History Of Diabetic Retinopathy Research Articles

Evaluation of optical coherence tomography angiography metrics in children and adolescentswith type 1 diabetes: 4-year longitudinal study.

To evaluate longitudinal changes in optical coherence tomography angiography (OCTA) metrics in children and adolescents with type 1 diabetes (T1D). This prospective observational cohort study included thirty-two eyes from thirty T1D children with no history of diabetic retinopathy (DR) who were followed up for 4 years. Participants underwent OCTA examinations at baseline and during follow-up. Quantitative OCTA metrics were measured using a customized MATLAB algorithm. Generalized mixed-effect models were used to determine their relationship with DR development. Systemic parameters and OCTA metrics were screened using least absolute shrinkage and selection operator to identify predictors for visual function. Over the 4-year period, seven of the included eyes developed DR, and most OCTA metrics decreased with diabetes duration. Higher peripapillary and parafoveal nasal quadrant vessel area density (VAD) in the superficial capillary plexus (SCP) and vessel skeleton density (VSD) in both the SCP and the deep capillary plexus (DCP) were associated with a lower risk of DR in T1D. Parafoveal DCP VSD and VAD in the temporal and inferior quadrants were anticorrelated with changes in best corrected visual acuity. OCTA metrics dynamically change over the duration of diabetes and can be used as biomarkers to improve the risk evaluation of DR development and visual function in T1D children and adolescents.

Retinal age gap as a predictive biomarker for future risk of clinically significant diabetic retinopathy.

Retinal age derived from fundus images has been verified as a novel ageing biomarker. We aim to explore the association between retinal age gap (retinal age minus chronological age) and incident diabetic retinopathy (DR). Retinal age prediction was performed by a deep learning model, trained and validated based on 19,200 fundus images of 11,052 disease-free participants. Retinal age gaps were determined for 2311 patients with diabetes who had no history of diabetic retinopathy at baseline. DR events were ascertained by data linkage to hospital admissions. Cox proportional hazards regression models were performed to evaluate the association between retinal age gaps and incident DR. During the median follow-up period of 11.0 (interquartile range: 10.8-11.1) years, 183 of 2311 participants with diabetes developed incident DR. Each additional year of the retinal age gap was associated with a 7% increase in the risk of incident DR (hazard ratio [HR] = 1.07, 95% confidence interval [CI] 1.02-1.12, P = 0.004), after adjusting for confounding factors. Participants with retinal age gaps in the fourth quartile had a significantly higher DR risk compared to participants with retinal age gaps in the lowest quartile (HR = 2.88, 95% CI 1.61-5.15, P < 0.001). We found that higher retinal age gap was associated with an increased risk of incident DR. As an easy and non-invasive biomarker, the retinal age gap may serve as an informative tool to facilitate the individualized risk assessment and personalized screening protocol for DR.

Comparison of Cataract Surgery Outcomes in Patients with Type 1 versus Type 2 Diabetes and Patients without Diabetes.

To report outcomes of cataract surgery in type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM) and patients without diabetes (DM). Academic tertiary referral university hospital eye center, Aurora, CO, USA. Retrospective chart review using the University of Colorado Cataract Outcomes Database for all cataract surgeries between 2014-2020. Demographics, ocular history, and postoperative outcomes were compared across groups using general linear and logistic regression modeling with estimating equations to account for some patients having two eyes included. A total of 8117 patients and 13,383 eyes were included. Compared to T2DM eyes undergoing cataract surgery (n=3115), T1DM eyes (n=233) were more likely to have a history of diabetic retinopathy (DR) (60.5% vs 23.6%), p<0.0001), of which proliferative DR was the most common (63.1% vs 42.4%, p<0.0001). T1DM eyes were also more likely to have a history of retinal detachment (RD) (9.0% vs 2.9%, p<0.0001) and prior vitrectomy surgery (12.9% vs 4.0%, p<0.0001). Despite having similar preoperative best-corrected visual acuity (BCVA) as T2DM eyes (logMAR 0.52 vs. 0.44, p=0.092), T1DM eyes had worse BCVA following cataract surgery (logMAR 0.27 vs 0.15, p=0.0003). In a multivariable analysis, a history of proliferative DR and prior RD were significant predictors of worse postoperative BCVA (p<0.0001) but type of DM was not (p=0.894). T1DM eyes have worse visual outcomes after cataract surgery compared to T2DM eyes. Worse postoperative visual acuity was associated with worse preoperative diabetic retinopathy and history of retinal detachment rather than type of DM.

