Eye Complications Research Articles

Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis.

This review presents an overview of the available literature regarding intranasal corticosteroids (INCs) for the treatment of allergic rhinitis (AR). Various treatment options exist for AR including INCs, antihistamines and leucotriene antagonists. INCs are considered to be the most effective therapy for moderate-to-severe AR, as they are effective against nasal and ocular symptoms and improve quality of life. Their safety has been widely observed. INCs are effective and safe for short-term use. Local adverse events are observed but generally well-tolerated. The occurrence of (serious) systemic adverse events is unlikely but cannot be ruled out. There is a lack of long-term safety data. INC may cause serious eye complications. The risk of INCs on the hypothalamic-pituitary-adrenal axis, on bone mineral density reduction or osteoporosis and on growth in children, should be considered during treatment. Pharmacological characteristics of INCs (e.g. the mode of action and pharmacokinetics) are well known and described. We sought to gain insight into whether specific properties affect the efficacy and safety of INCs, including nasal particle deposition, which the administration technique affects. However, advances are lacking regarding the improved understanding of the effect of particle deposition on efficacy and safety and the effect of the administration technique. This review emphasizes the gaps in knowledge regarding this subject. Advances in research and health care are necessary to improve care for patients with AR.

Assessment of Diabetic Patients' Adherence to Diabetic Retinopathy Screening and the Influencing Factors in Al-Ahsa, Saudi Arabia

BackgroundDiabetic retinopathy (DR) is one of the diabetic complications that leads to the loss of vision. Most diabetic patients will have DR that is varying in its severity under the effect of many factors such as type of diabetes, duration of diabetes, and poor glycemic control. This study aimed to assess the level of adherence of diabetic patients to diabetic retinopathy screening (DRS) and to identify the influencing factors of adherence among diabetic patients in Al Ahsa, Saudi Arabia.MethodsA cross-sectional study was conducted via a self-administered questionnaire among diabetic patients who were attending the primary health-care centers in Al Ahsa, Saudi Arabia, from July to August 2021. This questionnaire included five sections: sociodemographic data, diabetic profile, assessment of the knowledge, attitude toward DRS, and barriers to DRS.ResultsA total of 397 diabetic patients were involved in the study. Diabetic ocular complications were reported among 35.3% of the patients. The most commonly reported diabetic eye complication was cataract (37.1%; 52) followed by retinopathy (36.4%). Among the participants, 32.2% had a good awareness level regarding DR. In addition, 46.9% of diabetic patients have DRS. The most reported barriers were having no visual or eye problems, difficulty getting an appointment, and the cost and lack of information about the screening procedure (50.9%, 50.1%, 42.1%, and 39.8%, respectively). ConclusionImprovement of patients’ knowledge is a significant step to enhancing adherence to DRS. The availability of screening programs and well-established ophthalmology clinics in primary healthcare centers in addition to trained physicians will help to overcome the barriers of DRS.

Diabetic Retinopathy May Covariate With Stroke in Diabetes Mellitus.

Diabetes mellitus is a chronic metabolic disorder with increasing prevalence per hour. Cataracts are one of the most common eye complications, and they affect all structures of the eye. The incidence of cataracts is increasing in patients with diabetes by several mechanisms. With the advancement of technology, cataract surgery is now a necessary procedure for diabetic patients. High-risk complications, like diabetic macular oedema, diabetic retinopathy (DR), phakic, postoperative cyst, and postoperative macular oedema, and macular oedema and endophthalmitis following surgery for a pseudocyst, could result in blindness. The importance of preoperative, intraoperative, and postoperative factors cannot be overestimated in managing complications and improving visual outcomes. DR can be a severe problem if it worsens and causes non-proliferative or proliferative DR or if fluid accumulation in the eye is diagnosed as macular oedema. A woman progressing to sight-threatening DR during childbearing age experiences distress and often requires ocular treatment. Diabetes that has been present for a more extended period, as well as more significant hyperglycaemia, hypertension, cardiovascular diseases, and elevated blood pressure, substantially predict the development of DR. Oxidative stress can be caused by hyperglycaemia, irregular metabolic processes, and people with DR developing neurodegeneration. Therefore, controlling postprandial hyperglycaemia is crucial for preventing DR. Femtosecond laser technology, multifocal intraocular lenses, and other surgical innovations are popularly referred to as surgical management; it will be engaged in the coming era to determine whether there will be a continued reduction in the complication of cataract surgery. This article aims to review the correlation of DR with stroke and its screening and to outline the critical management strategies.

