Complications Of Diabetic Retinopathy Research Articles

Identification of key biomarkers for early warning of diabetic retinopathy using BP neural network algorithm and hierarchical clustering analysis

Diabetic retinopathy is one of the most common microangiopathy in diabetes, essentially caused by abnormal blood glucose metabolism resulting from insufficient insulin secretion or reduced insulin activity. Epidemiological survey results show that about one third of diabetes patients have signs of diabetic retinopathy, and another third may suffer from serious retinopathy that threatens vision. However, the pathogenesis of diabetic retinopathy is still unclear, and there is no systematic method to detect the onset of the disease and effectively predict its occurrence. In this study, we used medical detection data from diabetic retinopathy patients to determine key biomarkers that induce disease onset through back propagation neural network algorithm and hierarchical clustering analysis, ultimately obtaining early warning signals of the disease. The key markers that induce diabetic retinopathy have been detected, which can also be used to explore the induction mechanism of disease occurrence and deliver strong warning signal before disease occurrence. We found that multiple clinical indicators that form key markers, such as glycated hemoglobin, serum uric acid, alanine aminotransferase are closely related to the occurrence of the disease. They respectively induced disease from the aspects of the individual lipid metabolism, cell oxidation reduction, bone metabolism and bone resorption and cell function of blood coagulation. The key markers that induce diabetic retinopathy complications do not act independently, but form a complete module to coordinate and work together before the onset of the disease, and transmit a strong warning signal. The key markers detected by this algorithm are more sensitive and effective in the early warning of disease. Hence, a new method related to key markers is proposed for the study of diabetic microvascular lesions. In clinical prediction and diagnosis, doctors can use key markers to give early warning of individual diseases and make early intervention.

Advancements in the Treatment of Diabetic Macular Edema: Current Strategies and Future Directions

This narrative review examines current and emerging treatment strategies for diabetic macular edema (DME), a complication of diabetic retinopathy characterised by fluid accumulation in the macula, which can lead to vision impairment. The incidence of DME is particularly high in patients with long-standing diabetes and advanced retinopathy. The current treatment options for DME include anti-vascular endothelial growth factor (anti-VEGF) agents, corticosteroids, and laser therapies. Anti-VEGF agents, including bevacizumab, ranibizumab, aflibercept, and the more recently developed brolucizumab and faricimab, have been demonstrated to reduce macular thickness and improve visual acuity. Brolucizumab offers the advantage of fewer injections due to its longer duration of action, although it carries a higher risk of ocular inflammation compared to other anti-VEGF agents. The dual inhibition of the VEGF and angiopoietin-2 (Ang-2) pathways by faricimab may enhance vascular stability and reduce inflammation, potentially improving patient outcomes. Steroid therapies, including dexamethasone, fluocinolone acetonide, and triamcinolone acetonide, represent an alternative for patients who do not respond adequately to anti-VEGF treatment. Laser therapies, including focal, navigated, and subthreshold laser treatments, remain a crucial component in the management of DME, with the ability to seal leaking vessels and reduce fluid accumulation. In order to achieve the best outcomes for patients, it is essential to continue to advance these treatment modalities and adopt a personalised, multifaceted approach.

Burden of Disease Study of Patients with Diabetic Macular Oedema in Spain.

