Development Of Macular Edema Research Articles

Features of the development and progression of diabetic macular edema in patients with type 2 diabetes

Background. In the developed world, the prevalence of type 2 diabetes in the population aged 65 years and older is 33 %, and prediabetes is 50 %. Macular edema can be the first symptom of diabetic retinopathy or occur at any stage of its development. In developed countries, the most common cause of central vision loss in people under the age of 50 is diabetic macular edema (DME). Long-term studies have found that the risk of developing DME is higher in patients with type 2 diabetes. The purpose was to investigate the features of the development and progression of DME in patients with type 2 diabetes. Materials and methods. A total of 180 patients (360 eyes) with non-proliferative diabetic retinopathy and type 2 diabetes were examined. The nature, frequency, and features of the development and progression of DME were evaluated. All patients were examined for uncorrected visual acuity, best corrected visual acuity, intraocular pressure, static computed perimetry, optical coherence tomography and optical coherence tomography angiography. We used the Student’s t-test to determine the statistical significance of the mean differences in two independent groups. The null hypothesis was rejected and the differences between indicators were considered statistically significant at a significance level of p < 0.05. Results. In patients of the Ukrainian population with non-proliferative diabetic retinopathy and type 2 diabetes, the incidence of DME 0 averaged 55.56 %, DME 1 — 15.0 %, DME 2 — 15.56 %, DME 3 — 13.89 %. There was a statistically significant relationship between the frequency of DME of different stages and the duration of type 2 diabetes. At presentation, the frequency of DME 0 was on average 55.56 %; with the duration of type 2 diabetes of up to 10 years, it was 3 and 24 % statistically significantly higher (p < 0.05) than in patients with duration from 11 to 20 and above 20 years, respectively. The incidence of DME 1 was 15.0 %, DME 2 was 15.56 %; with the duration of type 2 diabetes of up to 10 years, it was 2 times lower (p < 0.05) than in patients with duration of 11 to 20 years and more than 20 years, respectively. The incidence of DME 3 was 13.89 %; with the duration of type 2 diabetes of up to 10 years, it was 3 times lower (p < 0.05) than in patients with duration of 11 to 20 years and above 20 years, respectively. A statistically significant dependence of the incidence of diabetic macular edema on treatment in patients with non-proliferative diabetic retinopathy and type 2 diabetes has been found. When taking hypoglycemic drugs, the incidence of DME 0 increases statistically significantly, and when insulin therapy is used, the incidence of DME 1–3 increases. Conclusions. A statistically significant relationship was found between the frequency of DME of different stages and the duration of type 2 diabetes. The longer the duration of type 2 diabetes, the higher the frequency of DME stages 1, 2 and 3. The incidence of DME 1–3 in patients on insulin therapy is 2 times higher compared to patients taking hypoglycemic drugs (p < 0.01).

New risk factors and predictions of the development of retinal vein occlusion after cardiac surgeries with the use of artificial circulation

