Management Of Diabetic Retinopathy Research Articles

Development and Novel Therapeutics in Diabetic Retinopathy.

Diabetic retinopathy (DR) is a complication of diabetes mellitus which causes retinal damage which when left untreated will cause visual problems. As the prevalence of DR increases over the years, there is a need to optimise the currently available treatments as well as developing novel drugs to improve the therapy provided for the patients in the clinical practice. Several pharmacological therapies like, anti-vascular endothelial growth factor and anti-inflammatory therapies which include intravitreal, and implant of corticosteroids are significant in the management to decrease the risk of DR-related vision impairment. Clinical trials for novel drug therapies are still ongoing till this day to enhance the efficacy of DR treatment. Even though there are also modern treatments such as laser therapy for the patients, prevention should be done to lower the number of individuals affected by DR. Due to the complexity of DR, there are numerous obstacles to develop new medications for DR which include the increasing healthcare cost of DR treatment. New insights such as utilisation of artificial intelligence will be implemented into the management of DR as it has proved its potential in aiding the screening process. In parallel with the increase in DR prevalence and the number of treatments developed, extensive understanding of the mechanism of action of DR should be further improved to prevent more complications in the future. This review summarises the epidemiological trend, prevention strategies, challenges in treatment, current novel therapeutics (including drugs under clinical trials), future therapeutic trends and possibilities for implementing AI in the early diagnosis and management of DR.

Management of diabetic retinopathy in pregnancy

Introduction The onset and development of diabetic retinopathy are more common during pregnancy. Pregnancy has no long-term effect on diabetic retinopathy; however, in 50-70% of cases, changes in retinopathy continues. The probability of worsening is highest in the second trimester and up to one year postpartum. Additional factors that have been associated with disease progression include duration of diabetes, the degree of retinopathy at the time of conception, management of hyperglycemia, anemia, and development of associated hypertension. In cases of severe non-proliferative retinopathy, it is recommended to promptly initiate laser photocoagulation rather than wait for early proliferative changes. Maintaining good diabetic control before and during pregnancy can help prevent disease progression and serious vision loss. Material and methods Diabetic retinopathy management in pregnancy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: „Diabetic retinopathy”; „pregnancy”; „laser photocoagulation”; „intravitreal steroids”; „anti-vascular endothelial growth factor”. Results It is suggested that women with diabetes receive pre-conception and post-pregnancy counselling from a multidisciplinary team including an ophthalmologist, endocrinologist, and perinatologist, as diabetic retinopathy may worsen during pregnancy. The risk of progression of the disease and the importance of appropriate metabolic control before and during pregnancy should be clearly explained to the patient. Careful monitoring is required in patients with advanced gestation, significant retinopathy, concomitant hypertension, and nephropathy. Conclusion The risk of retinopathy development may increase during pregnancy. Serious effects can arise for both the mother and the fetus, even though retinopathy is not common during pregnancy. It is possible to avoid significant retinopathy by carefully planning a young diabetic woman's pregnancy and proceeding promptly to laser photocoagulate in cases of severe non-proliferative retinopathy. A tendency for regress is frequently seen in diabetic retinopathy during the post-natal period. Subsequent pregnancies do not significantly increase the risk of progression if the retinopathy is stable before pregnancy.

Current research and future strategies for the management of vision-threatening diabetic retinopathy

Diabetic retinopathy (DR) is a major ocular complication of diabetes and the leading cause of blindness and visual impairment, particularly among adults of working-age adults. Although the medical and economic burden of DR is significant and its global prevalence is expected to increase, particularly in low- and middle-income countries, a large portion of vision loss caused by DR remains preventable through early detection and timely intervention. This perspective reviewed the latest developments in research and innovation in three areas, first novel biomarkers (including advanced imaging modalities, serum biomarkers, and artificial intelligence technology) to predict the incidence and progression of DR, second, screening and early detection of referable DR and vision-threatening DR (VTDR), and finally, novel therapeutic strategies for VTDR, including diabetic macular oedema (DME), with the goal of reducing diabetic blindness.

