Management Of Diabetic Retinopathy Research Articles

Use of Fenofibrate in the Management of Diabetic Retinopathy—Large Population Analyses

Use of Fenofibrate in the Management of Diabetic Retinopathy—Large Population Analyses

Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Women With Preexisting Diabetes

Diabetic retinopathy (DR) may be worsened by pregnancy in pregnant women with preexisting type 1 diabetes (T1D) or type 2 diabetes (T2D). Conflicting findings from previous studies have resulted in inconsistencies in guidelines regarding DR management in pregnancy. Global estimates of DR prevalence and progression in pregnancy are therefore required to provide clearer information about the overall true burden of DR in this population. To estimate the prevalence of DR and its progression rate in pregnant women with preexisting T1D or T2D diagnosed before pregnancy. For this systematic review and meta-analysis, conducted from November 27, 2018, to June 29, 2021, a systematic literature search was conducted in MEDLINE/Ovid, Embase/Ovid, and Scopus databases to identify English-language articles that were published from inception through October 2020. Observational studies that reported on DR and its changes in pregnant women with preexisting T1D and T2D. Two independent reviewers extracted relevant data from each included study. Data were pooled using a random-effects model with the Freeman-Tukey double arcsine transformation. This study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Prevalence of any DR, proliferative DR (PDR), and DR progression rates. A total of 18 observational studies involving 1464 pregnant women with T1D and 262 pregnant women with T2D were included in the analysis. The pooled prevalence of any DR and PDR in early pregnancy was 52.3 (95% CI, 41.9-62.6) and 6.1 (95% CI, 3.1-9.8) per 100 pregnancies, respectively. The pooled progression rate per 100 pregnancies for new DR development was 15.0 (95% CI, 9.9-20.8), worsened nonproliferative DR was 31.0 (95% CI, 23.2-39.2), progression from nonproliferative DR to PDR was 6.3 (95% CI, 3.3-10.0), and worsened PDR was 37.0 (95% CI, 21.2-54.0). DR progression rates per 100 pregnancies were similar between the T1D and T2D groups, except for the development of new DR (T1D groups: 15.8; 95% CI, 10.5-21.9; T2D groups: 9.0; 95% CI, 4.9-14.8). A global trend toward a lower DR progression rate was observed after the 1989 St Vincent Declaration. Results of this systematic review and meta-analysis suggest that women with T1D and T2D had a similar risk of DR progression during pregnancy. Despite improvements in the management of diabetes and diabetes during pregnancy, DR prevalence and progression in pregnant women with diabetes remains higher than the nonpregnant population with diabetes, highlighting the need to improve DR management in pregnancy.

Nonperfusion Area and Other Vascular Metrics by Wider Field Swept-Source OCT Angiography as Biomarkers of Diabetic Retinopathy Severity.