Background. Cardiovascular diseases are one of the risk factors for the development of retinal vein occlusion (RVO). Cardiac interventions with artificial circulation (AC) can be associated with perioperative complications, including retinal vessel occlusion. The actual task of modern ophthalmology is to determine the frequency of retinal vessel occlusions, clinical features, risk factors, the role of markers of inflammation and endothelial dysfunction in RVO in patients with cardiovascular diseases after surgeries with artificial circulation. The purpose of the study was to investigate new risk factors and predict the development of retinal vein occlusions after cardiac surgeries using artificial circulation. Materials and methods. Three hundred and ninety-four patients (638 eyes) were under observation. Of them, 220 people (405 eyes) had cardiovascular diseases and underwent heart surgeries with the use of AC. In these patients, we determined the nature, frequency and features of the development and clinical course of RVO after cardiac surgery with AC in the early and late periods of observation (3 and 6 months). Also, a study was conducted of 174 patients (233 eyes) with cardiovascular diseases who underwent cardiac surgeries with AC, and the serum levels of markers of inflammation (IL-6 and IL-8) and endothelial dysfunction (VE-cadherin) were determined before and after operations depending on the time of RVO occurrence. The main group included 126 patients (137 eyes) who were diagnosed with occlusion of the central retinal vein (CRV) or its branches after surgery with AC; the comparison group — 43 patients (86 eyes) who did not have retinal vein occlusion during the entire observation period; the control group — 5 patients (10 eyes) who had the same degree and duration of the underlying disease, indications for surgery with AC, but were examined before the operation, and within 180 days after it, and did not have RVO. The patients were examined by an ophthalmologist 2, 7, 30, 60, 90 and 180 days after cardiac surgery. The content of IL-6, IL-8 and VE-cadherin in blood serum was determined by the enzyme immunoassay (Bender MedSystems, Austria). Statistical data were processed using the Statistica 10 program (StatSoft Inc., USA), regression analysis was performed with the help of the GLZ software package. Results. As a result of the research, it was found that the frequency of retinal vein occlusions after cardiac surgeries with the use of artificial circulation was 0.99 % on the 2nd day, 3.95 % on the 7th day, 10.2 % after 3 months, 1.4 % after 6 months. The conducted discriminant analysis showed that the type of occlusion was determined by age, lower visual acuity, and the order of occlusion of the CRV branches. An increase in the macular volume of the retina was also significant, reflecting the development of macular edema. The regression model for predicting the type of occlusion based on visual acuity, the order of occlusion of the CRV branches and age had a prediction accuracy of 82.5 %. Cardiac surgeries with the use of AC caused an increase in interleukin content in the early period (IL-6 on days 2 and 7, and IL-8 — up to day 30), while the content of VE-cadherin was slightly increased during almost the entire observation period. In the presence of RVO, IL-6 content was significantly higher at all stages of occlusion development, IL-8 content — up to 30 days, and VE-cadherin content — mostly after 7 days. Regression analysis showed that after 1–2 days, the occurrence of RVO was directly related to the content of IL-6 and IL-8 in the blood, on days 3–7 — to the content of only IL-8, on days 8–30 — to the content of all markers, and later — to the content of IL-6 and VE-cadherin. The prediction accuracy for the presence or absence of RVO in the corresponding term according to the calculated regression models is at least 78 % (p < 0.001), which proves the influence of markers on the development of RVO. Conclusions. The conducted study shows the importance of acute inflammation and endothelial dysfunction in the occurrence of RVO when using AC, which justifies the use of preventive measures in the early stages of limiting the activity of the inflammatory process, in the later stages — preventing the development of endothelial dysfunction.

Intravitreal Dexamethasone Implants for Macular Edema Secondary to Acute Retinal Necrosis

ABSTRACT Purpose To assess the effectiveness and risk of intravitreal injection of dexamethasone implants in treating macular edema (ME) secondary to acute retinal necrosis (ARN). Methods In this retrospective, noncomparative case series study, five patients who developed secondary ME after ARN and received an intravitreal dexamethasone implant injection were enrolled. The features of secondary ME on OCT and the outcomes of dexamethasone intravitreal implanting were presented. Results The mean age of the patients was 59 years (range, 51–61 years). All patients had unilateral involvement, and all 5 eyes showed mild to moderate anterior uveitis, retinal necrosis, and vasculitis. Herpes zoster virus was detected in all eyes using PCR, and timely antiviral and anti-inflammatory treatment was performed. Aqueous humor samples were negative for herpes zoster virus DNA, and resolution of viral retinitis was noted upon the occurrence of ME. Additionally, three eyes received pars plana vitrectomy with silicone oil prior to ME development. All eyes presented with intraretinal fluid, hyper-reflective foci, and impairments of the external limiting membrane/ellipsoid zone at varying degrees on OCT images. Epiretinal membrane was exhibited in 80% of eyes, but no vitreoretinal traction was detected. Subretinal fluid was visible in 60% of eyes. ME was relieved effectively in all eyes after intravitreal dexamethasone implanting. One of these patients experienced three episodes of ME. No recurrence of retinal necrosis or corticosteroid-associated ocular hypertension was observed during the follow-up period. Conclusion Intravitreal injection of dexamethasone implants can effectively alleviate ME secondary to ARN and improve visual acuity with no adverse reactions.

Potential of Sulodexide in the Treatment of Diabetic Retinopathy and Retinal Vein Occlusion.

