Advanced Diabetic Eye Disease Research Articles

Efficacy of intravitreal injection of Ziv-aflibercept before vitrectomy for proliferative diabetic retinopathy

Purpose The aim of this study was to evaluate the efficacy of intravitreal injection of Ziv-aflibercept before small-gauge pars plana vitrectomy compared to pars plana vitrectomy alone in eyes with advanced diabetic eye disease. Patients and methods This is a prospective, randomized, interventional study that enrolled 60 eyes of 46 patients with advanced diabetic eye disease between February 2019 and December 2020. Intravitreal Ziv-aflibercept injection was given in 30 eyes before vitrectomy, while the other 30 eyes served as the control group (without intravitreal injection). The recorded data included intraoperative bleeding, surgical time, endodiathermy use, iatrogenic retinal breaks, and incidence of postoperative vitreous hemorrhage at 1 week, 1 month, 3, 6, and 12 months postoperatively. Results Intraoperative bleeding was noted in 18 (60%) eyes in the study group compared to 26 (86.66%) eyes in the control group, with no statistically significant difference (P=0.39). However, grade 2 intraoperative bleeding was reported significantly less in the study group (eight eyes, 26.66%) than in the control group (20 eyes, 66.66%) (P=0.004). At least one intraoperative iatrogenic retinal break was detected in 10 (33.33%) eyes in the study group compared to 18 (60%) eyes in the control group (P=0.44). The mean surgical time was significantly shorter (51.67±7.30 min) in the study group than in the control group (63.17±10.16 min) (P<0.001). However, there was no statistically significant difference in the rate of postoperative vitreous hemorrhage between the study group and the control group at 1 week, 1, 3, 6, and 12 months, postoperatively (P>0.05). Conclusion Preoperative intravitreal Ziv-aflibercept significantly decreased the surgical time and reduced the rate of severe intraoperative bleeding during diabetic vitrectomy.

Prevalence of Diabetic Retinopathy and Associated Risk Factors in Diabetic Type II Patients in Ajdabiya, Libya

Diabetic retinopathy (DR) is One of the most well-known microvascular complications of diabetes mellitus (DM) and is a frequent side effect of untreated diabetes that can lead to blindness and visual impairment. This study was conducted to assess the prevalence of diabetic retinopathy and associated factors among type 2 diabetic patients. A cross sectional study was done at Ajdabiya diabetic center from November 2023 to January 2024. Subjects and Methods: 52 patients (104 eyes) with T2DM were included in this study, their fasting blood sugar and glycosylated hemoglobin level, lipid profile measured.in addition to fundus examination (done by noncontact +90-diopter lens), fundus photographs taken by Non-Mydriatic Fundus Camera TFC-1000. Around 61 eyes (58.7%) had diabetic retinopathy, 27 eyes (26%) had back ground DR, 6 eyes (5.8 %) had pre-proliferative DR, 4 eyes (3.8%) had proliferative DR, 2 eyes (1.9%) had advanced diabetic eye disease, 22 eyes (21.2%) had CSME. Their ages ranges between 36–74 years with mean (58.90) years, (26.9%) were males, (73.1%) were females. There was a significant association between the development of DR and duration of DM (p=0.003), The FBS levels were also determined to be a significant risk factor for DR (p = 0.031), also LDL with (p=0.039). No other factors were found to have a significant association with DR. In this study more than half of diabetic patients had diabetic retinopathy. There was a significant association between the development of DR and duration of DM, FBS, LDL levels, there was no significant relation between diabetic retinopathy and hypertension, HgA1c Serum cholesterol or triglyceride levels or previous cataract surgery.

Ocular Complications Associated With Diabetes And The Risk Of Sustainable Blindness; A Real World Analysis.

To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision 28 threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications.

Progression of Diabetic Retinopathy during COVID-19 Pandemic: A Retrospective Study

