Non-proliferative Diabetic Retinopathy Research Articles

Optical coherence tomography angiography for detection of microvascular changes in early diabetes: A systematic review and meta-analysis.

To evaluate the effectiveness of optical coherence tomography angiography (OCTA) in detecting early intraocular microvascular changes in diabetic patients. A systematic study search was performed on PubMed, Medline, Embase, and the Cochrane Library, ranging from January 2012 to March 2023. Controlled studies compared diabetes mellitus (DM) patients with non-diabetic retinopathy (NDR) or patients with mild non-proliferative diabetic retinopathy (mild NPDR) to healthy people. These studies included parameters of OCTA such as foveal avascular zone (FAZ), vessel density of superficial capillary plexus (VDscp), vessel density of deep capillary plexus (VDdcp), and peripapillary VD. The relevant effect model was used according to the heterogeneity, and the mean difference and 95% confidence intervals were calculated. A total of 18 studies with 2101 eyes were eventually included in this meta-analysis. Our results demonstrated that early alterations of VDscp, VDdcp, and peripapillary VD in NDR patients had a significant difference compared with healthy people by OCTA (VDscp: WMD=-1.34, 95% CI: -1.99 to -0.68, P<0.0001. VDdcp: WMD=-2.00, 95% CI: -2.95 to -1.04, P<0.0001. Peripapillary VD: WMD=-1.07, 95% CI: -1.70 to -0.43, P=0.0010). However, there was no statistically significant difference in total FAZ between them (WMD=-0.00, 95% CI: -0.02-0.01, P=0.84). In addition, for patients with mild NPDR, OCTA could illustrate prominent changes in VDscp, VDdcp, and total FAZ compared with healthy people (VDscp: WMD=-6.11, 95% CI: -9.90 to -2.32, P=0.002. VDdcp: WMD=-4.26, 95% CI: -5.95 to -2.57, P<0.00001. FAZ: WMD=0.06, 95% CI: 0.01-0.11, P=0.03). In diabetic patients with or without retinopathy, the parameters of OCTA such as VDscp, VDdcp, and peripapillary vessel density were demonstrated as potential biomarkers in monitoring the early alterations of retinal microangiopathy, while total FAZ may have no significant changes in diabetic patients without retinopathy.

Genetic association of TIE2 with diabetic retinopathy and diabetic macular edema

PurposeTo evaluate the associations of the TIE2 gene with diabetic retinopathy (DR) and diabetic macular edema (DME). MethodsThis study included a Chinese cohort of 285 non-proliferative DR patients and 433 healthy controls. The DR patients were classified further into those with or without DME. Thirty haplotype-tagging single-nucleotide polymorphisms (SNPs) in TIE2 were genotyped using TaqMan technology. Associations of DR and subtypes were analyzed by logistic regression adjusted for age and sex. Stratification association analysis by sex was performed. ResultsTIE2 rs625767 showed a nominal but consistent association with DR [odds ratio (OR) = 0.71, P = 0.005] and subtypes (DR without DME: OR = 0.69, P = 0.016; DME: OR = 0.73, P = 0.045). SNP rs652010 was consistently associated with overall DR (OR = 0.74, P = 0.011) and DR without DME (OR = 0.70, P = 0.016), but not with DME. Moreover, SNPs rs669441, rs10967760, rs549099 and rs639225 showed associations with overall DR, whilst rs17761403, rs664461 and rs1413825 with DR without DME. In stratification analysis, three SNPs, rs625767 (OR = 0.62, P = 0.005), rs669441 (OR = 0.63, P = 0.006) and rs652010 (OR = 0.64, P = 0.007), were associated with DR in females, but not in males. Moreover, one haplotype T-T defined by rs625767 and rs669441 was significantly associated with DR in females only. ConclusionsThis study revealed TIE2 as a susceptibility gene for DR and DME in Chinese, with a sex-specific association in females. Further validation should be warranted.

Evaluating Ocular Blood Flow in Diabetic Macular Edema using Three-dimensional Pseudocontinuous Arterial Spin Labeling.