Retinal vascular diseases, such as diabetic retinopathy or retinal vein occlusion, are common causes of severe vision loss. Central to the pathophysiology of these conditions are endothelial dysfunction, inflammation, capillary leakage, ischemia, and pathological neoangiogenesis. Capillary damage leads to leakage and the development of macular edema, which is associated with vision loss and requires complex treatment. Sulodexide, a glycosaminoglycan composed of heparan sulfate and dermatan sulfate with high oral bioavailability, exhibits several favorable pharmacologic properties, including antithrombotic, anti-inflammatory, and endothelium-protective effects. Additionally, treatment with sulodexide has been associated with the reduction of oxidative stress and decreased expression of angiogenic growth factors, such as vascular endothelial growth factor. This review aims to provide an overview of the pharmacological properties, mechanisms of action, and therapeutic effects of sulodexide. Furthermore, its potential for clinical application in venous and diabetic diseases, such as venous thromboembolism, chronic venous insufficiency, peripheral artery disease, or diabetic nephropathy, is summarized. We also present experimental and clinical studies evaluating the potential of sulodexide in ocular conditions and discuss its therapeutic implications for the treatment of retinal vascular diseases.

Microcystic Macular Edema Caused by Non-Glaucomatous Optic Atrophy: A Single-Center, Retrospective, Cohort Study in France.

Optic Atrophy (OA) can be associated with the development of microcystic macular edema (MME) in the perifoveal retinal inner nuclear layer (INL). We aimed here to retrospectively determine the prevalence of MME in patients with non-glaucomatous OA in our tertiary ophthalmology department between 2015 and 2020. We then examined how MME affected the thicknesses of the different retinal layers and the differences in demographic and clinical characteristics between those patients who developed MME and those who did not. A total of 643 eyes (429 patients) were included (mean age 45.9 ± 17.8 years, 52% female). MME developed in 95 (15%) eyes and across all etiologies of OA except for toxic/nutritional causes, but the prevalence of MME varied between the different etiologies. The development of MME was associated with thinning of the ganglion cell layer (11.0 vs. 9.6 μm; p = 0.001) and the retinal nerve fiber layer (10.1 vs. 9.15 μm; p = 0.024), with INL thickening in the 3- and 6-mm diameter areas of the central fovea. Patients developing MME had significantly worse distance best-corrected visual acuity than those not developing MME (0.62 vs. 0.38 logMAR; p = 0.002). Overall, the presence of MME in OA cannot be used to guide the diagnostic work-up of OA.

Association Between Tobacco Smoking and the Development of Diabetic Macular Edema

Introduction: To explore the effect of cigarette smoking on the risk for developing diabetic macular edema (DME) among patients with diabetes. Methods: This retrospective exactly-matched cohort study used claims data for patients from all 50 states in the United States from 2010 through 2020. Patients with an initial diagnosis of diabetes were stratified into 3 cohorts as follows: active smokers, never smokers, and former smokers. After exact matching based on demographics and comorbidities, Kaplan-Meier survival functions for the 3 cohorts were compared using pairwise log-rank tests. Results: After matching, there were 42 298 patients in each cohort. Over 6 years of follow-up, the cumulative risk for DME was significantly higher among never smokers (1.18%) than among active smokers (0.88%) and former smokers (0.90%) (both P < .001). Conclusions: Among patients with diabetes, smoking may decrease the risk for developing DME. Although the harms of smoking far outweigh any potential protective benefits, further investigation into the mechanisms behind these findings has potential to uncover new therapeutic targets.

Association of SDF-1-3' Gene A Variant with Diabetic Retinopathy in the Hungarian Population.