Introduction: Emergence and subsequent exponential spread of Coronavirus Disease-2019 (COVID-19) infection during 2020 forced the Government to issue countrywide lockdown from March 2020. Diabetic Retinopathy (DR) is one of the debilitating diseases of the eye which requires regular follow-ups and timely intervention to prevent permanent vision loss. The impact of countrywide lockdown on prevalence and progression of DR needs to be evaluated. Aim: To assess the effect of COVID-19 pandemic situation on the prevalence and progression of DR and analyse the possible risk factors for progression of DR in the ongoing pandemic period by comparing retrospective data from immediate prepandemic quarter with post lockdown quarter. Materials and Methods: This retrospective study was conducted in the Department of Opthalmology at Regional Institute of Ophthalmology, Kolkata, West Bengal, India. The study was done during the prepandemic period, from November 2019 to February 2020. In the present study, a cohort of 83 diabetic patients with pre-existing DR was selected from past medical records and compared with post lockdown period during November 2020 to February 2021. Data regarding prevalence of various types of DR, mean Central Macular Thickness (CMT), mean Visual Acuity (VA), proportion of patients requiring &gt;3 doses of monthly anti-Vascular Endothelial Growth Factors (VEGF) and additional laser therapy or vitrectomy, VA improvement and reduction of mean CMT were gathered and compared between those two quarters. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The prevalence of moderate Non Proliferative Diabetic Retinopathy (NPDR) (13% vs 25%), severe NPDR (19% vs 8%), Proliferative DR (PDR) (18% vs 7%), Advanced Diabetic Eye Disease (ADED) (4.8% vs 1%) and Diabetic Macular Oedema (DME) (62% vs 28%) increased several folds during post lockdown quarter in comparison to prepandemic quarter. There was a statistically significant difference (p-value&lt;0.05) in baseline mean LogMar Best Corrected Visual Acuity (BCVA) (0.4±0.08 vs 0.9±0.07), mean CMT (386.4±26.8 to 421.8±21.6) positive correlations of some of the possible risk factors for poor visual outcome among the same cohort of patients in the post lockdown period: poor socioeconomic status (35%; Odds Ratio (OR):3.59, Relative Risk (RR):2.68), irregular diabetic medication (52%; OR:3.56, RR:2.23), residence more than 100 km from the hospital (38%; OR:3.03, RR:2.26). Conclusion: The present study, concludes that, the status of DR stage among study subjects in the post lockdown period has deteriorated when compared with the prepandemic period.

Postoperative Bleed after PARS Plana Vitrectomy with Pre-Operative Intra Vitreal Bevacizumab in Diabetic Patients with Advance Diabetic Eye Disease

Objectives: The aim of this study is to investigate the effect of preoperative intravitreal Bevacizumab on postoperative incidence of vitreous cavity hemorrhage in patients with advance diabetic eye disease undergoing 23 gauge pars plana vitrectomy. Study Duration: This study was conducted in the department of Ophthalmology Services Hospital Lahore from April 2021 to September 2021. Study Design: Randomized Controlled Trail Patients &amp; Methods: Forty eyes of forty diabetic patients with advance diabetic eye disease were selected for three port 23 gauge pars plana vitrectomy (PPV) and were split into two groups of twenty patients each. One week before the pars plana vitrectomy, Group A received preoperative intravitreal bevacizumab (1.25 mg/0.05 ml) and sham injection were given to Group B patients and postoperative vitreous cavity bleeding was noted on day one , day three , day seven and bleeding was graded from no bleeding to mild and severe based on clinical examination. Practical implication: To assess the decrease in potential risk of postoperative vitreous cavity bleeding following 23 gauge three port pars plana vitrectomy Results: The patients in this study had an average age of 58.46 ±3.62 yrs and mean duration of diabetes among these patients selected for this trial was 11.25±1.52 years (range 8-22 years). Out of 20 eyes in Group A , 15 (75.0%) had no bleeding, 4 (20.0%) had mild and 1(5.0%) had severe postoperative vitreous cavity bleed. In group B , out of 20 eyes 11(55.0%) had no bleeding , 7(35%) had mild to moderate bleeding and 2(10.0%) had severe vitreous cavity hemorrhage. Conclusion: Preoperative Intravitreal bevacizumab prior to pars plana vitrectomy was found effective in reducing the risk of postoperative vitreous cavity bleeding in patients with advance diabetic eye disease. Keywords: Intravitreal Bevacizumab, advanced diabetic eye disease, vitreous hemorrhage, Postoperative bleed, Vitrectomy

A retrospective study of the prevalence and management of complications of proliferative diabetic retinopathy and its visual outcome in patients in a tertiary care hospital