Diabetic macular oedema (DMO) is a complication of diabetic retinopathy that can result in vision loss. The disease can impact different spheres of a patient's life, including physical and psychological health, work, and activities of daily living, entailing an important use of healthcare and non-healthcare resources. This study aimed to estimate the socio-economic burden of DMO in Spain. The burden of DMO was estimated from a societal perspective, per patient, year of treatment since diagnosis, and type of treatment. Four categories were considered: direct healthcare costs (DHC), direct non-healthcare costs (DNHC), labour productivity losses (LPL), and intangible costs (IC) associated with loss of quality of life. Average annual costs were calculated by multiplying the resources used per patient by their corresponding unit price (or financial proxy). For a more accurate estimation, differences in resource use between treatments (intravitreal anti-vascular endothelial growth factor injections of ranibizumab or aflibercept, and intravitreal dexamethasone implants) and year since diagnosis (first, second, and third year or beyond) were considered and presented separately. The reference year for costs was 2021. The average annual costs of DMO in the first year of treatment after diagnosis was estimated at €18,774, €17,512, and €16,188 per patient treated with ranibizumab, aflibercept, and dexamethasone, respectively. This burden would be reduced to €15,783, €15,701, and €12,233 in the second year, and to €15,119, €15,043, and €12,790 in the third year, respectively. Diagnosis of DMO entails an additional one-off cost of €485. DHC accounted for the greatest proportion of total annual costs per patient, independent of the year, with LPL also making an important contribution to total costs. The socio-economic impact of DMO on patients, the healthcare system, and society at large is substantial. The constant increase in its prevalence accentuates the need for planning and implementation of healthcare strategies to prevent vision loss and reduce the socio-economic burden of the disease.

Prevalence and associated factors of proliferative diabetic retinopathy among adult diabetic patients in Northwest Ethiopia, 2023: A cross-sectional multicenter study.

Proliferative diabetic retinopathy is one of the advanced complications of diabetic retinopathy. If left untreated, almost all eyes could lose a significant portion of their vision within four months. There is limited evidence regarding the magnitude of proliferative diabetic retinopathy and associated factors in the study setting and also in Ethiopia. To determine the magnitude and associated factors of proliferative diabetic retinopathy among adult diabetic patients attending Specialized Comprehensive Hospital-Diabetic Care Clinics in Northwest Ethiopia, 2023. A multicenter, hospital-based, cross-sectional study was conducted on 1219 adult diabetic patients selected by systematic random sampling technique. Data were collected through an in-person interview and physical examination. The Statistical Package for Social Science Version 20 was used to analyze the data. Logistic regression methods were used to test the association between predisposing factors and proliferative diabetic retinopathy. The adjusted odds ratio with a 95% confidence interval was used to determine the strength of association. The prevalence of proliferative diabetic retinopathy was 3.1% (95% CI: 2.10%-4.10%). Hypertension (AOR = 4.35 (95% CI: 1.87-10.12)), peripheral neuropathy (AOR = 3.87 (95% CI: 1.57-9.54)), nephropathy (AOR = 2.58 (95% CI: 1.13-5.87)), ≥10 years duration of diabetes mellitus (AOR = 5.30 (95% CI: 2.32-12.14)), insulin use (AOR = 3.07 (95% CI: 1.08-8.68)), and poor adherence to diabetes mellitus medications (AOR = 3.77 (95% CI: 1.64-8.64)) were confirmed to have statistically significant association with proliferative diabetic retinopathy. The prevalence of proliferative diabetic retinopathy among adult diabetic patients in the diabetes clinic was higher than the global study. Hypertension, peripheral neuropathy, nephropathy, ≥10 year's duration of diabetic mellitus, insulin use and poor adherence to diabetes mellitus medications were among the factors significantly associated with proliferative diabetic retinopathy.

Comparative Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists, Sodium-Glucose Cotransporter 2 Inhibitors, Dipeptidyl Peptidase-4 Inhibitors, and Sulfonylureas for Sight-Threatening Diabetic Retinopathy