Midterm results of conjunctival reconstruction with buccal mucosa and amniotic membrane after resecting ocular surface squamous neoplasia of the fornix

ObjectifÉvaluer les résultats à mi-parcours de la résection d'une tumeur avec ou sans traitement d'appoint d'une néoplasie squameuse de la surface oculaire touchant le fornix, traitement qui incluait une reconstruction conjonctivale par greffe de muqueuse buccale et de membrane amniotique. MéthodesIl s'agit ici d'une analyse rétrospective portant sur une série de cas qui comprenait les résultats de l'examen à la lampe à fente, des photographies et les résultats de la biopsie (qui était répétée en cas de nouvelles observations cliniques). L'analyse portait sur la fonction oculaire, les complications, les interventions supplémentaires et le taux de récurrence. La technique chirurgicale reposait sur la résection de la tumeur et la reconstruction de la portion de la conjonctive excisée par greffe de muqueuse buccale et de membrane amniotique. RésultatsNotre étude a regroupé 83 yeux provenant de 76 patients (âge moyen : 63,10 ± 14,45 ans; 34 femmes); la durée moyenne du suivi a été de 26,56 ± 21,17 mois. Nous avons réussi à préserver le globe oculaire dans 82 yeux (98,79 %) et, en général, à conserver l'acuité visuelle (acuité visuelle moyenne de 0,2 ± 0,5 logMAR et de 0,3 ± 0,5 logMAR lors de l'examen initial et au moment du dernier suivi, respectivement). Qui plus est, seulement 23 patients (27,71 %) ont dû subir une chirurgie réparatrice en raison de complications cliniques connexes. Au nombre des principales complications, citons le symblépharon (9,64%; n = 8), l'ectropion cicatriciel (9,64 %; n = 8), le pannus (9,64 %; n = 8) et la décompensation cornéenne (8,43 %; n = 7). Enfin, 23 patients (27,71 %) ont subi une récurrence locale de leur tumeur. ConclusionsCes résultats à mi-parcours confirment l'efficacité de la reconstruction conjonctivale par greffe de muqueuse buccale et de membrane amniotique après résection d'une néoplasie squameuse de la surface oculaire touchant le fornix et comprenant une atteinte de la conjonctive palpébrale et bulbaire. Non seulement avons-nous été en mesure d'obtenir une bonne maîtrise de la tumeur, un bon pourcentage de conservation du globe oculaire et des taux élevés de préservation des tissus transplantés, mais nous avons en outre réussi à obtenir de bons résultats fonctionnels et un taux de récurrence acceptable. Toutes les complications cliniquement significatives ont pu être corrigées dans le cadre d'interventions distinctes.

Awareness and Compliance Behavior of Diabetic Patients for Eye care to Prevent Diabetic Retinopathy: The Status of Jazan Region, Saudi Arabia