Alterations in ocular blood flow play an important role in the pathogenesis of diabetic macular edema; however, this remains unclear. This study aimed to investigate ocular blood flow in eyes with or without diabetic macular edema using arterial spin labeling. This cross-sectional study included 118 eyes of 65 patients with diabetic retinopathy analyzed between November 2018 and December 2019. We included a total of 53 eyes without diabetic macular edema (mean [SD] age, 57.83 [7.23] years; 29 men [54.7%]) and 65 eyes with diabetic macular edema (mean [SD] age, 60.11 [7.63] years; 38 men [58.5%]). Using a 3.0-T magnetic resonance imaging, participants were imaged with arterial spin labeling with multiple post-labeling delays. The mean ocular blood flow at post-labeling delays of 1.5 and 2.5 s was significantly lower in eyes with diabetic macular edema among patients with diabetic retinopathy compared with the remaining subgroups (P=0.022 and P <0.001, respectively). The mean ocular blood flow exhibited a significant decrease in eyes with diabetic macular edema when the post-labeling delay was set at 2.5 s in the nonproliferative and proliferative diabetic retinopathy groups, compared with the remaining subgroups (P=0.005 and P=0.002, respectively). The cutoff points of ocular blood flow at post-labeling delays of 1.5 s and 2.5 s were 9.40 and 11.10 mL/100 g/min, respectively. Three-dimensional pseudocontinuous arterial spin labeling can identify differences in the ocular blood flow of patients with diabetic eyes with and without diabetic macular edema.

Pregnancy and diabetic retinopathy

Background: An increase in the worldwide prevalence of diabetes, especially among younger populations, has led to a higher prevalence of pre-existing diabetes among pregnant women. The precise mechanisms underlying the development or progression of diabetic retinopathy (DR) during pregnancy are not entirely understood. This narrative review incorporates all available data to offer fresh insights into the pathogenesis and mechanisms of the pregnancy-induced development and/or progression of DR. Moreover, the author aims to offer clinical recommendations for DR both before conception and during pregnancy to appropriately counsel these susceptible patients. Methods: A literature search was performed using various combinations of the following keywords: diabetes, pregnancy, diabetic retinopathy, ocular, eye, retina, microangiopathy, mechanism, pathophysiology, hyperglycemia, hypoxia, neovascularization, growth factors, immune system, blood flow, and recommendations. The search was conducted using PubMed/MEDLINE, ISI Web of Science, Scopus, and Google Scholar, and only English articles published from January 1, 2020, to December 31, 2023, involving human participants, were considered. The International Diabetes Federation Diabetes Atlas website was searched for clinical recommendations. Results: Pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in the development and progression of DR. Hyperglycemia leads to significant stress on the capillary endothelium through increased glucose flux via the polyol and hexosamine pathways, activation of protein kinase C, and increased formation of advanced glycation end-products. These pathways act in several ways that may lead to increased oxidative stress, inflammation, and vascular blockage. Thus, eye examinations are crucial before, during, and up to 12 months after pregnancy. Individuals with severe non-proliferative and proliferative DR should gradually decrease their blood glucose levels to near-normal levels over a period of 6 months before conception. Statins and medications inhibiting the renin–angiotensin system should be discontinued before pregnancy or at the initial antenatal visit if they are still being used. Retinal examinations should be performed shortly after conception and during the first trimester using tropicamide eye drops and digital imaging. Subsequent examinations should be scheduled based on DR severity at the initial examination. Conclusions: While the precise mechanism underlying the progression of DR during pregnancy remains uncertain, the available literature suggests that pregnancy-induced hyperglycemia, blood flow changes, growth factors, and the immune system play important roles in its development and progression. Pregnant women with diabetic eye manifestations benefit from the expertise of multidisciplinary teams comprising ophthalmologists, diabetologists, and gynecologists to improve both maternal and perinatal outcomes. Moreover, postpartum follow-up requires special attention.

Сytokines as promising diagnostic and prognostic biomarkers of microvascular complications of diabetes