To provide the prevalence of complications of proliferative diabetic retinopathy (PDR) in patients visiting the retina clinic in Dr. B. R. Ambedkar Medical College and Hospital and to evaluate their visual acuity (VA) status. A retrospective study in which the chart review was done of the patients diagnosed with PDR, attending the retina clinic in Dr. B.R. Ambedkar Medical College and Hospital. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to at least 5 years were included. Evaluating the prevalence of the complications of PDR, presenting VA of people with PDR, short-term outcomes at 6 months and 5 years are the main outcomes of the study. The most common complication of PDR was diabetic macular edema (DME). Eyes receiving treatment early in the disease course (i.e. baseline VA 6/18 or better) had significantly better VA outcomes at 5 years versus eyes treated at a later stage (i.e. baseline VA &amp;#60;6/18 - ≥3/60). The treatment of patients with VA &amp;#60;3/60 can also lead to significant improvement in visual outcome. Our results suggest that early diagnosis and treatment of patients with PDR is of utmost importance in preventing severe vision loss due to advanced diabetic eye disease. People with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Prevalence of Advanced Diabetic Eye Disease among diabetic patients in a tertiary care hospital in South India

Introduction:To analyze the Prevalence of advanced diabetic eye disease(ADED) among diabetic patients&#x0D; Methods:This was a prospective cross-sectional study in a tertiary care hospital. A total of 1650 patients with a history of type 2 diabetes who visited ophthalmology department were enrolled in study. History regarding socioeconomic status, literacy level, duration of diabetes, comorbidities, medications, HbA1c levels were analyzed. Visual acuity,Slit-lamp, fundus examination were done.Medical/surgical intervention was done to restore vision.&#x0D; Results: A total of 1650 patients with a history of type 2 diabetes were analyzed. Among them 327 patients had fundus changes of diabetic retinopathy, hence the prevalence of DR among diabetics was 19.81%. Out of 327 patients, 53 patients had advanced diabetic eye disease and the prevalence of ADED among Diabetics was 3.20%. The mean age of the patients was 50.91+/- 9.06years.There were 42 (79.24%)males and 11 (20.7%)females.24 (45.28%)patients had vision of 6/6 - 6/60, 28 (52.83%|) patients had vision 5/60-CFCF.15(28.30%) patients had PDR with vitreous hemorrhage.12 patients (22.64%) had PDR with subhyaloid hemorrhage,11 patients (20.75%) had PDR with FVP sparing macula,13 patients(24.52%) had PDR with FVP involving the macula,2 patients(3.77 %) had PDR with Neovascular glaucoma.34 patients (64.15%) underwent PRP,19 patients (35.84 %) needed surgical intervention.&#x0D; Conclusion: This study shows that the prevalence of diabetic retinopathy among diabetic patients was 19.81%. The prevalence of Advanced Diabetic Eye Disease among diabetic patients was 3.2%. Hence Effective implementation of primary, secondary and tertiary prevention strategies has the potential to significantly reduce blindness due to DR.

Witnessing the spectacle/eye goggles in the eye

Witnessing the spectacle/eye goggles in the eye

Etiology of permanent visual impairment among persons attending a disability board in Central Kerala

Introduction: Permanent visual handicap is one of the most troublesome disabilities to affect an individual, a family, and a society. Objectives: To determine the important etiological factors leading to permanent visual impairment (VI) in Kerala and their frequency trends over the recent years. Materials and Methods: Retrospective study of case records of the medical board of a government medical college hospital in Kerala from 2017 to 2020. Inclusion Criteria: Data of all individuals with permanent VI of categories 1 to 4. Exclusion Criteria: Category zero of permanent disability. The guidelines included under the Rights of Persons with Disabilities Act, 2016 were followed for assessing the extent of visual disability. The age, gender, place, diagnosis in the right eye, diagnosis in the left eye, and percentage of disability were entered in an Excel spreadsheet and analyzed by SPSS software (version 20.0). Results: Data of 545 persons were analyzed. The mean age ± SD was 36.21 ± 17.70 years. Most of the study population were males (n = 348, 63.85%). The most frequent etiological factors noted are congenital malformations of the eye (20.18%), high myopia (14.13%), corneal blindness (13.58%), trauma (11.56%), optic atrophy (10.46%), retinitis pigmentosa (7.34%), and advanced diabetic eye disease (3.85%). 50% of factors were preventable and nearly 50% were causing progressive worsening of disability. Conclusion: There is a slowly increasing proportion of congenital malformations, congenital cataracts, and glaucoma. Corneal blindness showed a decreasing trend.

