Diabetic Retinopathy Control Research Articles

12-HETE/GPR31 induces endothelial dysfunction in diabetic retinopathy.

12-hydroxyeicosatetraenoic acid (12-HETE), a major metabolite of arachidonic acid, is converted by 12/15-lipoxygenase and implicated in diabetic retinopathy (DR). Our previous study demonstrated a positive correlation between 12-HETE and the prevalence of DR. However, reasons for the increased production of 12-HETE are unclear, and the underlying mechanisms through which 12-HETE promotes DR are unknown. This study aimed to elucidate the correlation between 12-HETE and DR onset, investigate potential mechanisms through which 12-HETE promotes DR, and seek explanations for the increased production of 12-HETE in diabetes. We conducted a prospective cohort study, which revealed that higher serum 12-HETE levels could induce DR. Additionally, G protein-coupled receptor 31 (GPR31), a high-affinity receptor for 12-HETE, was expressed in human retinal microvascular endothelial cells (HRMECs). 12-HETE/GPR31-mediated HRMEC inflammation occurred via the p38 MAPK pathway. 12-HETE levels were significantly higher in the retina of mice with high-fat diet (HFD)- and streptozotocin (STZ)-induced diabetes than in those with only STZ-induced diabetes and healthy controls. They were positively correlated with the levels of inflammatory cytokines in the retina, indicating that HFD could induce increased 12-HETE synthesis in patients with diabetes in addition to hyperglycemia. Conclusively, 12-HETE is a potential risk factor for DR. The 12-HETE/GPR31 axis plays a crucial role in HRMEC dysfunction and could be a novel target for DR prevention and control. Nevertheless, further research is warranted to provide comprehensive insights into the complex underlying mechanisms of 12-HETE in DR.

Effects of retinopathy on visual function in type 2 diabetes mellitus

Objective: To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR. Methods: This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants' near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye's damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level. Results: A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores (β=0.136, P=0.003), near vision (β=0.163, P<0.001), visual adaptation (β=0.092, P=0.042), subjective vision (β=0.120, P=0.009) and stereo vision (β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion: Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

Effect of Subcutaneous Semaglutide on Diabetic Retinopathy among Adults with Type 2 Diabetes in Saudi Arabia. A Systematic Review

Diabetic Retinopathy (DR) is one of the leading causes of progressive and irreversible vision loss. The relationship between metabolic control and progression of DR is observed in previous landmark randomized clinical studies. Moreover, a potential association between DR progression and glucagon-like peptide1 receptor agonists (GLP1-RA) is reported in diabetes literature. Objectives: To explore the effect of semaglutide treatment on diabetic retinopathy progression in adults with type 2 diabetes (T2DM) among the Middle East and North Africa (MENA) area. Methods: This is a systematic review of randomized clinical trials, we searched electronic databases including Google Scholars, PubMed, Science Direct, Cochrane, ClinicalTrials.gov, and The Medical Subject Heading (MeSH) terms using the PRISMA flow chart based on our inclusion criteria and used PROSPERO for searching for registered systematic reviews in MENA area. Results: Among 12 studies 11,854 patients were included in the mean follow-up period which was 52.5 weeks on semaglutide therapy with non-significant association with a pooled effect size for retinopathy incidence of 1.12 (95% CI: 1.00, 1.12). Conclusion: The current literature revealed that semaglutide has an uncertain effect on diabetic retinopathy progression. A need for larger randomized clinical trials in MENA area to expose the definitive effect.

Ferric particle-assisted LDI-MS platform for metabolic fingerprinting of diabetic retinopathy.

To explore the metabolic fingerprints of diabetic retinopathy (DR) in individuals with type 2 diabetes using a newly-developed laser desorption/ionization mass spectrometry (LDI-MS) platform assisted by ferric particles. Metabolic fingerprinting was performed using aferric particle-assisted LDI-MS platform. A nested population-based case-control study was performed on 216 DR cases and 216 control individuals with type 2 diabetes. DR cases and control individuals with type 2 diabetes were comparable for a list of clinical factors. The newly-developed LDI-MS platform allowed us to draw theblueprint of plasma metabolic fingerprints from participants with and without DR. The neural network afforded diagnostic performance with an average area under curve value of 0.928 for discovery cohort and 0.905 forvalidation cohort (95 % confidence interval: 0.902-0.954 and 0.845-0.965, respectively). Tandem MS and Fourier transform ion cyclotron resonance MS with ultrahigh resolution identified seven specific metabolites that were significantly associated with DR in fully adjusted models. Ofthese metabolites, dihydrobiopterin, phosphoserine, N-arachidonoylglycine, and 3-methylhistamine levels in plasma were first reported to show the associations. This work advances the design of metabolic analysis for DR and holds the potential to promise as an efficient tool for clinical management of DR.