RWC Update: Gas Versus Silicone Oil in the Surgical Management of Proliferative Diabetic Retinopathy; Intraocular Foreign Body with Secondary Branch Retinal Artery Occlusion

RWC Update: Gas Versus Silicone Oil in the Surgical Management of Proliferative Diabetic Retinopathy; Intraocular Foreign Body with Secondary Branch Retinal Artery Occlusion

Determining direct, indirect healthcare and social costs for diabetic retinopathy management: a systematic review

IntroductionDiabetic retinopathy (DR) is a rapidly growing global public health threat; it affects 1 in 3 people with diabetes and is still the leading cause of blindness among the working-age population. The management of diabetic retinopathy is becoming more advanced and effective but is highly expensive compared to other ocular diseases.AimTo report direct medical, indirect medical, and nonmedical costs of diabetic retinopathy in developed and developing countries through a systematic review.MethodsRelated articles published in the PubMed, Google Scholar, and EMBASE electronic databases from 1985 to 2022 were identified using the keywords direct medical and indirect medical and social costs of diabetic retinopathy. However, previous systematic reviews, abstracts, and case reports were excluded.ResultsThirteen articles were eligible for assessing the economic burden of diabetes management and its complications. Our analysis revealed that increasing prevalence and severity of diabetic retinopathy (DR) are associated with higher direct and indirect healthcare expenditures. The impact of DR on working-age adults, leading to irreversible blindness in advanced stages, underscores the urgent need for cost-effective prevention and management strategies.DiscussionThis study systematically reviewed the direct medical, indirect medical, and nonmedical costs of DR in developed and developing countries. Our findings highlight the significant economic burden of DR, emphasizing the importance of implementing effective prevention and management measures to alleviate costs and enhance patient outcomes.ConclusionThe substantial financial burden of DR necessitates a re-evaluation of current screening and management programs. Revision of these programs is crucial to improve quality of care, reduce costs, and ultimately achieve Sustainable Development Goal 3, which aims to ensure good health and well-being for all.

Forecasting the Pharmacological Mechanisms of Plumbago zeylanica and Solanum xanthocarpum in Diabetic Retinopathy Treatment: A Network Pharmacology, Molecular Docking, and Molecular Dynamics Simulation Study.

(1) Background: Diabetic retinopathy (DR) is a major complication of diabetes, marked by abnormal angiogenesis, microaneurysms, and retinal hemorrhages. Traditional Ayurvedic medicine advocates multi-target strategies for DR management. However, the mechanisms by which Solanum xanthocarpum (SX) and Plumbago zeylanica (PZ) exert therapeutic effects are not well understood; (2) Methods: To investigate these mechanisms, we employed network pharmacology and molecular docking techniques. Phytochemicals from SX and PZ were identified using the IMPPAT database and Swiss Target Prediction tool. DR-related protein targets were sourced from the GeneCards database, and common targets were identified through Venn diagram analysis. STRING and Cytoscape were used to construct and analyze protein-protein interaction networks. Pathway enrichment was performed with Gene Ontology and KEGG databases; (3) Results: We identified 28 active phytoconstituents, targeting proteins such as EGFR, SRC, STAT3, AKT1, and HSP90AA1. Molecular docking and dynamics simulations confirmed the strong binding affinities of these compounds to their targets; (4) Conclusions: The study highlights the multi-target activity of SX and PZ, particularly in pathways related to EGFR tyrosine kinase inhibitor resistance and PI3K-AKT signaling. These findings provide valuable insights into their therapeutic potential for DR, suggesting the effective modulation of key molecular pathways involved in the disease.