PurposeTo study the wider field (WF) swept-source OCT angiography (SS-OCTA) metrics, especially the nonperfusion area (NPA), in the diagnosing and staging of diabetic retinopathy (DR).DesignCross-sectional observational study (November 2018 to September 2020).ParticipantsA total of 473 eyes of 286 patients (69 eyes of 49 control patients and 404 eyes of 237 diabetic patients).MethodsWe imaged using 6 × 6 mm and 12 × 12 mm angiograms on WF SS-OCTA. Images were analyzed using the ARI Network and FIJI ImageJ. Mixed effects multiple regression models and receiver operating characteristic (ROC) analysis were used for statistical analyses.Main Outcome MeasuresQuantitative metrics such as vessel density (VD); vessel skeletonized density (VSD); foveal avascular zone (FAZ) area, circularity, and perimeter; and NPA in DR and their relative performance for its diagnosis and grading.ResultsAmong patients with diabetes (median age, 59 years), 51 eyes had no DR, 185 eyes (88 mild, 97 moderate-severe) had nonproliferative DR (NPDR), and 168 eyes had proliferative DR (PDR). Trend analysis revealed a progressive decline in superficial capillary plexus (SCP) VD and VSD, and increased NPA with increasing DR severity. Additionally, there was a significant reduction in deep capillary plexus (DCP) VD and VSD in early DR (mild NPDR), but the progressive reduction in advanced DR stages was not significant. The NPA was the best parameter to diagnose DR (area under the curve [AUC], 0.96), whereas all parameters combined on both angiograms efficiently diagnosed (AUC, 0.97) and differentiated between DR stages (AUC range, 0.83–0.97). The presence of diabetic macular edema was associated with reduced SCP and DCP VD and VSD within mild NPDR eyes, whereas increased VD and VSD in SCP were observed in the moderate-severe NPDR group.ConclusionsOur work highlights the importance of NPA, which can be measured more readily and easily with WF SS-OCTA compared with fluorescein angiography. It is quick and noninvasive, and thus can be an important adjunct for DR diagnosis and management. In our study, a combination of all OCTA metrics on both 6 × 6 mm and 12 × 12 mm angiograms had the best diagnostic accuracy for DR and its severity. Further longitudinal studies are needed to assess NPA as a biomarker for progression or regression of DR severity.

Telescreening satisfaction: disparities between individuals with diabetic retinopathy and community health center staff

BackgroundThe success of telescreening and the management of diabetic retinopathy (DR) in communities depends on stakeholder satisfaction, including both individuals with diabetes and community health center (CHC) staff. In this study, we investigated the satisfaction of both individuals with vision-threatening DR (VTDR) and CHC staff within the Shanghai Eye Disease Study (SEDS) comprehensive system for managing diabetic eye diseases at the primary care level.MethodsThe cross-sectional survey of patients receiving the service included 3,817 respondents with VTDR and focused on their satisfaction with the SEDS system, including the telescreening process, speed of feedback, interpretation of results, increased awareness of related diseases, and eye care services. The survey of the providers included 234 CHC staff respondents and focused on their satisfaction and the main barriers encountered during the implementation of the system. Sociodemographic characteristics and perceived barriers related to satisfaction were identified by conducting univariate and multivariate logistic regression analyses.ResultsThe overall satisfaction of service recipients was 96.0%, and 75.8% of them were willing to undergo future telescreening for DR. The convenience of telescreening, organization of telescreening, and improvement in related disease awareness significantly correlated with satisfaction. Only 48.3% of the providers were satisfied with the SEDS system. The most frequently mentioned barriers to the development of the system were the inadequate levels of staffing (particularly technical staff), insufficient funding, and incomplete information transmission systems.ConclusionsDisparities between high patient satisfaction and low provider satisfaction with the SEDS system were mainly related to the current weak level of ophthalmic expertise in the CHCs and the low awareness of screening for diabetic eye diseases among both patients and providers.

A Novel Approach for Identification of Biomakers in Diabetic Retinopathy Recognition

In the emergence of anti-Antivascular endothelial growth factor (VEGF) drugs such as ranibizumab and bevacizumab, it has become obvious that the presence of outer retinal and subretinal fluid is the primary signal of the need for anti-VEGF therapy, and used to identify disease activity and assist diabetic retinopathy treatment. Despite advancements in diabetic retinopathy (DR) treatments, early detection is critical for DR management and remains a significant barrier. Clinical DR can be distinguished from non proliferative DR without visible vision loss and vision-threatening consequences such as macular edoema and proliferative retinopathy by retinal alterations in diabetes. The proposed method aggrandize the process of accurate detection of biomakers responsible for higher risk of diabetic retinopathy development in color fundus images. Furthermore, the proposed approach could be employed to quantify these lesions and their distributions efficientively as evident in the experimentation results.

Telehealth Screening for Diabetic Retinopathy: Economic Modeling Reveals Cost Savings.