A study of knowledge attitude practices and identification of perceived barriers towards screening for diabetic retinopathy amongst diabetics in an industrial area in western Maharashtra

Introduction and aim. Diabetic retinopathy (DR) screening is first step in prevention of diabetic retinopathy related ocular morbidity. The aim of the study was to assess the gaps in the knowledge and awareness and evaluate its effects on the attitude and practice in known diabetic patients and to assess any anticipated barriers and its association with knowledge, attitude and practices. Material and methods. A closed-ended questionnaire was given to 112 diabetics who met the inclusion criteria and visited a tertiary eye hospital in western Maharashtra. The purpose of the questionnaire was to assess knowledge, attitude and practices and perceived barriers to the study of DR. The statistical analysis was done on SPSS software. Results. In our study, 73.4% did not know about DR, suggesting poor awareness about the disease, 59.5% did not feel the need for regular eye checkup. 67 (61.1%) had no knowledge about blood sugar control level and lipid control for effective control of DR, 89 (79.5%) of participants did not know about effective treatment options. Moreover, 74 (66.1%) participants were advised for DR screening by physician, while 60 (53.5%) were willing to get screened, negative attitude was not getting screened when vision is good seen in 87 (79.1%) participants. Furthermore, 84 (75%) patient think eye checkup are expensive, 66% people believe availability of doctor is an issue. 60 (54.5%) think that eye checkups are time consuming. Conclusion. Our study demonstrated, that Spearman’s correlation coefficient between knowledge and awareness and based on attitude and practice, is 0.54, and that this is statistically significant (p&lt;0.01). Our study has shown poor awareness and knowledge about the disease thus affecting attitude and practices, eye screening is considered expensive has been pointed out a major barrier in this study.

Impact of sarcosine on diabetic retinopathy: Findings based on weighted gene co-expression network analysis and machine learning techniques.

To quantify the association between serum sarcosine and diabetic retinopathy (DR) using weighted gene co-expression network analysis (WGCNA). We measured serum metabolites in 69 pairs of type 2 diabetes (T2D) patients with and without DR matched by age, gender, body mass index（BMI and HbA1c, using a propensity score matching-based approach. To identify modules and metabolites linked to DR, pathway analysis was performed using WGCNA, the Kyoto Encyclopedia of Genes and Genomes and Small-Molecule Pathway Database. The association of sarcosine with DR was estimated by restricted cubic spline and conditional logistic regression models. Its joint effects with covariates on DR were also extensively examined. With per interquartile range elevation of sarcosine, the adjusted odds ratio (AOR) of DR significantly decreased by 67% (AOR: 0.33, 95% confidence interval [CI]: 0.19-0.58). Similar results were also found in the tertile analysis. Compared with those in the first tertile of sarcosine, the AOR significantly decreased by 54% (AOR: 0.46, 95% CI: 0.18-1.17) and 78% (AOR: 0.22, 95% CI: 0.08-0.59) for subjects in the second and third tertiles, respectively. Compared with subjects with lower sarcosine and lower HDL-C levels, those with higher sarcosine and lower HDL-C levels had the lowest odds of DR (OR: 0.13, 95% CI: 0.04, 0.43). Serum sarcosine was inversely related to DR, especially in T2D patients with insufficient HDL-C. This study provides insights on a possible novel target for DR precision prevention and control, as well as a better understanding of the DR mechanism.