Management of retinal diseases, therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy

Introduction: Effective management of retinal diseases, especially diabetic retinopathy, is crucial for preventing severe visual complications. Collaboration between ophthalmologists and endocrinologists plays a fundamental role in the effective treatment of this condition, aiming to preserve vision and improve patients' quality of life. Methods: A bibliographic review was conducted to understand the management of retinal diseases and the therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy. We used databases such as MEDLINE, PubMed, and Scielo to identify relevant articles published in the last 20 years. Inclusion and exclusion criteria were defined to ensure the selection of pertinent studies. Results: After the search and selection of articles, patterns and trends in the management of diabetic retinopathy were identified. A variety of treatment options were located, including laser photocoagulation, intravitreal injections of medications, and vitreoretinal surgery. The importance of metabolic control of diabetes to prevent retinal damage was noted. The analysis of the studies also highlighted that the interaction between these specialties ensures better clinical outcomes. Conclusion: The importance of collaboration between ophthalmologists and endocrinologists in the management of diabetic retinopathy is reinforced. An integrated approach that considers both ophthalmological and endocrinological aspects of the disease is essential to provide effective care to patients. This cooperation can result in better visual outcomes and quality of life for those affected by diabetic retinopathy.

Improved diabetic retinopathy severity classification using squeeze-and-excitation and sparse light weight multi-level attention u-net with transfer learning from xception.

Diabetic Retinopathy (DR) is a significant cause of vision loss in diabetic patients, making early detection and accurate severity classification essential for effective management and prevention. This study aims to develop an enhanced DR severity classification approach using advanced model architectures and transfer learning to improve diagnostic accuracy and support better patient care. We propose a novel model, Xception Squeeze-and-Excitation Sparse Lightweight Multi-Level Attention U-Net (XceSE_SparseLwMLA-UNet), designed to classify DR severity using fundus images from the Messidor 1 and Messidor 2 datasets. The XceSE_SparseLwMLA-UNet integrates several advanced mechanisms: the Squeeze-and-Excitation (SE) mechanism for adaptive feature recalibration, the Sparse Lightweight Multi-Level Attention (SparseLwMLA) mechanism for effective contextual information integration, and transfer learning from the Xception architecture to enhance feature extraction capabilities. The SE mechanism refines channel-wise feature responses, while SparseLwMLA enhances the model's ability to identify complex DR patterns. Transfer learning utilizes pre-trained weights from Xception to improve generalization across DR severity levels. The proposed XceSE_SparseLwMLA-UNet model demonstrates superior performance in DR severity classification, achieving higher accuracy and improved multi-class F1 scores compared to existing models. The model's color-coded segmentation outputs offer interpretable visual representations, aiding medical professionals in assessing DR severity levels. The XceSE_SparseLwMLA-UNet model shows promise for advancing early DR diagnosis and management by enhancing classification accuracy and providing valuable visual insights. Its integration of advanced architectural features and transfer learning contributes to better patient care and improved visual health outcomes.

Isolation of Mouse Retinal Capillaries and Subendothelial Matrix for Stiffness Measurement Using Atomic Force Microscopy.

Retinal capillary degeneration is a clinical hallmark of the early stages of diabetic retinopathy (DR). Our recent studies have revealed that diabetes-induced retinal capillary stiffening plays a crucial and previously unrecognized causal role in inflammation-mediated degeneration of retinal capillaries. The increase in retinal capillary stiffness results from the overexpression of lysyl oxidase, an enzyme that crosslinks and stiffens the subendothelial matrix. Since tackling DR at the early stage is expected to prevent or slow down DR progression and associated vision loss, subendothelial matrix, and capillary stiffness represent relevant and novel therapeutic targets for early DR management. Further, direct measurement of retinal capillary stiffness can serve as a crucial preclinical validation step for the development of new imaging techniques for non-invasive assessment of retinal capillary stiffness in animal and human subjects. With this view in mind, we here provide a detailed protocol for the isolation and stiffness measurement of mouse retinal capillaries and subendothelial matrix using atomic force microscopy.

Allicin Mitigates Diabetic Retinopathy in Rats by Activating Phosphatase and Tensin Homolog-induced Kinase 1/Parkin-mitophagy and Inhibiting Oxidative Stress-mediated NOD-like Receptor Family Pyrin Domain Containing 3 Inflammasome.