Classical knowledge about the pathogenesis of diabetes and its complications in recent years has been supplemented by ideas about the role of chronic inflammation. It has been established that inflammatory reactions play a role in the beta cell dysfunction, the formation of insulin resistance and remodeling of the vascular wall. Cytokines, soluble low molecular weight proteins and peptides that perform informational and regulatory functions, play central role in the development of inflammation. A wide range of biological activity and involvement in many aspects of pathogenesis make it possible to consider cytokines as promising molecules for diagnosing and predicting the complications. In this review, we summarize data from studies that assessed the role of cytokines as diagnostic and prognostic markers for the development of microvascular diabetic complications. Current data indicate that angiogenic and pro-inflammatory cytokines (VEGF, TNF-α, IL-6, IL-8, IL-15, IL-17, MCP-1, IP-10, INF-γ, PEDF, etc.) are promising biomarkers for proliferative diabetic retinopathy, especially when their local production is assessed (in vitreous, aqueous humor and tears). The role of these molecules as biomarkers of non-proliferative diabetic retinopathy and diabetic macular edema needs further research. Serum proinflammatory and fibrogenic cytokines (primarily MCP-1, IL-6, TNF-α, YKL-40, TGF-β and bFGF) and cytokine receptors (sTNFR1, sTNFR2) are considered as promising diagnostic and prognostic markers of diabetic kidney disease. Urinary excretion of IL-6 and MCP-1 turned out to be a predictor of the progression of diabetic nephropathy. Multi-bead assay and mass spectrometry make it possible to study cytokine panels in small samples of biological material. Combined biomarkers, including several cytokines, may increase the reliability of the prognosis of diabetic complications.

A Case of Rapidly Progressive Proliferative Diabetic Retinopathy in the Setting of Severe Anorexia Nervosa

Purpose: To report a case of rapidly progressive diabetic retinopathy in the setting of admission for severe anorexia nervosa. Methods: Case report Results: A 21-year-old female with type 1 diabetes mellitus and mild nonproliferative diabetic retinopathy of both eyes was admitted for severe anorexia nervosa with a BMI of 12.5 and hemoglobin A1c of 10.6. Three months after admission, the patient reported visual complaints and was found to have severe nonproliferative diabetic retinopathy in the right eye and proliferative diabetic retinopathy with vitreous hemorrhage in the left eye. She was lost to follow-up for 4 months, then presented to clinic with bilateral proliferative diabetic retinopathy and a tractional retinal detachment of the right eye. Conclusion: There is a potential relationship between severe eating disorders and rapid worsening of diabetic retinopathy. Patients with type 1 diabetes who have acute complications due to eating disorders should be evaluated by an ophthalmologist to monitor for rapid progression of retinopathy.

Patients with Type 2 Diabetes, Higher Blood Pressure, and Infrequent Fundus Examinations Have a Higher Risk of Sight-Threatening Retinopathy.

Background: Diabetic retinopathy (DR) is the most common cause of preventable blindness among working-age adults. This study aimed to evaluate the impact of the regularity of fundus examinations and risk factor control in patients with type 2 diabetes (T2DM) on the prevalence and severity of DR. Methods: One hundred and fifty-six T2DM patients were included in this cross-sectional study. Results: In this sample, the prevalence of DR was 46.2%. Patients with no DR mainly did not examine the fundus regularly, while most patients with mild/moderate nonproliferative DR (NPDR) underwent a fundus examination regularly. In 39.7% of patients, this was the first fundus examination due to diabetes, and 67% of them had sight-threatening DR (STDR). Diabetes duration (p = 0.007), poor glycemic control (HbA1c) (p = 0.006), higher systolic blood pressure (SBP) (p < 0.001), and diastolic blood pressure (DBP) (p = 0.002) were the main predictors of DR. However, the impact of SBP (AOR 1.07, p = 0.003) and DBP (AOR 1.13, p = 0.005) on DR development remained significant even after adjustment for diabetes duration and HbA1c. The DR prevalence was higher in patients with higher blood pressure (≥130/80 mmHg) than in those with target blood pressure (<130/80 mmHg) (p = 0.043). None of the patients with target blood pressure had STDR. The peaks in SBP and DBP were observed in T2DM with DR and the first fundus examination due to diabetes. Conclusions: In this T2DM sample, DR prevalence was very high and strongly related to blood pressure and a lack of regular fundus examinations. These results indicate the necessity of establishing systematic DR screening in routine diabetes care and targeting blood pressure levels according to T2DM guidelines.

Meta-analysis of the relationship between ocular and peripheral serum IL-17A and diabetic retinopathy.

