Advanced Proliferative Diabetic Retinopathy Research Articles

Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in diabetic and non-diabetic retinopathy: associated factors and anatomical correlation

BackgroundThis study aims to investigate the factors affecting the vitreous levels of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VGEF) among patients with pars plana vitrectomy (PPV). Also, this study correlates the levels of PEDF with RRD characteristics.MethodsAll patients who were scheduled for PPV for any indication were included in the study. They were divided into a case group which included patients with advanced PDR and a control group which included the remaining diagnoses. During the PPV, an undiluted vitreous sample was taken and the enzyme-linked immunosorbent assay method was utilized to measure the levels of VEGF and PEDF.ResultsEighty eyes were involved. Patients diagnosed with advanced PDR and endophthalmitis exhibited higher levels of VEGF. PEDF was affected inversely by the age of the patients and PEDF levels were higher in RRD and endophthalmitis cases. In patients with RRD, the level of PEDF was higher if the tear was found inferiorly, if the macula was detached, and with a longer duration of RRD.ConclusionsThis study highlights the clinical importance of those biomarkers. Anti-VEGF-based treatment is the mainstay against PDR. PEDF may show a promising predictive values regarding patients with RRD.

Classification Features of Severe Stages of Proliferative Diabetic Retinopathy (Clinical Cases)

Purpose: analysis of clinical cases illustrating the classification features of severe stages of proliferative diabetic retinopathy (PDR).Patient and methods. Three clinical cases of PDR are presented, in which ophthalmoscopic signs (according to the classification of the Early Treatment Diabetic Retinopathy Study, 1991) corresponded to severe PDR (high risk 1, high risk 2) and advanced PDR. The ophthalmological status was assessed using standard methods based on measuring the best corrected distance visual acuity, performing ultrasound (Opticon 2000, Italy), photographic recording of the condition of the fundus (Carl Zeiss Visucam 500, Germany) and optical coherence tomography of the macular region (on an RTVue-100 tomograph, OptoVue, USA).Results and conclusion. The presented clinical examples will provide the ophthalmologist with a more complete understanding of the clinical picture of pathological changes in the retina in diabetes mellitus, which will ultimately increase the level of diagnosis and tactics of surgical intervention both during the initial (preoperative) examination and after vitrectomy.

New Approaches to Surgical Treatment of Patients with Advanced Stage of Proliferative Diabetic Retinopathy

Purpose. Development and evaluation of the clinical effectiveness and safety of a vitrectomy (VE) technique for patients with advanced stage proliferative diabetic retinopathy (ASPDR).Materials and methods. We observed 132 patients (mean age 62.8 ± 2.4 years) with the following criteria for inclusion in the study, corresponding to the classification criteria of ASPDR: it is impossible to estimate the area of neovascularization; the fundus of the eye is partially ophthalmoscoped or not ophthalmoscoped in the posterior pole; preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs; retinoschisis in the macular zone. All patients were divided into the following two groups, equal in age, gender and visual status of the “healthy” eye: the main group (MG, 69 patients, 69 eyes), who underwent VE was performed according to the developed method and a control group (CG, 63 patients, 63 eyes), in which VE was performed according to the traditional method.Results. The incidence of intraoperative complications in patients in the MG (5.8 %) was 8.1 % (p < 0.05) lower than in the CG (13.9 %). The incidence of postoperative complications in patients from the MG (5.5 ± 0.5 %) was 4.2 % (p < 0.01) lower than in the CG (9.7 ± 1.0 %). The increase in best-corrected visual acuity after surgery in patients from the MG was significantly (by 0.13 rel. units, p < 0.001) higher than in the CG. The value of the average decrease in the developed qualitative criteria for the condition of the fundus in patients in the MG (1.6 ± 0.1) was 23.1 % (p < 0.05), higher than in the CG (1.3 ± 0.1).Conclusion. Surgical treatment of patients with ASPDR using the developed technique provides (compared to the traditional approach) a higher level of safety and clinical effectiveness. The main advantage of the developed technique is an integrated approach to surgical intervention, including the improvement of ophthalmological “techniques” (use of one-stage combined surgery, endolaser coagulation technology, etc.) and drug support (administration of ranibizumab at a dose of 0.05 mg 3–5 days before surgery) and the choice of intravenous sedation as the optimal anesthetic aid.

