Ophthalmic evaluation in patients after simultaneous pancreas-kidney transplantation (SPK) due to complications of type 1 diabetes mellitus, and in type 1 diabetic patients assessed for eligibility for SPK

Introduction
Ophthalmic evaluation of patients after simultaneous pancreas-kidney transplantation (SPK) due to complications of type 1 diabetes mellitus, and type 1 diabetic patients assessed for eligibility for SPK.

Material and methods
We performed an ophthalmic evaluation in 37 patients after SPK and 49 patients assessed for eligibility for SPK in the Central Clinical Hospital of the Ministry of Interior in Warsaw between January 2016 and March 2020. Ophthalmic evaluation included measurements of best corrected visual acuity, anterior and posterior eye segment examinations, fundus digital photography, and OCT.

Results
In the patients after SPK, we found a statistically significant correlation between atrophy in the photoreceptor inner segment/outer segment junction (IS/OS line) on OCT and the pre-transplant HbA1 level. In the group of patients evaluated before and within one year after SPK, we confirmed activation of retinopathy in 66.7% of examined eyes. OCT performed during the assessment of eligibility for SPK revealed atrophy in the IS/OS line in 47% of examined eyes.

Conclusions
Changes in the retina associated with poor pre-transplant diabetes control determine the best achievable visual acuity even after long-term normalization of glycemia following SPK. Patients after SPK require frequent comprehensive ophthalmological follow-up examinations during the first year after transplantation because of the risk of diabetic retinopathy progression. Despite the limitations resulting from their baseline status, more than half of all patients after SPK (51%) have a visual acuity of > 0.6 at least in one eye, which is sufficient for independent functioning. Patients eligible for SPK exhibit macular changes on OCT, hypoperfusion on angio-OCT, and 47% atrophy in the IS/OS line.