Degree Of Diabetic Retinopathy Research Articles

DIABETES DURATION AND RETINAL NERVE FIBER LAYER THICKNESS RELATED DEGREE OF DIABETIC RETINOPATHY

Introduction & ObjectivesDiabetic retinopathy is an ocular complication of diabetes mellitus (DM). Several studies have shownthat neurodegenerative changes in the retina occur earlier than microvascular changes.Measurement of retinal nerve fiber layer thickness can detect neurodegeneration at an early stage.This study aims to analyze the relationship of diabetes duration and retinal nerve fiber layerthickness with degree of diabetic retinopathy in type 2 diabetes mellitus patients.
 MethodsThis research was analytic observational research with cross-sectional design. The sample was type2 diabetes mellitus patients with diabetic retinopathy who visited the eye clinic at the University ofSumatera Utara General Hospital. The sample were then analyzed with the Kruskal Wallis test tofind relationship of diabetes duration and retinal nerve fiber layer thickness with degree of diabeticretinopathy in type 2 diabetes mellitus patients.
 ResultsThe sample of this study were 20 subjects with diabetic retinopathy and 20 subjects without diabeticretinopathy as the control group. The mean duration of having DM in the group of patients with mildNPDR was 5.33 years, with moderate NPDR was 9.13 years and with PDR was 15.33 years. Usingthe Kruskal Wallis test revealed that there was no significant relationship between degree ofdiabetic retinopathy with Avg RNFL (p=0.495), superior RNFL (p=0.385), inferior RNFL (p=0.111),temporal RNFL (p=0.064), nasal RNFL (p=0.535).
 ConclusionThere was a significant difference between diabetes duration with degree of diabetic retinopathy butno significant between retinal nerve fiber layer thickness with degree of diabetic retinopathy.

EFFECT OF LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL VALUE ON NON-PROLIFERATIVE DIABETIC RETINOPATHY (NPDR) IN PATIENTS WITH TYPE II DIABETES MELLITUS (T2DM): A SYSTEMATIC REVIEW

Introduction & Objectives : Type 2 Diabetes Mellitus (T2DM) is a metabolic disease in which the body is unable to control blood sugar levels and is characterized by hyperglycemia caused by lack of insulin action. One of the most common microvascular complications of DM that can cause blindness to sufferers is Diabetic Retinopathy (DR). One of the risk factors that can exacerbate the progression of T2DM is the level of Low-Density Lipoprotein (LDL). However, there are still differences of opinion in several studies if LDL has a significant role in the occurrence of DR. This study aimed to determine whether there is a relationship between the value of LDL cholesterol and the occurrence of Non-Proliferative Diabetic Retinopathy.
 Methods : Systematic review utilizing MeSH terminology and PICO methods were done for information extraction of online database, including PubMed, and Google Scholar by utilizing the following keyword “Low-Density Lipoprotein”, “Non-Proliferative Diabetic Retinopathy”, “Diabetes Melitus”. The extracted studies were then analyzed using the New-Castle Ottawa Scale (NOS).
 Results : In total, 2 eligible studies (103 subjects) were found. Dornan et al., stated that total cholesterol levels were higher in NPDR Patients (5.1 +/- 0.7 mmol/l, p ? 0,02) and Mursi et al., shows that in patients with uncontrolled LDL cholesterol, NPDR was found (53,7%, p < 0,015). NOS was used to evaluate the quality of the studies and all studies showed to be in good quality.
 Conclusion : According to the results of this systematic review, there is a significant correlation between the degree of diabetic retinopathy and LDL cholesterol.

The association between the severity of diabetic retinopathy and cognitive impairment: a cross-sectional study.