We investigated the association between the SDF-1-3' (c801G > A) variant and the development of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR) in a Hungarian cohort. SDF-1-3' (c801G > A) was genotyped in 103 patients with diabetic retinopathy and 31 age- and sex-matched non-diabetic controls. Central retinal and choroidal thickness was measured by swept-source optical coherence tomography. The distribution of heterozygous and homozygous SDF-1-3' (c801G > A) genotypes was similar in diabetic and control subjects. The SDF-3'(c801AA) genotype was associated with DME (n = 94 eyes, allele distribution p = 0.006, genotype distribution p = 0.01 OR: 2.48, 95% CL: 1.21-5.08) in both univariable and multivariable modelling, independent of duration and type of diabetes, HbA1C, hypertension and microalbuminuria (p = 0.03). DME occurred earlier in patients carrying the SDF-1 (c801A) allele (Kaplan-Meier analysis, log-rank test p = 0.02). A marginally significant association was found between the presence of the SDF-1 (c801A) allele and the development of PDR (n = 89 eyes, p = 0.06). The SDF-1-3' (c801A) allele also showed a correlation with central retinal (p = 0.006) and choroidal (p = 0.08) thickness. SDF-1-3' (c801G > A) is involved in the development of macular complications in DM independent of critical clinical factors, suggesting that SDF-1 may be a future therapeutic target for high-risk patients, especially those carrying the SDF-1 (c801A) allele.

Transient Macular Edema after Uncomplicated Cataract Surgery: Below the Surface

To present analysis of 17 case reports of 17 patients who had an acute transient macular edema appeared after uneventful cataract surgery. Observations: In literature about 12 case series of toxic macular edema development after cataract surgery are described and all of them were accompanied by the cefuroxime intracameral usage. Also, there are reports of macular edema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular edema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient acute macular edema with 3,8% incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or acute inflammation. Optical coherence tomography (OCT) was performed on patients complaining on blur vision and who had signs of macular edema by ophthalmoscopy. By OCT high and often extensive neuroepithelium and local pigment epithelium detachments were observed on the first day after surgery in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3-6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME) and vitreomacular traction syndrome. Conclusion: It’s obvious that observed case series are cefuroxime induced. But its comparison with CME in terms of morphology of the macula could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues.

Effect of Intravitreal Injection of Ranibizumab (Lucentis®) on Corneal Endothelial Cell Density and Morphology

Abstract Background VEGF has an essential role in initiating wound and inflammation-related neovascularization. Several studies have demonstrated that VEGF is an important mediator of blood– retinal-barrier breakdown, leading to fluid leakage below the macula and inducing the development of macular edema and choroidal neovascular membranes. Anti-VEGF agents interfere with its receptor binding, thus inhibiting VEGF’s signal, which results in inhibition of abnormal blood vessel formation and decreasing vascular permeability. Aim of the Work This study aimed is to report early changes in the corneal endothelial cell density (ECD) and morphology in patients undergoing intravitreal anti-VEGF injections (ranibizumab) for treatment of macular edema. Patients and Methods This prospective study included 22 eyes of 22 DME patients indicated for IVI of Ranibizumab, with mean age 57.1±7.4 years, ranging from 42.0 years to 70.0 years. The majority of them were females (77.3%). Results Cell density (endothelial cell count) at baseline (2601.8±220.0) didn’t show statistically significant difference than that at one month (2598.9±198.1) after IVI. Coefficient variant was not significantly changed at month-1 as compared to baseline. Coefficient variant at baseline was 29.8±4.0, ranging from 22.0 to 39.0. and at one month was 31.3±5.4, ranging from 21.0 to 48.0. Hexagonal cells (HEX) were not significantly changed at one month as compared to baseline. Hexagonal cells at baseline were 68.9±3.2, ranging from 63.0 to 75.0 and after one month, it was 67.8±4.1, ranging from 60.0 to 76.0. Pachymetry was not significantly changed at one month as compared to baseline. The corneal thickness (pachymetry) at baseline was 538.8±40.1 ranging from 448.0–587.0 to 447.0–597.0. after one month of IV ranibizumab it was 536.3±42.1 0.183. Conclusion A single IV injection of Ranibizumab in phakic and otherwise normal eyes with DME showed no change in ECD and pachymetry but a statistically non-significant increase in CV and decrease in HEX 1-month after injection.