Background: Diabetic retinopathy (DR) as a complication of diabetes mellitus (DM) and other diabetic complications are of great worldwide concern. In order to control both DM and DR, patients must be informed and comply with prevention and treatment recommendations. Objectives: The study aimed to assess the knowledge, attitudes, and patient compliance behavior regarding DR among diabetic patients from Jazan Region of Saudi Arabia and identify factors related to patient awareness and compliance. Patients and Methods: This cross-sectional study was done on 385 diabetic patients from six primary healthcare centers in Jazan region. A self-administered questionnaire was used to solicit responses regarding knowledge, attitudes, and compliance with regular ophthalmic eye examinations. The questionnaire also comprised questions related to the sociodemographic data and other questions related to the diabetic status. The collected responses were presented as frequencies and percentages, and the associations between the variables were accomplished using Chi-squared test. P-value < 0.05 was considered significant. Results: About half of the participants (50.6%) were females, and 51.4% were within the age group 45-64 years. Less than half of the participants (40.8%) had low monthly income, and 45.5% were illiterate or had primary education. About 33.6% of the participants had the disease for more than 10 years, and 90.1% were controlled. There was a high awareness level of diabetes-related eye complications (96.4%) and the need for regular eye exams (93.5%). About 54.0% had never seen an ophthalmologist. Participants in the low to medium economic levels and those with primary education had a significant positive attitude. No significant associations were found between the diabetic variables and most of the knowledge and attitude questions (P> 0.05). Conclusion: There is a need to increase patient awareness about the complications of diabetes and the need for policy guidance for primary healthcare providers to follow best practices when treating diabetic patients to guard against and/or control its complications. Keywords: Diabetes, Knowledge, Attitudes, Ophthalmic eye examination, Compliance, Behavior, Diabetic retinopathy, Jazan.

Prediction of complications of type 2 Diabetes: A Machine learning approach

AimTo construct predictive models of diabetes complications (DCs) by big data machine learning, based on electronic medical records. MethodsSix groups of DCs were considered: eye complications, cardiovascular, cerebrovascular, and peripheral vascular disease, nephropathy, diabetic neuropathy. A supervised, tree-based learning approach (XGBoost) was used to predict the onset of each complication within 5 years (task 1). Furthermore, a separate prediction for early (within 2 years) and late (3–5 years) onset of complication (task 2) was performed. A dataset of 147.664 patients seen during 15 years by 23 centers was used. External validation was performed in five additional centers. Models were evaluated by considering accuracy, sensitivity, specificity, and area under the ROC curve (AUC). ResultsFor all DCs considered, the predictive models in task 1 showed an accuracy > 70 %, and AUC largely exceeded 0.80, reaching 0.97 for nephropathy. For task 2, all predictive models showed an accuracy > 70 % and an AUC > 0.85. Sensitivity in predicting the early occurrence of the complication ranged between 83.2 % (peripheral vascular disease) and 88.5 % (nephropathy). ConclusionsMachine learning approach offers the opportunity to identify patients at greater risk of complications. This can help overcoming clinical inertia and improving the quality of diabetes care.

Deep Capillary Nonperfusion on OCT Angiography Predicts Complications in Eyes with Referable Nonproliferative Diabetic Retinopathy

To evaluate the ability of capillary nonperfusion parameters on OCT angiography (OCTA) to predict the development of clinically significant outcomes in eyes with referable nonproliferative diabetic retinopathy (NPDR). Prospective longitudinal observational study. In total, 59 patients (74 eyes) with treatment-naive moderate and severe (referable) NPDR. Patients were imaged with OCTA at baseline and then followed-up for 1 year. We evaluated 2 OCTA capillary nonperfusion metrics, vessel density (VD) and geometric perfusion deficits (GPDs), in the superficialcapillary plexus, middle capillary plexus (MCP), and deep capillary plexus (DCP). We compared thepredictive accuracy of baseline OCTA metrics for clinically significant diabetic retinopathy (DR) outcomes at1year. Significant clinical outcomes at 1 year, defined as 1 or more of the following-vitreous hemorrhage, center-involving diabetic macular edema, and initiation of treatment with pan-retinal photocoagulation or anti-VEGF injections. Overall, 49 patients (61 eyes) returned for the 1-year follow-up. Geometric perfusion deficits and VD in the MCP and DCP correlated with clinically significant outcomes at 1 year (P < 0.001). Eyes with these outcomes had lower VD and higher GPD, indicating worse nonperfusion of the deeper retinal layers than those that remained free from complication. These differences remained significant (P= 0.046 to < 0.001) when OCTA parameters were incorporated into models that also considered sex, baseline corrected visual acuity, and baseline DR severity. Adjusted receiver operating characteristic curve for DCP GPD achieved an area under the curve (AUC) of 0.929, with sensitivity of 89% and specificity of 98%. In a separate analysis focusing on high-risk proliferative diabetic retinopathy outcomes, MCP and DCP GPD and VD remained significantly predictive with comparable AUC and sensitivities to the pooled analysis. Evidence of deep capillary nonperfusion at baseline in eyes with clinically referable NPDR can predict short-term DR complications with high accuracy, suggesting that deep retinal ischemia has an important pathophysiologic role in DR progression. Our results suggest that OCTA may provide additional prognostic benefit to clinical DR staging in eyes with high risk.

Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study.

PurposeWe aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU.Materials and methodPatients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratios, partial pressure of carbondioxide (PaCO2), PEEP, and FiO2 were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected.ResultsIn all positions, PaO2 value during PP was significantly higher than PaO2 before and after prone position (p = 0.001). PaO2 values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO2 values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO2/FiO2 increases after proning compared to before proning. PaO2/FiO2 during PP were higher compared to before proning ones. PaO2/FiO2 during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO2 levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient.ConclusionWe believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

The diagnosis and treatment of Bell’s palsy

Bell’s palsy is an idiopathic peripheral nerve disorder involving the facial nerve. It is of rapid onset, and almost always unilateral. It is the most common diagnosis associated with facial nerve palsy. It has been described in patients of all ages, but the incidence is slightly higher after age 40. Methods: Using internet search, a comprehensive literature review was done and words such as facial nerve palsy, Bell’s palsy were searched. Results: In confirmed Bell’s palsy, unless contraindicated, corticosteroids should be given to all patients with Bell’s palsy as early as possible, (ideally within 72 hours). Combination therapy with steroids and antiviral agents are recommended for patients with severe to complete paresis. Patients with incomplete eye closure should be given eye protection, with lubricating drops and ointments, to prevent corneal damage. Conclusion: Establishing the correct diagnosis is imperative to avoid missing another treatable condition. Determining whether the facial nerve paralysis is central or peripheral is important. The history of a Bell’s palsy case should include discomfort or sensory symptoms in the distribution of the facial nerve in the hours or days preceding facial palsy, and it is very important to reveal whether the symptoms were progressive in nature. Although many patients with Bell palsy will experience improvement in their facial nerve function without treatment, persistent facial weakness can have implications for quality of life. Choosing the correct treatment options for suitable patients can optimize the likelihood of recovery. Oral steroids should be prescribed within 72 hours of symptoms onset for Bell’s palsy patients. Combined steroid and antiviral treatment are recommended for patients with severe to complete paresis. Physiotherapy may be suggested in severe Bell’s palsy. Surgical decompression is not recommended and may be considered in severe facial nerve degeneration on electroneuronography if the patient is willing to accept the surgical risks. Eye protection remains crucial in preventing long-term eye complications. Clinical and ophthalmological follow-up, and referral to a specialist for patients with no improvement or progressive weakness are recommended. Key words: Facial nerve palsy, Bell’s palsy, Glucocorticoids, Antiviral.

Effects of Recombinant Human Epidermal Growth Factor Eye Drops Combined with Phacoemulsification on Short- and Long-Term Visual Acuity Recovery and Related Dry Eye Complications in Patients with Senile Cataract.