Diabetic retinopathy (DR) is one of the significant disabling outcomes of diabetes mellitus characterized by retinal microvascular damage, inflammation, and neuronal dysfunction. Allicin (Alc), a natural compound found in garlic, has garnered attention for its antioxidant and anti-inflammatory properties, positioning it as a potential therapeutic agent for DR. The aim of the present study was to investigate the therapeutic efficacy of Alc in DR management and elucidate its underlying mechanisms of action. We established a DR model in male Sprague-Dawley rats (n = 50, 200-250 g, 12 weeks old) using a high-fat diet for 8 weeks plus a low dose of streptozotocin administered at the start of the 4th week. The diabetic (Diab) animals were administered Alc (16 mg/kg/day, orally), either alone or in combination with mitochondrial division inhibitor-1 (Mdivi-1) as a mitophagy inhibitor, starting 28 days before tissue sampling. We evaluated histopathological changes, metabolic abnormalities associated with type 2 diabetes mellitus (T2DM), the expression of proteins regulating pyroptosis (NOD-like receptor family pyrin domain containing 3, cleaved-caspase 1, and gasdermin D-N terminal) and mitophagy (phosphatase and tensin homolog-induced kinase 1 [PINK1] and Parkin), as well as the levels of oxidative stress mediators and proinflammatory cytokines. Alc treatment effectively ameliorated histopathological changes and metabolic abnormalities associated with T2DM. It downregulated pyroptosis-related proteins, upregulated mitophagy-related proteins, reduced proinflammatory cytokine levels, and attenuated oxidative stress. Treatment with Mdivi-1 suppressed the beneficial effects of Alc. Our findings highlight the therapeutic potential of Alc in managing DR by targeting multiple pathophysiological pathways, including pyroptosis, inflammation, and oxidative stress. The observed antipyroptotic effects of Alc were partially mediated by the activation of the PINK1/parkin-mediated mitophagy pathway. Additional studies are necessary to thoroughly understand the therapeutic mechanisms of Alc and its viability as a treatment choice for DR.

A Review on Diabetic Retinopathy.

Diabetic retinopathy is a well-recognised microvascular complication of diabetes and is among the leading cause of blindness all over the world. Over the last decade, there have been advances in the diagnosis of diabetic retinopathy and diabetic macular edema. At the same time, newer therapies for the management of diabetic retinopathy have evolved. As a result of these advances, a decline in severe vision loss due to diabetes has been witnessed in some developing countries. However, there is a steady increase in the number of people affected with diabetes, and is expected to rise further in the coming years. Therefore, it is prudent to identify diabetic retinopathy, and timely intervention is needed to decrease the burden of severe vision loss. An effort has been made to review all the existing knowledge regarding diabetic retinopathy in this article and summarize the present treatment options for diabetic retinopathy.

Diabetic Retinopathy and Vision Loss: A Public Health Concern

Diabetic Retinopathy (DR), a known complication of diabetes, is one of the top three leading causes of blindness in the U.S. Minorities are disproportionately affected and, most often, diagnosed at advanced stages. This review consolidates current epidemiological data, pathophysiological insights, clinical classifications, and treatment approaches for DR. Despite advancements in therapies like anti-VEGF drugs and laser treatments, significant disparities persist, particularly affecting racial minorities and those with lower socioeconomic status. Early detection via regular eye exams and improved healthcare access are crucial in mitigating DR's increasing global impact. Public health strategies must address these disparities and ensure inclusivity in clinical research to improve DR management and outcomes. Continued awareness of primary and secondary forms of prevention is crucial in all populations with DR, especially minorities, because progression to severe stages can be recognized, treated, and ameliorated. Although anti-vascular endothelial growth factors have advanced, further research is needed to aid understanding of DR in populations disproportionately affected by severe diseases.

Hybrid Explainable Artificial Intelligence Models for Targeted Metabolomics Analysis of Diabetic Retinopathy.