Отдаленные результаты этапного хирургического лечения осложненной начальной катаракты у пациентов с далекозашедшей диабетической ретинопатией

Purpose. To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). Material and methods. 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the group I patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step — PE+IOL implantation + silicone oil removal. In the group II PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the group III patients were subjected to a two-step surgical procedure: VRS with gas tamponade performed as the first step in their treatment; followed by the second step, PE and the IOL implantation. In the group IV PE performed simultaneously with VRS with gas tamponade. Results. Patients in subgroup I and group III had better functional results than those in subgroup II and group IV, respectively (p < 0,001). The subgroup IIa (n = 9; 14.5 %) showed higher incidence of NVG than the subgroup Ia (n = 2; 3.2 %), p = 0.027. There also was a higher rate of NVG in group IV (n = 6; 19,3 %) compared to group III (n = 1; 3,1 %), p = 0,04. Conclusion. Phacoemulsification of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications. Keywords: proliferative diabetic retinopathy; vitreoretinal surgery; phacoemulsification

Clinical Outcome in Lens Drop evacuation after a High-Risk Characteristics Proliferative Diabetic Retinopathy Post Pars Plana Vitrectomy Case

Introduction : Vitrectomy surgery affects zonular strength, which increases the risk of lens drop and can be sight- threatening if not managed correctly. Pars plana vitrectomy (PPV) and evacuation of dislocated lens fragments have to be done very carefully.
 Case Illustration : A 42-year-old female with blurred vision in the right eye for two months and a history of right-eye surgery three months ago due to proliferative diabetic retinopathy (PDR) was tamponed with SF6 gas. On examination was found visual acuity (VA) was 6/120, with cloudy lens and attached retina. The patient was diagnosed with a right-eye complicated cataract with advanced PDR post-PPV and planned to undergo phacoemulsification. While waiting for the surgery, the lens dropped into the posterior chamber, then planned to do the evacuation immediately. Dropped lens evacuation, PPV, retro-pupil IOL implantation, and silicone oil (SO) tamponing were done. Two months after the SO evacuation, the best corrected VA improved to 6/15.
 Discussion : Cataract progression after vitrectomy is common. In a vitrectomized eye, there is a lack of vitreous tamponade and a less stable lens. Peripheral zonules are attached to the pars plana, which can be disrupted during the vitrectomy surgery. Improvements in visual acuity and lower rates of complications were found if the lens fragment was evacuated soon.
 Conclusion : Cataract surgery is better done soon after PPV to prevent dropped lenses into the posterior chamber, whether the zonulisis sign is seen or not. The interval between the dropped lens incident and evacuation was associated with better final visual outcomes.

Cataract Progression dan Lens Drop after Pars Plana Vitrectomy and Gas Tamponade : A Case Report

Introduction : Vitreous Hemorrhage (VH) in proliferative diabetic retinopathy (PDR) is common cause of acute vision loss.If the retina cannot be visualized and the etiology of the VH is unknown, pars plana vitrectomy (PPV) is indicated. 1Intraocular gases like SF6 or C3F8 are one of the most useful adjuncts in vitreoretinal surgery. Exposure to intraocular gases additionally increases retrolental oxygen levels, resulting in development of lens opacities.
 Case Illustration : Patient female 52 y.o, came with sudden blurry vision in the left eye since two weeks ago. History of Diabetes Mellitus 10 years with insulin treatment. From the examination left eye visual acuity 1/60, zonulysis, VH, and negative fundus reflect. On ultrasonography found vitreous opacity. The patient was diagnosed with left eye VH ec advanced PDR and scheduled PPV with C3F8 gas tamponade. Patient difficult to maintain prone position after surgery. 2 month after the surgery the patient scheduled with phacoemulsification surgery because progressive lens opacity. While prepare to the second operation, the lens found drop to the vitreous. The second surgery done with lens evacuation and Intraocular lens implantation. Last follow up, best correction visual acuity was 6/18.
 Discussion : PPV and Gas tamponade are presdisposing lens opacity progression. Lens opacity after gas tamponade include longer intraocular longevity gas and patients who fail to maintain a prone position. Risk factors for zonulysis in this patient increase the occurrence of lens drop after PPV with gas tamponade.
 Conclusion : Regular slit-lamp examination needs to be performed for early detection of cataract after PPV with gas tamponade.

