Incidence Of Diabetic Macular Edema Research Articles

Advancements in the Treatment of Diabetic Macular Edema: Current Strategies and Future Directions

This narrative review examines current and emerging treatment strategies for diabetic macular edema (DME), a complication of diabetic retinopathy characterised by fluid accumulation in the macula, which can lead to vision impairment. The incidence of DME is particularly high in patients with long-standing diabetes and advanced retinopathy. The current treatment options for DME include anti-vascular endothelial growth factor (anti-VEGF) agents, corticosteroids, and laser therapies. Anti-VEGF agents, including bevacizumab, ranibizumab, aflibercept, and the more recently developed brolucizumab and faricimab, have been demonstrated to reduce macular thickness and improve visual acuity. Brolucizumab offers the advantage of fewer injections due to its longer duration of action, although it carries a higher risk of ocular inflammation compared to other anti-VEGF agents. The dual inhibition of the VEGF and angiopoietin-2 (Ang-2) pathways by faricimab may enhance vascular stability and reduce inflammation, potentially improving patient outcomes. Steroid therapies, including dexamethasone, fluocinolone acetonide, and triamcinolone acetonide, represent an alternative for patients who do not respond adequately to anti-VEGF treatment. Laser therapies, including focal, navigated, and subthreshold laser treatments, remain a crucial component in the management of DME, with the ability to seal leaking vessels and reduce fluid accumulation. In order to achieve the best outcomes for patients, it is essential to continue to advance these treatment modalities and adopt a personalised, multifaceted approach.

Aspirin intake is not associated with diabetic retinopathy and diabetic macular edema: A report from the Fushun diabetic retinopathy cohort study.

We aimed to study the effects of aspirin intake for diabetic retinopathy (DR) and diabetic macular edema (DME) in a cohort from northeastern China. Participants in the Fushun Diabetic Retinopathy Cohort Study were enrolled between July 2012 and May 2013. Fundus photographs of six fields were graded according to the modified Airlie House Classification system. The prevalence, incidence, progression, and regression of DR, as well as the prevalence/incidence of DME, were evaluated at baseline and during follow-up examinations after at least 1 year. In total, 1370 patients were enrolled in the study, and 270 (19.7%) were taking aspirin. The prevalence of any DR in participants with and without aspirin intake was 47.4% and 44.9%, respectively (P = 0.46). The incidence of any DR in patients with and without aspirin intake was 9.2% and 8.3%, respectively (P = 0.74). In univariate regression, there was no association between aspirin intake and the prevalence of any DR and DME (odds ratios (OR), 95% confidence intervals (CI): 0.93, 0.68-1.27 and 1.22, 0.79-1.88, respectively). Aspirin intake was not significantly associated with the prevalence and incidence of DME (OR, 95% CI: 1.22, 0.79-1.88 and 1.79, 0.62-5.17, respectively). Furthermore, aspirin intake was not significantly associated with DR progression or regression (OR, 95% CI: 1.04, 0.66-1.66 and 0.75, 0.52-1.09, respectively). Aspirin intake was not associated with the prevalence and incidence of any DR or DME in a northeastern Chinese population. Neither progression nor regression of DR revealed a significant association with aspirin intake.

Comparison of Diabetic Retinopathy Lesions Identified Using Ultrawide Field Imaging and Optical Coherence Tomography Angiography