A systematic evaluation and Meta-analysis were performed to determine the relationship between IL-17A levels in ocular aqueous and peripheral venous serum samples and diabetic retinopathy (DR). PubMed, Embase, Web of Science, and CNKI databases were searched from the time of library construction to 2023-09-20.The results were combined using a random-effects model, sensitivity analyses were performed to determine whether the arithmetic was stable and reliable, and subgroup analyses were used to look for possible sources of heterogeneity. A total of 7 case-control studies were included. The level of IL-17A was higher in the Nonproliferative DR(NPDR) group than in the Non-DR(NDR) group [SMD=2.07,95%CI(0.45,3.68),P=0.01], and the level of IL-17A in the proliferating DR(PDR) group was higher than that of the NDR group [SMD=4.66,95%CI(1.23,8.08),P<0.00001]. IL-17A levels in peripheral serum and atrial fluid were significantly higher in NPDR and PDR patients than in non-DR patients in subgroup analyses, and detection of peripheral serum IL-17A concentrations could help to assess the risk of progression from NPDR to PDR. Sensitivity analyses suggested that the results of the random-effects arithmetic were stable and reliable. Subgroup analyses based on assay method and sample source showed that the choice of these factors would largely influence the relationship between IL-17A levels and DR. Elevated peripheral serum and ocular aqueous humor IL-17A levels in diabetic patients are associated with the risk of DR, IL-17A may serve as a potential predictor or therapeutic target for DR, and IL-17A may be an important predictor of inflammation for the progression of NPDR to PDR. https://www.crd.york.ac.uk/prospero/, identifier CRD42024532900.

Characterization of central-involved diabetic macular edema using OCT and OCTA.

To characterize the occurrence of diabetic macular edema and the presence of abnormal retinal fluid accumulation in nonproliferative diabetic retinopathy (NPDR). In this two-year prospective study, a total of 122 eyes with diabetes type 2 underwent optical coherence tomography (OCT) and OCT-Angiography in association with OCT-Fluid imaging, a novel algorithm of OCT analysis allowing quantification of abnormal accumulation of fluid in the retina through low optical reflectivity ratios (LOR). Early Treatment Diabetic Retinopathy Study (ETDRS) grading for diabetic retinopathy (DR) severity assessment was performed using 7-field color fundus photography. Best corrected visual acuity was also recorded. During the 2-year follow-up, 23 eyes (19%) developed central-involved diabetic macular edema (CI-DME) and 2 eyes (2%) developed clinically significant macular edema (CSME). In the two-year period of the study, eyes that developed CI-DME showed a progressive increase in central retinal thickness (CRT) (β = 7.7 ± 2.1 µm/year, p < 0.001) and in LOR values (β = 0.009 ± 0.004 ratio/year, p = 0.027). The increase in CRT and abnormal retinal fluid, represented by increased LOR ratios, are associated with increased retinal perfusion in the deep capillary plexus (DCP) (skeletonized vessel density, p = 0.039). In contrast, the eyes with CSME showed decreased retinal perfusion and abnormal fluid located in the outer layers of the retina. CI-DME and CSME appear to represent different entities. Eyes with CI-DME show increases in abnormal retinal fluid associated with increased retinal vascular perfusion in the DCP. Eyes with CSME are apparently associated with decreased retinal vascular perfusion in the DCP and abnormal fluid in the outer retina.

Frequency of Peripheral Arterial Disease in Type-II Diabetic Patients presenting with Diabetic Retinopathy

Background: Type-II Diabetes Mellitus (T2DM) often leads to Diabetic Retinopathy (DR), but the prevalence of coexisting Peripheral Arterial Disease (PAD) in these patients is unclear, creating controversy in existing literature. This study aims to fill this gap by investigating the frequency of PAD in T2DM patients with DR, enhancing our understanding of diabetes-related complications. Objective: To determine frequency of peripheral arterial disease in T2DM patients presenting with diabetic retinopathy. Study Design: It was a cross sectional study. Settings: This study was conducted at the Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat Pakistan. Duration: Six months from 05-01-2022 to 04-07-2022. Methods: A total 165 T2DM patients presenting with diabetic retinopathy and meeting inclusion criteria were enrolled in this study after taking informed written consent. Ankle brachial pressure index was measured. Two blood pressure readings were taken 5 minutes apart and average was calculated for analysis. Peripheral arterial disease was labeled. SPSS version 26.0 was used for data analysis. Results: The mean age of the participants was 51.1±14.69. There were 63 (38.2%) females and 102 (61.8%) males. Mean BMI was 26.87±3.73 kg/m2. The mean duration of diabetes in the participants was 6.43±2.36 years. As regards type of retinopathy, 62 (37.6%) had Proliferative Diabetic Retinopathy (PDR), and 103 (62.4%) had Non-Proliferative Diabetic Retinopathy (NPDR). Mean Ankle Brachial Pressure Index (ABPI) among the participants was 1.01±0.25. Peripheral arterial disease was noticed in 28.5% of the T2DM patients presenting with diabetic retinopathy. Stratification of frequency of PAD for various sub groups of age, gender, BMI, duration of disease and type of retinopathy produced insignificant difference between sub groups (p-value&gt;0.05). Conclusion: In conclusion, our investigation of Type 2 diabetic patients with diabetic retinopathy uncovers a significant 28.5% prevalence of peripheral arterial disease (PAD). Stratification across age, gender, BMI, disease duration, and retinopathy type reveals no substantial differences. These results underscore the systemic nature of vascular complications, emphasizing the importance of comprehensive care strategies.