To investigate whether the choice of glucose-lowering agent for type 2 diabetes (T2D) impacts a patient's risk of developing sight-threatening diabetic retinopathy complications. Retrospective observational database study emulating an idealized target trial. Adult (≥21 years) enrollees in United States commercial, Medicare Advantage, and Medicare fee-for-service plans from January 1, 2014, to December 31, 2021, with T2D and moderate cardiovascular disease (CVD) risk who had no baseline history of advanced diabetic retinal complications, initiating treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sulfonylureas. We used inverse propensity scoring weights in time-to-event Cox proportional hazards models. Treatment for either diabetic macular edema or proliferative diabetic retinopathy. The final study population included 371 698 patients, of whom 42 265 initiated GLP-1 RA, 53 476 initiated SGLT2i, 78 444 initiated DPP-4i, and 197 513 initiated sulfonylurea agents. The probability of treatment for sight-threatening retinopathy within 2 and 5 years was 0.3% and 0.7% for patients initiating SGLT2i (median follow-up 830 [interquartile range (IQR), 343-1401] days), 0.4% and 1.0% for GLP-1 RA (669 [IQR, 256-1167] days), 0.4% and 0.9% for DPP-4i (1263 [IQR, 688-1938] days), and 0.5% and 1.2% for sulfonylurea (1223 [IQR, 662-1879] days). Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of treatment for sight-threatening retinopathy compared with all other medication classes, including GLP-1 RA (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.97), DPP-4i (HR, 0.79; 95% CI, 0.64-0.97), and sulfonylurea (HR, 0.61; 95% CI, 0.50-0.74). Glucagon-like peptide-1 receptor agonists use was associated with a similar risk of sight-threatening retinopathy as DPP-4i (HR, 1.07; 95% CI, 0.85-1.35) and sulfonylurea (HR, 0.83; 95% CI, 0.67-1.03). Sodium-glucose cotransporter 2 inhibitors use was associated with a lower risk of sight-threatening diabetic retinopathy among adults with T2D and moderate CVD risk compared with other glucose-lowering therapies. Glucagon-like peptide-1 receptor agonists does not confer increased retinal risk, relative to DPP-4i and sulfonylurea medications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Short Term Effect of Pre-Operative Anti-VEGF on Angiogenic and Fibrotic Profile of Fibrovascular Membranes of Proliferative Diabetic Retinopathy.

Adjuvant, pre-operative intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections have been used to reduce peri-operative bleeding in eyes undergoing pars-plana vitrectomy for complications of proliferative diabetic retinopathy (PDR). To address the concern over their potential off-target effects of progressive fibrous contraction, we sought to dissect the transcriptional changes in the surgically extracted fibrovascular membranes (FVMs). We analyzed surgically extracted FVMs from 10 eyes: 4 eyes pretreated with intravitreal bevacizumab (IVB) and 6 untreated eyes. FVMs were digested into single cells, mRNA was extracted from endothelial cell-enriched (microbead selection with CD31) and non-endothelial cell compartments, followed by RT-qPCR quantification. We then compared the relative expression of genes involved in angiogenesis, endothelial cell integrity, and myofibroblastic processes between treated and untreated FVMs. Endothelial cells from IVB pretreated FVMs showed significant reduction of VEGFA, VEGF receptors (FLT1 and KDR), and angiopoietin 2 expression as well as increased vascular endothelial cadherin and endothelin, suggesting reduced angiogenesis and enhanced vascular integrity. The non-endothelial cell fraction showed decreased expression of VEGFA and fibronectin, without significant difference in the expression of other profibrotic factors. Our findings confirm that adjuvant pre-operative IVB decreased fibronectin and increase endothelin-1 expression without affecting other profibrotic gene expression, uncovering an important interaction between IVB and endothelin-1 that deserves further study.

Интраоперационная периферическая эндолазеркоагуляция сетчатки в профилактике неоваскулярной глаукомы