Introduction: Optical coherence tomography (OCT) angiography (OCTA) has the potential to influence the diagnosis and management of diabetic eye disease. This study aims to determine the correlation between diabetic retinopathy (DR) findings on ultrawide field (UWF) color photography (UWF-CP), UWF fluorescein angiography (UWF-FA), and OCTA. Methods: This is a cross-sectional, prospective study. One hundred and fourteen eyes from 57 patients with diabetes underwent mydriatic UWF-CP, UWF-FA, and OCTA. DR severity was assessed. Ischemic areas were identified on UWF-FA using ImageJ and the nonperfusion index (NPI) was calculated. Diabetic macular edema (DME) was assessed using OCT. Superficial capillary plexus vessel density (VD), vessel perfusion (VP), and foveal avascular zone (FAZ) area were automatically measured on OCTA. Pearson correlation coefficient between the imaging modalities was determined. Results: Forty-five eyes were excluded due to non-DR findings or prior laser photocoagulation; 69 eyes were analyzed. DR severity was associated with larger NPI (r = 0.55944, p < 0.0001) even after distinguishing between cones (Cone Nonperfusion Index [CPI]: r = 0.55617, p < 0.0001) and rods (Rod Nonperfusion Index [RPI]: r = 0.55285, p < 0.0001). In eyes with nonproliferative DR (NPDR), NPI is correlated with DME (r = 0.51156, p = 0.0017) and central subfield thickness (CST) (r = 0.67496, p < 0.0001). UWF-FA macular nonperfusion correlated with NPI (r = 0.42899, p = 0.0101), CPI (r = 0.50028, p = 0.0022), and RPI (r = 0.49027, p = 0.0028). Central VD and VP correlated with the DME presence (r = 0.52456, p < 0.0001; r = 0.51952, p < 0.0001) and CST (r = 0.50133, p < 0.0001; r = 0.48731, p < 0.0001). Central VD and VP were correlated with macular nonperfusion (r = 0.44503, p = 0.0065; r = 0.44239, p = 0.0069) in eyes with NPDR. Larger FAZ was correlated with decreased central VD (r = −0.60089, p = 0.0001) and decreased central VP (r = −0.59224, p = 0.0001). Conclusion: UWF-CP, UWF-FA, and OCTA findings provide relevant clinical information on diabetic eyes. Nonperfusion on UWF-FA is correlated with DR severity and DME. OCTA metrics of the superficial capillary plexus correlate with the incidence of DME and macular ischemia.

OCT ASSESSMENT OF MACULAR THICKNESS IN NON-PROLIFERATIVE DIABETIC RETINOPATHY IN RELATION TO GLYCOSYLATED HEMOGLOBIN

Background: Diabetic retinopathy (DR), also known as diabetic eye disease, is a retinal damage that occurs due to diabetes. Blindness can be the end result of diabetic retinopathy. Objective: To evaluate the relation of macular thickness to glycosylated hemoglobin in patients with non-proliferative diabetic retinopathy. Patients and Methods: This study included 100 eyes of 100 patients with a diagnosis of type 2 DM. This was designed as an observational, cross-sectional and non-cohort study during the period from 6/2019 to 3/2020. One hundred eyes were divided into two equal groups: one group included diabetic patients with no diabetic retinopathy and the other group included diabetic patients with non-proliferative diabetic retinopathy. Patients were recruited from Retinal clinic in Al-Azhar University Hospital and asked to participate in this study. Results: The results showed that non-proliferative diabetic retinopathy (NPDR) group and group of no DR were comparable as regard age, sex and best corrected visual acuity (BCVA). There was a statistically insignificant difference between group of no DR and NPDR group, but group of no DR had shorter duration of DM, lower HbA1c level, lower macular thickness in all of the 9 standard early treatment diabetic retinopathy study (ETDRS) subfields, lower total macular volume (TMV) than NPDR Group. The results showed that central subfield macular thickness (CST) is positively and significantly related to glycosylated hemoglobin (HbA1c) level in each group of no DR and NPDR, and that severity of DR stage was significantly increased with increased HbA1c levels. The results also showed that there’s significant positive association between severity of DR stage and macular thickness in all of the nine standard ETDRS subfields. There was a positive significant relation between duration of DM and HbA1c level in type 2 diabetic patients, while there was no significant relation between duration of DM and macular thickness. The results also showed significant inverse relation between insulin use and HbA1c level, and significant inverse relation between insulin use and prevalence of DR in type 2 diabetic patients. Conclusion: Increased incidence of DR, increased macular thickness and increased incidence of diabetic macular edema were associated with increased level of glycosylated hemoglobin in type II diabetic patients.