Objective To investigate the effects of recombinant human epidermal growth factor eye drops combined with phacoemulsification on short- and long-term visual acuity recovery and related dry eye complications in patients with senile cataract. Methods Sixty patients with senile cataract cured from January 2019 to January 2021 were enrolled in our hospital. The patients in the control group were arbitrarily assigned into the control and the research group. The former group received phacoemulsification, and the latter group received recombinant human epidermal growth factor (RhEGF) eye drops combined with phacoemulsification. The curative effect, the incidence of xerophthalmia, short-term and long-term vision improvement, changes of corneal endothelial cells, serum factors, and life quality scores were compared. Results The effective rate of the research group was 90.00%, and the effective rate of the control group was 66.67%; the curative effect of the research group was higher than that of the control group (P < 0.05). The incidence of dry eye in the research group was lower than that in the control group (P < 0.05). The short-term and long-term visual acuity improvement effect of the research group was better than that of the control group (P < 0.05). After treatment, the density of corneal endothelial cells in the research group was higher than that in the control group, while the proportion of hexagonal cells and the coefficient of variation of corneal endothelial cells in the research group were lower than those in the control group (P < 0.05). After treatment, IL-6 and TNF-α in the research group were lower than those in the control group (P < 0.05). Compared with the control group, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower (P < 0.05). Conclusion Cataract is the leading cause of blindness in the world. With the continuous improvement of cataract phacoemulsification technology, the incidence of some serious complications has gradually lessened. Xerophthalmia is one of the most obvious and predictable complications after cataract surgery and may affect the recovery of postoperative visual acuity. Recombinant human epidermal growth factor eye drops can effectively enhance the visual acuity of patients, promote the curative effect, and strengthen the life quality.

Metabolic Status Modulates Choroidal Thickness - A Possible Early Indicator for Diabetic Eye Complications?

To investigate the impact of metabolic status on choroidal thickness (ChT) in healthy subjects, patients with obesity, and type 2 diabetes. Fasting blood glucose, insulin, insulin-like growth factor-1 (IGF-1), and ChT measured by optical coherence tomography were assessed in healthy normal-weight (n=17), obese participants (n=20), and obese participants with T2D (n=16). ChT increased in obese participants and obese participants with T2D as compared to healthy normal-weight participants (P<0.0001). A negative correlation was observed between IGF1 and ChT (r=-0.268, P=0.050) for all cohorts. Furthermore, body mass index (BMI; R2=0.209; P=0.002; beta=0.388) and model assessment-estimated insulin resistance (HOMA-IR; R2=0.074; P=0.015; beta=0.305) were independent variables of ChT, explaining 20.9 and 7.4% of its variance (both p<0.016), whereas age, sex, and IGF-1 were not significant confounders of ChT (p>0.975). ChT is associated with metabolic characteristics, i. e., BMI and HOMA-IR. Due to the key role of choroidal function in retinal physiology, future studies are needed to evaluate whether metabolic traits, ChT, and potential metabolic eye complications are mechanistically linked.

Incidence of eye complications among sickle cell disease patients in Jeddah, Saudi Arabia: A cross-sectional study

IntroductionSickle cell disease (SCD) is a heritable blood disorder resulting in deformed, rigid red blood cells, rendering them more prone to vaso-occlusion. Ocular complications are known to affect multiple organs through the body's vasculature. Here, we evaluated the incidence of eye complications in patients with SCD at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Materials and methodsWe used a cross-sectional approach and collected relevant medical data from nine patients with SCD. Ophthalmic assessment included visual acuity and an in-clinic dilated fundus examination. All patients were asked to attend the ophthalmology clinic to undergo optical coherence tomography (OCT) angiography, macular OCT scan, and fundus photography. The results of the imaging tests were interpreted by a certified ophthalmology consultant specializing in retinal diseases. Descriptive analyses of the results were also performed. ResultsThe mean age of the nine patients was 24.78 ± 10.9 years. All patients were non-hypertensive, one had type 1 diabetes, and another had type 2 diabetes. Five patients had normal visual acuity, two had slight impairments in at least one eye, and two had moderate impairment in at least one eye. One of the nine patients exhibited retinal ischemia in the right eye despite normal macular thickness (visual acuity, OD, 6/30; OS, 6/21). The remaining eight patients showed no ocular abnormalities. ConclusionOf the nine patients with SCD, five showed no symptoms of ocular complications. One patient showed retinal ischemia in the right eye, despite a normal macular thickness. This study's results suggest routine ophthalmologic examination may not be able to detect or monitor macular or retinal abnormalities unless augmented with detailed imaging techniques.