A Case of Seropositive Autoimmune Glial Fibrillary Acidic Protein Encephalitis with Renal Cell Carcinoma (P4-5.010)

<h3>Objective:</h3> NA <h3>Background:</h3> Autoimmune glial fibrillary acidic protein (GFAP) encephalitis is a novel disorder characterized for subacute neuropsychiatric symptom development and rapid remission with corticosteroid therapy. Here we describe a case of GFAP encephalitis presenting with renal cell carcinoma (RCC). <h3>Design/Methods:</h3> A 71-year-old man with a history of diabetic retinopathy and monoclonal gammopathy of undetermined significance (MGUS) presented for four months history of memory problems, intermittent word-finding difficulties and later development of auditory hallucinations requiring assistance with activities of daily living. On admission, he was oriented to person, his language was affected with decreased fluency and difficulty following commands. On work up, metabolic causes, toxins, and nutritional deficiencies were ruled out. Brain MRI was degraded by motion artifacts, but no obvious abnormality was appreciated. Lumbar puncture was remarkable for leukocytosis (37 WBC), but infectious workup was negative. Creutzfeldt Jakob Disease was ruled out with a negative RT-QUiC following a 14-3-3 protein level elevation. Mayo autoimmune panel detected GFAP IgG (1:16, reference &lt;1:2), with follow up imaging showing RCC confirmed on nephrectomy. Patient was treated with daily intravenous methylprednisolone 1000mg for 5 days and showed improvement. However, the day after treatment was stopped, he had a rapid decline in cognition. Long term steroid treatment with 1mg/kg/day prednisone and steroid sparing agent, mycophenolate 500mg BID were started. Patient returned to baseline after four days and was discharged. <h3>Results:</h3> NA <h3>Conclusions:</h3> Although there is no specific diagnostic criteria, the identification of GFAP-IgG in serum or CSF is a marker of disease and the patient’s response to corticosteroid treatment further supports an autoimmune etiology. Further work is needed to create stringent diagnostic criteria and treatment protocols for GFAP encephalopathy and its associations with neoplasms. <b>Disclosure:</b> Ms. Arrabothu has nothing to disclose. Mr. Govindan has nothing to disclose. Dr. Rodriguez has nothing to disclose. Ms. Xie has nothing to disclose. Dr. Tapia has nothing to disclose.

Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery.

To investigate whether a history of prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) predisposes to the development of pseudophakic cystoid macular edema (CME). New York Eye and Ear Infirmary of Mount Sinai, New York, New York. Retrospective cohort study. Records of 365 subjects who underwent PPV for RRD and subsequent cataract surgery between 2017 and 2020 were reviewed. Patients with a history of diabetic retinopathy, inflammatory retinal vascular disease, uveitis, advanced age-related macular degeneration, intraocular infection, myopic maculopathy, or significant intraoperative complications precluding posterior chamber intraocular lens placement were excluded. Age-matched subjects who underwent routine cataract surgery served as controls. Clinical data and macular optical coherence tomography (OCT) findings up to 4 years postoperatively were obtained. 54 eyes underwent uneventful cataract surgery by phacoemulsification and had a history of PPV with gas tamponade. 55 eyes underwent uneventful cataract surgery only. The average follow-up time after cataract surgery was 39.1 months. In eyes with a history of PPV, the incidence of OCT-detected CME was 27.8% (15/54) compared with 3.8% (2/55) in the control group ( P < .001) and the incidence of clinically significant CME was 18.5% (10/54) compared with 1.8% (1/55) in the control group ( P = .004). 80% (12/15) of CME cases were treated with topical therapy, and none required intravitreal injection. Prior PPV for RRD is associated with an increased incidence of pseudophakic CME after uneventful cataract surgery. Prophylactic or prolonged postoperative anti-inflammatory topical therapy may be prudent to consider in these patients.