A spectral domain optical coherence tomography (SD-OCT) study of intraretinal hyperreflective foci and its relationship with visual acuity and grades of retinopathy among patients of diabetes mellitus in Indian population

BackgroundHyperreflective foci (HRF) are biomarkers in detection of diabetic retinopathy (DR). Presence of HRF on spectral domain optical coherence tomography (SD-OCT) can give a correlation with visual acuity change and grades of DR. Purpose of this study is to determine the presence, location, and role of HRF in the retina of DM patients with and without retinopathy. MethodsA total of 192 eyes of patients suffering from type II DM were evaluated. Patients were divided into 2 groups, with Group A having diabetes without retinopathy (20 patients) and group B (76 patients) having diabetes and various grades of retinopathy. SD-OCT was performed in all patients, passing through the center of fovea. On OCT, presence and absence of HRF were noted. Characteristics of the hyper-reflective spots were evaluated: location, shape, size, back shadowing and association with central macular thickness (CMT), visual acuity, and grades of retinopathy. ResultsHRF were present in 169 eyes (88%) out of 192 eyes. The shape and location of HRF tend to change with disease progression. HRF were significantly associated with increasing grades of retinopathy (χ2 = 57.586, p < 0.01) Association of macular edema was significant with both retinopathy (χ2 = 8.895, p < 0.05) and HRF (χ2 = 34.720, p < 0.01). Association of best-corrected visual acuity with HRF (χ2 = 21.232, p < 0.01), macular edema (χ2 = 86.960, p < 0.01), and CMT (χ2 = 47.959, p< 0 .01) was significant. ConclusionHRF is a great indicator for early diagnosis of subclinical retinopathy and can be used to monitor the progression of disease and development of macular edema. Significant difference is present in HRF distribution and morphology.

Effect of Fenofibrate on Progression of Diabetic Retinopathy

BackgroundFindings from cardiovascular outcome trials suggest that fenofibrate therapy may reduce the progression of diabetic retinopathy.MethodsWe recruited and followed adults with nonreferable diabetic retinopathy or maculopathy using the national Diabetic Eye Screening (DES) program in Scotland. We randomly assigned participants to receive 145-mg fenofibrate tablets or placebo (taken daily or, in those with impaired renal function, on alternate days). The primary outcome was a composite of developing referable diabetic retinopathy or maculopathy (based on Scotland’s DES grading scheme) or treatment (intravitreal injection, retinal laser, vitrectomy) for retinopathy or maculopathy.ResultsA total of 1151 participants were randomly assigned to treatment. During a median of 4.0 years, progression to referable diabetic retinopathy or maculopathy, or treatment thereof, occurred in 131 (22.7%) of 576 participants in the fenofibrate group and 168 (29.2%) of 575 in the placebo group (hazard ratio, 0.73; 95% confidence interval [CI], 0.58 to 0.91; P=0.006). In the fenofibrate group compared with the placebo group, the frequencies for any progression of retinopathy or maculopathy were 185 (32.1%) vs. 231 (40.2%); hazard ratio, 0.74; 95% CI, 0.61 to 0.90 and for the development of macular edema were 22 (3.8%) vs. 43 (7.5%); hazard ratio, 0.50; 95% CI, 0.30 to 0.84. Seventeen (3.0%) participants assigned fenofibrate and 28 (4.9%) assigned placebo were given treatment for retinopathy (hazard ratio, 0.58; 95% CI, 0.31 to 1.06). There was no effect on visual function, quality of life, or visual acuity. Trial-averaged estimated glomerular filtration rate was 7.9 (95% CI, 6.8 to 9.1) ml/min/1.73 m2 lower in participants in the fenofibrate group compared with the placebo group. Serious adverse events occurred in 208 (36.1%) participants allocated fenofibrate and 204 (35.5%) participants allocated placebo.ConclusionsFenofibrate reduced progression of diabetic retinopathy compared with placebo among participants with early retinal changes. (Funded by the National Institute for Health and Care Research; ClinicalTrials.gov number, NCT03439345; ISRCTN number, ISRCTN15073006.)