Efficacy and safety of atropine to control childhood myopia progression

Introduction: Nearsightedness is one of the most common eye defects in people all over the world. If left untreated, it leads to a number of serious eye complications that can result in irreversible loss of vision. It is estimated that by 2050. Half of humanity will be burdened with this disadvantage, so it has become a priority to try to find ways to prevent and treat myopia, among which the administration of atropine drops is very effective.&#x0D; Aim of the study: The aim of this study is to evaluate the safety and efficacy of atropine in controlling the progression of myopia and to investigate the relationship between the dose of atropine and the effectiveness of controlling the progression of myopia.&#x0D; Material and methods: The PubMed and Google Scholar databases were used to review the literature.&#x0D; Results: Eye drops with 1% atropine showed the greatest efficacy in the control of myopia. However, their use was limited due to the occurrence of side effects such as impaired accommodation and photophobia. In the ATOM 2 study, which investigated the use of atropine in a variety of concentrations, it was found that 0.01% is the optimal concentration with good efficacy and minimal side effects. One of the breakthroughs was the LAMP study using atropine at a concentration of 0.05%, 0.025%, 0.01% in eye drops. This study provided evidence for the first time that low-concentration atropine is effective compared with placebo in myopia. In addition, both efficacy and side effects followed a concentration-dependent response ranging from 0.01% to 0.05% of atropine. Among them, 0.05% of atropine was the optimal concentration to achieve the best efficacy and safety profile.&#x0D; Conclusion: Low concentration of atropine is effective in the control of myopia. Its widespread use can help prevent the progression of myopia. However, further investigation of the rebound phenomenon and a long term, individualized approach to treatment are warranted.&#x0D; &#x0D;

Intraoperative complications and visual outcomes of cataract surgery in patients with retinal vein occlusion: multicenter database study.

To compare the visual outcomes and the rate of intraoperative complications in eyes with and without retinal vein occlusion (RVO) after phacoemulsification over a period of 15 years in a real-world clinical setting. 8 independent U.K. National Health Service ophthalmology departments. Retrospective, multicenter cohort study. Eyes were classified based on the presence or absence of RVO. For analyzing visual acuity (VA) and the incidence of postoperative cystoid macular edema, eyes with any copathology, combined ocular surgical procedures, and intraoperative complications, or of diabetic patients were excluded. Of 178 856 eyes, 1796 eyes with RVO preoperatively and 177 060 eyes without RVO were allocated to the RVO group and the reference group, respectively. Cataract surgery in eyes with RVO was associated with an improvement in the mean VA of 0.35 logMAR (3 to 4 Snellen lines), and a substantial gain (≥0.30 logMAR units [3 Snellen lines]) was achieved in 55.10% of eyes at 4 to 12 weeks postoperatively. The mean postoperative VA was worse in eyes with RVO compared with that in eyes without RVO at 4 to 12 weeks (logMAR 0.40 vs 0.12 [20/50 vs 20/25]; P < .0001). The proportion of eyes achieving a visual gain of ≥ 0.3 logMAR (3 Snellen lines) was also lower in eyes with RVO (55.10% vs 64.55%; P = .0076). There was no statistically significant difference in posterior capsule rupture rates between the 2 groups (1.73% vs 1.72%; P = .9741). Although postoperative vision improved significantly in eyes with RVO after cataract surgery, this improvement was worse than that achieved by eyes without RVO.