Treatment approaches in patients with advanced diabetic eye disease

Treatment approaches in patients with advanced diabetic eye disease

PREVALENCE OF ADVANCED DIABETIC EYE DISEASE AND ITS ASSOCIATED RISK FACTORS IN TYPE 2 DIABETES MELLITUS

Purpose:To determine the prevalence of advanced diabetic eye disease (ADED ) in patients with type 2 diabetes mellitus (DM) attending a tertiary eye care centre in eastern India and the risk factors associated with the disease. Methods: All patients of type 2 DM attending at the out-patient-department of a tertiary eye care centre, with any stage of diabetic retinopathy (DR) were recruited for this study. Examination was carried out with the help of slit-lamp biomicroscope with +90D lens, direct and indirect ophthalmoscopy, Snellen's chart, refraction trial lens and B-scan Ultrasonography. Medical records were reviewed and data were extracted. Results: Out of 200 patients with DR, 22 patients presented with advanced diabetic eye disease (ADED). Thus, the prevalence of ADED in this study was 11%. Those with increased age of presentation, long duration of DM, deranged HbA1c and lipid prole are at signicantly higher risk of presenting with ADED. Conclusion: Prevalence of 11 % of ADED in patients with DM attending a tertiary eye care centre shows that this condition continues to be a major social problem despite current knowledge about advanced DR.

Pre-Emptive Topical Ketorolac Tromethamine 0.5% for Panretinal Photocoagulation.

Purpose: To evaluate the efficacy of topical ketorolac tromethamine 0.5% given pre-emptively a day before, for alleviating pain in patients undergoing panretinal photocoagulation (PRP) treatment. Methods: A controlled single-blinded study was conducted on 33 patients with diabetic retinopathy (DR; severe nonproliferative DR, proliferative DR, or advanced diabetic eye disease) who required PRP treatment in both eyes simultaneously. Each eye of the patients was randomly assigned for ketorolac tromethamine 0.5% eyedrop or placebo. Both eyedrop bottles were randomly labeled. Eyedrops were self-administered by the patients, 4 times a day before the procedure (at 6 am, 12 noon, 6 pm, and 12 midnight) and every 15 min for 1 h (4 times) before the laser. Each patient was subjected to PRP using a Visulas 532s Zeiss device set to spot size 200 μm, time 0.10 s, and ∼600 burns in each eye. The pain score was evaluated immediately after treatment in each eye independently with Scott's visual analog scale (VAS) and the McGill Pain Questionnaire (MPQ). Results: VAS pain score in ketorolac-treated eyes (median 3.0, interquatile range [IQR] ±2.5) was lower than in placebo-treated eyes (median 5.0, IQR ±3.0). Total Pain Rate Index score from MPQ was lower in ketorolac-treated eyes (median 3.0, IQR ±3.0) than in placebo-treated eyes (median 3.0, IQR ±2.5). Both pain score differences are statistically significant with P ˂ 0.05. Conclusion: Topical ketorolac tromethamine 0.5% given pre-emptively a day before is effective in alleviating pain in patients undergoing PRP treatment.

Clinical Study of Risk Factors for Diabetic Maculopathy

Aim: To determine the association between various systemic risk factors with diabetic maculopathy. Methodology: A prospective observational study was conducted on 50 patients having diabetic maculopathy. Patients with maculopathies secondary to Vitreous Haemorrhage, Ocular disorders like Glaucoma, Uveitis, Advanced Diabetic Eye Disease, Vitreo-macular traction, maculopathy along with proliferative diabetic retinopathy, ischemic maculopathy, and history of laser treatment in last six months were excluded from the study. Data was collected using a structured proforma that included name, age, sex, occupation, height, weight, history of other systemic diseases like hypertension, investigations and treatment taken in past, family history, duration of DM, smoking, hyperlipidemia, hyperglycemia and nephropathy. Results: Out of 50 patients, 38 (76%) were males and 12 (24%) were females suggestive of male predominance. Mean age of the patient was 57.36±11.65 years in males and 56.67±10.17 years in females. Among 50 patients, 19 patients had diabetes mellitus for 6-10 years duration, 14 patients had diabetes mellitus for 1-5 years, in 12 patients for 11-15 years, in 2 patients for 16-20 years, in 2 patients for 21-25 years and only 1 patient more than 25 years. Mean duration of DM was 12.2±6.1 years. Majority of patients having maculopathy had duration of DM up to 20 years. Among 50 patients, 27 patients (54%) had systemic hypertension, 37 patients (74%) had uncontrolled blood sugar level, 29 patients (58%) were found to have hyperlipidemia and 20 patients (40%) had nephropathy. Among 50 patients, pseudophakia was noted in 7 patients (14%), obesity was noted in 21patients (42%). Eleven patients (22%) were found to have anemia, 6 patients (12%) had family history of DM and 13 patients (26%) had history of smoking. Conclusion: Hyperglycemia, hypertension, duration of DM, hyperlipidemia are the major risk factors for the development and progression of diabetic maculopathy. While anemia, smoking, and obesity, family history of DM are the less significant risk factors.