To assess the correlation among cognitive impairment (CI) and the degree of diabetic retinopathy (DR). The current analytic cross-sectional study has been carried out on two hundred ten individuals having diabetes mellitus type 2. Individuals were split into 7 groups in order of severity of DR in the worse eye with 30 cases in each group. Cognition function has been determined utilizing mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) tests. Comparing the severity of CI using both MMSE and MoCA tests, statistically substantial differences have been discovered among individuals without DR, those having non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) (p < 0.001). The greatest percentage of severe and moderate CI was seen in the PDR group. Regarding the severity of CI, there has been a statistically substantial difference among NPDR and PDR groups, as well as among no-DR and PDR groups (p < 0.001). Moreover, the severity of CI in the MMSE and MoCA tests had a negative connection with the grades of DR (r = -0.522, P < 0.001 and r = -0.540, P < 0.001, respectively). We discovered a negative connection between the grades of DR and the severity of CI that persisted as a significant finding, showing that patients with more severe DR tended to have higher levels of CI. These results might offer retinal examination or retinal photography as a promising strategy for mass screening of CI in diabetic patients, especially if it is combined with artificial intelligence and telemedicine.

Analysis of independent risk factors for progression of different degrees of diabetic retinopathy as well as non-diabetic retinopathy among type 2 diabetic patients.

To study the independent risk factors for development of different degrees of diabetic retinopathy (DR) as well as non-DR (NDR) among type 2 diabetic patients. This cross-sectional study included 218 patients with type 2 diabetes between January 2022 and June 2022. All the patients were divided into two groups: the DR group and the NDR group. The DR group was subdivided into the mild, moderate and severe non-proliferative DR (NPDR) group and the proliferative DR (PDR) group. Data recorded for all patients included age, gender, duration of diabetes, blood pressure, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), blood lipids, best corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), and renal function. Logistic regression methods were used to analyze the risk factors for DR. The prevalence of DR in type 2 diabetes was 28.44%. The duration of diabetes, age, mean arterial pressure (MAP), HbA1c, FBG, urinary albumin/creatinine ratio (UACR), BCVA, AL, and ACD were significantly different between the DR and the NDR groups (p < 0.05). Multivariate logistic regression analysis identified age, FBG, UACR, and AL as the independent risk factors for DR (OR = 0.843, 2.376, 1.049, 0.005; p = 0.034, 0.014, 0.016, p < 0.001). Young age, short AL, higher levels of FBG and UACR were the independent risk factors for the progression of DR in type 2 diabetes.

Telemedicine screening program for diabetic retinopathy in patients with type 1 diabetes mellitus

PurposeTo analyze the results of the telemedicine screening program for diabetic retinopathy (DR) in patients with type 1 diabetes conducted by the Endocrinology and Nutrition Management Unit of Virgen del Rocío University Hospital. MethodsThis cross-sectional study comprised patients with type 1 diabetes mellitus (DM) in our DR screening program from January 2018 to November 2020. Fundus photographs are performed by trained nurses and reviewed by a trained endocrinologist. Those suggestive of pathology are sent to ophthalmology through a telematic program for review. ResultsOf the 995 fundus photographs evaluated, 646 (65.3%) showed no evidence of DR, 327 (33.1%) presented possible DR, and 16 (1.6%) were not gradable. The diagnosis was confirmed in 254 patients after reviewing by ophthalmology, and the screening program achieved a positive predictive value for DR of 77.7%. Seventy-three were excluded by ophthalmology due to the absence of DR (false positive rate – 22.3%). In 92.5% of the cases classified by the ophthalmologist, the degree of DR was mild or very mild. ConclusionOur telemedicine screening program for DR in patients with type 1 DM is consistent with the literature. Effective screening for DR is performed, with patients diagnosed in the early stages. Telemedicine programs facilitate efficient communication among healthcare personnel.