A PROFILE OF DIABETIC RETINOPATY PATIENTS RECEIVING GREEN LASER FROM 2015 TO 2019 IN D.I.KHAN DIVISION, PAKISTAN

ABSTRACT: Background: Diabetic retinopathy (DR) is one of the leading cause of blindness worldwide and laser therapy has a basic role in the control of diabetic retinopathy. Green laser therapies are performed both for proliferative diabetic retinopathy and diabetic macular edema. The aim of our study was to determine the frequencies of different stages of diabetic retinopathy in patients undergoing laser in our setup. Materials &amp; Methods: This descriptive study was conducted at the department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2019.The sample consisted of all the diabetic patients undergoing green laser procedures during this period at Eye Unit, DHQ Teaching Hospital D.I.Khan Pakistan. Results: Out of a total of 1,893 green laser procedures performed for diabetic patients from January 2015 to December 2019, 1,011 were male and 882 were female. 969 (51.1%) patients were having relatively early stages of DR, 676 (35.7) patients had advanced DR and 248 (13.1%) had diabetic macular edema (DME). Conclusion: Laser therapy is frequently needed for the control of diabetic eye disease so keeping in mind the disease burden the laser facilities should be expanded in our setup.

Corneal Endothelial Morphology and Central Corneal Thickness Changes in Type 2 Diabetes Mellitus using Specular Microscopy and Ultrasonic Pachymetry: A Cross-sectional Comparative Study

Introduction: Diabetes Mellitus (DM) is a metabolic condition characterised by chronic hyperglycaemia, causing raised blood glucose levels which result in microvascular and macrovascular disorders and may introduce ocular manifestations including changes in corneal Endothelial Cell Density (ECD), corneal thickness, and intraocular pressure. It is clinically important to analyse the corneal endothelial status in patients with type II DM as preoperative corneal endothelial cell dysfunction may cause more corneal endothelial cell damage postoperatively leading to corneal decompensation. With the advent of precise and better measurement tool Central Corneal Thickness (CCT) and corneal endothelial morphology measurement has become more accurate. Aim: To compare corneal endothelium cell density, polymorphism, polymegathism and CCT in type 2 DM with age-matched, non diabetic control subjects using CEM-530 Specular microscope and ultrasonic pachymeter Tomey SP-100. Materials and Methods: This cross-sectional, comparative study was conducted at Eye Department at ESI Post Graduate Institute of Medical Sciences and Research, Basaidarapur, Delhi, India, from October 2018 to November 2019. Patients with ages between 40 to 70 years of either gender who were diagnosed to have DM were recruited in the study through non probability convenience sampling. A total of 150 subjects that met the inclusion criteria and exclusion criteria were included in the study. Seventy five known type 2 DM patients were enrolled in diabetic group (case group) and 75 non diabetic, age-matched subjects were enrolled as control group. Cases were classified under three major groups, namely on the basis of duration of DM and severity of Diabetic Retinopathy (DR) and glycaemic control {glycosylated haemoglobin (HbA1c) level}. All the findings were endorsed on a predesigned performa. Statistical Package for Social Sciences (SPSS) version 17.0 was used for analysis of data. Age and corneal parameters compared using unpaired t-test in diabetic and control group. Also, for comparison in between subgroup of diabetic patients on HbA1c level done by using Analysis of Variance (ANOVA) test. Chi-square test applied for categorical variables. Results: Among the 150 patients evaluated, type 2 DM patient’s corneas (540.51±32.578 µ) were thicker as compared to control group 517.51±22.155 µ (p-value&lt;0.001). The mean ECD of control and diabetic group patients was 2723.75±287.253 cells/mm2 and 2716.11±296.081 cells/mm2 , respectively, found insignificant (p-value=0.821). The mean Coefficient of Variation (CV) of cell area of control and diabetic patients was 28.87±3.950 and 29.85±4.027, respectively, and was significant (p-value=0.034). The mean percentage of endothelial Hexagonal cells (HEX%) of control and diabetic patients were 67.39±6.419 and 67.41±5.493, respectively and was non significant (p-value=0.985). Thus, statistically significant difference was found with CCT (p-value&lt;0.001) and CV (p-value=0.034) but not with ECD and hexagonality, between control and diabetic eyes. There was a correlation between CCT, CV, HEX% and ECD with duration of DM2 but it was statistically insignificant. There were higher CCT, CV and HEX% and lower ECD in &gt;10 years of duration of diabetes mellitus than in patients with duration of diabetes mellitus ≤10 years. There was a correlation of CCT, CV, ECD and HEX with HbA1c level. There were significant higher CCT and CV values in &gt;7% HbA1c level group than in group with ≤7% HbA1c level. There was also increased ECD in &gt;7% group, but it was found to be insignificant. Percentage of hexagonality in &gt;7% HbA1c level group was lower than in group with ≤7% HbA1c level, but found insignificant. There were higher values of CCT and CV in Non Proliferative Diabetic Retinopathy (NPDR) subgroup compared to Proliferative Diabetic Retinopathy (PDR) and no Diabetic Retinopathy group. CCT values were significant (p-value=0.007), so as CV values (p-value=0.001). There was increase in HEX% (p-value=0.005) which was significant, along with lower ECD in NPDR (p-value=0.143), group which was insignificant. Conclusion: The present study documented that DM has considerable effects on all the layers of the cornea especially endothelial layer, causes reduction of ECD and increased CV. Diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects. In addition, there is a correlation between the changes in corneal parameters like ECD, CV, HEX%, CCT with the duration of DM and severity of DR and glycaemic control {glycosylated haemoglobin (HbA1c) level}.