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus, and early detection is crucial for effective management. Metabolomics profiling has emerged as a promising approach for identifying potential biomarkers associated with DR progression. This study aimed to develop a hybrid explainable artificial intelligence (XAI) model for targeted metabolomics analysis of patients with DR, utilizing a focused approach to identify specific metabolites exhibiting varying concentrations among individuals without DR (NDR), those with non-proliferative DR (NPDR), and individuals with proliferative DR (PDR) who have type 2 diabetes mellitus (T2DM). A total of 317 T2DM patients, including 143 NDR, 123 NPDR, and 51 PDR cases, were included in the study. Serum samples underwent targeted metabolomics analysis using liquid chromatography and mass spectrometry. Several machine learning models, including Support Vector Machines (SVC), Random Forest (RF), Decision Tree (DT), Logistic Regression (LR), and Multilayer Perceptrons (MLP), were implemented as solo models and in a two-stage ensemble hybrid approach. The models were trained and validated using 10-fold cross-validation. SHapley Additive exPlanations (SHAP) were employed to interpret the contributions of each feature to the model predictions. Statistical analyses were conducted using the Shapiro-Wilk test for normality, the Kruskal-Wallis H test for group differences, and the Mann-Whitney U test with Bonferroni correction for post-hoc comparisons. The hybrid SVC + MLP model achieved the highest performance, with an accuracy of 89.58%, a precision of 87.18%, an F1-score of 88.20%, and an F-beta score of 87.55%. SHAP analysis revealed that glucose, glycine, and age were consistently important features across all DR classes, while creatinine and various phosphatidylcholines exhibited higher importance in the PDR class, suggesting their potential as biomarkers for severe DR. The hybrid XAI models, particularly the SVC + MLP ensemble, demonstrated superior performance in predicting DR progression compared to solo models. The application of SHAP facilitates the interpretation of feature importance, providing valuable insights into the metabolic and physiological markers associated with different stages of DR. These findings highlight the potential of hybrid XAI models combined with explainable techniques for early detection, targeted interventions, and personalized treatment strategies in DR management.

Effect of a self-care promoting program on engagement in self-care behaviors and health-related outcomes among persons with type 2 diabetes and diabetic retinopathy: A single-blind randomized controlled trial.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, leading to visual impairment and eventual blindness. Promoting self-care behaviors is crucial in controlling DR progression and preventing blindness. This study aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, HbA1c levels, visual acuity (VA), severity of DR, and vision-related quality of life (VRQoL) among individuals with type 2 diabetes and DR. This study employed a single-blind randomized controlled trial design to compare SCPP with conventional diabetic care interventions (standard care). The SCPP was based on the Self-Care of Chronic Illness Theory, Self-efficacy theory, and the Association of Diabetic Care and Education Specialist (ADCES) guidelines incorporating health education, self-care maintenance, monitoring, and management skills training over 12 weeks. Ninety-eight participants were randomly allocated to the experimental or control group (n = 49 per group). While the experimental group received SCPP alongside standard care, the control group received standard care alone. Data collection occurred between May 2022 and March 2023 and included demographic information, the Self-Care of Diabetes Index questionnaire (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment questionnaire (IVI-Thai version), and retinal images for DR severity grading. Data analysis utilized descriptive statistics, Chi-Square tests, t-tests, and MANOVA. Following 8 and 16 weeks of SCPP, the experimental group had significantly higher mean scores in engagement with self-care and eye-care behaviors compared to the control group (p <0.001). The highest scores were observed in self-care and eye-care confidence behaviors, followed by maintenance, monitoring, and management. Furthermore, HbA1c levels and VRQoL significantly decreased and were lower than those of the control group at week 16 (p <0.001 and p <0.05, respectively). However, there were no significant differences in VA, and DR severity increased in both groups by week 16. SCPP benefits individuals with DR, enhancing their confidence and ability to perform, monitor, and manage self-care behaviors. These strategies contribute to improved diabetes management, enhanced quality of life, and reduced DR-related blindness. Integrating SCPP into routine DR management is recommended, with nurses playing a pivotal role in overseeing and driving this integration, highlighting the critical role of nurses in managing this widespread global disease. Thai Clinical Trials Registration (TCTR20230302002).

