Frequency and Severity of Diabetic Retinopathy in Patients With Diabetic Foot Ulcers at a Tertiary Hospital in Bangladesh.

Background Diabetic retinopathy (DR) and diabetic foot ulcers (DFUs) are major complications of type 2 diabetes mellitus (T2DM) that significantly contribute to morbidity, particularly in low- and middle-income countries such as Bangladesh. While DR is a leading cause of vision loss, DFU is a major contributor to lower-limb amputation. These complications may coexist as manifestations of systemic vascular damage. This study aimed to determine the frequency and severity of DR among patients with DFU and to evaluate its association with ulcer severity using Wagner's classification. Methodology This cross-sectional study was conducted from August 2021 to July 2022 at Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh. A total of 100 adult patients with T2DM and Wagner-graded DFU were included using purposive sampling. Ophthalmologic evaluation included visual acuity assessment, slit-lamp biomicroscopy, dilated fundus examination, fundus photography, and optical coherence tomography. DR was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification, and DFU severity was assessed using the Wagner grading system. Laboratory parameters, including HbA1c, lipid profile, serum creatinine, and hemoglobin, were recorded. Statistical analysis was performed using SPSS version 23.0, with chi-square tests applied to assess associations (p < 0.05 considered significant). Results The mean age of participants was 55.7 ± 10.9 years, and 67 (67%) patients were male. DR was present in 80 (80%) patients, with mild non-proliferative diabetic retinopathy (NPDR) being the most common subtype in 36 (36%) patients, followed by severe NPDR in 21 (21%) patients, moderate NPDR in 14 (14%) patients, proliferative diabetic retinopathy (PDR) in 9 (9%) patients, high-risk PDR in 3 (3%) patients, and advanced diabetic eye disease in 6 (6%) patients. Visual impairment (≤6/60) was observed in 33 (33%) patients in the right eye and 36 (36%) patients in the left eye. A significant association was found between DR severity and higher Wagner grades of DFU (p = 0.001). Patients with DR had a longer duration of diabetes (15.3 ± 6.6 vs. 9.7 ± 4.5 years, p = 0.006), were more likely to smoke (31 patients, 38.8% vs. 0 patients, 0%; p = 0.018), and had lower hemoglobin levels (10.9 ± 1.8 vs. 12.1 ± 1.1 g/dL, p = 0.046). Conclusion DR is highly prevalent among patients with DFUs, with severity closely associated with ulcer grade. These findings support the need for routine ophthalmologic screening in patients presenting with DFU and highlight the importance of integrated care to reduce the risk of both vision loss and limb amputation.