Introduction: The use of telehealth screening (TS) for diabetic retinopathy (DR) consists of fundus photography in a primary care setting with remote interpretation of images. TS for DR is known to increase screening utilization and reduce vision loss compared with standard in-person conventional diabetic retinal exam (CDRE). Anti-vascular endothelial growth factor intravitreal injections have become standard of care for the treatment of DR, but they are expensive. We investigated whether TS for DR is cost-effective when DR management includes intravitreal injections using national data. Materials and Methods: We compared cost and effectiveness of TS and CDRE using decision-tree analysis and probabilistic sensitivity analysis with Monte Carlo simulation. We considered the disability weight (DW) of vision impairment and 1-year direct medical costs of managing patients based on Medicare allowable rates and clinical trial data. Primary outcomes include incremental costs and incremental effectiveness. Results: The average annual direct cost of eye care was $196 per person for TS and $275 for CDRE. On average, TS saves $78 (28%) compared with CDRE and was cost saving in 88.9% of simulations. The average DW outcome was equivalent in both groups. Discussion: Although this study was limited by a 1-year time horizon, it provides support that TS for DR can reduce costs of DR management despite expensive treatment with anti-VEGF agents. TS for DR is equally effective as CDRE at preserving vision. Conclusions: Annual TS for DR is cost saving and equally effective compared with CDRE given a 1-year time horizon.

Update on Management of Non-proliferative Diabetic Retinopathy without Diabetic Macular Edema; Is There a Paradigm Shift?

Diabetic retinopathy (DR) is the major cause of visual impairment and blindness in the working-age population. Conventional management for nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME) is derived from the findings of the Early Treatment Diabetic Retinopathy Study (ETDRS). Although the ETDRS protocol basically includes observation, selected cases of severe NPDR may undergo scatter laser photocoagulation. Post-hoc analysis of recent trials has shown that patients with NPDR receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) for DME would experience improvement in the DR severity scale (DRSS). In addition, recent randomized trials (PANORAMA and Protocol W) have revealed that early intervention with intravitreal aflibercept in eyes with moderately severe to severe NPDR is associated with significant improvement in DRSS and reduced vision-threatening complications of DR. Based on recent studies, it seems that the therapeutic approach to NPDR may undergo a substantial change and a paradigm shift toward considering early intervention with the administration of intravitreal anti-VEGF injections. However, the long-term results and the duration of adherence to anti-VEGF therapy for eyes with NPDR are not yet defined. It is also not apparent whether improvement in DRSS is a true disease modification. Studies showed that DRSS improvement is not associated with retinal reperfusion. In addition, DRCR.net Protocol W showed no visual acuity benefit with the early intravitreal aflibercept injection in moderate to severe NPDR as compared with performing observation plus intravitreal aflibercept applied only after progression to proliferative DR or vision-impairing DME. The cost–benefit ratio is also a challenge. Herein, we look at different aspects of early anti-VEGF application and discuss its pros and cons in the process of treating NPDR.

Prevalence of diabetic retinopathy among diabetic patients in Northwest Ethiopia-A cross sectional hospital based study.

BackgroundDiabetic retinopathy is the most common microvascular complication of diabetes mellitus on eye and it is the leading cause of visual impairment among productive segment of the population. Globally, the prevalence of diabetic retinopathy is reported to be 27%. In Ethiopia, sufficient data is lacking on the prevalence of diabetic retinopathy as well as information on its predisposing factors. The study was required to assess the prevalence of diabetic retinopathy and its predisposing factors in diabetic patients attending at a General Hospital in Ethiopia.MethodsAn institution based cross sectional study was employed on 331 diabetic patients recruited with a systematic random sampling technique. Data were collected through structured questionnaire, tracing patients’ medical folder and ocular health examination. Data were analyzed with Statistical Package for Social Science Version 20. Logistic regression methods of analysis were used to figure out predisposing factors of diabetic retinopathy. Adjusted odds ratio with 95% confidence interval was used to determine the strength of association.ResultA total of 331 diabetic patients completed the study with a response rate of 99.10%. The median duration of diabetes was 5 years. The prevalence of diabetic retinopathy was 34.1% (95%Confidence Interval (CI): 28.7%-39.3%). Low family monthly income (Adjusted Odds Ratio (AOR) = 7.43, 95% CI: 2.44–22.57), longer duration of diabetes (AOR = 1.44, 95% CI: 1.30–1.58), poor glycemic control (AOR = 4.76, 95%CI: 2.26–10.00), and being on insulin treatment alone (AOR = 3.85, 95%CI: 1.16–12.74) were independently associated with diabetic retinopathy.Conclusion and recommendationThe prevalence of diabetic retinopathy was 34.1%, higher than national and global figures. Low family monthly income, longer duration of diabetes, poor glucose control and being on insulin treatment alone were important risk factors of diabetic retinopathy. Proper diabetes self management and early screening of diabetic retinopathy in all diabetic patients were recommended.