560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema

560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema

HMBG-1: A Biomarker in the Management of Diabetic Retinopathy

Introduction: High mobility group box (HMGB)-1 protein is a promising prognostic marker for predicting the course of retinopathy and the prognosis in patients with diabetic retinopathy (DR). The aim of this study is to investigate whether serum HMGB-1 protein levels can be used as a biomarker about the severity of the disease in patients with diabetic retinopathy. Material and methods: This study was carried out in the internal medicine and ophthalmology departments of the Gaziantep Medicalpark Hospital. The records of 50 patients diagnosed with type 2 diabetes mellitus with diabetic retinopathy and 47 healthy subjects who applied to our clinic between January 2016 and December 2018 were retrospectively scanned. Five cc of venous blood was taken from the patients, and control groups were included in the study for routine laboratory tests and serum HMGB-1 levels to be studied under appropriate conditions. Human HMGB-1 levels were measured using the ELISA method. Results: There was a significant difference among the groups in terms of HMGB-1 levels (p&lt;0.001) (Table-1). There was a positive correlation between blood glucose and HMGB-1 in the diabetic retinopathy group (Spearman's rho (ρ)=0.07). Similarly, there was a positive correlation between HbA1c and HMGB-1 levels in the diabetic retinopathy group. (Spearman's rho (ρ)=0.06). Conclusions: Our study suggests that HMGB-1 may be a useful biomarker in managing DR, aiding in the prediction and treatment of microvascular complications.

Anti-vascular endothelial growth factor (anti-VEGF): its function in proliferative diabetic retinopathy management

Introduction. Among working-age adults, diabetes is a primary cause of visual impairment. Pan-retinal photocoagulation, the standard treatment for proliferative diabetic retinopathy, is effective but comes with well-established adverse effects, including limitations on the peripheral visual field. The mechanism of vascular proliferation is thought to be triggered by vascular endothelial growth factor (anti-VEGF). Anti-VEGF medications have been studied extensively in the treatment of diabetic macular edema, and the results suggest that treatment with anti-VEGF medications causes a decrease in diabetic retinopathy. Anti-VEGF therapies can be used to treat underlying proliferative diabetic retinopathy in cases of vitreous bleeding when platelet-rich plasma cannot be used, delaying, or reducing the necessity for a vitrectomy. However, the limitations of anti-VEGF therapy require careful patient selection and constant observation. Recent clinical trials and recommendations for the use of anti-VEGF in proliferative diabetic retinopathy are presented in this review. Material and methods. The effectiveness of anti-VEGF medicines in the treatment of diabetic retinopathy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus, and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: “angiogenesis inhibitors”, “anti-VEGF”, “pan-retinal photocoagulation”, “intravitreal injection”, “diabetic retinopathy”. Accurate diagnosis, side effects, quality of life, and patient satisfaction were analyzed and compared for each treatment option. Results. Anti-VEGF treatments have been demonstrated to be beneficial in reducing macular edema, enhancing visual acuity, and slowing the advancement of diabetic retinopathy. While generally safe, different anti-VEGF medicines have varied side effects profiles. Conclusion. When choosing an anti-VEGF treatment for diabetic retinopathy, factors such as patient satisfaction, quality of life, side effects, and correct diagnosis should be taken into account. While anti-VEGF treatments show promise, further study is required to fully understand their advantages and disadvantages and to optimize their application.

Evaluation of Artificial Intelligence Algorithms for Diabetic Retinopathy Detection: Protocol for a Systematic Review and Meta-Analysis.

Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus. The global burden is immense with a worldwide prevalence of 8.5%. Recent advancements in artificial intelligence (AI) have demonstrated the potential to transform the landscape of ophthalmology with earlier detection and management of DR. This study seeks to provide an update and evaluate the accuracy and current diagnostic ability of AI in detecting DR versus ophthalmologists. Additionally, this review will highlight the potential of AI integration to enhance DR screening, management, and disease progression. A systematic review of the current landscape of AI's role in DR will be undertaken, guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) model. Relevant peer-reviewed papers published in English will be identified by searching 4 international databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Eligible studies will include randomized controlled trials, observational studies, and cohort studies published on or after 2022 that evaluate AI's performance in retinal imaging detection of DR in diverse adult populations. Studies that focus on specific comorbid conditions, nonimage-based applications of AI, or those lacking a direct comparison group or clear methodology will be excluded. Selected papers will be independently assessed for bias by 2 review authors (JS and DM) using the Quality Assessment of Diagnostic Accuracy Studies tool for systematic reviews. Upon systematic review completion, if it is determined that there are sufficient data, a meta-analysis will be performed. Data synthesis will use a quantitative model. Statistical software such as RevMan and STATA will be used to produce a random-effects meta-regression model to pool data from selected studies. Using selected search queries across multiple databases, we accumulated 3494 studies regarding our topic of interest, of which 1588 were duplicates, leaving 1906 unique research papers to review and analyze. This systematic review and meta-analysis protocol outlines a comprehensive evaluation of AI for DR detection. This active study is anticipated to assess the current accuracy of AI methods in detecting DR. DERR1-10.2196/57292.

