The effects of renal transplantation on diabetic retinopathy: Clinical course and visual outcomes

Purpose: To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. Design: Retrospective study. Materials and Methods: A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. Results: The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 +/- 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. Conclusions: RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.