Identification of Genetic Variants for Diabetic Retinopathy Risk Applying Exome Sequencing in Extreme Phenotypes.

Diabetic retinopathy (DR) risk has been shown to vary depending on ethnic backgrounds, and thus, it is worthy that underrepresented populations are analyzed for the potential identification of DR-associated genetic variants. We conducted a case-control study for the identification of DR-risk variants in Mexican population. We ascertained 60 type 2 diabetes mellitus (T2DM) patients. Cases (n = 30) were patients with advanced proliferative DR (PDR) with less than 15 years after a T2DM diagnosis while controls (n = 30) were patients with no DR 15 years after the diagnosis of T2DM. Exome sequencing was performed in all patients, and the frequency of rare variants was compared. In addition, the frequency of variants occurring in a set of 169 DR-associated genes were compared. Statistically significant differences were identified for rare missense and splice variants and for rare splice variants occurring more than once in either group. A strong statistical difference was observed when the number of rare missense variants with an aggregated prediction of pathogenicity and occurring more than once in either group was compared (p = 0.0035). Moreover, 8 variants identified more than once in either group, occurring in previously identified DR-associated genes were recognized. The p.Pro234Ser KIR2DS4 variant showed a strong protective effect (OR = 0.04 [0.001-0.36]; p = 0.04). Our study showed an enrichment of rare splice acceptor/donor variants in patients with PDR and identified a potential protective variant in KIR2DS4. Although statistical significance was not reached, our results support the replication of 8 previously identified DR-associated genes.

Vitreoretinal surgery in difficult cases

In the everyday practice, we are dealing with various level of difficulty, while performing vitreoretinal cases. There are some cases which require high level of skills and experience in order to perform successful and effective surgery. Refractory or myopic macular holes, optic disk pit cases, PVR cases, advanced proliferative diabetic retinopathy cases, trauma cases and paediatric vitreoretinal cases are some examples. The purpose of the SIS is a group of very experienced vitreoretinal surgeons with high volume of cases, to provide tips and pearls in to how to perform safer surgery, with the best results, anatomically and functionally. We will also provide advise into how to use chandelier additional lighting and how to use and remove heavy silicone oil and buckles.

Алгоритм лечения далеко зашедшей пролиферативной диабетической ретинопатии

Purpose. To develop an algorithm for the treatment of patients with advanced proliferative diabetic retinopathy with the determination of the stages of laser and surgical methods and evaluate its effectiveness. Material and methods. The study group included 38 patients (38 eyes) with type 1 diabetes mellitus (21 patients) and type 2 diabetes mellitus (17 patients, 16 of them with the insulin-requiring form of the disease). Patients age ranged from 24 to 75 years (41±8.6 years) old. All patients underwent staged treatment. Primary subtotal three-port 27 G vitrectomy was performed. Transpupillary patterned panretinal laser coagulation was performed at 1,5–2 months after the first stage of treatment. Panretinal laser coagulation was performed with a hexagonal matrix pattern with a laser spot diameter of 300 µm, exposure time of 30 ms on an Integre Pro Scan laser device (Ellex, Australia) with a wavelength of 561 nm using a panfundus lens. In cases of gas-air tamponade, panretinal laser coagulation was performed according to the same parameters in two sessions with an interval of 1–2 months between them, the average number of coagulates per session was 1053±107 applications. As the third stage of treatment, 1,5–2 months after panretinal laser coagulation, those patients whose vitreal cavity was tamponed with silicone oil underwent vitrectomy with the removal of silicone oil and it's replacement with a balanced solution. Results. The total number of treatment steps in the observation group (n=34) ranged from 1 to 5 and averaged 3±0.97. The time from primary vitrectomy followed by patterned panretinal laser coagulation to silicone oil removal was at average 3.7±0.48 months. Performing primary subtotal vitrectomy as the first stage of combined treatment made it possible achieve retinal attachment and its visualization throughout, to perform surgical intervention without massive endolaser coagulation, which reduced the duration of surgery and accelerated postoperative rehabilitation. The subsequent transpupillary panretinal laser coagulation of the retina in the pattern mode provided a dosed precision effect on the retina and made it possible perform the laser stage of treatment in one session. Conclusion. A step-by-step algorithm, including primary subtotal vitrectomy followed by simultaneous transpupillary pattern laser coagulation of the retina, is effective and safe in the treatment of proliferative diabetic retinopathy complicated by hemophthalmos. Key words: proliferative diabetic retinopathy, treatment algorithm, surgical treatment, laser treatment, vitrectomy, pattern laser coagulation