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Telemedicine screening program for diabetic retinopathy in patients with type 1 diabetes mellitus

PurposeTo analyze the results of the telemedicine screening program for diabetic retinopathy (DR) in patients with type 1 diabetes conducted by the Endocrinology and Nutrition Management Unit of Virgen del Rocío University Hospital. MethodsThis cross-sectional study comprised patients with type 1 diabetes mellitus (DM) in our DR screening program from January 2018 to November 2020. Fundus photographs are performed by trained nurses and reviewed by a trained endocrinologist. Those suggestive of pathology are sent to ophthalmology through a telematic program for review. ResultsOf the 995 fundus photographs evaluated, 646 (65.3%) showed no evidence of DR, 327 (33.1%) presented possible DR, and 16 (1.6%) were not gradable. The diagnosis was confirmed in 254 patients after reviewing by ophthalmology, and the screening program achieved a positive predictive value for DR of 77.7%. Seventy-three were excluded by ophthalmology due to the absence of DR (false positive rate – 22.3%). In 92.5% of the cases classified by the ophthalmologist, the degree of DR was mild or very mild. ConclusionOur telemedicine screening program for DR in patients with type 1 DM is consistent with the literature. Effective screening for DR is performed, with patients diagnosed in the early stages. Telemedicine programs facilitate efficient communication among healthcare personnel.

Association Between Uric Acid to HDL Cholesterol Ratio and Diabetic Complications in Men and Postmenopausal Women

Previous studies have implicated the uric acid to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) was associated with type 2 diabetes. However, the association between UHR and diabetes-related vascular damages is still unclear. The total of 4551 patients with type 2 diabetes from the cross-sectional Environmental Pollutant Exposure and Metabolic Diseases in Shanghai study (METAL study) were enrolled. UHR was calculated as uric acid to HDL-C ratio. Cardiovascular disease (CVD) was defined as previously diagnosed with stroke, coronary heart disease, or peripheral arterial disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate ≤60 mL/min/1.73 m2 and/or urinary albumin to creatinine ratio ≥30 mg/g. Fundus image was examined by trained individuals and degree of diabetic retinopathy (DR) was evaluated. UHR was positively correlated with CVD (OR = 1.28, 95% CI: 1.02-1.61) and CKD (OR = 1.78, 95% CI: 1.39-2.27) after adjusting for all confounders. No association was found between UHR and DR. In stratified analyses, UHR was predominantly correlated with CVD in diabetic patients with age older than 65 (OR = 1.41, 95% CI: 1.08-1.85), female (OR = 1.43, 95% CI: 1.06-1.94) and BMI≥24kg/m2 (OR = 1.57, 95% CI: 1.17-2.11). A 1-SD increment of UHR was also positively associated with CVD (OR 1.26, 95% CI 1.03, 1.15) and CKD (OR 1.28, 95% CI 1.20,1.39). UHR was positively associated with CKD in all subgroups analysis. No significant interaction effect was observed between UHR and all subgroup variables in CVD and CKD risk. Our study reported a positive association between the UHR and diabetic-related vascular complications in men and postmenopausal women. The relationship between the UHR and DR seems to be uncertain and requires further investigation. And no significant interaction effect was observed between the UHR and all subgroup variables in CVD and CKD risk.

Prolactin and vasoinhibin are endogenous players in diabetic retinopathy revisited.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are major causes for visual loss in adults. Nearly half of the world’s population with diabetes has some degree of DR, and DME is a major cause of visual impairment in these patients. Severe vision loss occurs because of tractional retinal detachment due to retinal neovascularization, but the most common cause of moderate vision loss occurs in DME where excessive vascular permeability leads to the exudation and accumulation of extracellular fluid and proteins in the macula. Metabolic control stands as an effective mean for controlling retinal vascular alterations in some but not all patients with diabetes, and the search of other modifiable factors affecting the risk for diabetic microvascular complications is warranted. Prolactin (PRL) and its proteolytic fragment, vasoinhibin, have emerged as endogenous regulators of retinal blood vessels. PRL acquires antiangiogenic and anti-vasopermeability properties after undergoing proteolytic cleavage to vasoinhibin, which helps restrict the vascularization of ocular organs and, upon disruption, promotes retinal vascular alterations characteristic of DR and DME. Evidence is linking PRL (and other pituitary hormones) and vasoinhibin to DR and recent preclinical and clinical evidence supports their translation into novel therapeutic approaches.