Neovascular glaucoma (NVG) is a severe long-term complication of proliferative diabetic retinopathy (PDR), including that developing in patients after vitreoretinal surgical treatment. Methods of influence aimed at breaking the cascade of biochemical processes leading to neovascularization, thereby preventing the development of NVG, are pathogenetically justified. The use of retinal laser photocoagulation (RLP) of ischemic zones and intravitreal angiogenesis inhibitors (AI) are effective. The problem of choosing a method and developing a strategy for preventing NVG is relevant. Purpose. To comparatively evaluate the effectiveness of peripheral intraoperative endolaser RLP in the prevention of NVG. Material and methods. The study included 182 patients (182 eyes) who received vitreoretinal surgical treatment for PDR complications. At baseline, all patients did not have NVG or other forms of glaucoma. Patients were divided into comparable groups depending on the type of intraoperative intervention. All patients underwent standard three-port 25 Ga vitrectomy with membrane peeling. Patients in 2nd group underwent panretinal endolaser RLP in the area from the arcades to retianl equator. Patients in 3rd group underwent peripheral endolaser RLP in the area from the retinal equator to ora serrata in combination with intravitreal injection of AI. In 1st group, endolaser RLP and AI were not used. Results. At a follow-up period of 1 month after treatment, no statistically significant differences in the incidence of rubeosis iridis were observed, and there were no cases of NVG development. At a follow-up period of 12 months after treatment in 3rd group, the development of rubeosis iridis was noted in one case and the absence of cases of NVG. In 2nd group, rubeosis iridis was detected in five patients, and NVG was detected in four patients. In 1st group, rubeosis iridis was detected in seven patients, and NVG was detected in ten patients, which is statistically significantly higher than in the other groups of the study. Conclusion. It has been established that the use of peripheral endolaser RLP in combination with intravitreal injection of AI is the most effective method for the prevention of postoperative neovascular complications in the anterior segment of the eye. Further study of the method on a representative sample of patients and in a longer postoperative period is promising. Keywords: vitreoretinal surgery, proliferative diabetic retinopathy, retinal laser photocoagulation, neovascular glaucoma, neoangiogenesis

Novel Antidiabetic Drugs and the Risk of Diabetic Retinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: The aim of this study is to compare the effect of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and dipeptidyl peptidase-4 inhibitors (DPP-4i) on the risk of diabetic retinopathy (DR) in patients with type 2 diabetes (DM2). Methods: We systematically searched the databases Pubmed, Embase, and Clinicaltrials up to October 2, 2023, for randomized clinical trials (RCTs) of drugs from the GLP-1RA, SGLT-2i, and DPP-4i groups, with at least 24 weeks duration, including adult patients with DM2 and reported ocular complications. A pairwise meta-analysis was performed to calculate the odds ratio (OR) of DR incidents. Results: Our study included 61 RCTs with a total of 188,463 patients and 2773 DR events. Pairwise meta-analysis showed that included drug groups did not differ in the risk of DR events: GLP1-RA vs. placebo (OR 1.08; CI 95% 0.94, 1.23), DPP-4i vs. placebo (OR 1.10; CI 95% 0.84, 1.42), SGLT2i vs. placebo (OR 1.02; CI 95% 0.76, 1.37). Empagliflozin may be associated with a lower risk of DR, but this sub-analysis included only three RCTs (OR 0.38; 95% CI 0.17, 0.88, p = 0.02). Conclusions: Based on currently available knowledge, it is challenging to conclude that the new antidiabetic drugs significantly differ in their effect on DR complications.

Clinical Profile and Ocular Morbidities in Patients with Both Diabetic Retinopathy and Uveitis