Trimanual vitrectomy for severe proliferative diabetic retinopathy.

To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases. We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6months after the surgery. Forty eyes of 36 patients with the mean age of 51.42years (range 28-69) were evaluated. The anatomical success at 6months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p < 0.001). More eyes in the trimanual PPV group (55.0%) could achieve better vision (> 6/60) 6months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant. Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.

Rarest rare emerging again: A case report of mauriac syndrome

This is a case report of a young male with poorly controlled type 1 diabetes mellitus who presented with the clinical features of diabetic ketoacidosis. On examination, he had severe growth retardation, elevated liver enzymes, advanced diabetic eye disease, and other diabetes-related microvascular complications. Along with the other clinical features, the patient was diagnosed as a case of Mauriac syndrome. Mauriac syndrome, initially described by Mauriac in 1930, is one of the causes of growth retardation and elevated liver enzymes in poorly controlled diabetic patients. Patients with poorly controlled type 1 diabetes must be closely observed for sexual maturation and growth. An early intervention with optimal therapy to bring glycemic control combined with a close follow-up would help avoid such late complications.

Small-gauge vitrectomy for advanced diabetic eye disease: outcomes and predictive factors for poor postoperative vision

Objective: To evaluate the anatomical and visual outcomes of small-gauge vitrectomy in patients with advance diabetic eye diseases (ADED) and the predictive factors for poor visual outcome.&#x0D; Materials and methods: A retrospective study was conducted from 2009 to 2014. Data at baseline, 6 months, and 12 months post-surgery were collected along with baseline demographic data, indications of surgery, systemic associations, visual and anatomical outcome, and postoperative complications. Poor visual outcomewas defined as visual acuity worse than 6/36.&#x0D; Results: A total of 158 eyes from 133 patients were recruited. Mean age was 54.01 ± 11.57 years and mean follow-up was 9.9 ± 3.7 months. Indications for vitrectomy were vitreous haemorrhage (VH, 77 eyes [48.7%]), tractional retinal detachment (TRD) with macular involvement (75 eyes [47.5%]), and other causes in 6 eyes (3.8%). There was visual improvement in 59.3% of patients, 23.6% worsened, and 17.1% stabilized at 12 months post-surgery. Patients with VH (75.4%) showed significant improvement compared to patients with TRD (48.3%). Successful anatomical outcomes were achieved in VH (98.2%) and TRD (96.7%). However, patients with TRD were found to have a 2.4-fold higher risk of having poor visual outcomes.&#x0D; Conclusion: Small-gauge vitrectomy for ADED resulted in excellent visual and anatomical outcomes. Eyes with TRD were at a higher risk of developing poor visual outcomes.

Frequency of Post-Operative Hypotony in 23 Gauge and 25 Gauge Pars Plana Vitrectomy in Advanced Diabetic Eye Disease

Purpose: To compare the frequency of post-operative hypotony between 23G PPV and 25G PPV in advanced diabetic eye disease.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Study was conducted at department of Ophthalmology, Lahore General Hospital, Lahore from 7th April 2016 to 6th October 2016.&#x0D; Methods: Total 100 cases of advanced diabetic eye disease with age ranging from 25 – 65 years and either gender were selected. Patients with nystagmus and claustrophobia, lamellar macular holes, epiretinal membrane and neovascular glaucoma were excluded. Patients were divided by lottery method into 2 groups. Data of the patient i.e. name, age, sex, patient’s registration number and address was recorded. Every patient had detailed preoperative work-up; including best corrected visual acuity by Snellen’s chart, intraocular pressure by applanation tonometer, indirect ophthalmoscopy and B-scan for retinal status. Group A underwent 23G PPV and group B underwent 25G PPV. Patients were followed after 24 hours of surgery to measure intraocular pressure to access hypotony.&#x0D; Results: Mean age of patients in group A was 50.16 ± 10.40 years and in group B was 50.26 ± 9.91 years. Out of 100 patients 57 (57.0%) were females and 43 (43.0%) were males, with female to male ratio of 1.1:1. Post-operative hypotony was seen in 24 (48.0%) patients with 23G PPV and 02 (4.0%) patients with 25G PPV (p-value = 0.0001).&#x0D; Conclusion: This study concluded that the frequency of post-operative hypotony in 23G Pars Plana Vitrectomy was higher as compared to 25G Pars Plana Vitrectomy in advanced diabetic eye disease.&#x0D; Key Words: Diabetic retinopathy, Pars Plana Vitrectomy, Hypotony.