Development of a diabetic retinopathy screening model for a district health system in Limpopo Province, South Africa

Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented.Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA.Setting: The study was conducted through Voortrekker District Hospital, Limpopo Province, SA.Methods: A saturated strategy sample study was employed, and questionnaires were distributed to 24 endocrinologists in both private and public practices in Gauteng Province and to three ophthalmologists and 10 medical officers (MOs) in ophthalmology in health institutions in Waterberg and Capricorn districts of Limpopo Province. The questionnaires distributed included questions relating to the recommended roles of primary healthcare (PHC) nurses, MOs in general practice, MOs in ophthalmology, ophthalmic nurses, optometrists, and ophthalmologists to manage patients with DM in the public sector. The Delphi technique was employed requiring experts to comment qualitatively and quantitatively to elicit the required information.Results: At PHC level, PHC nurses are to document a comprehensive patient case history and assess vitals before referring to MOs in general practice. Medical officers in general practice are to assess DM control and screen for target organ disease. All patients with DM are to be referred to optometrists for retinal photography. Optometrists and ophthalmic nurses are to detect, grade and monitor pre-proliferative stages of DR, and refer to MOs in ophthalmology or ophthalmologists at district or tertiary hospitals for surgical intervention or treatment.Conclusion: Based on the expertise of the endocrinologists and ophthalmologists concerned, a DR screening model for a DHS was proposed, reflecting the role of HCPs in the management of DM and DR in the DHS of Limpopo Province, SA.

Ischemia modified albumin as a useful marker for diagnoses and management of diabetic retinopathy.

Objectives:Ischemia modified albumin (IMA) may aid in the early detection and management of diabetic retinopathy (DR). In this study, we examined the relationship between IMA and DR, and the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) on IMA levels in patients with DR.Methods:This Quasi-experimental study was conducted from March-December 2018 at a Al-Ibrahim Eye Hospital in Karachi, Pakistan. Adult patients (age ≥ 18 year) with Type-2 diabetes mellitus (T2DM) presenting to the Diabetic Clinic were categorized as control (Group-A n=30: DM without DR) or case (Group-B n=59: DM with DR). Patients in Group-B received an intravitreal injection of bevacizumab (anti-VEGF). Visual acuity, retinoscopy and serum IMA were recorded at baseline and at a 30-day follow-up for both groups.Results:A significant drop in IMA levels was seen one month after bevacizumab (IMA baseline: 1590.82±121.22 and follow up: 940.8±91.26; p<0.01) in Group-B subjects. Visual acuity (VA) of patient in Group-B also improved one month after bevacizumab injection in both eyes (p<0.001). Whereas, the IMA levels in Group-A showed an upward rising trend after one month (baseline 448.80±22.4ng/ml and follow up 522.21±33.15 ng/ml; p>0.05) indicating disease progression.Conclusion:Ischemia modified albumin may be used as an effective and novel screening biomarker for assessing oxidative stress associated with DR, and to quantify response to and prognosis after intravitreal bevacizumab injection for DR.

