Syndrom časného normoglykemického zhoršení
| Title in English | The early normoglycemic worsening syndrome |
|---|---|
| Authors | |
| Year of publication | 2015 |
| Type | Article in Periodical |
| Magazine / Source | Kazuistiky v diabetologii |
| MU Faculty or unit | |
| Citation | |
| Field | ORL, ophthalmology, stomatology |
| Keywords | compensation of diabetes; ocular complication; diabetic retinopathy; early worsening syndrome; transient worsening syndrome |
| Description | The early (transient) normoglycemic worsening syndrome (early worsening syndrome - EW, transient worsening syndrome - TW) belongs among the ophthalmic complications of diabetes mellitus (DM). A rapid improvement of compensation of diabetes, most often due to the intensified insulin regimen, leads to a paradoxical worsening of the already present diabetic retinopathy (DR). The case report presents a 50 years old patient with a level of glycated Hb 120 mmol/mol at the beginning of treatment of diabetes mellitus. The treatment with oral antidiabetic drugs gliclazide (Diaprel MR), metformin (Metformin 500 mg Zentiva) and sitagliptin (Januvia 100 mg) was initiated for a compensation of diabetes. Newly formatted vessels in the papilla of the ophthalmic nerve (the proliferative diabetic retinopathy) were present during the first ophthalmic examination. The laser photocoagulation of retina was immediately initiated, but yet a fast compensation of diabetes resulted in the development of the EW syndrome. The finding in both eyes was so advanced that it was not manageable by panretinal photocoagulation and it required a surgical procedure. The ocular fundus finding has been stable in both eyes after the surgery. The visual acuity of 5/5 was not achieved in any eye. The visual acuity wor¬sened from 5/7.5 to 5/15 in the right eye, and it improved from 5/20 to 5/7.5 in the left eye. The cause of the decreased visual acuity is a persistent edema of the area of the sharpest vision (the yellow spot - macula). If the intensified insulin treatment is initiated in patients with decompensated diabetes, both the diabetologist and ophthalmologist must keep in mind the syndrome of early normoglycemic worsening. The intensive cooperation between ophthalmologist and diabetologist is inevitable. |