PurposeTo describe the clinical profile and complications of diabetic retinopathy (DR) and uveitis in patients with co-existing conditions and to derive associations based on site of primary inflammation, stage of DR and complications of each. DesignSingle-center, cross-sectional observational study. Participants66 patients with co-existing diabetic retinopathy and uveitis. MethodsElectronic medical records of 66 such cases were evaluated. The demographic data, diabetic status, clinical characteristics and complications of DR and uveitis on the final follow-up were recorded. Main Outcome MeasuresAssociations between best corrected visual acuity, prevalence of various stages and complications of DR among eyes with and without uveitis. Also, correlation between the intensity and primary sites of inflammation among eyes with proliferative and non-proliferative changes. ResultsOf the 132 eyes, all had DR and 97 eyes had uveitis (35 unilateral and 31 bilateral cases). Mean age of patients was 53.4±8.7 years, duration of diabetes was 10.5±6.9 years and duration of uveitis was 61.3±68.8 months. 54.6% uveitis patients had anterior uveitis, 20.6% had intermediate, 10.3% posterior and 14.4% pan-uveitis. 49.5% eyes had proliferative diabetic retinopathy (PDR) changes. There was a higher proportion PDR cases among anterior (56.6%), posterior (70%), and pan uveitis (64.3%), with difference in anterior uveitis cases approaching statistical significance (p=0.067). Conversely, significant (p<0.001) intermediate uveitis cases had non-proliferative changes (80%). Final BCVA was significantly poorer in the group with uveitis (p=0.045). The proportion of fibrovascular proliferations, tractional detachments and iris neovascularisation among proliferative retinopathy eyes with uveitis (14.6%, 18.8% and 12.5% respectively) was higher than those without uveitis (5.3%, 10.5% and 5.3%). Among uveitis cases, 58.5% eyes developed cataracts, 44.3% had posterior synechiae, 12.3% developed secondary glaucoma, 4.1% had epiretinal membrane, 4.1% had band-shaped keratopathy and 1.0% developed macular neovascularisation. ConclusionsEyes with co-existing DR and uveitis have a higher prevalence of neovascular and uveitis complications along with a risk of poorer visual outcomes. Treatment should aim at limiting the duration and intensity of inflammation. Strict glycaemic control is essential for inflammation control and preventing the progression of DR to more advanced stages.

Controllable editing via diffusion inversion on ultra-widefield fluorescein angiography for the comprehensive analysis of diabetic retinopathy.

By incorporating multiple indicators that facilitate clinical decision making and effective management of diabetic retinopathy (DR), a comprehensive understanding of the progression of the disease can be achieved. However, the diversity of DR complications poses challenges to the automatic analysis of various information within images. This study aims to establish a deep learning system designed to examine various metrics linked to DR in ultra-widefield fluorescein angiography (UWFA) images. We have developed a unified model based on image generation that transforms input images into corresponding disease-free versions. By incorporating an image-level supervised training process, the model significantly reduces the need for extensive manual involvement in clinical applications. Furthermore, compared to other comparative methods, the quality of our generated images is significantly superior.

Clinical Features for Detecting Diabetic Macular Edema using Artificial Intelligence

Background:Vision is a valuable part of life: influencing our perception of the world and of memories. Diabetes, and more specifically, Diabetic Retinopathy (DR) can affect our vision, taking away sight potentially permanently if left untreated. Currently, Diabetic Retinopathy is the leading cause for adult blindness and will continue to rise with increasing prevalence of adult diabetes. Diabetic Macular Edema (DME), a complication of DR, is diagnosed by ophthalmologists using optical coherence tomography (OCT); however, the sheer amount of DME-related imaging creates a time strain on ophthalmologists, creating a demand to further optimize the image reading process. In this study, we hypothesize that increasing the rate and ease of diagnosing DME by introducing artificial intelligence-based methods in primary medical clinics will increase the long-term preservation of ocular health in diabetic patients.&#x0D; Methods:Due to the nature of our retrospective cohort study, consent was not acquired and images were also de-identified. We categorized 676 patient files by HbA1c, non-proliferative diabetic retinopathy (NPDR) severity, and proliferative diabetic retinopathy (PDR). Retinal OCT images were annotated to identify central macular edema, a common feature of DME. Retinal fundus images were also annotated to identify microaneurysms and hemorrhages, two additional features commonly used for detecting either DR or DME.&#x0D; Results:A lesion features dataset was prepared to train our AI model. OCT and fundus imaging features were extracted and combined to train the AI model for DME detection. From annotations of the in-house Macular thickness dataset, it was seen that 167 patients had DME from the total 389 diabetic retinopathy patients.&#x0D; Conclusion:We will continue to prepare more datasets like the macular thickness dataset for our AI. We predict that after our AI receives substantial training with the datasets, the AI will potentially demonstrate some capability of diagnosing DME, supporting its use in medical diagnostics.