Early Diabetic Retinopathy Detection Using Deep Learning Algorithms

Abstract: Diabetic Retinopathy (DR) is caused by the high blood glucose level which causes micro vascular complications in eyes which lead to vision loss. (MA)Microaneurysms formation in the retinal is sign of diabetic rent ropy which can be cured at early stage. Finding Microaneurysms (MA) presence in the eye image and recognition of diabetic retinopathy at early stage is difficult. Technology of deep learning makes it easier and efficient for analysis of eyes to detect MA presence which can be done by image detection and segmentation with good performance and accuracy using deep learning algorithms. This will help us to differentiated between affected retina and non-affected one. The given system can use deep convolution neural network for semantic segmentation of fundus images which increase efficiency and accuracy of NPDR (non- proliferated diabetic retinopathy) prediction. Keywords: PCA Principle Component Analysis DA Diabetic Retinopathy MA Microaneurysms NPDR Non proliferated diabetic retinopathy BPNN Back propagation neural network

KNOWLEDGE OF DIABETIC COMPLICATIONS AND PRACTICE OF ROUTINE MEDICAL CHECK-UP AMONG DIABETICS (&gt;10 YEARS) IN THE FIELD PRACTICE AREA OF GOVERNMENT MEDICAL COLLEGE, AMRITSAR

Context: Awareness about diabetic complications and regular medical check-up are essential for prevention, early detection and treatment of diabetic complications. Aims &amp; Objectives: 1. To assess the knowledge about diabetes complications among diabetic patients (&gt;10 years). 2. To evaluate the practices of routine medical check –up among Diabetics (&gt;10 years). Settings and Design: A community based cross-sectional study was conducted in rural and urban field practice areas of Government Medical College, Amritsar. Methods and Material: A total of 200 diabetic patients who had diabetes equal to or more than 10 years of duration were interviewed using pretested and predesigned questionnaire Statistical analysis used: Data such collected were analyzed and Chi-square/ Yates correction was used to know the level of significance at P &lt; 0.05. Results: Out of 200 respondents, 50% (100/200) were from urban area and 50% (100/200) were from the rural area. In both urban and rural areas, majority were literate and unemployed. The mean age of diabetic respondents was 61.08 years with a male to female ratio of 1.1:0.9. 44.5%(89) of the respondents were aware of diabetic complications(P&lt;0.05).92%(82), 89%(79), and 73%(65) of respondents had good knowledge about complications of Eye, Kidney and cardiac disease while respondents knowledge of Stroke and Nephropathy was inadequate i.e. 28%(25),47% (42) respectively. Only 25% (51) had followed definite routine for examination ,Out of which 61%(31) were doing health check up every 3 monthly and 27%(14) were doing every 6 monthly and 6(12%) were doing every yearly(P&lt;0.05). Conclusions: The practice of regular medical check-up was poor among diabetic patients, and this may be due to inadequate knowledge about specific diabetic complications.

Perspectives on the provision of diabetic retinopathy screening: Survey of eye health care professionals in Haryana.

Purpose:To examine the current provision and practice patterns of diabetic retinopathy screening (DRS) in Haryana.Methods:This was a descriptive cross-sectional survey in Haryana. All ophthalmologists registered with Haryana Ophthalmological Society in Haryana state were invited to participate on an online survey comprised of twenty questions exploring diabetic retinopathy screening provision, and barriers to screening services in Haryana.Results:The response rate was 82% (153/186). The majority (84%) of the eye care providers practiced in urban areas. Most ophthalmologists (89%, 136/153), considered diabetic retinopathy screening by non-ophthalmic human resource inappropriate because of technical feasibility issues (62%) followed by non-availability of trained staff (33%). Only half (54%) of the respondents had access to written protocols for the diagnosis and management of diabetic retinopathy in their practice. Barriers to optimize diabetic retinopathy screening were lack of knowledge or awareness among patients (95.5%), perception that eye complications were unlikely (76%) and cost of care (30%).Conclusion:Diabetic retinopathy screening practices are mainly opportunistic and urban-centric, likely delivering inequitable services for the rural populations in the state. The inclusion of other personnel in screening will require stakeholder engagement from all health professions and changing the perceptions of ophthalmologists about task shifting.