Silicone Oil Utilized in Pars Plana Vitrectomy for Patients with Advanced Proliferative Diabetic Retinopathy: Physico-Chemical and Optical Properties

Silicone Oil Utilized in Pars Plana Vitrectomy for Patients with Advanced Proliferative Diabetic Retinopathy: Physico-Chemical and Optical Properties

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

The Prevalence of Diabetic Retinopathy and Associated Risk Factors among Diabetic Patients in a Tertiary Care Hospital

Background: One of the most serious complications of diabetes that places an enormous strain on the patient, the healthcare system, and the world economy is diabetic retinopathy (DR). It includes long-term exposure to the metabolic changes linked to diabetes, which cause damage to the retina's microvasculature. Objectives: The aim of the study was to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in a tertiary care hospital. Methods: This cross-section observational study was carried out in the Department of Ophthalmology, North Bengal medical College. Convenience sampling technique was followed. Face to face interview was done to collect data with a semi-structured questionnaire. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). The duration of the period from July 2018 to July 2022. A total of 120 patients were participate in the study. Results: About 58.33% respondents were male and 41.67% were female. Majority (33.33%) of the respondents were within the age group of 50-59. 33.33% were service holder, 41.67% were businessman, 12.5 were day labor, 6.67% were farmer. 75% were from urban area and 25% from rural area. The prevalence of DR in this study was 41.1%. About 90% had DM of &lt;5 years, 55% had 6-10 years, 40% had 15-20 Years, 30% had 16-20 years and only 7% had &gt;21 years. About 50% had normal grade of diabetic retinopathy in the worse eye, 15% had Mild NPDR, 8.33% had Moderate NPDR, 6.67% had Mild to moderate NPDR with non-CSME, 2.5% Moderate NPDR with CSME, Severe NPDR with non-CSME Severe NPDR with CSME and Advanced PDR respectively. Mean FBS (mg/dl) was 160.86±70.6, Total cholesterol (mg/dl) was 183.2 ± 2.1, Triglycerides (mg/dl) was 161.2 ± 2.6, Systolic BP was 130.56±15.7 and Diastolic BP was 80.86±13.4. Patients with baseline age of &lt;60 years were three times (AOR = 3.2:95% CI: 1.19–8.63) more likely to develop DR. The odds of DR is about 3 times (AOR = 2.91:95% CI: 1.01–8.35) higher for patients with disease duration of ≥6 years as compared to disease duration of &lt;6 years. Systolic blood pressure also had statistically significant association with patients having blood pressure of &lt;140 mmHg being about 3.6 times (AOR = 0.28:95% CI: 0.09–0.82) less likely to have DR as compared to hypertensive patients with systolic blood pressure of ≥140 mmHg. The other cofactors, history of hypertension, and total cholesterol level were not independent significant factors for the development of DR in our study. Conclusion: Systolic hypertension, being on insulin alone or in combination with OHA, and having diabetes for a longer period of time were all independently linked to the occurrence of DR. The significant DR prevalence our study suggests that routine patient care, including treatment facilities, has to be improved. Healthcare practitioners must make a consistent effort to educate diabetic patients about the importance of blood sugar control and hypertension management in lowering the risk of the start and progression of DR. It is advised that diabetic patients get health education regarding the importance of routine eye exams for the early detection and treatment of diabetes-related eye problems.