Corneal Endothelial Morphology and Central Corneal Thickness Changes in Type 2 Diabetes Mellitus using Specular Microscopy and Ultrasonic Pachymetry: A Cross-sectional Comparative Study

Introduction: Diabetes Mellitus (DM) is a metabolic condition characterised by chronic hyperglycaemia, causing raised blood glucose levels which result in microvascular and macrovascular disorders and may introduce ocular manifestations including changes in corneal Endothelial Cell Density (ECD), corneal thickness, and intraocular pressure. It is clinically important to analyse the corneal endothelial status in patients with type II DM as preoperative corneal endothelial cell dysfunction may cause more corneal endothelial cell damage postoperatively leading to corneal decompensation. With the advent of precise and better measurement tool Central Corneal Thickness (CCT) and corneal endothelial morphology measurement has become more accurate. Aim: To compare corneal endothelium cell density, polymorphism, polymegathism and CCT in type 2 DM with age-matched, non diabetic control subjects using CEM-530 Specular microscope and ultrasonic pachymeter Tomey SP-100. Materials and Methods: This cross-sectional, comparative study was conducted at Eye Department at ESI Post Graduate Institute of Medical Sciences and Research, Basaidarapur, Delhi, India, from October 2018 to November 2019. Patients with ages between 40 to 70 years of either gender who were diagnosed to have DM were recruited in the study through non probability convenience sampling. A total of 150 subjects that met the inclusion criteria and exclusion criteria were included in the study. Seventy five known type 2 DM patients were enrolled in diabetic group (case group) and 75 non diabetic, age-matched subjects were enrolled as control group. Cases were classified under three major groups, namely on the basis of duration of DM and severity of Diabetic Retinopathy (DR) and glycaemic control {glycosylated haemoglobin (HbA1c) level}. All the findings were endorsed on a predesigned performa. Statistical Package for Social Sciences (SPSS) version 17.0 was used for analysis of data. Age and corneal parameters compared using unpaired t-test in diabetic and control group. Also, for comparison in between subgroup of diabetic patients on HbA1c level done by using Analysis of Variance (ANOVA) test. Chi-square test applied for categorical variables. Results: Among the 150 patients evaluated, type 2 DM patient’s corneas (540.51±32.578 µ) were thicker as compared to control group 517.51±22.155 µ (p-value&lt;0.001). The mean ECD of control and diabetic group patients was 2723.75±287.253 cells/mm2 and 2716.11±296.081 cells/mm2 , respectively, found insignificant (p-value=0.821). The mean Coefficient of Variation (CV) of cell area of control and diabetic patients was 28.87±3.950 and 29.85±4.027, respectively, and was significant (p-value=0.034). The mean percentage of endothelial Hexagonal cells (HEX%) of control and diabetic patients were 67.39±6.419 and 67.41±5.493, respectively and was non significant (p-value=0.985). Thus, statistically significant difference was found with CCT (p-value&lt;0.001) and CV (p-value=0.034) but not with ECD and hexagonality, between control and diabetic eyes. There was a correlation between CCT, CV, HEX% and ECD with duration of DM2 but it was statistically insignificant. There were higher CCT, CV and HEX% and lower ECD in &gt;10 years of duration of diabetes mellitus than in patients with duration of diabetes mellitus ≤10 years. There was a correlation of CCT, CV, ECD and HEX with HbA1c level. There were significant higher CCT and CV values in &gt;7% HbA1c level group than in group with ≤7% HbA1c level. There was also increased ECD in &gt;7% group, but it was found to be insignificant. Percentage of hexagonality in &gt;7% HbA1c level group was lower than in group with ≤7% HbA1c level, but found insignificant. There were higher values of CCT and CV in Non Proliferative Diabetic Retinopathy (NPDR) subgroup compared to Proliferative Diabetic Retinopathy (PDR) and no Diabetic Retinopathy group. CCT values were significant (p-value=0.007), so as CV values (p-value=0.001). There was increase in HEX% (p-value=0.005) which was significant, along with lower ECD in NPDR (p-value=0.143), group which was insignificant. Conclusion: The present study documented that DM has considerable effects on all the layers of the cornea especially endothelial layer, causes reduction of ECD and increased CV. Diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects. In addition, there is a correlation between the changes in corneal parameters like ECD, CV, HEX%, CCT with the duration of DM and severity of DR and glycaemic control {glycosylated haemoglobin (HbA1c) level}.

