الفهرس 
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Abstract
Since the complications of diabetes mellitus are very serious including microvascular complications: retinopathy, nephropathy and neuropathy and macrovascular complications such as: cardiovascular diseases may lead to infarction or cerebrovascular disease as stroke so studying this complication is very important since these complications can affect the patient’s quality of life and can lead to disabilities such as retinopathy.
Retinopathy is regarded one of the most important complications of diabetes that occurs after long duration of the disease with untight glycemic control, and it is regarded one of the preventable causes of blindness so proper evaluation of diabetic patients and their complications can prevent blindness.
Nailfold Videocapillaroscopy is a new modality which is non-invasive is used to evaluate the nailfold capillaries it has a specific pattern is known to scleroderma and nowadays it is widely used in diseases other than rheumatological diseases such as diabetes mellitus. Assessment of the capillaries in the nailfold of diabetic patients and trying to relate these findings to the microvascular complications is the aim of our work.
Our study was conducted on 62 diabetic type 2 diabetes mellitus patients (16 male, 46 female) their ages above 18 years lies between (36-66) years.
All these patients were subjected to: full history taking and thorough clinical examination, body mass index measurement, nailfold capillaroscopy imaging , slit-lamp dilated fundus examination using second hand-held lens and laboratory work up including: renal functions test serum urea and serum creatinine , Lipid profile: Total cholesterol, low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG) cardiovascular risk ratio, HbA1c (%): with optimal control below 7 % , Fasting blood glucose and Albumin/Creatinine ratio.
Nailfold capillaroscopy imaging revealed that 50% of our patients had branched and tortuous capillaries, 54.8% had hemorrhage ,8.1% with dilated apical capillary, 74.2% showed elongated capillaries, 77.4% with dilated capillary width and all patients had the normal capillary density 9-11 in 1 linear millimeter.
Our study reported that patients with diabetic retinopathy 26 patients showed higher duration of disease 13 ± 5.61 more than non-diabetic retinopathy patients 36 patients which showed low duration of diabetes 8 ± 4.65 years. Also, patients with DR showed higher levels of HbA1c 9.72 %± 1.94 more than the non-DR patients which was 8.65% ± 2.1.
Patients with diabetic retinopathy show high percentages of tortuous, branched capillaries respectively:69.2%, 69.2% of the DR patients. 46.2% of the DR patients had precapillary edema verses 19.4% of the non-DR patients who had precapillary edema. The mean capillary width in the DR group of patients was 27.68 ± 5.7 verses 23.02 ± 3.29 in the non-DR patients which indicate that patients with DR had more wide capillaries than the non-DR patients.
More fasting glucose levels were detected in the DR patients than the non-DR patients. Higher serum cholesterol and higher serum LDL levels were reported in the non-DR patients more than the DR patients.
Branched, tortuous capillaries, hemorrhage and dilated apical capillaries are documented in the patients with higher median diabetic years in the DR group of patients which lies between 15-20 diabetic year. Tortuosity, precapillary edema and dilated apical capillaries are shown to be positive in patients with higher median diabetic years.
50 patients had HbA1c ≥7 and 12 patients had HbA1c <7 .24 patients documented to have DR with HbA1c 7% or more and only 2 patients had DR with HbA1c <7. 29 patients had tortuous capillaries with HbA1c ≥7 verses 2 patients had tortuous capillaries with HbA1c <7. Also, all the 19 patients who had precapillary edema were with HbA1c ≥7 while no patients had precapillary edema in the HbA1c <7 group of patients.
Capillary width and branched capillaries are the variants in the multivariant regression analysis which had statistical significance as a predictor of diabetic retinopathy in the last step regarding the capillaroscopic findings. Using KAPLAN MIEIER analysis test, it was found that the Median time needed to develop DR is 15 years with 95%CI (14.3-15.7).
So nailfold capillaroscopy is regarded a helpful non-invasive newly emerging tool to assess the capillaroscopic changes in diabetic patients as an indicator to diabetic complication development such as diabetic retinopathy.