Diabetic retinopathy awareness in urban and rural population: A structured interview

Diabetes has been termed one of the largest health emergencies of the 21st century. The Diabetic Retinopathy is a leading cause of blindness that affects 34 million worldwide. Diabetic retinopathy is caused when high blood sugar damages blood vessels in the retina. Damaged blood vessels can swell & leak, causing blurry vision or stopping blood flow. Sometimes new blood vessels grow but they are not normal and can cause further vision problems. Diabetic retinopathy usually affects both eyes. The blindness as a result of diabetic retinopathy can be prevented by early detection and management. For this, patients need to be screened as per guidelines recommended by International Diabetes Federation. Patient awareness to Diabetic retinopathy is the key to early detection, prevention and further improvements in Diabetic retinopathy management as patients play an important role in their glycemic control and eye care. Managing diabetes by patient himself and getting regular eye examinations can help prevent vision problem and stop them from getting worse.The primary goal of this study is to assess the awareness about diabetic retinopathy in Indian urban and rural population. The present study was conducted on 451 subjects out of which 62.08% and 47.67% had knowledge of diabetes and Diabetic retinopathy respectively. Knowledge about Diabetes mellitus & Diabetic retinopathy was more in urban population as compared to rural. Compared with those who had no knowledge of Diabetic retinopathy, significant percentage of individuals with knowledge had the right attitude to go for regular eye examination and good practices for control of the disease.

MiR-125a-5p attenuates macrophage-mediated vascular dysfunction by targeting Ninjurin1.

Ninjurin1 (Ninj1), an adhesion molecule, regulates macrophage function in hyaloid regression, multiple sclerosis, and atherosclerosis. However, its biological relevance and the mechanism underlying its function in vascular network integrity have not been studied. In this study, we investigated the role of Ninj1 in physiological (postnatal vessel formation) and pathological (endotoxin-mediated inflammation and diabetes) conditions and developed a strategy to regulate Ninj1 using specific micro (mi)RNAs under pathological conditions. Ninj1-deficient mice exhibited decreased hyaloid regression, tip cell formation, retinal vascularized area, recruitment of macrophages, and endothelial apoptosis during postnatal development, resulting in delayed formation of the vascular network. Five putative miRNAs targeting Ninj1 were selected using the miRanda algorithm and comparison of expression patterns. Among them, miR-125a-5p showed a profound inhibitory effect on Ninj1 expression, and miR-125a-5p mimic suppressed the cell-to-cell and cell-to-matrix adhesion of macrophages and expression of pro-inflammatory factors mediated by Ninj1. Furthermore, miR-125a-5p mimic inhibited the recruitment of macrophages into inflamed retinas in endotoxin-induced inflammation and streptozotocin-induced diabetes in vivo. In particular, miR-125a-5p mimic significantly attenuated vascular leakage in diabetic retinopathy. Taken together, these findings suggest that Ninj1 plays a pivotal role in macrophage-mediated vascular integrity and that miR-125a-5p acts as a novel regulator of Ninj1 in the management of inflammatory diseases and diabetic retinopathy.

Medical Versus Surgical Management of Proliferative Diabetic Retinopathy: A Review of Current Treatments, Efficacy, Cost-effectiveness, and Compliance-related Outcomes.

International Ophthalmology Clinics: Fall 2022 - Volume 62 - Issue 4 - p 3-16 doi: 10.1097/IIO.0000000000000437

LESSONS LEARNED FROM PACORES IN PROLIFERATIVE DIABETIC RETINOPATHY MANAGEMENT, DATA FROM LATIN AMERICA AND SPAIN: The Asbury Lecture 2020.