Ephrin B1 Regulates Inflammatory Pathways in Retinal Müller Cells.

The role of inflammation has been accepted as a factor in the complications of diabetic retinopathy. Discovery of the upstream regulation of these inflammatory factors has remained a challenge. In this study, we explored the actions of ephrin B1 in retinal Müller cells and their actions on inflammatory proteins. We used diabetic human and mouse samples, as well as Müller cells in culture to measure ephrin B1 in Müller cells. We then generated Müller cell specific ephrin B1 knockout mice. We measure levels of key inflammatory proteins, including high mobility group box 1 (HMGB1) and NOD-like receptor protein 3 (NLRP3) pathway proteins in retinal lysates from the ephrin B1 floxed and ephrin B1 Müller cell specific knockout mice. Data show that ephrin B1 is significantly increased in the retina of diabetic humans and mice, as well as in Müller cells grown in high glucose. Elimination of ephrin B1 in mouse Müller cells led to a significant decline in all inflammatory proteins studied. In conclusion, a reduction in ephrin B1 in the diabetic retina may offer a new therapeutic modality for diabetic retinopathy.

Ocular microvascular complications in diabetic retinopathy: insights from machine learning

IntroductionDiabetic retinopathy (DR) is a leading cause of preventable blindness among working-age adults, primarily driven by ocular microvascular complications from chronic hyperglycemia. Comprehending the complex relationship between microvascular changes in...

Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy.

To investigate the clinical benefits of the co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy. Patients who underwent vitrectomy for proliferative dia-betic retinopathy complications were preoperatively given in-travitreal injection with either bevacizumab and tissue plasminogen activator (Group 1) or bevacizumab alone (Group 2). Primary outcomes were surgery time and number of intraoperative iatrogenic retinal breaks. Secondary outcomes included changes in the best-corrected visual acuity and postoperative complications at 3 months postoperatively. The mean surgery time in Group 1 (52.95 ± 5.90 min) was significantly shorter than that in Group 2 (79.61 ± 12.63 min) (p<0.001). The mean number of iatrogenic retinal breaks was 0.50 ± 0.59 (0-2) in Group 1 and 2.00 ± 0.83 (0-3) in Group 2 (p<0.001). The best-corrected visual acuity significantly improved in both groups (p<0.001). One eye in each group developed retinal detachment. Preoperative co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy shortens the surgery time and reduces the number of intraoperative iatrogenic retinal breaks.

Outcomes of bimanual vitreoretinal surgery in the treatment of diabetic retinopathy complications

This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.

Патогенез, ангиогенез диабетического макулярного отека и общая характеристика его лечения (Обзор литературы. Часть I)

Currently, the increase in the prevalence of diabetes mellitus is in the nature of a pandemic. Diabetic macular edema is a vision-threatening complication of diabetic retinopathy, the pathogenesis of which is multifactorial and includes hyperglycemia, endothelial dysfunction, leukostasis and inflammation, vasoconstriction and occlusion, oxidative stress and ischemia, neovascularization, which leads to the accumulation of exudative fluid, thickening of the central zone of the retina and irreversible processes of photoreceptors neurodegeneration with a significant decrease in visual functions. The article presents up-to-date information on the epidemiology, patho- and angiogenesis of this condition as well as the general characteristics of the DMO therapy. It consists of primary treatment of diabetes, laser photocoagulation and anti-angiogenic therapy. Intravitreal drug therapy based on VEGF inhibitors is currently the standard first-line treatment for DMO. The authors emphasize the necessity for further study of trigger points in the pathogenesis of diabetic retinopathy and the development of diabetic macular edema in order to find new drugs and work out a more individualized approach to patients. Key words:: diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor, VEGF-therapy

Impact of Dyslipidemia Medications on the Prevalence of Diabetic Retinopathy Among a Large US Cohort