Vitreous hemorrhage during GLP-1 receptor agonist treatment

BackgroundThe purpose of this case report is to describe a case of vitreous hemorrhage in a patient with a history of diabetic retinopathy and receiving dulaglutide for the management of type 2 diabetes mellitus (T2DM). Case summaryA 64-year-old African American male with a past medical history of T2DM and severe diabetic retinopathy for 4 years was restarted on dulaglutide 1.5 mg weekly after being off therapy for 3 months. Baseline laboratory test results included hemoglobin A1c (HbA1c) of 8.8% and random blood glucose (BG) of 280 mg/dL. In addition, the patient had an average fasting BG of 150 mg/dL. In absence of intolerance, the dulaglutide dose was gradually maximized to 4.5 mg weekly and HbA1c decreased to 7.3% and random BG to 121 mg/dL at week 12 since reinitiation. At week 17 of therapy, the patient presented to the emergency department with a 1-day history of vision loss in the left eye and was diagnosed as having vitreous hemorrhage. The etiology for vitreous hemorrhage is unclear and may be a spontaneous episode. In discussion with the patient and the ophthalmologist, dulaglutide was restarted at 1.5 mg once weekly. After 4 weeks of reinitiation, the patient denied any recurrent symptoms of vitreous hemorrhage or worsening diabetic retinopathy. The most recent ophthalmology evaluation indicated no change in diabetic retinopathy. Practice implicationsThis case report adds to the limited body of evidence available for the incidence of vitreous hemorrhage in the setting of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) therapy and pre-existing diabetic retinopathy. The case report illustrates that a history of diabetic retinopathy should not automatically preclude the use of GLP-1 RAs.

The Effectiveness of Laser Treatment for Diabetic Retinopathy in Patients with Chronic Kidney Disease

Background: Panretinal photocoagulation (PRP) remains one of the effective methods of treatment in pre- and proliferative forms of retinopathy with high efficiency. The aim of this study was to investigate the efficacy of PRP depending on the somatic status, laboratory parameters, and the severity of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and a history of diabetic retinopathy (DR). Methods and Results: The study included 76 patients (50 women and 26 men) with T2D who underwent PRP for DR (152 eyes) using a VISULAS® 532s solid-state laser (ZEISS). The patients were divided into two groups depending on the severity of CKD. Group 1 (n=32, 64 eyes) included patients with CKD Stage 1, Group 2 (n=44, 88 eyes) included patients with CKD Stage 2. All patients underwent standard ophthalmological examination: visometry, tonometry, perimetry, biomicroscopy of the anterior segment of the eye and vitreous body, and fundus ophthalmoscopy. Thickness map of the retina was obtained using the RTVue-100 OCT (Optovue, Fremont, CA) EMM5 scan protocol and the Stratus OCT (Carl Zeiss Meditec, USA) radial scan protocol. Laboratory methods included a general blood test, PPG, FG, HbA1c, general urine analysis, and the assessment of blood levels of creatinine, ALT, and AST. PRP was carried out according to the standard method, gradually, in three stages; the interval between the stages of laser treatment was 1 month. After laser treatment, all patients, regardless of the treatment stage, were prescribed topical Broxinac® (Bromfenac ophthalmic solution 0.09%). The dynamics of corrected visual acuity (CVA) parameters and the retinal thickness of the macular region were assessed before PRP and 3 months after the complex treatment. Multivariate analysis revealed a linear and nonlinear effect of lipid spectrum indicators (TC and LDL) on the formation of CL (crystalline lens) pathology. After treatment, a significant increase in CVA was noted in both study groups. The effectiveness of PRP coagulation depended on the severity of the CKD stage in T2D patients with DR. Normalization of morphometric parameters of the macular region of the retina was noted in 93.8% of cases in Group 1 and in 86.4% of cases in Group 2. The decrease in the effectiveness of treatment was associated with the presence of macroangiopathy (CAD), concomitant diseases (CHF, AH and dyslipidemia), and CKD stage. Conclusion: Prolonged administration of the non-steroidal, anti-inflammatory drug Bromfenacum® for a month after each stage of PRP is effective.