To review the current literature on the management of proliferative diabetic retinopathy (PDR) and the challenges in the real-world setting. A review of the literature was performed on the therapeutic options for PDR, with a focus on the real-world data presented by the Pan-American Collaborative Retina Study Group. Data from clinical trials and previous literature have reported that intravitreal antivascular endothelial growth factor (anti-VEGF) therapy is noninferior to the gold standard panretinal photocoagulation for treating PDR. However, PDR recurs rapidly after cessation of anti-VEGF therapy. This is especially important in the context of the diabetic population that is prone to loss to follow-up. In a real-world, prospective study, patients with prior panretinal photocoagulation followed by anti-VEGF therapy had higher rates of sustained PDR regression relative to anti-VEGF therapy alone. Owing to its transient therapeutic effect, anti-VEGF therapy in patients with diabetes can present a risk of recurrent retinal neovascularization and progression of PDR if follow-up cannot be guaranteed. A combined paradigm with less aggressive, immediate panretinal photocoagulation followed by anti-VEGF therapy should be considered in this population.

Knowledge, Attitude and Practice about Diabetic Retinopathy among Medical Students

Purpose: The study was conducted with the aim to decipher knowledge, attitude and practice of diabetic retinopathy among MBBS students of a medical college. Study Design: A cross sectional survey. Place and Duration of Study: Dow Medical College, from October 2019 to March 2020. Methods: A cross sectional study was conducted among 3rd and 4th year medical students. A total of 133 students were questioned through specific questionnaire. After informed consent, demographic details were noted. Apart from source of information of students’ knowledge, set of 14 questions were asked. In the first 7 questions information of knowledge of diabetic retinopathy was addressed. Four questions were about attitude and 3 regarding practice towards diabetic retinopathy. Windows MS Excel was used for quantitative and qualitative analysis. Results: The mean of the overall KAP score for all students was 53.3 ± 1.2 (maximum, 70). Male students scored better in knowledge (24.8 vs 23.7) and attitude (17.3 vs 16.5). Students scored poor in identifying correct values of HbA1c and prevalence of diabetes in our country in the knowledge section. Students also lacked in identifying proper time of followup for screening of diabetic retinopathy. Many students thought uneducated people develop diabetic retinopathy earlier than educated. Conclusion: Our study pointed out weakness in knowledge and practice of medical students regarding prevention and management of diabetic retinopathy. Proper training and teaching of students is required for improved management and counselling of diabetic retinopathy. Key Words: Diabetic retinopathy, Medical students

Knowledge and Awareness of Diabetic Retinopathy among Diabetic Sudanese Patients, Khartoum State, Sudan, 2018

Background: The level of awareness of diabetic retinopathy is considered an important factor for early diagnosis and management of diabetic retinopathy. This study aimed to assess the level of awareness of diabetic retinopathy among patients with diabetes mellitus in Khartoum, Sudan.&#x0D; Methods: This cross-sectional study was conducted among diabetic patients attending Zeenam and Abdullah Khalil Diabetic Centers between June and September 2018. A convenience sample of diabetic patients was used. Information on the sociodemographic characteristics of the patients, patients’ knowledge, compliance with available treatments, and routine eye examinations was collected using a semi-structured questionnaire. Patients were also asked about the barriers that may interfere with a regular eye examination.&#x0D; Results: A total of 200 patients were enrolled and 94 (47%) of them were female; 13% of the respondents were diagnosed with diabetic retinopathy, 31.5% were hypertensive, and 13.5% had hyperlipidemia. Additionally, 88.5% of the patients were aware that DM can affect their eyes and 87% had never been diagnosed with diabetic retinopathy. Although around 83% thought that diabetic retinopathy could lead to blindness, only 35.5% of them had undergone fundus examination by ophthalmologists. Moreover, 39% of the participants had irregular diabetes follow-up and 43% monthly follow-up. Only 31% went for regular eye check-up; however, their compliance with routine retinal assessment was poor, with a total of 72.5% of participants assuming that they have good vision and need not get their eyes checked up regularly. The chief factor that was related to increased awareness of diabetic retinopathy in the study was the level of education.&#x0D; Conclusion: Although a large proportion of diabetic patients in Khartoum are aware that diabetes mellitus can affect their eyes, regular retinal assessment of patients was poor, thus hindering early diagnosis and management.