A Feasibility Study of Diabetic Retinopathy Detection in Type II Diabetic Patients Based on Explainable Artificial Intelligence.

Diabetic retinopathy (DR) is vision impairment and a life-threatening condition for diabetic patients. Especially type II diabetic people have higher chances of getting retinal problems. Hence, early prediction of DR is necessary for preventing the diabetic patients from vision impairment. The main aim of this feasibility study is to identify the most critical risk features that could lead to diabetic retinopathy. This study investigated type II diabetic patients' socio-analytical, diabetes, behavioral, and clinical risk factors. We conducted a self-individual questionnaire session for all participants. Our questionnaire asked about the reliability of results, feeling comfortable during the screening test, willingness to participate in future screenings, overall perspective, and satisfaction with the DR screening test. We proposed a random forest model for predicting the prevalence of DR risk among diabetics. Further explanations of the model were conducted using more robust SHAP eXplainable Artificial Intelligence (XAI) tools. The SHAP method makes it possible to understand how input variables interact with their representative output records, as well as how input variables are ranked. In addition, various descriptive and inferential statistical analyses were performed on the data and evaluated the significant relationship between the factors discussed above via hypothesis testing. This feasibility study involved 172 type II diabetic patients (73 males and 99 females). Therefore, we found that 81 (47.09%) out of 172 participants had referable DR. The average age of the patients was determined as 55.08, with a standard deviation of ± 9.770 (ranging from 40 to 79). Type II patients were affected by mild, moderate, severe, and advanced proliferative diabetic retinopathy (PDR) stages with 23.83%, 13.95%, 5.81%, and 3.48%, respectively, of the total samples. The developed RF model obtained high accuracy of 94.9% using clinical dataset. Our results showed that the formation of tiny microminiature lesions was noticeable in type II diabetic patients with aged people, abnormal blood glucose levels, and prolonged diabetes duration.

Reasons for the Late Presentation of Diabetic Retinopathy in Saudi Arabia: A Survey of Patients Who Presented with Advanced Proliferative Diabetic Retinopathy to a Tertiary Eye Hospital.

This study aimed to understand the barriers that contribute to diagnostic and therapeutic delays in patients with advanced proliferative diabetic retinopathy (PDR). This cross-sectional study targeted patients with advanced PDR who never received any ocular intervention at King Khaled Eye Specialist Hospital in Saudi Arabia. An Arabic-language questionnaire was used to interview the participants over a period of 6 months. The questionnaire comprised sociodemographic questions followed by several sections to assess the causes of delay in diagnosis and management. Variables were analyzed descriptively and reported as numbers and percentages using SPSS 22. A total of 338 patients were included in the study. Most patients were older than 50 years (60.4%), and decreased vision was the main complaint at presentation (81%). Vitreous hemorrhage was the most common diagnosis (46%). Patients' lack of knowledge about the importance of DR screening programs and problems with healthcare system screenings were the most frequent causes of delay in diabetic retinopathy (DR) diagnosis and management. DR is still a major cause of permanent blindness that is treatable with regular follow-up and timely management. Even though DR screening and treatment in Saudi Arabia have improved drastically over the last years, socioeconomic and health system factors remain barriers to the improvement of outcomes of DR.