Rates of diabetic retinopathy screening in pregnant patients with type 1 and type 2 diabetes in a predominantly Indigenous Central Australian population

Pregnancy is a risk factor for the progression of diabetic retinopathy (DR) in women with pre-gestational diabetes. Australian screening guidelines recommend DR screening in the first trimester of pregnancy. The rates of DR screening in pregnant patients with pre-gestational diabetes are unknown in Australia. To determine the rates of DR screening in pregnant women with pre-gestational diabetes at Alice Springs Hospital Diabetes Antenatal Care and Education (DANCE) clinic. Retrospective review of women with pre-gestational diabetes who attended the DANCE clinic between July 2016 and June 2020. There were 146 pregnancies in 144 individual women included in this review. There were 93% (n=134) who identified as Aboriginal but not Torres Strait Islander. DR screening was performed in 23 (16%) pregnancies, in which DR was present in six (26%) and no retinal abnormality was found in 17 (74%). Of seven (5%) women who had a history of DR, only three had a screen during the pregnancy period. The location of the DR screen included Alice Springs Hospital (17%, n=4), Alice Springs general practice clinics (35%, n=8) and remote NT community clinics outside of Alice Springs (39%, n=9). The trimesters in which women received their DR screens were: trimester 1, 45%, n=10; trimester 2, 39%, n=9; trimester 3, 17%, n=4. The minority of pregnant women who attend the DANCE clinic at Alice Springs Hospital received DR screening in adherence with national guidelines.

FC 090EFFECTS OF FINERENONE ON CARDIORENAL OUTCOMES IN BLOOD PRESSURE SUBGROUPS IN PATIENTS WITH CKD AND T2D

Abstract Background and Aims Finerenone is a novel, selective, nonsteroidal mineralocorticoid receptor antagonist (MRA) that significantly reduced the risk of adverse kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the FIDELIO-DKD trial. In phase II studies, finerenone had modest effects on office blood pressure (BP) compared with the steroidal MRA spironolactone. We report an analysis of the relationship between baseline and changes in office systolic BP (SBP) and outcomes with finerenone in the FIDELIO-DKD trial. Method In FIDELIO-DKD, 5734 patients were randomised 1:1 to oral finerenone or placebo. Patients with T2D, urine albumin-to-creatine ratio (UACR) ≥30–&amp;lt;300 mg/g, estimated glomerular filtration rate (eGFR) ≥25–&amp;lt;60 ml/min/1.73 m2 and a history of diabetic retinopathy, or UACR ≥300–≤5000 mg/g and eGFR ≥25–&amp;lt;75 ml/min/1.73 m2, and treated with optimised renin–angiotensin system blockade were eligible. The primary endpoint was time to kidney failure, sustained eGFR decline ≥40% from baseline, or renal death. The key secondary endpoint was time to CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure. A Cox proportional hazards model was used to investigate the relationship between treatments and efficacy outcomes adjusted for baseline SBP and change in SBP from baseline to month 4. Results A total of 5669 patients with available baseline SBP data were analysed. At baseline, the mean SBP and diastolic BP were 138.0 and 75.8 mmHg, respectively. Patients treated for hypertension at baseline received an average of 3.3 antihypertensive therapies. The study population was stratified by quartiles (Q) of SBP at baseline: ≤128.7 mmHg (Q1); &amp;gt;128.7–≤138.3 mmHg (Q2); &amp;gt;138.3–≤148.0 mmHg (Q3); and &amp;gt;148.0 mmHg (Q4). Patients in higher SBP categories tended to be older, with higher median UACR, but similar mean eGFR at baseline. Effects of finerenone, estimated as hazard ratios (HRs), were consistent across the quartiles for the primary endpoint (HR [95% CI]: Q1, 0.87 [0.66–1.15]; Q2, 0.76 [0.59–0.98]; Q3, 0.81 [0.65–1.02]; Q4, 0.86 [0.70–1.07]; p-value for interaction=0.87) and the key secondary endpoint (HR [95% CI]: Q1, 0.95 [0.69–1.29]; Q2, 0.81 [0.60–1.10]; Q3, 0.79 [0.60–1.03]; Q4, 0.91 [0.70–1.18]; p-value for interaction=0.78) (Figure). Finerenone treatment resulted in a modest reduction in SBP; over the duration of the trial, overall mean difference in SBP between treatment groups was –2.7 mmHg. Maximum differences in SBP between finerenone and placebo were observed at month 4; the mean change in SBP from baseline to month 4 across SBP quartiles were: Q1: 4.99 and 9.01 mmHg; Q2: –0.85 and 2.43 mmHg; Q3: –5.63 and –2.40 mmHg; Q4: –11.76 and –6.44 mmHg, for finerenone and placebo, respectively. Adjusting for baseline SBP and SBP change to month 4 resulted in small changes in treatment effect for the primary endpoint and the key secondary endpoint, with only slightly increased HRs for treatment compared with the unadjusted primary analysis (primary endpoint: HR: 0.85 vs 0.82; key secondary endpoint: HR: 0.90 vs 0.86) and no strong indication of an interaction between treatment and SBP. Conclusion In FIDELIO-DKD, a small proportion of the effect of finerenone on cardiorenal outcomes can be attributed to BP. However, most of the effect appears to be via BP-independent mechanisms. (Funded by Bayer AG; FIDELIO-DKD ClinicalTrials.gov number, NCT02540993)