The Relationship Between Diabetic Retinopathy Degree With Visual Acuity And Retinal Nerve Fiber Layer Thickness In Type 2 Diabetes Mellitus Patients

Introduction: Diabetic retinopathy is an ocular complication of diabetes mellitus (DM), and is one of the leading causes of visual impairment and blindness worldwide.. More than one third of people with diabetes have signs of diabetic retinopathy.&#x0D; &#x0D; Methods: This was an analytic observational study with cross-sectional design. The sample was type 2 diabetes mellitus patients with diabetic retinopathy who visited the eye clinic at the University of Sumatera Utara General Hospital from September 2021-December 2021. The sample were then analyzed with the Mann-Whitney and Kruskal Wallis test to find the relationship between diabetic retinopathy degree with visual acuity and retinal nerve fiber layer thickness in type 2 diabetes mellitus patients.&#x0D; &#x0D; Results: The sample of this study were 20 subjects with diabetic retinopathy and 20 subjects without diabetic retinopathy as the control group. The mean visual acuity in subjects with mild diabetic retinopathy was 0.65+0.48. Average visual acuity in subjects with the degree of moderate diabetic retinopathy was 0.83+0.46. The mean visual acuity in subjects with a proliferative degrees diabetic retinopathy was 0.77+0.64. Mann Whitney test revealed no statistically significant relationship between the degree of diabetic retinopathy and visual acuity (p=0.734). Using the Kruskal Wallis test revealed that there was no significant relationship between the degree of retinopathy diabetic with Avg RNFL (p=0.495), superior RNFL (p=0.385), inferior RNFL (p=0.111), temporal RNFL (p=0.064), nasal RNFL (p=0.535).&#x0D; &#x0D; Discussion: Controlling blood glucose levels becomes more important than the duration of diabetes in preventing the development of retinopathy. Most patients are advised to have an HbA1c of 7% or lower, and for certain patients it is recommended to be lower than6.5%. Diabetic retinopathy slowly damages the retinal blood vessels or the optic nerve layer, leading to leakage, thus resulting in accumulation of fluid containing lipid and blood in the retina which will gradually lead to visual impairment, and even blindness.&#x0D; &#x0D; Conclusion: There is no significant relationship between diabetic retinopathy degree with visual acuity and retinal nerve fiber layer thickness in type 2 diabetes mellitus patients.

Retinal Transcriptome and Cellular Landscape in Relation to the Progression of Diabetic Retinopathy.

PurposePrevious studies that identify putative genes associated with diabetic retinopathy are only focusing on specific clinical stages, thus resulting genes are not necessarily reflective of disease progression.This study identified genes associated with the severity level of diabetic retinopathy using the likelihood-ratio test (LRT) and ordinal logistic regression (OLR) model, as well as to profile immune and retinal cell landscape in progressive diabetic retinopathy using a machine learning deconvolution approach.MethodsThis study used a published transcriptomic dataset (GSE160306) from macular regions of donors with different degrees of diabetic retinopathy (10 healthy controls, 10 cases of diabetes, 9 cases of nonproliferative diabetic retinopathy, and 10 cases of proliferative diabetic retinopathy or combined with diabetic macular edema). LRT and OLR models were applied to identify severity-associated genes. In addition, CIBERSORTx was used to estimate proportional changes of immune and retinal cells in progressive diabetic retinopathy.ResultsBy controlling for gender and age using LRT and OLR, 50 genes were identified to be significantly increased in expression with the severity of diabetic retinopathy. Functional enrichment analyses suggested these severity-associated genes are related to inflammation and immune responses. CCND1 and FCGR2B are further identified as key regulators to interact with many other severity-associated genes and are crucial to inflammation. Deconvolution analyses demonstrated that the proportions of memory B cells, M2 macrophages, and Müller glia were significantly increased with the progression of diabetic retinopathy.ConclusionsThese findings demonstrate that deep analyses of transcriptomic data can advance our understanding of progressive ocular diseases, such as diabetic retinopathy, by applying LRT and OLR models as well as bulk gene expression deconvolution.