Prevalence of retinal pathologies in people over 60 years: the Tehran Geriatrics Eye Study.

To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors. A cross-sectional study was conducted in Tehran using multistage cluster sampling. After selecting subjects aged 60 and over, optometric, and ophthalmic examinations were done. For retinal examination, a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops. Biometry was done using the IOL Master for all participants. Of 3791 people that were invited through cluster sampling, 3310 participated in the study (response rate=82%). The prevalence of retinal pigmented epithelium (RPE) change, drusen, geographic atrophy (GA), hypertensive retinopathy (HTR), nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), choroidal neovascularization (CNV), central retinal artery occlusion (CRAO), myopic retinopathy (MR), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO) was 27.42%, 11.08%, 4.52%, 3.03%, 4.05%, 0.54%, 0.82%, 0.39%, 0.20%, 0.49%, and 0.19%, respectively. After removing the effect of age, the odds of NPDR were 1.68 times higher in women compared to men (P=0.014). After removing the effect of sex, the odds of drusen, RPE change, GA, CNV, BRVO, and CRVO increased with age. There is a higher prevalence of RPE change, drusen, GA, CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values. Considering the correlation of most of the diseases with age and their effects on vision, attention should be paid to these diseases and the related screening programs to prevent vision impairment.

Impact of GLP-1 Agonists and SGLT-2 Inhibitors on Diabetic Retinopathy Progression: An Aggregated Electronic Health Record Data Study

PurposeTo examine the effects of GLP-1 agonists compared to SGLT-2 inhibitors on diabetic retinopathy. DesignRetrospective clinical cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health records network comprising multiple healthcare organizations. MethodsPatients with an International Classification of Diseases, Tenth Revision (ICD-10) code of non-proliferative diabetic retinopathy and monotherapy treatment, excluding insulin, with GLP-1 agonists or SGLT-2 inhibitors. Patients with history of proliferative diabetic retinopathy prior to initiation of treatment were excluded. Rate of progression to proliferative diabetic retinopathy and rate of development of diabetic macular edema were compared between patients on GLP-1 agonists compared to those on SGLT-2 inhibitors. The groups were propensity score matched for age, gender, ethnicity, race, type of diabetes, and severity of non-proliferative diabetic retinopathy. Main outcomes included rate and relative risk of progression to proliferative diabetic retinopathy and risk of diabetic macular edema in the GLP-1 agonist group versus the SGLT-2 inhibitor group. ResultsA total of 6481 patients were identified in the GLP-1 cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 year and 3 years after initiation of therapy, a higher rate of progression of proliferative diabetic retinopathy was noted (RR: 1.26, CI 1.04-1.51, p=0.017 at 1 year, RR: 1.284, CI 1.1-1.499, p=0.002 at 3 years) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. There was a higher rate of diabetic macular edema noted at 3 months (RR: 1.192, CI 1.059-1.276, p=0.002), 6 months (RR: 1.22, CI 1.13-1.32, p<0.001), 1 year (RR: 1.24, CI 1.15-1.33, p<0.001), and at 3 years (RR: 1.29, CI 1.21-1.38, p<0.001) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. ConclusionsA higher rate of progression of proliferative diabetic retinopathy and risk of new-onset diabetic macular edema was observed in patients on monotherapy with GLP-1 agonists compared to those on SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and to consider the current retinopathy status when initiating treatment with newer hypoglycemic agents to ensure these patients are appropriately monitored for developing potential vision threatening complications.