Bilateral diabetic papillopathy developed after starting insulin treatment. Potential toxic effect of insulin? A case report.

Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy. Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed. We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.

Clinical factors affecting operating room utilization in cataract surgery: Results from the PCIOL study.

To identify preoperative clinical characteristics affecting cataract surgery operative time. Academic center. Large-scale retrospective cohort study. All cases of cataract extraction by phacoemulsification and intraocular lens insertion performed by Comprehensive Ophthalmology at Massachusetts Eye and Ear between January 1, 2014, and December 31, 2014, were reviewed. Clinically relevant predictors of operative time were identified a priori, and a multivariate analysis was used to identify which predictors were associated with operative time. To quantify the surgeon effect, 2 regression models were built, one inclusive of surgeon identity and the other with years of experience and the training level of the supervised resident instead of identity. Overall, 1349 cataract surgeries in 1072 patients were included. The mean operative time was 22.1 ± 7.8 minutes. Multiple clinical factors were significantly associated with operative time, with attending surgeon identity being the most important. In the multivariate model with surgeon identity, longer operative time was associated with male sex, increased body mass index, first-eye surgery, left operative eye, advanced cataract, use of iris hooks, use of Malyugin ring, use of trypan blue, history of diabetic retinopathy, short axial length, and shallow anterior chamber depth. The R value for the model inclusive of attending identity was 0.42, significantly higher than the R value of 0.23 for the model exclusive of identity. Preoperative clinical characteristics, such as patient demographics, biometry data, and cataract severity, significantly correlate with operative time. Surgeon identity is highly correlated with operative time. Incorporating these results into predictive algorithms may allow for more predictable surgical scheduling and more efficient use of operative resources.

Prevalence and epidemiological characteristics of patients with diabetic retinopathy in Slovakia: 12-month results from the DIARET SK study.

PurposeTo evaluate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Slovakian patients with Type 1 and 2 diabetes mellitus (DM) in the DIARET SK study.Patients and methodsAn epidemiological multi-center survey that included 4,078 adult patients (aged ≥18 years) from 51 diabetologists and 47 ophthalmologists. Data were collected from February to December 2015.ResultsThe final data set consisted of 4,014 patients; 3,700 were enrolled (Type 2 DM = 3,405, Type 1 DM = 295) using a quasi-random approach; 16 (Type 2 DM = 15, Type 1 DM = 1) patients in the pre-specified group had DM duration of <5 years with a history of DR while 298 patients (Type 2 DM = 204, Type 1 DM = 94) had DM duration of ≥ 20 years. The mean (standard deviation [SD]) age of patients at diagnosis for Types 2 and 1 DM was 53.4 (9.5) and 27.6 (12.9) years, respectively. The mean (SD) glycated hemoglobin (HbA1c) was 7.5 (1.4) and 8.5 (1.6) in Types 2 and 1 DM patients, respectively, whereas a slightly higher proportion of patients had >11.0 HbA1c in Type 1 DM (5.8%) than Type 2 (2.0%). The mean (SD) duration of Type 2 DM was shorter compared with Type 1 (7.5 [5.2] vs 10.3 [6.9] years). In Type 2 DM patients, there were 516 (15.5%) cases of DR, 19 (0.56%) of proliferative DR (PDR), and 106 (3.11%) of diabetic macular edema (DME). In Type 1 DM patients, there were 86 (29.15%) cases of DR, 10 (3.39%) PDR, and 12 (4.07%) DME.ConclusionsIn Slovakian patients with DM, the duration of disease and higher HbA1c were the most prevalent factors that contributed to the development of DR and DME.

Effects of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on diabetic retinopathy and its progression: A real-world Korean study.

The sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce the incidence of macrovascular complications of diabetes, while their effect on diabetic retinopathy has not been clarified. We compared the effects of SGLT2is with those of dipeptidyl peptidase-4 inhibitors (DPP4is) on the risk of diabetic retinopathy and its progression in people with type 2 diabetes. We performed a retrospective cohort study among people with type 2 diabetes who started on a SGLT2i or DPP4i from 2014 to 2016 according to the Korean National Health Insurance Service database. Subjects initiated on a SGLT2i or DPP4i were matched on a 1:1 basis according to their propensity scores, and Cox proportional hazards regression models were used to calculate the hazard ratios for the risk of diabetic retinopathy and its progression. After propensity score-matching, 41,430 patients without a history of diabetic retinopathy were identified as new users of a SGLT2i (n = 20,175) or DPP4i (n = 20,175). The hazard ratio (95% CI) for diabetic retinopathy was 0.89 (0.83–0.97) for SGLT2i initiators compared with DPP4i initiators. In patients with a history of diabetic retinopathy (n = 4,663 pairs), there was no significant difference in diabetic retinopathy progression between SGLT2i initiators and DPP4i initiators (hazard ratio 0.94, 95% CI 0.78–1.13). This real-world cohort study showed that SGLT2is might be associated with lower risk of diabetic retinopathy compared with DPP4is. Randomized controlled trials are needed to investigate the long-term effect of SGLT2is in diabetic retinopathy in people with diabetes.

Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices

Summary: This prospective observational study evaluated the performance of a diabetic retinopathy diagnostic system (IDx-DR) compared to the gold standard diagnostic for diabetic retinopathy. Nine hundred individuals with diabetes but without a history of diabetic retinopathy were examined. Retinal images of the patients were obtained using a robotic camera, and a clinical diagnosis was made in 20 seconds by an artificial intelligence (AI) diagnostic system and compared to images read by three experienced and validated readers. The AI system correctly identified 173 of the 198 individuals with more than mild diabetic retinopathy, (a sensitivity of 87%), and 556 of the 621 disease-free individuals (a specificity of 90%).

Impact of Early Vitrectomy for Dense Vitreous Hemorrhage of Unknown Etiology

Background: Surgical intervention for dense vitreous hemorrhage (DVH) with unclear etiology is often delayed in favor of conservative follow-up despite possible disease progression and the availability of safe minimally invasive vitrectomy. Objectives: The aim of this study is to investigate the efficacy of early surgical intervention for DVH with unknown etiology. Methods: Eighty-eight cases (88 eyes) of DVH with unknown origin were retrospectively reviewed. Inclusion criteria were as follows: (1) measured visual acuity (VA) of 20/200 or worse and (2) fundus invisibility requiring B-scan ultrasonography. Eyes with a history of diabetic retinopathy, recent trauma, or likely retinal detachment (RD) as revealed by B-scan ultrasonography were excluded. Outcome measures were a cause of vitreous hemorrhage and final VA following early (≤2 weeks after symptom onset) or delayed vitrectomy. Results: The most frequently occurring causes of DVH were central or branch retinal vein occlusion (30 eyes, 34%) and retinal tear or RD (29 eyes, 33%). logMAR VA significantly improved after treatment (p < 0.001). Final VA was significantly higher for eyes treated within 2 weeks compared with eyes treated later than 2 weeks after symptom onset (p = 0.020). Conclusions: Surgical intervention within 2 weeks after symptom onset may prevent a lower visual outcome.

2283-PUB: Association between Higher Health-Related Quality of Life Physical Component Score Measured by SF-8 and Lower All-Cause Mortality Risk among Japanese Patients with Type 2 Diabetes: A Prospective Cohort Study