Effect of intravitreal Bevacizumab injection at the time of phacoemulsification on the development of macular edema in diabetic patients with and without preoperative retinopathy

Aim The aim of this study was to evaluate the effect of intravitreal Bevacizumab injection at the time of phacoemulsification on the incidence of postoperative diabetic macular edema (DME) in diabetic patients without preexisting DME.Patients and methods The study included 40 diabetic patients with no preexisting DME who underwent phacoemulsification. They were divided into two groups: group A (controls) included 20 eyes in which phacoemulsification was performed without Bevacizumab injection and group B (Bevacizumab): included 20 eyes in which 1.25 mg Bevacizumab was injected at the conclusion of surgery. Macular optical coherence tomography and visual acuity were assessed at 2 weeks, 2 months, and 6 months postoperatively.Results The incidence of DME in the noninjected patients was 5, 20, and 30% at 2 weeks, 2 months, and 6 months, respectively, compared with 0, 5, and 5% in the Bevacizumab injected patients. This difference in incidence was only statistically significant at 6 months (P=0.15 at 2 months and 0.04 at 6 months). On comparing the baseline central macular thickness in the control and Bevacizumab groups (229.4±26.8 and 230.8±26.7 μm, respectively) to the 6-month follow-up values (278.3±52.3 and 254.7±26.2 μm, respectively), a higher statistically significant difference was found in the control group (P=0.0001) versus the injected group (P=0.002) denoting more progression of DME in the control group.Conclusion Prophylactic intravitreal injection of Bevacizumab at the time of phacoemulsification is potentially effective in the midterm prevention of DME in cases with and without preoperative diabetic retinopathy.

Optical Coherence Tomography Assessment of Macular and Choroidal Thickness in Patients with Proliferative Diabetic Retinopathy in Relation to Hemoglobin A1C

Background: Diabetic retinopathy affects up to 80 % of all patients who have had diabetes for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there were proper treatment and monitoring of the eyes blindness. Objective: To evaluate the relation of macular and choroidal thickness to HbA1c in patients with proliferative diabetic retinopathy. Patients and methods: This study included 40 eyes of 33 patients with a diagnosis of proliferative diabetic retinopathy (PDR). Patients were recruited from Retinal Clinic in Imbaba Eye Hospital and they were asked to participate in this study. This study was designed as an observational, cross-sectional and non-coherent study in the period from 5/2018 to 4/2019. Results: the results showed that the macular thickness was higher and the choroidal thickness was lower in uncontrolled HbA1c group than controlled HbA1c group. We assumed that increase level of glycosylated hemoglobin lead to increase macular thickness and decrease choroidal thickness and increase incidence of diabetic macular edema and choroidal atrophy. Conclusion: Optical coherence tomography is a sensitive and noninvasive diagnostic tool in the evaluation of macular and choroidal thickness. Hypertension is also an important risk factor in the development of diabetic retinopathy, diabetic macular edema and diabetic choroidopathy.

Intravitreal Bevacizumab In Diabetic Macular Edema At RSUP Cipto Mangunkusumo in 2017

Introduction: Diabetic Macular Edema (DME) is a manifestation of diabetic retinopathy and is the most common cause of vision loss in diabetics. The incidence of DME has a tendency to increase, concomitant with the prevalence of diabetes globally by more than 50% from 2000 to 2030. This study aims to evaluate the proportion of central macular thickness (CMT) improvement and visual acuity in DME patients treated with intravitreal bevacizumab (IVB) injection.&#x0D; Methods: This study is a retrospective descriptive study. The study was conducted in the Department of Ophthalmology at RSUP Cipto Mangunkusumo (RSCM) Jakarta. Data were obtained from the medical records of all diabetic retinopathy patients with macular edema who were treated with IVB at RSCM Kirana Vitreoretina Polyclinic on January – December 2017.&#x0D; Results: Of the 44 subjects, improvement in best corrected visual acuity (BCVA) occurred in 24 (54.54%) subjects at the first-month evaluation and 19 (43.18%) subjects at the third-month evaluation. CMT decreased in 37 (84.41%) subjects at the first-month evaluation and 35 (81.81%) subjects at the third-month evaluation.&#x0D; Conclusion: Visual acuity improvement and central macular thickness reduction 3 months after IVB injection. These results strengthen IVB injection to be an alternative to adjuvant therapy in DME.&#x0D; &#x0D; Keywords: Diabetic Macular Edema, Intravitreal Bevacizumab Injection