Association between the response of intravitreal antivascular endothelial growth factor injection and systemic factors of diabetic macular edema

BackgroundThis study investigated the effects of systemic factors in response to intravitreal injections in patients with macular edema due to non-proliferative diabetic retinopathy (NPDR).MethodsWe retrospectively reviewed the medical records of patients treated with intravitreal injections for macular edema secondary to NPDR between January 2018 and January 2021. The patients were divided into three groups according to the injection response. When patients with diabetic macular edema showed 20µ or more reduction in central retinal thickness compared to baseline, they were classified as responsive group, and if not, they were classified as refractory group. The responsive group was further divided into the complete and incomplete response groups. Patients with complete disappearance of edema at seven months were classified as the complete response group, whereas those in which edema did not disappear were classified as the incomplete response group. The clinical characteristics of each group, including medical history, ophthalmic examination results, and laboratory examination results at the time of diagnosis, were analyzed.ResultsOf the 112 eyes (91 patients) that satisfied the inclusion criteria, 89 (77 patients) in the responsive group and 23 (14 patients) in the refractory group were included in the analysis. The responsive group was further divided into the complete (51 eyes) and incomplete (38 eyes) response groups. The refractory group had significantly higher glycated hemoglobin levels and significantly lower estimated glomerular filtration rates than the responsive group (p = 0.026 and p = 0.012, respectively). In the multivariate logistic regression analysis, both factors were found to be significant in predicting the degree of response (all p < 0.05). No factor showed a significant difference between the incomplete and complete response groups(all p > 0.05).ConclusionsIn macular edema caused by NPDR, low glomerular filtration rates and high glycated hemoglobin levels may be used as predictors of poor response to intravitreal injection therapy. In addition to blood glucose control, education should be provided regarding the need for the continuous monitoring of renal function.

SUPERFICIAL AND DEEP VASCULAR COMPLEXES DAMAGED TO DIFFERENT EXTENTS IN ADVANCED STAGES OF DIABETIC RETINOPATHY.

To identify the extent of damage to the superficial vascular complex and deep vascular complex as the stage of diabetic retinopathy (DR) increases. Subjects were divided into four groups: patients with type 2 diabetes without DR (Group 1), those with mild-to-moderate nonproliferative DR (Group 2), those with severe-to-very severe nonproliferative DR (Group 3), and those with proliferative DR (Group 4). The vessel densities of the superficial vascular complex (superficial vessel density, SVD) and deep vascular complex (deep vessel density, DVD) and their ratios were compared. Linear regression analyses were used to identify factors associated with the SVD/DVD ratio. The SVDs were 25.5% ± 6.1%, 25.1% ± 7.0%, 24.5% ± 9.0%, and 21.6% ± 6.9% (P = 0.048); the DVDs 25.6% ± 5.3%, 23.0% ± 7.0%, 22.3% ± 8.8%, and 17.5% ± 5.0% (P < 0.001); and the SVD/DVD ratios 1.00 ± 0.16, 1.12 ± 0.20, 1.14 ± 0.33, and 1.24 ± 0.27 (P < 0.001) in Groups 1 to 4, respectively. In multivariate analysis, DR severity (B = 7.16, P < 0.001) and the HbA1c level (B = 1.57, P = 0.042) were significantly associated with the SVD/DVD ratio. Both the SVD and DVD tended to decrease in the advanced stages of DR, and the SVD/DVD ratio increased, indicating more severe damage to the deep vascular complex than the superficial vascular complex. The ratio was positively associated with the HbA1c level, indicating a significant relationship between that level and DVD rather than SVD damage.

The Effect of Diabetic Retinopathy and Blood Glucose Regulation on Corneal Biomechanical Parameters

Purpose The aim of this study was to evaluate the effects of different stages of diabetic retinopathy (DR) and metabolic control of blood glucose levels on corneal biomechanical parameters. Methods Diabetic patients were categorized into three groups: no DR group, nonproliferative DR (NPDR) group, and proliferative DR (PDR) group. Of the 141 eyes examined, 40 belonged to the control group, 34 to no DR group, 34 to NPDR group, and 33 to PDR group. Using an Ocular Response Analyzer to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc). IOP was assessed using a Tono-Pen, while central corneal thickness (CCT) was determined using an ultrasonic pachymeter. HbA1c levels were also recorded. We conducted comparisons among these groups across biomechanical parameters and IOP (tonopen), and CCT, while also investigating the impact of HbA1c levels on these parameters. Results Among any groups show a statistically significant difference in CCT, IOP (tonopen), CH, CRF, IOPg, and IOPcc. In diabetic patients, CRF, CTT, and IOPg values were significantly higher in those with HbA1c levels ≥ 7 mg/dl than in those with HbA1c levels < 7 mg/dl (p = 0.009, p = 0.013, p = 0.038), respectively, while there was no statistically significant difference in IOPcc, CH, and IOP (tonopen). Linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001), HbA1c (p < 0.05), and negatively associated with diagnosis of DR (p < 0.05). Conclusion This study underscores the influence of metabolic control, as reflected by HbA1c levels, on corneal biomechanical parameters in diabetic patients, emphasizing the importance of monitoring and managing glycemic control in this population.