Prevalencia de Retinopatia en pacientes del programa integral de diabetes del centro de Salud San Genaro de Villa, Chorillos

Objectives: To determine the prevalence and factors associated with retinopathy in patients of the Comprehensive Diabetes Program of the San Genaro Health Center in Villa Chorrillos. Methods: Descriptive, observational, cross-sectional, prospective study; with a sample of 119 adults and older adults. Non-probabilistic convenience sampling was used. The variables studied were diabetic retinopathy, type of diabetic retinopathy, degree of diabetic retinopathy, age, sex, educational level, time of illness, time belonging to the program, type of treatment, personal history of arterial hypertension, personal history of dyslipidemia, mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), Body Mass Index (BMI), Glycosylated Hemoglobin (HbA1c), Total Cholesterol, LDL Cholesterol, HDL Cholesterol, Triglycerides, creatinine clearance, microalbuminuria, visual efficiency of Snell-Sterling, associated ocular pathology and ocular pressure. Descriptive statistical methods were used. Results: The prevalence of diabetic retinopathy (DR) was 15.1%, of which 77.8% is nonproliferative RD and 22.2% proliferative RD. In relation to the degrees in Non-Proliferative DR, 64.3% is mild and 35.7% moderate; and in Proliferative DR, 25% is early, 25% high risk and 50% severe. The biochemical value that showed a considerable difference was microalbuminuria, reaching a value of 356.9 mg/dl/24hrs. Conclusions: The prevalence of retinopathy is 15.1%, of which 77.8% is non-proliferative retinopathy and 22.2% proliferative retinopathy and the associated factors were systolic blood pressure (p&lt;0.001) and microalbuminuria(p&lt;0.001).

Evaluation of central corneal epithelial thickness with anterior segment OCT in patients with type 2 diabetes mellitus.

This study aimed to evaluate the central corneal thickness (CCT) and central corneal epithelial thickness (CCET) in patients with Type 2 diabetes mellitus (DM), and the effect of the duration of diabetes, the degree of diabetic retinopathy (DR), and HbA1c level. CCT and CCET values of 72 patients diagnosed with type 2 DM and 72 healthy individuals were measured by anterior segment optical coherence tomography. The eye tear function was evaluated with the Tear Break-up Time test (TBUT) and the Schirmer test. From the results of fundus examination, the diabetic patients were grouped as those without DR, non-proliferative DR, and proliferative DR. The disease duration and the HbA1c levels were recorded. In the diabetic patients, the mean CCT was determined to be thicker (p = 0.025), the CCET was thinner (p = 0.003), and the TBUT and Schirmer values were lower (p<0.001, p<0.001, respectively). The duration of diabetes and the HbA1c level was not found to have any statistically significant effect on these parameters (p>0.05). The presence of retinopathy had no significant effect on CCT, TBUT, and Schirmer values. The CCET was determined to be thinner in patients with retinopathy (p<0.001). As the corneal epithelial thickness is reduced in patients with advanced diabetic retinopathy, corneal epithelial pathologies can be seen more often. Therefore, early and effective treatment can be started by taking into consideration the complications which may develop associated with the corneal epithelium following surgical procedures, especially those applied to the cornea.