Ocular surface microbiome in diabetes mellitus

This cross-sectional, age- and gender-matched study included 20 eyes of non-diabetic subjects (non-DM group) and 60 eyes of type 2 diabetes mellitus (DM group). Subgroups of DM were classified by diabetic retinopathy (DR) staging into no DR (DM-no DR), non-proliferative DR (DM-NPDR), proliferative DR (DM-PDR), and by glycemic control (well-controlled DM; HbA1c < 7%, poorly controlled DM; HbA1c ≥ 7%). Conjunctival swabs were performed for ocular surface microbiome analysis using conventional culture and next-generation sequencing analysis (NGS). A higher culture-positive rate was found in DM (15%) than in non-DM group (5%) (p value = 0.437). Pathogenic organisms and antibiotic-resistant strains were detected in the DR groups (DM-NPDR and DM-PDR). The NGS analysis showed that potentially pathogenic bacteria such as Enterobacteriaceae, Neisseriaceae, Escherichia-Shigella, and Pseudomonas predominated in DM, especially in DR. There was dissimilarity in the ocular surface microbiome between DM and non-DM groups. The subgroup analysis showed that the DR group had significantly different microbial community from DM-no DR and non-DM groups (p value < 0.05). The microbial community in the poorly controlled DM was also significantly different from well-controlled DM and non-DM groups (p < 0.001). Using the NGS method, our study is the first to signify the importance of DR and glycemic control status, which affect the changes in the ocular surface microbiome.

Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy.

In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers.

Analysis of community intervention effects for diabetic eye diseases in Shanghai Xinjing community from 2016 to 2018

Objective: To analyze the effects of community-based interventions for diabetic eye diseases in Xinjing community, Shanghai from 2016 to 2018. Methods: Based on the project of "Establishment of Service Model for Comprehensive Prevention and Treatment of Diabetic Eye Diseases in Shanghai", the participants were not suffering diabetic retinopathy (DR) in Xinjing community in 2016 before interventions and received community-based interventions for diabetic eye diseases. The incidence of DR, visual acuity and awareness of DR were used as evaluation indicators to analyze the effects of interventions for diabetic eye diseases in the community. Results: A total of 537 patients were included in this study, the incidence of DR among diabetic patients in Xinjing community was 7.6% after interventions. The duration of diabetes (OR= 1.065) and HbA1c (OR= 1.090) were the risk factors of DR. Before and after the interventions, the patients with monocular low vision and binocular low vision were 27 cases (5.0%), 8 cases (1.5%), 19 cases (3.5%) and 7 cases (1.3%) respectively. After interventions, the awareness on the prevention and treatment of DR increased significantly, and the proportion of regular visits to ophthalmology examination, diet control and physical exercise also increased significantly. Conclusion: Community-based interventions for diabetic eye diseases are helpful to improve the awareness of DR prevention and control, reduce the incidence of DR.

Visualization of translocator protein (18kDa) (TSPO) in the retina of diabetic retinopathy rats using fluorine-18-DPA-714.

