. 2008;47(13):1241–4.

    Article  PubMed  Google Scholar 

  61. Krifa F, et al. Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1. Gastroenterol Clin Biol. 2010;34(4–5):319–20.

    Article  CAS  PubMed  Google Scholar 

  62. Talat L, et al. The influence of diabetes mellitus on the management and visual outcome of patients with uveitis. Acta Ophthalmol. 2014;92(4):e329–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rola N. Hamam.

Ethics declarations

Conflict of Interest

Wajiha J. Kheir, Huda A. Sheheitli, and Rola N. Hamam declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Microvascular Complications—Retinopathy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kheir, W.J., Sheheitli, H.A. & Hamam, R.N. Intraocular Inflammation in Diabetic Populations. Curr Diab Rep 17, 83 (2017). https://doi.org/10.1007/s11892-017-0910-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-017-0910-3

Keywords

Navigation