Applying supervised contrastive learning for the detection of diabetic retinopathy and its severity levels from fundus images

Diabetic Retinopathy (DR) is a major complication in human eyes among the diabetic patients. Early detection of the DR can save many patients from permanent blindness. Various artificial intelligent based systems have been proposed and they outperform human analysis in accurate detection of the DR. In most of the traditional deep learning models, the cross-entropy is used as a common loss function in a single stage end-to-end training method. However, it has been recently identified that this loss function has some limitations such as poor margin leading to false results, sensitive to noisy data and hyperparameter variations. To overcome these issues, supervised contrastive learning (SCL) has been introduced. In this study, SCL method, a two-stage training method with supervised contrastive loss function was proposed for the first time to the best of authors' knowledge to identify the DR and its severity stages from fundus images (FIs) using “APTOS 2019 Blindness Detection” dataset. “Messidor-2” dataset was also used to conduct experiments for further validating the model's performance. Contrast Limited Adaptive Histogram Equalization (CLAHE) was applied for enhancing the image quality and the pre-trained Xception CNN model was deployed as the encoder with transfer learning. To interpret the SCL of the model, t-SNE method was used to visualize the embedding space (unit hyper sphere) composed of 128 D space into a 2 D space. The proposed model achieved a test accuracy of 98.36%, and AUC score of 98.50% to identify the DR (Binary classification) and a test accuracy of 84.364%, and AUC score of 93.819% for five stages grading with the APTOS 2019 dataset. Other evaluation metrics (precision, recall, F1-score) were also determined with APTOS 2019 as well as with Messidor-2 for analyzing the performance of the proposed model. It was also concluded that the proposed method achieved better performance in detecting the DR compared to the conventional CNN without SCL and other state-of-the-art methods.

Peripheral anterior synechiae after selective laser trabeculoplasty among Chinese patients.

Peripheral anterior synechiae (PAS) have been reported as a complication after argon laser trabeculoplasty, but rarely reported after selective laser trabeculoplasty (SLT). This study aims to determine the incidence and predictors of this potential complication in phakic eyes of Chinese patients. A retrospective review of consecutive Chinese phakic patients who underwent SLT for primary open-angle glaucoma or ocular hypertension from 2011 to 2015 was analyzed for post-operative outcomes, including the development of PAS. There was a total of 292 patients (509 eyes) that were of Chinese ethnicity and eligible in our analysis. The 4-year incidence of PAS was 13.57% for the 221 eyes with documented gonioscopy after SLT, and the time, since first SLT, to PAS diagnosis was 5.62years (2052 ± 75.2days). After accounting for the inter-eye correlation by the mixed effect Cox regression model (AUC = 0.885), the predictors of earlier PAS diagnosis were baseline intraocular pressure (≥ 18 versus < 18) (HR = 4.6, p = 0.031), baseline use of bimatoprost (HR = 14.97, p = 0.006), and pre-existing hypertension (HR = 11.78, p = 0.016). There was no significant association of earlier PAS diagnosis with age (p = 0.434), baseline number of medications used (p = 0.693), and baseline use of brinzolamide (p = 0.326). PAS development after SLT appears to be more common in Chinese patients, with a presumed 4-year incidence of 13.6%, based on retrospective review of eyes with subsequent documented gonioscopy findings. Hong Kong University Clinical Trials Registry (HKUCTR-2350).

Diabetische Augenkomplikationen: Screenen - erkennen - behandeln

Diabetische Augenkomplikationen: Screenen - erkennen - behandeln