To investigate the feasibility of a noninvasive method for imaging translocator protein (18kDa) (TSPO) in the retina of diabetic retinopathy (DR) rats using fluorine-18-DPA-714 ([18F]-DPA-714) micro-positron emission tomography (PET)/X-ray computed tomography (CT). Sprague-Dawley (SD) rats were intraperitoneally injected with streptozocin (STZ) (65mgkg-1, ip) to induce diabetes mellitus (DM). The TSPO in both eyes was detected by PET/CT using [18F]-DPA-714 12weeks after the establishment of the DM model. The mean standardized uptake value (SUVmean) was analyzed. Western blot and quantitative real-time polymerase chain reaction (PCR) were performed to detect the TSPO protein and mRNA levels in the retina. PET/CT results showed that the SUV of [18F]-DPA-714 was markedly reduced in the retina of DR rats compared with that of normal controls 12weeks after diabetes induction. The SUVmean of regions of interest (ROIs) in the retinas of DR and normal control rats was 0.883 ± 0.078 and 2.525 ± 0.213 (P < 0.001), respectively. The results of PET/CT were in line with the Western blots and quantitative real-time PCR. The PET results demonstrated that TSPO was decreased in the early stage of DR. [18F]-DPA-714 PET/CT appears to be a useful noninvasive imaging method for detecting TSPO in the retina. A decrease in the TSPO level in the retina may play an important role in the development of DR.

An intensive and personalised care planning programme improves clinical outcomes in patients with diabetic retinopathy: a pilot randomised controlled trial

According to the clinical appearances and the characteristics of the onset of 86 Rb cases, some points in the diagnosis merit consideration: 1) Since the average symptomatic age was 21.75 months and the mean diagnostic age was 24.32 months, children under 3 years with leukocoria should be carefully examined, while adult Rb should not be neglected. 2) The primary symptom of Rb is mostly leukocoria, but Rb eyes without any symptoms or leukocoria (26 out of 105 eyes in our groups) might also be encountered. 3) 4 out of the 86 cases were retinocytoma which is supposed to be a type of Rb degeneration or benign Rb. 4) Attention should be paid to abnormalities and second primary tumors in Rb patients. 5) The pedigree investigations, twin method and laboratory studies in Rb such as chromosome analysis, EsD, LDH measurement and RFLP technique are useful in the prenatal diagnosis, early diagnosis and the diagnosis of the carriers.

Investigation of disease-related knowledge-attitude-practice in patients with diabetic retinopathy and its influencing factors

Objective To explore the knowledge-attitude-practice (KAP) level in patients with diabetic retinopathy (DR) and analyze the correlation between these factors and KAP. Methods Totally 318 DR patients were selected using cluster sampling and investigated for their demographic information and KAP from March 2018 to March 2019. Spearman correlation analysis was used to analyze the factors related to KAP. Results The total KAP score of the 315 DR patients was (19.26±5.77) , and their score of DR prevention and control knowledge was (9.37±4.08) , with an accuracy rate of 43.81%. The most common way for DR patients to obtain knowledge is was mobile phone / WeChat / other online channels, followed by communication with patients; the most desired way for DR patients to obtain knowledge was lectures by doctors / nurses, and the DR-related service that they wanted the most was free blood sugar and fundus examination. The DR attitude score was (4.61±1.33) . The positive response rate for glycemic monitoring and control is very important for DR, and all patients must control blood glucose within the normal range was 86.03%, ranking the highest, while the positive response rate for willing to receive psychological guidance was 19.68%, ranking the lowest. The DR behavior score was (5.28±1.96) . The positive response rate for ask family, friends, or medical professionals for help with vision problems was 89.52%, ranking the highest, while the positive rate for able to abide by the principles of diabetes diet on holidays, birthdays, or outing was 34.29%, ranking the lowest. Spearman correlation analysis revealed that there were positive correlations between the course of disease and the total score of KAP (r=0.510, P=0.032) , education levels (r=0.171, P=0.011) and DR prevention knowledge, the average monthly family income (r=0.922, P=0.021) , with or without complications (r=0.671, P=0.027) and DR attitude, and living style (r=0.381, P=0.013) , average monthly household income (r=0.884, P=0.024) and DR behavior. Conclusions The overall level of KAP in DR patients is low, and health education for medical staff needs to be strengthened. KAP is closely related to factors such as age, education, complications, average family income, and living style. KAP in DR patients should be improved through many ways in clinical practice. Key words: Diabetes; Diabetic retinopathy; Knowledge; Attitude; Practice