Optical coherence tomography based analysis of changes in macula in diabetes after phacoemulsification surgery

Purpose: To assess quantitative changes of the macula after cataract surgery using optical coherence tomography (OCT) in diabetic eyes and to estimate the incidence of development of macular edema (ME) in type II diabetic eyes. Materials and Methods: In this prospective observational case control study, 100 eyes out of which 50 are of type II diabetic patients and 50 are non-diabetic patients who underwent phacoemulsification surgery with acrylic foldable IOL lens implantation were evaluated at post op day 1, day 7, 1 month and 3 months post operatively. Macular thickness as described in early treatment of diabetic retinopathy study (ETDRS) with OCT was evaluated in 9 zones. 4 patients developed DME at 1 month after surgery and were withdrawn from further analysis. Result: The mean central foveal thickness of the diabetic group preoperatively was 231.06±38.785µ. The increase in central foveal thickness was statistically significant at 1 month postoperatively (p=0.004). The mean perifoveal thickness changes in the inferior and temporal quadrants was also statistically significant at 1 month postoperatively (p=0.002). However, the overall change in macular thickness was found to be insignificant at 3 months postoperatively. The incidence of diabetic macular edema was found to be 8%. Conclusion: We found that after uncomplicated phacoemulsification, changes in macular thickness as measured by OCT was without any significance. Keywords: Cataract, Diabetes, Macular edema, OCT.

Intravitreal therapy of diabetic macular edema in Russian Federation: current state of the problem

Currently there is a significant increase in the incidence of diabetes mellitus all over the world, and Russia is not an exception. With the increase in patients with diabetic retinopathy, also rises the incidence of diabetic macular edema, which can lead to persistent loss of vision and disability dramatically affecting the quality of life. Antiangiogenic therapy that is effectively used all over world has specific features for clinical practice in Russia because of its high cost, insufficient public funding, low patient compliance, remoteness of patients from the places of medical care, and low awareness of both patients and doctors about the treatment effectiveness and required regimen. All these problems slow the adoption of this progressive treatment method. Analyzing the causes of low adoption of antiangiogenic therapy and proposing new ways to solve these problems can help reduce the rate of blindness and disability caused by eye complications of diabetes mellitus in Russian Federation, particularly in young and working population.

Incidence and Progression of Diabetic Retinopathy in Urban India: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS II), Report 1

ABSTRACTPurpose: To evaluate the 4-year incidence and progression of and risk factors for diabetic retinopathy (DR) in an Indian population.Methods: From a cross-sectional study of 1425 subjects with diabetes, 911 (63.9%) returned for 4-year follow-up. After excluding 21 with ungradable retinal images, data from 890 subjects were analyzed. Participants underwent examinations based on a standard protocol, which included grading of retinal photographs.Results: The incidences of DR, diabetic macular edema (DME), and sight-threatening diabetic retinopathy (STDR) were 9.2%, 2.6%, and 5.0%, respectively. In subjects with DR at baseline, the incidence of DME and STDR had increased (11.5% and 22.7%, respectively). 1-step and 2-step progressions of DR were seen in 30.2% and 12.6% of participants, respectively, and 1-step and 2-step regressions were seen in 12.0% and 1.8%, respectively. Incident DR, DME, and STDR were associated with higher systolic blood pressure (odds ratio, OR, 1.21, 2.11 and 1.72, respectively, for every 10 mmHg increase). Incident DR and DME were associated with increasing duration of diabetes (OR 2.29 and 4.77, respectively, for every 10-year increase) and presence of anemia (OR 1.96 and 10.14, respectively). Incident DR was also associated with higher hemoglobin A1c (OR 1.16 for every 1% increase). Variables associated with 1-step progression were every 10 mg/dL increase in serum total cholesterol (OR 15.65) as a risk factor, and 10 mg/dL increase in serum triglyceride (OR 0.52) as a protective factor.Conclusions: The incidences of STDR and DME were higher in people with pre-existing DR than in those without DR at baseline.