Background and Objective: Dyslipidemia medications such as statins and fibrates may be associated with a reduction in diabetic retinopathy (DR) progression, but real-world data is lacking. This study evaluates cholesterol-lowering medications and their association with the prevalence of DR and advanced DR complications. Patients and Methods: Data was collected using codes from the International Classification of Diseases on TriNetX, a cross-sectional database of over 79 million Americans, between June and August 2022. Prevalence and prevalence odds ratios (POR) were calculated. Results: Patients taking pitavastatin (OR 0.64, 95% CI 0.49, 0.84), fenofibrate (OR 0.83, CI 0.79, 0.87), or evolocumab (OR 0.80, CI 0.68, 0.95) had lower POR of proliferative DR compared to nonproliferative DR. Patients taking any cholesterol medication had a lower POR of vitreous hemorrhage. Patients taking fibrates also had lower POR of neovascular glaucoma. Conclusion: This exploratory study highlights positive associations between DR and dyslipidemia and medications that may have fewer worsening events in DR patients. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:626–633.]

Risk factors related to diabetic retinopathy in Vietnamese patients with type 2 diabetes mellitus

Along with the rising incidence of diabetes, the prevalence of diabetic retinopathy (DR) is quickly growing across the world. The incidence of DR complications is high, and many people are not detected until they have complications and visual impairment, causing many difficulties for the treatment process. Aims: The goal of this cross-sectional was to investigate the clinical and subclinical features of Vietnamese diabetic retinopathy patients. Methods: DR was diagnosed using International Clinical Diabetic Retinopathy scale. Complete clinical information (Age, sex, weight, height, history of hypertension and diabetes mellitus, smoking, alcohol), subclinical information (Glucose, urea, creatinine, HbA1c, uric acid, cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol blood levels, Complete blood count) were collected. Results: The research enrolled 140 type 2 diabetic patients (70 in each group: DR and no DR). DR patients had significantly higher age, RBC, Hb, eGFR, uric acid, and creatinine blood levels than patients without DR. A duration of diabetes mellitus of over 15 years was associated with an 8.319-fold increased risk of DR. In conclusion, age, RBC, Hb, eGFR, uric acid, creatinine blood levels and duration of diabetes mellitus over 15 years are risk factors for DR.

Faktor-faktor yang Mempengaruhi Kesadaran Penderita Diabetes Mellitus terhadap Komplikasi Retinopati Diabetik

This research aims to analyze the factors that influence DM sufferers' awareness of Diabetic Retinopathy complications. The research method used is an integrative review through 5 stages, namely problem identification, literature search, data evaluation, data analysis and presentation of findings. The research results show that lack of information about RD, lack of knowledge in carrying out eye examinations, lack of health insurance, are among the causes of the low level of awareness of DM sufferers regarding RD complications. Meanwhile, DM sufferers' awareness of RD complications is influenced by the fear of blindness as a complication of untreated RD. In conclusion, the government and health service providers need to adapt interventions and specifically increase the knowledge of DM sufferers about DM disease itself and its complications, especially RD, so that it is handled well so that permanent blindness can be prevented.&#x0D; &#x0D; Keywords: Diabetes Mellitus, Awareness, Diabetic Retinopathy

Current Approaches and Developments in the Surgical Treatment of Proliferative Diabetic Retinopathy Complications

According to World Health Organization data, diabetes mellitus (DM) affects 425 million people in the world today, most of them from low- and middle-income countries and social segments. About a third of diabetic patients have diabetic retinopathy of any stage (DR), and 7% have proliferative diabetic retinopathy (PDR). Even in the ETDRS study, which included cases with timely laser photocoagulation, the 5-year cumulative incidence of vitrectomy was found to be 5.3%. The incidence of PDR and associated blindness has decreased owing to the improvements in diabetes monitoring and treatment. Also, the application of anti-vascular endothelial growth factors (anti-VEGF) and refinement of surgical techniques have greatly improved the management of diabetic eye complications.