Demographic and Metabolic Risk Factors Associated with Development of Diabetic Macular Edema among Persons with Diabetes Mellitus

PurposeDiabetic macular edema (DME), a leading cause of visual impairment, can occur regardless of diabetic retinopathy (DR) stage. Poor metabolic control is hypothesized to contribute to DME development though large-scale studies have yet to identify such an association. This study aims to determine whether measurable markers of dysmetabolism associate with DME development in persons with diabetes. DesignRetrospective cohort study ParticipantsUsing data from the Sight Outcomes Research Collaborative (SOURCE) repository, patients with diabetes mellitus (DM) and no pre-existing DME were identified and followed over time to see what factors associated with DME development. MethodsCox proportional hazard modeling was used to assess the relationship between demographic variables, diabetes type, smoking history, baseline DR status, blood pressure (BP), lipid profile, body mass index (BMI), hemoglobin A1C (HbA1C) and new onset of DME. Main Outcome MeasuredAdjusted Hazard Ratio (HR) of developing DME with 95% confidence intervals. ResultsOf 47,509 eligible patients from 10 SOURCE sites (mean age 63±12 years, 58% female sex, 48% white race), 3633 (7.6%) developed DME in the study period. The mean±standard deviation time to DME was 875±684 days (∼2.4 years) with those with baseline NPDR (HR 3.67 95% [confidence interval (CI]):3.41-3.95) and PDR (HR 5.19 95% [CI]:4.61-5.85) more likely to develop DME. There was no difference in DME risk between type 1 and type 2 patients, however Black race was associated with a 40% increase in DME risk (HR 1.40 95% [CI]:1.30-1.51). Every one unit increase in HbA1C had a 15% increased risk of DME (HR 1.15 95% [CI]:1.13-1.17) and each 10 mmHg increase in systolic blood pressure associated with a 6% increased DME risk (HR 1.06 95% [CI]:1.02-1.09). No association was identified between DME development and BMI, triglyceride levels, or high-density lipoprotein levels. ConclusionsThese findings suggest that in patients with diabetes modifiable risk factors such as elevated HbA1C and blood pressure confer a higher risk for DME development, however other modifiable systemic markers of dysmetabolism such as obesity and dyslipidemia did not. Further work is needed to identify the underlying contributions of race in DME.

Современные алгоритмы терапии диабетического макулярного отека (Обзор литературы. Часть II)

This review presents up-to-date information on officially approved intravitreal angiogenesis inhibitors, provides the comparative analysis of the data obtained during large-scale randomized trials on their efficacy and safety as well as possible schemes of their administration. Special attention is paid to the problem of refractory diabetic macular edema and alternative therapies, including the use of glucocorticoids, inhibition of Rho/ROCK signaling pathway. The dynamics of the central foveal thickness according to optical coherence tomography and best-corrected visual acuity are the main criteria for evaluating the diabetic macular edema therapy effectiveness. According to current data, intravitreal injection of angiogenesis inhibitors is a first-line treatment. In diabetic macular edema, the following drugs have been registered in Russia: ranibizumab, aflibercept, brolucizumab, faricimab. Laser retinal photocoagulation is used mainly for the non-central edema treatment. Intravitreal glucocorticoids are considered as an alternative therapy, but their use is limited by the presence of side effects in the form of secondary drug-induced ophthalmic hypertension and/or glaucoma and the development of cataracts. However, the suboptimal response to standard treatment and the development of refractory forms stimulate the development of novel drugs and delivery systems, as well as the use of several types of therapy that affect different points of the pathogenesis. The review emphasizes the need to further study the trigger points of the diabetic retinopathy pathogenesis and the development of diabetic macular edema in order to find novel drugs and individualize the treatment of each patient. Key words:diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor, VEGF-therapy

Impact of GLP-1 Agonists and SGLT-2 Inhibitors on Diabetic Retinopathy Progression: An Aggregated Electronic Health Record Data Study