Correlation Between Diabetic Retinopathy, Depression Level and Quality of Life in Eye Clinic Zainoel Abidin Hospital

Diabetic retinopathy (DR) is one of the eye disorders caused by complications of diabetes mellitus (DM). Indonesia has a high prevalence of DR (43.1%) compared to other Asia-Pacific countries. Damage and blockage of blood vessels in the retina causes impaired vision, which may lead to a total vision loss. DR requires special treatment, coupled with regular treatment, that is expensive and may result in depression and poor quality of life. This study aimed to determine the association between the degree of diabetic retinopathy with the level of depression and quality of life in people with DR in the eye clinic of Zainoel Abidin General Hospital Banda Aceh. This cross-sectional study was conducted from April 2018 to January 2019. Data were obtained through funduscopy reading, Hamilton Depression Rating Scale (HDRS) questionnaire, and Short-Form Health Survey (SF-36). The subjects of this study were all diabetic retinopathy patients who were sampled using the accidental sampling method. Based on the Spearman correlation analysis, there was a correlation between degree of DR and depression level (p value of 0.004) and quality of life (p value of 0,037). In conclusion, there is a moderate correlation between the degree of DR with depression level and quality of life among DM patients.

Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus.

BackgroundDiabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients.AimTo assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM.Patients and MethodsThis work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score.ResultsPatients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001).ConclusionThe presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.

Relationship between soluble protein ST2 (sST2) levels and microvascular complications in a cohort of patients with type 1 diabetes

AimTo determine the association and the prognostic value of soluble ST2 (sST2) levels in the development of diabetic retinopathy (DR), diabetic macular oedema (DMO) or diabetic nephropathy (DN), in a cohort of patients with type 1 diabetes (T1D). MethodsA total of 269 individuals with T1D (154 males and 115 females) were recruited. The overall mean age was 43.2±14.9 years, and the diabetes duration was 17.1±12.1 years. Levels of sST2 in serum were evaluated, and the presence as well as the degree of DR, DMO and DN was recorded. Additionally, other clinical and analytical parameters including demographic variables were recovered from patients’ electronic health record. Ten years later, the presence and stage of DR, DMO and DN were again recorded under the same criteria.The association between previously mentioned parameters with DR and DN was analysed by univariate and multivariate logistic regression. The variables in the final multivariate models were adjusted from complete models via backward elimination and maintained only when significant. ResultsAn increase of 10ng/ml in the levels of sST2 was associated with a 1.50 (1.02–2.19) and 1.48 (1.05–2.08) prevalence odds ratio (OR) in DMO and DR, respectively. There was no association between sST2 levels and DN. Meanwhile, sST2 levels did not display a prognostic effect in any of the microangiopathic diabetic complications studied. ConclusionsLevels of sST2 are associated with the presence of DR and DMO, they do not seem to be predictive for the development or deterioration of DR, DMO or DN.

ASSOCIATION BETWEEN THE DEGREE OF DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA

INTRODUCTION: WHO estimates more than 150 million diabetes patients worldwide. One of the complications of diabetes is diabetic retinopathy which is recognized as the leading cause of blindness in the working-age population and the cause of 12% of new cases of blindness each year due to macular edema, vitreous hemorrhage, and tractional retinal detachment. Macular edema is the most common cause of decreased visual acuity. The relationship between macular edema and the degree of retinopathy is unclear, so further research is needed. This study aimed to analyze the incidence of macular edema with the degree of diabetic retinopathy.METHOD: This study used a cross-sectional method. Samples were taken from the Retina Data Register at the National Diponegoro Hospital Eye Polyclinic of all diabetic retinopathy patients who attended National Diponegoro Hospital from July to December 2020 who were recruited as participants. The variables measured included the incidence of macular edema and the degree of diabetic retinopathy. Measurements using fundoscopy, slit lamp and condensing lens + 78D according to ETDRS (Early Treatment Diabetic Retinopathy Study) criteria by an ophthalmologist. Data analysis used a bivariate difference test for 2 groups. The statistical test used was the Kruskal-Wallis test, which was significant if p ≤ 0.05.RESULTS: In this study, out of 150 eyes examined, 28 (18.7%) had macular edema. 4 (2.7%) eyes were diagnosed with Moderate NPDR, 3 (2%) eyes were diagnosed with Severe NPDR. In eyes diagnosed with PDR with or without VH or TRD, 21 (14%) eyes had macular edema. The p-value was 0.03 with the Kruskal-Wallis test, where p ≤ 0.05.CONCLUSION: There is a significant difference between the degree of diabetic retinopathy and the incidence of macular edema. The incidence of macular edema is higher in the more severe degrees of diabetic retinopathy.