Non-dipping heart rate &amp; major adverse cardiovascular events in type 2 diabetes mellitus

Abstract Background Type 2 diabetes mellitus (T2DM) is a known major risk factor for cardiovascular disease. Whilst the influence of traditional risk factors such as hypertension, hyperlipidaemia and smoking are well-established determinants of major adverse cardiovascular events (MACE) in subjects with T2DM, the impact of insulin resistance, non-dipping blood pressure and heart rate status have not been adequately investigated. Purpose To determine predictors of MACE in a population of T2DM with underlying target-organ damage at baseline. Methods This study included 196 subjects with T2DM with advanced proliferative diabetic retinopathy. These subjects were recruited in 2008–2009 and were consequently followed up till February 2022 to determine independent predictors of MACE. At baseline, the median age of the participants was 64 years (IQR: 59–71 years) and the median diabetes duration was 18 years (IQR: 10–25 years). At baseline, all underwent 24-hour blood pressure and heart rate (HR) monitoring, and were assessed for markers of inflammation, insulin resistance, albuminuria, presence of peripheral neuropathy and peripheral vascular disease. Subjects whose night-time HR did not decrease by more than 10% as compared to daytime readings were classified as non-dippers. Similarly, a non-dipping BP profile was defined as a nocturnal decline of mean arterial pressure of less than 10%. At follow-up, the all-cause death rate was noted as well as MACE. The latter was defined as all-cause death, non-fatal MI, non-fatal stroke, coronary revascularisation or hospitalisation for unstable angina pectoris or heart failure. Univariate followed by multivariate Cox-regression analysis was performed to determine independent predictors of both all-cause mortality and MACE. Results At follow-up, 46% of the study participants had died whilst 63.1% had exhibited MACE. Multivariate analysis revealed age (OR: 1.05, 95% CI 1.02–1.07, p&amp;lt;0.001), ESR (OR: 1.012, 95% CI: 1.001–1.02, p=0.035), GGT (OR: 1.005, 95% CI 1.001–1.009, p=0.025) and eGFR (OR: 0.99, 95% CI 0.98–0.99, p=0.016) at baseline to be independent determinants of all-cause death. With regards MACE, likewise, age (OR: 1.028, 95% CI 1.007–1.05, p=0.009), GGT (OR: 1.004, 95% CI 1.001–1.008, p=0.017) and eGFR (OR: 0.99, 95% CI 0.98–0.99, p=0.022) were shown to be independent determinants together with diabetes duration (OR: 1.034, 95% CI 1.014–1.055, p=0.001) and presence of non-dipping heart rate at baseline. The latter was shown to be the strongest predictor of MACE (OR: 1.55, 95% CI 1.06–2.26, p=0.024). Conclusion Whereas increasing age and impaired renal function are known risk factors for cardiovascular disease, this long-term follow-up study has highlighted the relevance of non-dipping heart rate in type 2 diabetes mellitus. Previous studies had shown an association between non-dipping heart rate and target-organ damage in diabetic subjects. The impact on MACE merits further investigation. Funding Acknowledgement Type of funding sources: None.

Knockdown of Krüppel-Like Factor 9 Inhibits Aberrant Retinal Angiogenesis and Mitigates Proliferative Diabetic Retinopathy.

Advanced proliferative diabetic retinopathy (PDR) characterized by aberrant retinal angiogenesis is a leading cause of retinal detachment and blindness. Krüppel-like factor 9 (KLF9), a member of the zinc-finger family of transcription factors, participates in the development of diabetic nephropathy and the promotion of angiogenesis of human umbilical vein endothelial cells. Therefore, we speculate that KLF9 may exert a crucial role in PDR. The current study revealed that KLF9 was highly expressed in the high glucose (HG)-treated human retinal microvascular endothelial cells (HRMECs) and the retinas of oxygen-induced retinopathy (OIR) rats. Knockdown of KLF9 inhibited the proliferation, migratory capability, invasiveness and tube formation of HG-treated HRMECs. Besides, knockdown of KLF9 decreased the expression of yes-associated protein 1 (YAP1) in HG-treated HRMECs. Dual-luciferase reporter assays confirmed that KLF9 transcriptionally upregulated YAP1 expression. Overexpression of YAP1 reversed the KLF9 silencing-induced repression of HRMEC proliferation and tube formation. Further in vivo evidence demonstrated that knockdown of KLF9 reduced the expression of Ki67, CD31 and vascular endothelial growth factor A (VEGFA) in the retinas of OIR rats. Collectively, KLF9 silencing might mitigate the progression of PDR by inhibiting angiogenesis via blocking YAP1 transcription.