Association between Aldose Reductase Gene C(-106)T Polymorphism and Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Controversial results regarding the associations between aldose reductase (AR) genetic polymorphisms and diabetic retinopathy (DR) have been reported for many years. The present meta-analysis was performed to clarify the effects of the AR gene C(-106)T polymorphism on DR risk. The PubMed, Web of Sciences, Cochrane library, EMBASE, Chinese National Knowledge Infrastructure, and Wan Fang databases were extensively searched in Chinese to select relevant studies with an updated date of April 25, 2018. The Newcastle-Ottawa Scale (NOS) was applied to assess quality. The random-effects model was applied to calculate the pooled OR and 95% CI. This meta-analysis identified 23 studies with an average score of 7.52 for NOS analysis, including 4,313 DR cases and 5,128 diabetes mellitus (DM) control cases. In the overall analysis, a significant association between the AR gene C(-106)T polymorphism and DR susceptibility was found. In subgroups stratified by DM type and ethnicity, significantly increased risks for DR were found in DM type 1, East Asian populations, and Middle Eastern populations. Compared with DR control cases, the following associations were found: T vs. C: OR 0.91, 95% CI 0.85–0.97, I² = 72.9%; CT + TT vs. CC: OR 0.75, 95% CI 0.68–0.81, I² = 86.7%; and CT vs. CC: OR 0.86, 95% CI 0.78–0.94, I² = 70.5%. The results of this meta-analysis showed a significant association between the AR gene C(-106)T polymorphism and susceptibility to DR in DM patients. DM patients with allele T and CT+TT genotype of the AR gene may have a lower risk of DR.

Serum Pentraxin 3 level as a recent biomarker of diabetic retinopathy in Egyptian patients with diabetes

IntroductionSerum Pentraxin3 Level As A recent Biomarker Of Diabetic Retinopathy In Egyptian patients with diabetes. ObjectiveTo evaluate the association between elevated levels of plasma pentraxin 3 and the development and/or progression of diabetic retinopathy. Subjectsand methods: This case control study was carried out in internal medicine department, outpatient clinic of internal medicine and outpatient clinic of ophthalmology, at Zagazig university Hospital, 2018. Serum PTX3 level, HsCRP, HbA1c, lipid profile, serum creatinine were determined in 20 normal subjects, 20 patients with prediabetes, 20 patients with diabetes without diabetic retinopathy (DR), 20 patients with non-proliferative diabetic retinopathy (NPDR) and 20 patients with proliferative diabetic retinopathy (PDR). ResultsSerum PTX3 level significantly increased in patients with DR more than patients without DR with cut off point 1150 pg/ml, sensitivity 93.3%and specificity 72%. Serum HsCRP level significantly increased in patients with DR more than patients without DR with cut off point of 7.60 pg/ml has sensitivity 93.3% and specificity 68%.. Combined use of PTX3 and HsCRP decreases sensitivity to 76.7%, but combined use increases specificity to 90%.Significant relation between poor glycemic control and development of DR and its severity as showed by HbA1c. ConclusionSerum PTX3 levels mayt have significant role in the development of DR and its severity. Serum HsCRP increased with DR progression. Poor glycemic control significantly associated with high incidence of diabetic retinopathy and its severity. Longer diabetes duration is associated with progression of DR.

Awareness about diabetic retinopathy among doctors not specialized in ophthalmology

Introduction: Diabetic retinopathy is the most common microvascular complication of diabetes mellitus. Proper screening for diabetic retinopathy(DR) and appropriate management could prevent the occurrence of blindness. As doctors treating diabetes patients play a vital role in referring the patients to ophthalmologists for retinopathy screening, we decided to assess the level of awareness about DR. Methods and Materials: We conducted a cross-sectional study among doctors working in a tertiary care hospital with at least 2 years of experience. A set of questionnaire regarding DR was presented to participants to choose the answer of their choice. Analysis was done using SPSS software version 23. Results: Only 18.4% of them have referred all diabetic patients for retinopathy screening. Only 19 to 35% of participants were aware of the correct screening time for DR. 90 to 97% of the participants knew that DR is the most common microvascular complication of diabetes, and that it can even lead to blindness. 85 to 95 % of the participants were aware that both duration and level of glycemic control is associated with development of DR and glycemic control is the first step to prevent its progression. Conclusion: This study emphasizes the fact that awareness programs are necessary not only for diabetic patients, but also for the first contact health care professionals.

Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy.