Impact of COVID-19 on the Management of Diabetic Retinopathy

Diabetic retinopathy (DR) is one of the most common causes of vision loss in people across the world. COVID- Despite the fact that early diagnosis and management guidelines for DR have considerably lowered burden of disease, 19 disease outbreak limitations have had an impact on actual world clinical management in the care of DR patients. This research includes the most latest treatment guidelines and outcomes for DR in the context of the outbreak.&#x0D; When contrasted to equivalent instants of time in 2019, intravitreal doses for DR have declined dramatically globally during the outbreak, spanning from around 30 percent to around 100percent reduction. After a substantial amount of time, several research on operational findings demonstrate a loss in visual acuity.&#x0D; In the treatment of DR, changing practice methods have led to lower intravitreal doses and cumulative loss of vision acuity during follow-up. It will be vital to continue reviewing practise guidelines as more COVID mutations arise.

Decorin Concentrations in Aqueous Humor of Patients with Diabetic Retinopathy.

Diabetic retinopathy (DR) is a microvascular complication of diabetes in the retina. Chronic hyperglycemia damages retinal microvasculature embedded into the extracellular matrix (ECM), causing fluid leakage and ischemic retinal neovascularization. Current treatment strategies include intravitreal anti-vascular endothelial growth factor (VEGF) or steroidal injections, laser photocoagulation, or vitrectomy in severe cases. However, treatment may require multiple modalities or repeat treatments due to variable response. Though DR management has achieved great success, improved, long-lasting, and predictable treatments are needed, including new biomarkers and therapeutic approaches. Small-leucine rich proteoglycans, such as decorin, constitute an integral component of retinal endothelial ECM. Therefore, any damage to microvasculature can trigger its antifibrotic and antiangiogenic response against retinal vascular pathologies, including DR. We conducted a cross-sectional study to examine the association between aqueous humor (AH) decorin levels, if any, and severity of DR. A total of 82 subjects (26 control, 56 DR) were recruited. AH was collected and decorin concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Decorin was significantly increased in the AH of DR subjects compared to controls (p = 0.0034). AH decorin levels were increased in severe DR groups in ETDRS and Gloucestershire classifications. Decorin concentrations also displayed a significant association with visual acuity (LogMAR) measurements. In conclusion, aqueous humor decorin concentrations were found elevated in DR subjects, possibly due to a compensatory response to the retinal microvascular changes during hyperglycemia.

Stem cells perspective in cure and management of diabetic retinopathy

Diabetic retinopathy is the trending issue of the vision loss worldwide that occurs due to mismanagement of glycemic level of the diabetic patients. In diabetic retinopathy neurons and capillaries, which are associated with retina, start to damage that result in alteration in the vision function of retina. Long term effective strategy for diabetic retinopathy has not been proposed yet but the stem cells can make it possible to prevent or cure diabetic retinopathy. Stem cells have the potential of repairing and replacement of damaged or defected retinal cells. Different types of stem cells like induced pluripotent stem cells, mesenchymal stem cells, some other factors like CD34+ cells, HLA factors etc have a significant role in the treatment of diabetic retinopathy. In this review, other than the role of stem cells, we have discussed the management and screening of diabetic retinopathy. Management and screening, are the parts of the strategy to reduce the risk of diabetic retinopathy that act like the tools to treat diabetic retinopathy. As stem cells are the most feasible source of treatment of diabetic retinopathy. Management and screening of diabetic retinopathy at early stage could be helpful in treatment even when the patient doesn’t show symptoms. The stem cell therapy in diabetic retinopathy offers a long lasting treatment option. Keywords: CD34+ cells; Diabetic retinopathy; HLA factors; Induced pluripotent stem cells; Mesenchymal stem cells http://dx.doi.org/10.19045/bspab.2021.100147

Stem cells perspective in cure and management of diabetic retinopathy

Stem cells perspective in cure and management of diabetic retinopathy