Changes in the level of some tryptophan metabolites in the blood of patients with type 2 diabetes mellitus complicated by diabetic retinopathy

Aim: To study the content of tryptophan and the intermediate metabolites of kynurenine and serotonin pathways of its metabolism in the blood plasma of patients with type 2 diabetes mellitus (DM) and non-proliferative diabetic retinopathy as candidates for markers of the early stage of the pathological process.Material and Methods. Three groups of people were analyzed: the first group of 10 patients with type 2 diabetes mellitus and without diabetic retinopathy; the second group of 10 people with type 2 diabetes mellitus and non-proliferative stage of diabetic retinopathy; and the control group of 10 healthy people. The features of the first group were a decrease of macula’s photosensitivity in the fundus and a slight increase in the central thickness of the retina. Patients with diabetic retinopathy tended to have a moderate number of microaneurysms and microhemorrhages, moderately presented intraretinal microvascular anomalies in one quadrant, vein dilatation, clearness of the central retinal vein and its branches. In the macular zone there was an edema with hard exudates in the center and lateral to the fovea centralis. All participants of the study gave blood on an empty stomach in the morning, and after that in we measured the content of tryptophan (TRP), kynurenins ((kynurenine (KYN), 3-hydroxykynurenine (3-HKYN), kynurenic acid (KYNA)) and the level of L-5-hydroxytyrptophan (5HTrp) in blood plasma by HPLC method with fluorimetric and spectrophotometric detection.Results. The groups of people with type 2 diabetes mellitus showed the increasing of TRP level in blood relatively to healthy individuals: by 15.1% (p = 0.032) and 17.9% (p = 0.030) in the first and second groups, respectively. As for the patients of the first group, the content of their KYN was increased by 57.7% (p = 0.012) and KYNA by 33.6% (p = 0.012) relatively to the control and the concentration of 3-НKYN decreased by 18.1% (p = 0.020) relatively to healthy people. As for the patients in the second group, the changes in their level of kynurenines had the same direction, but were more visible. Thus, the concentration of KYN exceeded the same parameters of healthy individuals by 84.5% (p = 0.001) and the parameters of the first group by 18.0% (p = 0.049); the KYNA level increased by 56.6% (p = 0.001) relatively to the control and by 17.3% (p = 0.049) from that of the first group. There was a decrease in the content of 3-HKYN amounted to 18.6% of the control (p = 0.038) and an increase in the concentration of 5HTrp – 193,9% (p &lt; 0.001).

Improvement of visual acuity in non-proliferative diabetic retinopathy with Nimi Nirdishta Yoga- A case report

Ayurveda can serve in many disease conditions, whereas conventional systems face several limitations. Diabetic Retinopathy (DR) is among such conditions, where effective management is becoming a challenge. Diabetic Retinopathy leads to visual disability and is one of the major complications of Diabetes Mellitus (DM). Currently available conventional treatments for DR have certain limitations; considering this fact, options from alternative resources are being searched. In Ayurveda, retinal diseases can be included in Drishtigata roga (~eye sight disorder) and DR can be correlated with Timir (~a class of morbid affections of the coats of the eye), as pathology of Timir is secondary to systemic Dosha Dushti (~vitiation of body humor) and DR can be considered as Pramehajanya Timir. A male patient of 61 years visited the Netra (ophthalmic) OPD complaining of defective distant and near vision for two months. Based upon the history of diabetes and clinical signs and symptoms, he was diagnosed with Non-Proliferative Diabetic Retinopathy (NPDR) in both eyes. The indirect ophthalmoscopy investigation was used to confirm the diagnosis. Nimi Nirdishta yoga which contains Triphala, Yashtimadhu (Glycyrrhiza glabra Linn.), and Ghrita was administered for one month daily at night with honey. At the end of one month, there was improvement noted in distant vision without glasses from 6/18 to 6/12 in the right eye and 6/9 to 6/6p in the left eye while near vision from N/8 to N/6 in both eyes with glasses. Indirect ophthalmoscopy revealed a reduction in exudates and hemorrhages. The observations reveal that Ayurvedic approaches are helpful in managing Diabetic Retinopathy.