Trends in diabetic eye disorders and associated comorbidities in Taiwan: a 10-year nationwide population-based cohort study

Background/aimsIn-depth analysis is needed to investigate trends in diabetic retinopathy (DR), diabetic macular oedema (DME) and associated comorbidities in patients with type 2 diabetes mellitus (T2DM) so that we can...

Advanced Proliferative Diabetic Retinopathy

Advanced Proliferative Diabetic Retinopathy

Сравнительный анализ уровня провоспалительных цитокинов в слезной жидкости у пациентов с далекозашедшей стадией пролиферативной диабетической ретинопатии и осложненной начальной катарактой

Purpose. Undertake a comparative analysis of the level of pro-inflammatory cytokines (IL-8, MCP-1, ICAM-1) in tear of patients with advanced proliferative diabetic retinopathy and complicated primary cataract after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Material and methods. 34 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two-step surgical procedure: vitreoretinal surgery(VRS) with silicone oil tamponade performed as the first step in their treatment; followed by the second step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2 nd group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. On the 2 nd day after the first step surgery and before surgical treatment the tear samples of the patients of both groups have been examined. Results. At the early postoperative period after VRS, an increase in the inflammatory reaction was observed in patients of both groups by the 2 nd day, while the severity of the inflammatory reaction was significantly higher in the 2 nd group patients (p &lt; 0,001) relative to the 1 st group patients. A concentration of the following cytokines: IL-8, MCP-1, ICAM-1 in the 2 nd group was 2,5–5 times higher than in the 1 st group. In the 2 nd group patients, there was a statistically significant correlation between the development of NVH in the long-term postoperative period and the level of IL-8, MCP-1, ICAM-1 in tear on the 2 nd day after the first step surgery (p = 0.015). Conclusion. The research revealed that the patients with advanced PDR are accurately determined by the increased concentration of IL-8, MCP-1, ICAM-1 in tear after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Keywords: cytokines, diabetic retinopathy, cataract, vitreoretinal surgery.

Mean platelet component in nonproliferative and proliferative diabetic retinopathy

Introduction: Diabetic retinopathy (DR) remains a visually debilitating disease and is commonly classified according to its severity as non-proliferative DR (NPDR) or proliferative DR (PDR). Those suffering from PDR tend to have worse vascular complications and prognosis. Platelets exposed by vasculopathy caused by DR maybe activated to try to maintain haemostasis. This activity can be illustrated by the mean platelet component (MPC). Therefore, by MPC monitoring we may be able to predict the progression from NPDR into PDR.Purpose: To investigate the difference of MPC in patients with NPDR and PDR.Study design: Cross-sectional.Materials and methods: This study involved 71 DR patients. Preliminary data regarding the patients’ demographic characteristics, diabetes history, related diseases, medication history, and general eye examination were recorded. Fundus photographs were taken after dilating eyedrops and DR was graded by an ophthalmologist. The patients were grouped into NPDR and PDR. Mean platelet component was analyzed using the automatic hematology analyzer ADVIA 120.Results: Mean platelet component (MPC) was 26.69 g/dl (± 1.79) and 25.52 g/dl (± 1.20) in the NPDR and PDR group, respectively (p = 0.002), but was not clinically significant. In depth analysis into the DR grades differed significantly between mild NPDR and high-risk PDR (p = 0.015), and moderate NPDR and high-risk PDR (p = 0.024). Using our definition of mild DR (mild and moderate NPDR) and severe DR (high-risk and advanced PDR), there was a significant difference with mean MPC of 27.01 g/dl (± 1.64) and 25.31 g/dl (± 1.22), respectively (p = 0.001). The proportion of activated platelets was also higher in severe DR. Negative correlations were found between MPC with duration of DM (r = -0.333; p = 0.004) and MPC with systolic blood pressure (r = -0.241; p = 0.043).Conclusion: There was a significant difference in MPC between NPDR and PDR, but the results should be interpreted carefully. Further analysis between the mild and severe form of DR strengthened this finding.