Prevalence of Diabetic Retinopathy among Self-reported Newly Diagnosed Diabetics

Introduction: Diabetic Retinopathy (DR) poses a significant threat to individuals with diabetes, leading to visual impairment and blindness if not promptly addressed. This study focuses on the prevalence of diabetic retinopathy among self-reported newly diagnosed diabetics. Material method: This is a prospective study on 200 self-reported newly diagnosed diabetics from April 2022 to May 2023. Patient data, including complaints, diabetes duration, family history, hypertension, and therapy details, were comprehensively analyzed. Complete Ocular examinations including best-corrected visual acuity, intraocular pressure, slit lamp examination, fundus examinations, and Fundus fluorescein angiography were done. Diabetic Retinopathy was graded using a modified ETDRS grading system. Laboratory investigations included complete blood count, fasting and postprandial blood sugar, lipid profile, renal function test, and Hb1AC levels, providing a thorough assessment of patients’ ocular and systemic health. Result: Out of the 200 diabetics, 43.5% had diabetic retinopathy, with a slightly higher prevalence in males (44.64%) compared to females. The age group 50 - 59 had the highest prevalence (74.19%), and Hindus, Muslims, and other communities showed comparable percentages. Family history and hypertension were significant factors, with 88% of those with a family history developing retinopathy. NPDR was predominant (87.35%), while 12.64% had PDR. Clinically Significant Macular Edema (CSME) was present in 59.77%, with 80.76% of these cases having concomitant hypertension. Conclusion: The study emphasizes the imperative for early detection and comprehensive management of diabetic retinopathy among newly diagnosed diabetics. Age, gender, family history, and hypertension emerge as crucial determinants, advocating for integrated care and targeted screening programs to safeguard vision.

Does addition of intravitreal bevacizumab confer additional benefit in management of proliferative diabetic retinopathy?

To evaluate visual outcome and complications of PDR after treatment with Intravitreal Bevacizumab followed by Pan Retinal Photocoagulation A hospital based retrospective study was done in the Department of Ophthalmology, to evaluate visual outcome and complications of PDR after treatment with intravitreal Bevacizumab followed by Pan Retinal Photocoagulation. Visual Acuity, Dilated fundus examination, OCT macula were done on subsequent follow ups 135 eyes of 133 patients were included in the study.The mean pre procedure visual acuity is 0.639±0.5327 which improved to 0.451±0.4089 post procedure. P value is &amp;#60;0.001 which is statistically significant.i.e, 94 (69.62%) eyes had improved vision, 21(15.55%) had stable vision and 20(14.81%) eyes had decreased vision. After injection followed by PRP out of 135 eyes,4(2.96%) eyes developed vitreous hemorrhage which resolved with repeat intravitreal anti-VEGF injection, 6(4.44%) eyes developed diabetic macular edema,3(2.2%) eyes developed Neovascularisation of iris and 4(2.96%)eyes developed vitreous hemorrhage with traction retinal detachment.From our study it appears that addition of intravitreal anti VEGF to Pan Retinal Photocoagulation for PDR confers the additional benefit of less incidence of vitreous hemorrhage and less incidence of traction retinal detachment requiring surgery in the 1 one year of follow up. This amounts to more compliance by the patient for taking the treatment as well as better visual outcome