Clinical Outcome of Pars Plana Vitrectomy With Or Without Intravitreal Bevacizumab As A Pretreatment in Advanced Diabetic Eye Disease

Purpose: To find out the clinical outcome of Pars Plana Vitrectomy with and without Intravitreal Bevacizumab as a pretreatment in advanced diabetic eye disease.&#x0D; Place and Duration of Study: Ophthalmology department of holy family hospital Rawalpindi, from January 2018 to December 2018.&#x0D; Methods: Sixty patients with advanced proliferative diabeticretinopathy wereincluded. Patients were divided into two groups. In group A, patients had pars plana vitrectomy with pre procedure injection of intravitreal Bevacizumab and group B had vitrectomy without pre procedure intravitreal Bevacizumab. Amount of bleeding during vitrectomy, surgical time and rate of iatrogenic tears were noted in both groups. Outcome measures were post operative best corrected visual acuity at 6 months and post operative recurrent vitreous hemorrhage.&#x0D; Results: Patients had a mean age of 63.83 ± 7.314. In group A, mild bleeding was seen in 33%, moderate in 6.7% and severe in 0%. In group B, mild bleeding was seen in 13.3%, moderate in 46.7%, and severe bleeding in 40%. After 6 months, 27 (90%) patients in group A showed improvement in best corrected visual acuity while it was seen in 12 (40%) patients in group B. Iatrogenic tearswere seen in 10% in group A and 36% in group B. Mean time of surgery in group A was 59.27 ± 6.823 minutes and in group B was 77.87 ± 9.637 minutes. Rate of recurrent vitreous hemorrhage after vitrectomy was 6.7% in group A and 40% in group B.&#x0D; Conclusion: Intravitreal injection of Bevacizumab is helpful in reducing surgical time and also decreases intraoperative and post operative bleeding.&#x0D; Key Words: Bevacizumab, Vitrectomy, Proliferative Diabetic Retinopathy.

Early Detection of Diabetic Retinopathy through Machine Learning Techniques

Diabetic Retinopathy (DR) is progressive syndrome that leads to loss of vision if not detected and treated. Retina is inner tunic of the eyeball which is capillary and delicate transparent membrane. It is high developed tissue of eye which plays a major role for vision. Retina is the source for detection of many disorders. Part of retina with optic disc can be viewed through optamoloscope and termed as fundus image which is a basis of diagnosis for DR. DR can be categorized as Proliferative Diabetic Retinopathy (PDR), Diabetic Maculopathy, Nonproliferative Diabetic Retinopathy (NPDR) and Advanced Diabetic Eye Disease. Machine Learning (ML) techniques play a vital role in early detection of DR. In this paper a review on the existing techniques with open issues to be addressed is presented for diagnosing DR and model is proposed to consider the features namely Microaneurysms, Retinal Hemorrhages, Hard exudates, Cotton wool Spots, Neovascularization for classification of DR. These features can be combined with hypertension to predict other disorders like stroke, chronic heart disease, renal dysfunction, cardiovascular mortality and so on which overcome the need of other preliminary checkup .The complete profile of disorders for a diabetic patient can be deduced by the retinal fundus image.

Advanced Diabetic Eye Disease in Pregnancy

Women with pre-gestational diabetes are at risk of progression of diabetic retinopathy during the pregnancy. The adverse effects of pregnancy on retinal status persist into the first year postpartum. Diabetic eye disease may develop for the first time during pregnancy, and visual impairment at this stage has serious implications for both the patient and her family. Established sight-threatening retinopathy should be treated at an earlier stage in pregnant women compared to non-pregnant diabetics with a similar disease. This case report highlights a case of diabetic retinopathy in pregnancy which progressed rapidly and was successfully treated with timely surgical intervention resulting in good final visual outcome. J Clin Gynecol Obstet. 2018;7(3-4):72-75 doi: https://doi.org/10.14740/jcgo487w