AimsTo evaluate diabetic retinopathy (DR) data from across the SUSTAIN clinical trial programme.Materials and methodsThe SUSTAIN clinical trial programme evaluated the efficacy and safety of semaglutide, a glucagon‐like peptide‐1 analogue, for the treatment of type 2 diabetes (T2D). In SUSTAIN 6, a 2‐year, pre‐approval cardiovascular outcomes trial, semaglutide was associated with a significant increase in the risk of DR complications (DRC) vs placebo. DR data from across the SUSTAIN trials were evaluated, and post hoc analyses of the SUSTAIN 6 data were conducted. These included subgroup analyses to identify at‐risk patients and a mediation analysis with initial change in glycated haemoglobin (HbA1c; percentage‐points at week 16) as a covariate, to examine the role of the magnitude of reduction in HbA1c as an intermediate factor affecting risk of DRC.ResultsThere was no imbalance in DR adverse events across the SUSTAIN 1 to 5 and Japanese trials. The majority of the effect with semaglutide vs placebo in SUSTAIN 6 may be attributed to the magnitude and rapidity of HbA1c reduction during the first 16 weeks of treatment in patients who had pre‐existing DR and poor glycaemic control at baseline, and who were treated with insulin.ConclusionsEarly worsening of DR is a known phenomenon associated with the rapidity and magnitude of improvement in glycaemic control with insulin; the DRC findings in SUSTAIN 6 are consistent with this. Guidance regarding the early worsening of DR is recommended with insulin. Similar recommendations may be appropriate for semaglutide.

Retinopathy among patients with diabetes in Ramallah Governorate: a clinic-based study

BackgroundIn 2010, diabetes mellitus was the fourth cause of death in West Bank, causing 9% of deaths. Few reliable data on diabetes complications exist. We aimed to estimate prevalence of diabetic retinopathy and determinants in a clinic-based sample in Ramallah Governorate, West Bank. MethodsThe study was done in 11 clinics (four United Nations Relief and Works Agency [UNRWA], five Ministry of Health, two joint Ministry of Health and non-governmental organizations). It was approved by ethics committee at Institute of Community and Public Health (Birzeit University), Ministry of Health, and UNRWA and oral witnessed consent was obtained from patients. Patients with type 2 diabetes older than 25 years were identified in clinics or from clinic databases and were invited to participate in a slit lamp eye exam by a licensed ophthalmologist. Questionnaire, physical examination, and lab tests (glycated haemoglobin [HbA1c], lipid profile) were done. We classified retinopathy using International Clinical Diabetic Retinopathy Disease Severity Scale. Data were collected between Feb 28, 2012, and June 7, 2012, and analysed using the statistical package for social sciences (SPSS) version 22. FindingsMost eligible patients (517) consented to participate and were referred for eye exam; 376 (73%) underwent eye exam (127 men and 249 women). Mean age was 57·8 years (SD 9·0) and mean duration of diabetes was 8·9 years (SD 7·0). Only 21% (77) of patients had controlled diabetes (HbA1c<7%) and 37% (138) had never had an eye exam. The prevalence of retinopathy was 37% (138 patients, 52 [41%] men and 86 [35%] women). 26% (98) had mild-to-moderate non-proliferative retinopathy, 3% (11) had severe non-proliferative retinopathy, and 8% (29) had proliferative retinopathy. Multivariate regression showed that HbA1c, diabetes duration, and systolic blood pressure were associated with retinopathy (p<0·001). Patients with uncontrolled diabetes (HbA1c >7%) were four times more likely to have retinopathy compared with patients with controlled disease (odds ratio [OR] 4·16, 95% CI 1·76–9·85). Patients with diabetes duration more than 7 years were eight times more likely to have retinopathy than were patients whose diabetes duration was 7 years or less (OR 7·7, 95% CI 4·30–13·79). There was a 2% increase in risk of retinopathy per 1 mm Hg increase in systolic blood pressure (OR 1·02, 95% CI 1·01–1·04). InterpretationA third of patients with diabetes had retinopathy. Early regular screening might help early diagnosis and control of diabetic retinopathy, especially among high-risk patients (ie, those with uncontrolled diabetes, high systolic blood pressure, and long diabetes duration). FundingSwedish International Development Agency (SIDA); Umeå Centre for Global Health Research, Umeå University, Sweden.