Nonproliferative diabetic retinopathy dataset(NDRD): A database for diabetic retinopathy screening research and deep learning evaluation.

In this article, we provide a database of nonproliferative diabetes retinopathy, which focuses on early diabetes retinopathy with hard exudation, and further explore its clinical application in disease recognition. We collect the photos of nonproliferative diabetes retinopathy taken by Optos Panoramic 200 laser scanning ophthalmoscope, filter out the pictures with poor quality, and label the hard exudative lesions in the images under the guidance of professional medical personnel. To validate the effectiveness of the datasets, five deep learning models are used to perform learning predictions on the datasets. Furthermore, we evaluate the performance of the model using evaluation metrics. Nonproliferative diabetes retinopathy is smaller than proliferative retinopathy and more difficult to identify. The existing segmentation models have poor lesion segmentation performance, while the intersection over union (IOU) value for deep lesion segmentation of models targeting small lesions can reach 66.12%, which is higher than ordinary lesion segmentation models, but there is still a lot of room for improvement. The segmentation of small hard exudative lesions is more challenging than that of large hard exudative lesions. More targeted datasets are needed for model training. Compared with the previous diabetes retina datasets, the NDRD dataset pays more attention to micro lesions.

Coexistence of Diabetic Retinopathy and Diabetic Foot in Patients Admitted at Indoor Facility of a Tertiary Care Center

Purpose: To determine frequency of “diabetic retinopathy (DR)” in patients admitted at a tertiary care hospital with diabetic foot. Study Design: Cross sectional study. Place and Duration of Study: HBS medical and dental college, Islamabad from November 2022 to November 2023. Methods: Sixty two patients admitted with “diabetic foot ulcer”(DFU) were included in this study. Severity of DFU was assessed using . Patients were assessed for presence of “diabetic retinopathy (DR)” as well as its severity. Data was analyzed using SPSS 22. Results: Mean age was 49.37 ± 11.02 years. There were 34 (54.84%) males and 28 (45.16%) females. Mean HbA1C% was 9.46 ± 1.11%. Mean duration of diabetes was 10.06 ± 5.53 years. Forty five percent patients had diabetic retinopathy (DR). Amongst these patients diagnosed with DR (n = 45), 6 (13.33%) had mild non-proliferative DR, 20 (44.44%) had moderate non-proliferative DR, 14 (31.11%) had severe non-proliferative DR and 5 (11.11%) had proliferative DR. According to Wagner Grade there were 32 (51.61%), patients with grade 2 DFU, 19 (30.65%) had grade 1 and 11 (17.74%) had grade 3. Coexistence of diabetic retinopathy and diabetic foot in patients admitted at indoor facility was 72.58%. Conclusion: Prevalence of “diabetic retinopathy (DR)” in patients admitted with diabetic foot was 72.58%. Presence of diabetic foot can be considered as strong predictor of presence of concomitant “diabetic retinopathy”.

Analysis of the Choroidal Structure in the Early Stage of Type 2 Diabetic Retinopathy.

Our aim was to evaluate the choroidal structure in the early stage of Type 2 diabetic retinopathy (DR). The study included patients with nonproliferative diabetic retinopathy (NPDR) without edema (n = 30, NPDR group), patients with diabetes without retinopathy (n = 30, No DR group), and healthy subjects (n = 33, control group). Choroidal thickness (CT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were evaluated. The hypertension (HT) rate was highest in patients with NPDR (63.3%), and lowest in the control group (27.3%). Subfoveal, nasal, temporal CT, TCA, and LA were thinner in patients with diabetes compared to the control group for both patients with and without HT, although not significantly. CTs, TCA, LA, and SA were lower in hypertensive patients than patients without HT in all groups. CVI and LA/SA were significantly lower in NPDR group compared to the controls for both patients with and without HT. In patients with diabetes and before clinical retinopathy develops, the thinning of the CT and CVI begins. A decrease in CVI continues as the retinopathy progresses. HT appears to be a factor that can reduce CT, TCA, LA, and SA. [Ophthalmic Surg Lasers Imaging Retina 2024;55:392-399.].