Health-related quality of life (HRQoL) was reportedly associated with mortality; however, these studies used questionnaires with relatively large number of items ranging from 20 to 30. We thus evaluated the prospective association between HRQoL measured by Short-Form (SF)-8, a short version of SF-36, in Japanese individuals with type 2 diabetes. Longitudinal data of 3,269 individuals with diabetes were obtained from a large Japanese diabetes registry. To assess the independent correlation between the 10-point increment of SF-8 physical component summary score (PCS) or mental component summary score (MCS) and all-cause mortality, the Cox proportional hazards model was used with adjustment for age, sex, body mass index, HbA1c, types of diabetes therapy, urinary albumin-creatinine ratio, history of diabetic retinopathy, symptomatic diabetic neuropathy, and past medical history (acute myocardial infarction, chronic stable angina, peripheral artery disease, leg ulceration, ischemic stroke, and hemorrhagic stroke). The mean age, body mass index, and HbA1c level were 64.9 years (SD 11.2), 24.6 kg/m2 (SD 3.9), and 7.5% (SD 1.2) [or 58.6 mmol/mol (SD 12.7)], respectively. We recorded 248 deaths during the median follow-up of 6.1 years (incidence ratio = 14.0/1,000 person-years). We observed significant association of PSC score and all-cause mortality, and multivariable-adjusted hazard ratio (HR) was 0.775 [95% confidence interval (CI), 0.668-0.899; p = 0.001] per 10-point increment of PCS score. We did not observe significant association between MCS score and all-cause mortality [HR = 0.864 (95% CI, 727-1.027; p = 0.097)]. In conclusion, higher PCS of SF-8, not MCS, was associated with lower risk of all-cause mortality in Japanese individuals with type 2 diabetes. SF-8 could be useful for predicting mortality in individuals with diabetes. Disclosure Y. Hayashino: Speaker's Bureau; Self; Astellas Pharma Inc., Kowa Pharmaceuticals, Kyowa Hakko Kirin Co., Ltd., MSD K.K., Ono Pharmaceutical Co., Ltd. S. Okamura: None. H. Ishii: None. Funding Manpei Suzuki Diabetes Foundation; Japan Society for the Promotion of Science (25460641)

Preoperative Vision and Surgeon Volume as Predictors of Visual Outcomes after Cataract Surgery

To evaluate the relationship between preoperative vision and surgeon volume with visual outcomes after cataract surgery. Retrospective cohort study. Patients aged ≥18 years old enrolled in the Kaiser Permanente Southern California Health Plan who underwent cataract surgery by nontrainee surgeons. Patients who underwent cataract surgery between January 1, 2013 and December 31, 2015, were included. A multivariate analysis using Generalized Additive Mixed Models was performed to determine the relationship between surgeon volume and postoperative visual acuity after controlling for patient age, preoperative visual acuity, history of diabetes, and history of diabetic retinopathy. Modeling was done for the relationship between preoperative vision and visual outcomes while controlling for surgeon volume, patient age, history of diabetes, and history of diabetic retinopathy. Absolute letter change and percentage of patients to achieve ≥5 Early Treatment Diabetic Retinopathy Study (ETDRS) letter gain postoperatively. There were 103 920 cataract surgeries performed by 136 surgeons included in this analysis. Patients whose surgeons performed <91.0 surgeries/year (95% confidence interval [CI], 61.1-139; P < 0.05) gained fewer letters postoperatively than the overall average, whereas those whose surgeons performed >91 but <227 surgeries/year (95% CI, 169-∞; P < 0.05) gained more letters than average. Although statistically significant, the difference between the lowest and highest performing surgeons was approximately 1.25 letters. Surgeons who performed <110 surgeries/year (95% CI, 81.7-149; P < 0.05) had fewer patients who gained ≥5 letters. Surgeons who performed >110 but <293 surgeries/year (95% CI, 232-∞; P < 0.05) were approximately 15% more likely to have patients who gained ≥5 letters. Patients with preoperative vision <74.7 letters (95% CI, 74.7-74.8; P < 0.05) and <75.8 letters (95% CI, 75.8-75.9; P < 0.05) gained more letters and were more likely to gain ≥5 letters postoperatively, respectively. Patients whose vision is approximately 20/32 or worse are more likely to have significant visual gains after cataract surgery. Although statistically significant differences exist in postoperative vision based on surgeon volume, these do not appear to be clinically meaningful. Overall, visual outcomes are functionally comparable across a wide range of surgeon volumes.