Insulin use and risk of diabetic macular edema in diabetes mellitus: a systemic review and meta-analysis of observational studies.

BackgroundDiabetes mellitus is a common and serious disorder. A search of the literature reveals no comprehensive quantitative assessment of the association between insulin use and incidence of diabetic macular edema. Therefore, we performed a meta-analysis of observational studies to evaluate the effect of insulin use on the risk of developing macular edema.Material/MethodsComparative studies published until May 2014 were searched through a comprehensive search of the Medline, Embase, and the Cochrane Library electronic databases. A systematic review and quantitative analysis of comparative studies reporting the effect of insulin use on the incidence of macular edema was performed. All analyses were performed using the Review Manager (RevMan) v.5 (Nordic Cochrane Centre, Copenhagen, Denmark).ResultsA total of 202 905 individuals were included in the present meta-analysis. In a random-effects meta-analysis, the use of insulin was found to be associated with increased risk of macular edema (RR, 3.416; 95% CI, 2.417–4.829; I2, 86.6%). Analysis that just included high-quality studies showed that insulin use increased the risk of macular edema (RR, 2.728; 95% CI, 1.881–3.955; I2=77.7%). In cohort studies (RR, 4.509; 95% CI, 3.100–6.559; I2, 77.7%) but not in case-control studies (RR, 1.455; 95% CI, 0.520 to 4.066; I2, 95.9%), increased incidence of macular edema was observed.ConclusionsThe results of this meta-analysis of observational studies demonstrate that insulin use is a risk factor for diabetic macular edema. However, available data are still sparse, and in-depth analyses of the assessed associations in the context of additional longitudinal studies are highly desirable to enable more precise estimates and a better understanding of the role of insulin use in incidence of diabetic macular edema.

Incidence of Diabetic Macular Edema in type 1 Diabetes

AbstractPurpose Diabetic retinopathy is a serious vision threatening complication which can be prevented if detected early.Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development , children and adolescents are seldom included in screening programmes.. Our main goal is to screen for early retinal changes and review the risk factors involved in the development of diabetic retinopathy in children.Methods We prospectively enrolled 200 children and adolescents with insulin‐dependent type 1 diabetes mellitus diagnosed before the age of15.0years(disease duration of &lt; 12 years)and who were older than 5.0 years at the time of examination from our pediatric endocrinology clinics at 2 tertiary care hospitals(king abdulaziz university hospital and king faisal specialist hospital) in Jeddah,Saudia Arabia. all patients recived full eye examination including Best Corrected Visual Acuity,Retinal examination was performed with stereoscopic fundus examination by indirect ophthalmoscope for peripheral retinal changes and slit lamp exam with 75 D lens for macular edema.Ocular coherence tography(OCT)was performed for all patients to evaluate sub‐clinical macular edemaResults Non of our patients had proliferative diabetic retinopathy changes,we also did not see evidence of diabetic macular edema Mean diabetes duration was 3years and mean HbA1c was 6.5%.Mild non proliferative DR was diagnosed in 30 children (15 %), those with DR were significantly older(P &lt; 10−3),had a longer duration of diabetes (P = 0.001),and had higher HbA1c(P = 0.15). After adjustment for age, only longer duration remained significantly associated with DR (P = 0.01).Conclusion mainstay of prevention is tight glycemic control with regular screening and fundus examination,with OCT if suspension

Association Between Thiazolidinedione Treatment and Risk of Macular Edema Among Patients With Type 2 Diabetes