Relationship between Diabetic Retinopathy and Primary Open-Angle Glaucoma: A Systematic Review and Meta-Analysis

Background: Pathophysiological overlaps exist between diabetes and primary open-angle glaucoma (POAG) and presence of diabetes increases the risk of POAG. Considering that diabetic retinopathy (DR) is an ocular complication of diabetes, one could speculate that DR as a severity measure may associate with or even predict POAG. Given that POAG is asymptomatic in early stages, an association to DR may prove clinically important and facilitate an earlier diagnosis of POAG. Objectives: The aim of the study was to investigate if DR is associated with and predictive of POAG. Method: We systematically searched 11 literature databases on May 12, 2021. We screened a total of 1,535 records and found six studies eligible for qualitative and quantitative analysis. Two independent authors reviewed the studies, extracted data, and evaluated risk of bias within individual studies. Studies were reviewed qualitatively, and meta-analyses were made based on the odds ratios (ORs) with 95% confidence intervals (CI) of the association between DR and POAG using the random-effects model. Subgroup analyses were made on the association between subtypes of DR and POAG. Results: Six studies (two longitudinal and four cross-sectional) were eligible for review with a total of 255,614 patients with diabetes, of which 20,483 patients had any degree of DR and 5,258 had POAG. All studies were based on patients with type 2 diabetes except one with both type 1 and type 2 patients. Any DR was not associated with POAG (OR 1.17; 95% CI: 0.58–2.35; p = 0.65). Further stratification revealed that neither cross-sectional (OR 1.00; 95% CI: 0.56–1.81, p = 0.99) nor longitudinal studies (OR 1.47; 95% CI: 0.57–3.78, p = 0.43) demonstrated an association between DR and POAG. Conclusions: We did not find convincing evidence of an associations between DR and prevalent or incident POAG.

Exploración de la Relación de la Calidad del Sueño en Pacientes con Retinopatía Diabética, Villahermosa Tabasco

Introduction: In recent decades, there has been growing evidence suggesting that too little or too much sleep is associated with adverse health outcomes, including type 2 diabetes. There is a close association between diabetes and diabetic retinopathy (DR), so it is reasonable to assume that sleep may also have associations with DR. Objective: To explore the relationship between the perception of sleep quality and the degree of diabetic retinopathy in patients with type 2 Diabetes Mellitus treated at a 3rd level dophthalmological care service. Results: Significant correlations were found in: diastolic and systolic blood pressure (0.429), triglycerides and total cholesterol (0.707), glycosylated hemoglobin (HbA1c) and glycemia (0.561), Epworth sleepiness scale (ESS Score) and age (0.394) , ESS Score and weight (0.365), extended STOP questionnaire (Stop Bang) and age (0.317), Stop Bang and weight (0.579), Stop Bang and ESS Score (0.452), insomnia severity index (ISI Score) and Stop Bang (0.460). Although the reduced sample size limited the results in the associations by subgroups in the study, a trend towards an elevation of the ESS score can be seen in the subgroup of patients who reported sleeping 8 hours or more. Conclusions: Although the trends are not statistically significant, the authors consider that this finding is congruent with the state of the art on the subject of sleep and metabolic condition of retinopathic diabetic patients (increased trend of ESS score reported in the subgroup of 8 or more hours sleep), it will be necessary to explore this phenomenon in more detail and in a larger number of patients.

Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes.

Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes.Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed.Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD.Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.