Diabetic Retinopathy –Incidence And Risk Factors In A Community Setting- A Longitudinal Study

Aim: To evaluate the natural history of diabetic retinopathy (DR) in diabetic patients and to assess long term risk for other chronic diseases associated with DR.Methods: Retrospective, community-based study. Diabetics who underwent their first fundoscopic examination during 2000–2002, and had at least one follow- up examination by the end of 2007 were included. The primary outcome was the development of DR (proliferative diabetic retinopathy (PDR), non PDR (NPDR) or macular edema.Patients were followed for another 9 years for documentation of new diagnosis of related diseases.Results: 516 patients' (1,032 eyes) records were included and were followed first for an average of 4.15 ± 1.27 years. During follow-up, 28 (2.7%) of the total 1,032 eyes examined were diagnosed with PDR. An additional 194 (18.8%) eyes were diagnosed with new NPDR. The cumulative incidence of NPDR was 310/1,032 (30.0%). All the patients who developed PDR had prior NDPR. By the end of the 9 years extended follow up, patients with NPDR had a greater risk for developing chronic renal failure HR = 1.71 (1.14–2.56), ischemic heart disease HR = 1.57 (1.17–2.09), and had an increased mortality rate HR = 1.26 (1.02–1.57)Conclusion: DR is associated with a higher rate of diabetes complications. Patients with DR should be followed more closely.Key pointsDuring a mean follow-up of 4.5 years, the cumulative incidence of diabetic retinopathy in a community cohort was 18.8%.NDPR (non-proliferative diabetic retinopathy) is a predictor of PDR (proliferative diabetic retinopathy).In a real life setting NPDR is a marker of a poorer prognosis.Patients with NDPR should be monitored more closely.

New observation of microcystic macular edema as a mild form of cystoid macular lesions after standard phacoemulsification: Prevalence and risk factors.

We present the new observations of postoperative microcystic macular edema (MME) as a mild form of cystoid macular lesions (CMLs) after standard phacoemulsification.To report the incidence, risk factors, and pathophysiology of MME compared to conventional concept of pseudophakic cystoid macular edema (CME), we retrospectively reviewed patients’ records. Pseudophakic CMLs were defined as any cystic fluid collections that were newly formed after cataract surgery, confirmed by preoperative and postoperative optical coherence tomography (OCT) examinations. CMLs were classified into 2 groups, which are CME and MME, according to the change the central retinal thickness. The dataset consisted of 316 patients (mean age, 67.52 ± 12.95 years; range, 42–87 years). Topical nonsteroidal anti-inflammatory drug (NSAID) were administered in 197 eyes during the perioperative period; 147 eyes were not treated. CMLs were present in 22 out of 344 (6.39%) eyes. Six of 344 eyes (1.74%) had CME and 16 of 344 eyes (4.65%) had MME. The incidence of MME significantly decreased in the group of patients treated with topical NSAIDs (P = .039), while the incidence of CME was not different in both groups (P = .408). All of the patients with MME were experienced improvement with only topical NSAIDs. However, 67% (4/6) of patients with CME did not improve with topical NSAIDs alone and needed additional treatments. Pseudophakic MMEs were more likely to have a history of diabetic retinopathy, epiretinal membrane, and eyes were not treated with topical NSAID.This study showed a wide clinical spectrum of CMLs. MME has not been included in the conventional definition of pseudophakic CME. Topical NSAIDs could decrease the CML incidence. People with risk factors for CML should use topical NSAIDs and undergo regular follow-up OCT examinations.

Evaluation of effectiveness of contact transscleral diode laser cyclocoagulation drainage after neovascular glaucoma surgery

Relevance. Recently, drainage surgery has gained prevalence in the treatment of neovascular glaucoma. Unfortunately, studies have reported that their effectiveness does not exceed 70%80%. During the postoperative period, the attending physicians major concern is the normalisation of high IOP.&#x0D; Aim.To evaluate the effectiveness of contact transscleral diode laser cyclocoagulation drainage after neovascular glaucoma surgery, which did not lead to the normalisation of elevated intraocular pressure.&#x0D; Materials and methods. This study enrolled eight patients in the ophthalmic branch of the Endocrinology Research Center. All patients previously underwent a drainage operation for uncompensated secondary neovascular glaucoma with a history of diabetic retinopathy. During the postoperative period, because intraocular pressure failed to stabilise, we performed contact transscleral diode laser cyclocoagulation as per the original methodology.&#x0D; Results. After the execution of contact transscleral diode laser cyclocoagulation, intraocular pressure was compensated in all patients, and any complication was noted for up to 6 months.&#x0D; Conclusion. Contact transscleral diode laser cyclocoagulation can be used to normalise abnormal IOP after drainage surgery for the treatment of neovascular glaucoma in patients with diabetes mellitus.