Findings of prior studies have been inconclusive about the ocular effects of thiazolidinediones on diabetic macular edema (DME). We evaluated, in patients with type 2 diabetes (T2D), the short-term and long-term risks of developing DME among users vs nonusers of thiazolidinediones. A retrospective cohort study of 103,368 patients with T2D and no DME at baseline using The Health Improvement Network (THIN) database. Clinical, biochemical, and demographic information was obtained for the period January 1, 2000, through November 30, 2009. At 1 year, the incidence of DME was 1.3% (n = 41) and 0.2% (n = 227) among thiazolidinedione users (n = 3227) and nonusers (n = 100,141), respectively (odds ratio [OR], 5.7 [95% CI, 4.1-7.9]). After Cox multiple regression analysis (adjusted for age; systolic blood pressure; levels of lipids and hemoglobin A(1c); and use of aspirin, fibrates, insulin, oral antidiabetic drugs, or renin-angiotensin system blockers), multiple imputation analysis to adjust for missing values, and propensity score analysis to exclude for any selection bias, thiazolidinedione use was associated with an increased risk of DME at 1-year follow-up (OR, 2.3 [95% CI, 1.5-3.6]) and 10-year follow-up (hazard ratio [HR], 2.3; [95% CI, 1.7-3.0]). The effect was similar for pioglitazone and rosiglitazone. Combination therapy with insulin plus a thiazolidinedione was associated with a higher risk of DME after propensity score adjustment (HR, 3.0 [95% CI, 1.5-5.9]), while aspirin use (HR, 0.6 [95% CI, 0.4-0.9]) and angiotensin-converting enzyme inhibitor use (HR, 0.4 [95% CI, 0.2-0.7]) were associated with a reduced risk of DME. Among patients with T2D, treatment with a thiazolidinedione was associated with an increased risk of DME at 1-year and 10-year follow-up evaluations.

Effect of Ruboxistaurin on the Visual Acuity Decline Associated with Long-standing Diabetic Macular Edema

We read with interest the article, “Effect of Ruboxistaurin on the Visual Acuity Decline Associated with Long-standing Diabetic Macular Edema,” by Davis et al., in the January 2009 issue. Although we congratulate them for addressing a pertinent topic, we seek a few clarifications regarding the methodology and conclusions. Baseline data for factors such as diabetes type, body mass index, hemoglobin A1C, systolic and diastolic blood pressure, angiotensin-converting enzyme (ACE) inhibitor use, insulin use, serum lipid profile, and anemia are not compared between the two groups. These factors affect both the incidence of diabetic macular edema and its response to any kind of therapy. In Figure 2, it is evident that the two arms of the study differed significantly after 18 months of therapy, but because in the prior (PKC-DRS2) study only 75% of the patients completed follow-up, it is important to know how many of the patients with diabetic macular edema completed the follow-up. The authors briefly mention this issue in discussion, but the conclusions appear overdrawn and based on few data. The authors also gave the confidence limits in Figure 2 for the drug-induced change in visual acuity, but they did not provide a confidence interval for the same statistic after regression analysis, which is likely to have overlapping results. It would have been appropriate to mention the confidence intervals of both arms and the power of the study. We would appreciate having the authors clarify these aspects for the benefit of the readers. Atul Kumar Sahu Ajit Babu Majji

An epidemiological surrey on diabetic macular edema in Huizhou city

Objective To investigate the prevalence of diabetic macular edema (DME) in Huizhou city and to explore the relationship of DME with the degrees of diabetic retinopathy (DR) and visual loss and the course of diabetes mellitus (DM). Methods Population samples in Huizhou were randomly selected to survey with questionnaires for DM screening. The patients then received vision tests, +90D front- position eyeground examination under a slit-lamp microscope, fundus photography, and fluorescence fundus an-giography (FFA) for DR and DME. Results Of 645 with DM, 262 developed DR and 92 occurred DME. The incidence of DME was 0.91% in Huizhou population, 1.43% in patients with DM, and 35.1% in the diabetic patients with DR. In DME 38.20% was mild, 31.46% was moderate, and 30.33% was severe. DME worsened with the increasing degree of DR (r= 0.945, P= 0.035). Visual loss was significantly correlated with the degree of DME (r= 0.972, P= 0.005). The grading of DME was markedly associated with the disease course of DM (r= 0.954, P= 0.008). Conclusions DME leads to severe vision impairment in diabetic patients. The patients with DME should be screened and treated earlier to reduce the incidence of DR-induced blindness. The degree of DME is markedly related with the stages of DR, visual loss, and course of diabetes. Key words: Diabetic macular edema; Diabetic retinopathy; Diabetes mellitus