PurposeTo examine the effects of GLP-1 agonists compared to SGLT-2 inhibitors on diabetic retinopathy. DesignRetrospective clinical cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health records network comprising multiple healthcare organizations. MethodsPatients with an International Classification of Diseases, Tenth Revision (ICD-10) code of non-proliferative diabetic retinopathy and monotherapy treatment, excluding insulin, with GLP-1 agonists or SGLT-2 inhibitors. Patients with history of proliferative diabetic retinopathy prior to initiation of treatment were excluded. Rate of progression to proliferative diabetic retinopathy and rate of development of diabetic macular edema were compared between patients on GLP-1 agonists compared to those on SGLT-2 inhibitors. The groups were propensity score matched for age, gender, ethnicity, race, type of diabetes, and severity of non-proliferative diabetic retinopathy. Main outcomes included rate and relative risk of progression to proliferative diabetic retinopathy and risk of diabetic macular edema in the GLP-1 agonist group versus the SGLT-2 inhibitor group. ResultsA total of 6481 patients were identified in the GLP-1 cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 year and 3 years after initiation of therapy, a higher rate of progression of proliferative diabetic retinopathy was noted (RR: 1.26, CI 1.04-1.51, p=0.017 at 1 year, RR: 1.284, CI 1.1-1.499, p=0.002 at 3 years) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. There was a higher rate of diabetic macular edema noted at 3 months (RR: 1.192, CI 1.059-1.276, p=0.002), 6 months (RR: 1.22, CI 1.13-1.32, p<0.001), 1 year (RR: 1.24, CI 1.15-1.33, p<0.001), and at 3 years (RR: 1.29, CI 1.21-1.38, p<0.001) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. ConclusionsA higher rate of progression of proliferative diabetic retinopathy and risk of new-onset diabetic macular edema was observed in patients on monotherapy with GLP-1 agonists compared to those on SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and to consider the current retinopathy status when initiating treatment with newer hypoglycemic agents to ensure these patients are appropriately monitored for developing potential vision threatening complications.

OCT angiography 2023 update: focus on diabetic retinopathy.

Optical coherence tomography angiography (OCTA) has become part of the clinical practice and its growing applications are in continuous development. Coherently with the growing concern about the human and economic cost of diabetes, diabetic retinopathy (DR) was the most popular topic for OCTA studies in the past year. The analysis of the literature reveals that applications of OCTA in DR are in continuous growth. In particular, ultrawide field (UWF) OCTA and artificial intelligence (AI) based on OCTA images are affirming as the new frontiers of scientific research in the field. Diagnostic accuracy of AI methods based on OCTA is equal or superior to the one based on OCT methods and also bears potential to detect systemic associations. UWF OCTA is noninvasive method that is reaching similar accuracy of FA in detection of neovascularization and intraretinal microvascular abnormalities (IRMAs) and has allowed better characterization of microvascular peripherical changes in DR. Lastly, deep capillary plexus (DCP) characteristics seem to play a pivotal role in the development of diabetic macular edema (DME) and refinement of biomarkers for different phenotypes of DME and diabetic macular ischemia (DMI) is currently on its way.

BARRAGE LASER PHOTOCOAGULATION IN HIGH-MYOPIC PATIENT WITH SYMPTOMATIC RETINAL TEARS BEFORE PHACOEMULSIFICATION: A CASE REPORT

Introduction : Retinal tears can be present in up to 2.4% of cases of lattice degeneration, which is considered an important risk of retinal detachment in a high-myopic patient. Laser photocoagulation has been shown to reduce the risks of retinal detachment before phacoemulsification thus improve in the visual outcome. We report a case of a high myopic patient with symptomatic retinal tears who underwent phacoemulsification that was treated prophylactically with barrage laser photocoagulation.&#x0D; Case Illustration : A 43 years-old female with a history of high myopia complained of flashes and floaters on both eyes. She had high myopia measuring -13.0 dioptres and -28.0 dioptres in the right and left eyes respectively. Unaided visual acuity was 2/60 in both eyes. Fundus examination showed lattice degenerations with a small tear found on both eyes with no retinal detachments. She was treated with a barrage laser on both eyes followed by phacoemulsification. On the last follow-up, the retina remained stable and the visual acuity was significantly improved with no development of macular edema or retinal detachment in both eyes.&#x0D; Discussion : Although most cases of lattice degeneration do not need intervention, some present a risk of retinal detachment. Barrage laser photocoagulation may have a place in high myopic patient lattice degeneration with symptomatic retinal tears to maintain retinal stability and to obtain the optimal outcome after phacoemulsification.&#x0D; Conclusion : Barrage laser photocoagulation is beneficial as a prophylactic treatment of symptomatic retinal tears before phacoemulsification in high-myopic patients.