Update on Laser Treatment of Diabetic Macular Edema

Macular edema is the principal cause of visual impairment in diabetic patients.1 In the Wisconsin Epidemiologic Study of Diabetic Retinopathy, the incidence of diabetic macular edema (DME) was 20.1% in juvenile onset insulin-dependent patients, 25.4% in adult-onset insulin-dependent patients, and 13

Rosiglitazone and Delayed Onset of Proliferative Diabetic Retinopathy

To evaluate whether rosiglitazone maleate, an oral peroxisome-proliferating activated receptor gamma agonist and oral insulin sensitizing agent with potential antiangiogenic activity, delays onset of proliferative diabetic retinopathy (PDR). Longitudinal medical record review of all patients treated with rosiglitazone receiving both medical and ophthalmic care at the Joslin Diabetes Center from May 1, 2002, to May 31, 2003 (N = 124), and matched control patients not taking a glitazone drug (N = 158). The mean duration of follow-up was 2.8 years (range, 0.3-9.0 years). Baseline characteristics and final hemoglobin A(1c) values (7.6% and 7.8%, respectively) were similar in the rosiglitazone and control groups (P = .10). In eyes with severe nonproliferative diabetic retinopathy at baseline (rosiglitazone group, 14 eyes; control group, 24 eyes), progression to PDR over 3 years occurred in 19.2% in the rosiglitazone group and 47.4% in the control group, representing a 59% relative risk reduction (Wilcoxon, P = .045; log-rank, P = .059). Fewer eyes in the rosiglitazone group experienced 3 or more lines of visual acuity loss (P = .03). The incidence of diabetic macular edema was similar in both groups. Rosiglitazone may delay the onset of PDR, possibly because of its antiangiogenic activity. Future clinical investigations should consider analysis of this potential benefit along with ongoing evaluation of potential cardiac risk in studies where the risk-benefit profiles are deemed appropriate.

Diabetic macular edema and its relationship to renal microangiopathy: a sample of Type I diabetes mellitus patients in a 15-year follow-up study

Purpose In the present study, our objective was to determine the epidemiological risk factors for the development of diabetic macular edema, especially attendant on renal diabetic lesion (microalbuminuria or overt nephropathy) in 112 Type I diabetic patients after 15 years. Methods This is a 15-year follow-up study of a cohort of 112 consecutive Type I (insulin-dependent) diabetes mellitus patients without diabetic retinopathy or nephropathy who were enrolled in 1990. We studied the incidence of diabetic macular edema and its risk factors. The epidemiological risk factors included in the study were as follows: gender, diabetes duration, glycated hemoglobin (HbA 1c) levels, arterial hypertension, macroangiopathy, triglyceride levels, fractions of cholesterol [high-density lipoprotein cholesterol and low-density lipoprotein (LDL) cholesterol], and cigarette smoking. Results The incidence of diabetic macular edema after 15 years was as follows: the focal form of diabetic macular edema was present in 13 (11.6%) patients and the diffuse form of macular edema was present in 10 (8.9%) patients, among 23 (20.5%) patients. The following factors were significant in the development of diabetic macular edema: high levels of LDL-cholesterol ( P=.013), high levels (>7.5%) of HbA 1c ( P=.021), the presence of macroangiopathy ( P=.022), the severity of diabetic retinopathy ( P=.029), the presence of arterial hypertension ( P=.037), and the presence of overt nephropathy ( P=.047). Microalbuminuria was not significant in logistic regression ( P=.587), and cigarette smoking was not significant ( P=.976). The relationship between diabetic macular edema and duration of diabetes presented two peaks of incidence: first in patients with 15–20 years' duration of diabetes mellitus, and second in patients with >35 years' duration. Conclusions In summary, our data suggest that better control of glycemia, LDL-cholesterol levels, and blood pressure in Type I diabetes mellitus patients may be beneficial in reducing the incidence of diabetic macular edema. Finally, our data validate the current guidelines for ophthalmologic care for the detection of diabetic macular edema over the long-term course of diabetes.