Macular edema in ocular inflammation

Aim of this paper is to present the pathophysiological processes and the ultrastructure of the retina, important for the formation and development of macular edema. Macular edema is defined as an abnormal leakage and fluid and/ protein accumulation in the external plexiform layer and inner nuclear layer (on/under the macula), as well as swelling of Muller cells that lead to its thickening and swelling. It occurs as consequence of increased leakage from the retinal perifoveal capillaries and consequential macular thickening that, if it lasts longer than 6 months, is seen as chronic in nature. Based on clinical and imaging techniques, macular edema is classified as ischemic and non-ischemic (cystoid or diffuse). Macular edema is not an isolated ocular disease but is rather a complication of an isolated ocular inflammation or of an ocular inflammation that's associated with systemic non-infectious (autoimmune) or infectious diseases. This paper, in addition to the pathogenesis and clinical manifestations of macular edema, also briefly covers imaging and treatment procedures and emphasizes the importance of treating the underlying inflammatory diseases that has led to the formation of the macular edema.

Incidence of Central Involving Macular Oedema After Cataract Surgery in Diabetic Retinopathy Patients – A Prospective Study

Aim: To study the incidence of central macular oedema at 4, 8 and 12 weeks following cataract surgery in diabetic retinopathy eyes. Materials and Methods: A prospective observational study was conducted over a period of 3 months to investigate the presence of centrally involved macular oedema following cataract surgery in diabetic retinopathy patients. Preoperative OCT scans were performed and patients without centrally involved macular oedema were enrolled. Subfield thickness (central, outer and inner) was measured preoperatively and at 4, 8 and 12 weeks postoperatively. The correlation between diabetic macular oedema (DME) and HbA1c, as well as random blood sugar (RBS) levels at the time of surgery, was analysed. Best.corrected visual acuity (BCVA) was assessed preoperatively and postoperatively, and fundus examinations were conducted each visit to evaluate diabetic retinopathy progression. Results: This study included 80 eyes from 44 patients. Postoperatively, central subfield thickness (CSF) increased significantly at first (14.7 μm), second (26.7 μm) and third (30.3 μm) compared to baseline. Inner subfield thickness (ISF) also increased at first (13.3 μm), second (20.6 μm) and third (24.3 μm) months, while the outer subfield thickness (OSF) showed progression from 6.7 μm to 16.6 μm from the first to third month. A statistically significant shift in DME was observed three months post.cataract surgery. There was a significant association between HbA1c levels and the development of DME, but no correlation with RBS levels. BCVA improved remarkably from preoperative mean log MAR of 0.75 to a mean log MAR of 0.1 at 3 months postoperatively. About 30% had mild non-proliferative diabetic retinopathy (NPDR) preoperatively, and in that group, 60% progressed to moderate NPDR. The status of moderate and severe NPDR remained the same postoperatively at 3 months. Of all patients who progressed to moderate NPDR, 3 cases developed non-central macular oedema, and three cases developed both central and non.central macular oedema postoperatively at 3 months. All eyes with severe NPDR resulted in DME, except for one (9.1%) eye. Conclusion: Preoperatively, 57.5% had no macular oedema, while 42.5% had non.central macular oedema. Postoperatively, 4.4% had central oedema, and 10.9% had both central and non.central oedema among those who initially had no macular oedema. Additionally, 38.2% developed oedema in both central and non.central regions among patients initially presenting with non-central macular oedema. There was also a significant statistical difference with longer duration of diabetes mellitus, severity of diabetic retinopathy and elevated HbA1c values with the development of diabetic macular oedema postoperatively. However, larger sample sizes and longer-term follow-up are essential for assessing retinopathy progression and the incidence of DME.

Can the Location of the Iris Claw Lens Influence the Development and Timing of Pseudophakic Macular Edema?

This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses. This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications. A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66±0.55 logMAR preoperatively and 0.38±0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%). PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.

Impact of prostaglandin analogues on the likelihood of macular edema development in a model of autoimmune uveitis against the background of ophthalmotonus pressure

Impact of prostaglandin analogues on the likelihood of macular edema development in a model of autoimmune uveitis against the background of ophthalmotonus pressure