Occurrence Of Diabetic Retinopathy Research Articles

Discrimination of microaneurysm in color retinal images using texture descriptors

The occurrence of diabetic retinopathy and diabetic mellitus has been increasing worldwide. Currently, ophthalmologists face a lot of challenges in identifying various stages in diabetic retinopathy. Among these stages, the early stage is microaneurysm. A new computer-aided microaneurysm detection system based on texture features is presented. The histogram of texture descriptor reveals the texture characteristics of each pixel which effectively increases the accuracy of MA detection than shape-based features. The extracted features using Local Binary Pattern contribute more while discriminating the lesions using support vector machine classifier. Validations based on free-response receiver operating characteristic score and area under curve are obtained for ROC, MESSIDOR and DIARETDB1 dataset. The ability to process images with different intensities and less computation time guarantees the robustness of this system.

Association of diabetic retinopathy and diabetic macular oedema with renal function in southern Chinese patients with type 2 diabetes mellitus: a single-centre observational study

Background and objectivesThe association of diabetic retinopathy (DR) and diabetic macular oedema (DME) with renal function in southern Chinese patients with diabetes is poorly understood. So we aimed to study...

Accumulation of advanced glycation end products potentiate human retinal capillary endothelial cells mediated diabetic retinopathy.

The major ophthalmic complication in patients with diabetes is diabetic retinopathy (DR), which is one of the major eye diseases that causes blindness. It is well established that the occurrence and duration of DR is positively correlated with duration of diabetes. Advanced glycation end product (AGE) accumulation in patients with diabetes is one factor that leads to the development of DR. However, the underlying mechanisms remain unclear. In the present study, the role of phosphoinositide 3-kinase/protein kinase B (Akt) signaling in AGE-induced DR development was investigated. An in vitro experimental system was used to study the effects of AGEs on human retinal capillary endothelial cells (HRCECs) and Müller cells. Flow cytometry, MTT, western blotting and BrdU incorporation assays were performed. Reverse transcription-quantitative polymerase chain reaction was used to measure the expression of angiogenesis-associated genes. Functional assays of angiogenesis, including HRCEC invasion and tube formation assays. It was demonstrated that the expression of receptor for AGEs was upregulated in HRCECs and Müller cells following treatment with AGEs. AGE treatment did not affect Müller cell viability, but enhanced HRCEC viability. Akt inhibition increased cell apoptosis and death in HRCECs. AGE treatment upregulated the expression of pro-angiogenic genes, which was suppressed by Akt inhibitor treatment. In addition, Akt inhibitor treatment suppressed HRCEC invasion and tube formation ability. The present study suggested that Akt-mediated signaling may serve critical roles in the development of DR due to the accumulation of AGEs. Akt may be a potential therapeutic target in DR.

IL-10 gene polymorphism in diabetic retinopathy.

To investigate the relationship between the interleukin-10 (IL-10) gene polymorphism and the pathogenesis of diabetic retinopathy (DR). According to the fundus examination report, 420 patients with diabetes were divided into the non-DR group (n=200) and the DR group (n=220). The single nucleotide polymorphisms rs1145612 and rs11567245 in the promoter region of the IL-10 gene were classified by the conformational differential gel electrophoresis. No correlation was found between the polymorphism rs1145612 and the clinical information of DR patients. The polymorphism rs11567245 had correlations with multiple clinical indicators of DR patients, including body mass index (BMI), systolic blood pressure (SBP), blood urea nitrogen (BUN), fasting blood glucose (FBG), and 2-h postprandial blood glucose (2hBG) (p<0.05). The IL-10 gene promoter rs1145612 is not related to the occurrence and development of DR, but a relationship exists between the polymorphism rs11567245 and the occurrence and development of DR.

Association of MnSOD-47C/TGENE Polymorphism (Rs 4880-47C/T) in Sudanese Patient with Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is the common micro-vascular complication of diabetes mellitus (DM). It is the main cause of blindness among young adults worldwide. Poor glycemic control in addition to longer diabetic duration is the main risk factors for diabetic retinopathy. Many genes have been postulated as candidates for diabetic retinopathy. Little is known about anti-oxidative enzyme gene polymorphism and its association with diabetic retinopathy, mainly for catalase enzyme and manganese superoxide dismutase and glutathione genes. The study aims to assess the role of manganese superoxide dismutase MnSOD (rs4880) gene polymorphism in diabetic retinopathy Sudanese patients and its relation with MnSOD level. In addition to determine the association of Fasting Blood Glucose (FBS), HbA1c and Lipid in the pathogenesis of diabetic retinopathy.&#x0D; Methodology: The number of subject involved were 130 which, were classified into (n 60) clinically diagnosed as diabetic retinopathy and (n 70) diabetes mellitus without retinopathy as control group, age ranged from (22 – 80) years old, from Makkah Eye Complex. DNA was extracted and PCR product for MnSOD, gene segment was digested by NgoM enzymes, moreover gene polymorphisms were determined. Serum MnSOD, activity and FBS, TG, CHOL and HbA1c level were analyzed using Cobas Int 400 using absorption photometer and immunoassay methods respectively.&#x0D; Results: The results revealed that retinopathy is more common in female than male by approximately 2 fold =1.9:1. Type II is more common in our population that type 1. The majority of the patients had type II diabetes (128, 98.5%) and only 2(1.5%) patients were type I diabetes mellitus. The activity of MnSOD, was significantly higher in DNR when compared with DR (p= 0.003). Mean HbA1c and FBG concentration were significantly higher among DR than DNR p=0.001 and p=0.001 respectively. In contrast, mean serum CHOL and TG level revealed insignificant differences when compared DR with Diabetic without retinopathy (DNR).The genotyping for MnSOD-47C/T showed that the frequency of genotype CC was significantly lower in cases compared with control. Theses Associations for SNPs CCs, MnSOD-47C/T SNP rs4880, decreased risk after correction for multiple testing (OR = 0.088, 95% CI = 0.034-0.224 p= 0.001), While the frequency of the CT heterozygote genotype was significantly higher in cases group compare with control, the OR= 3.76(1.41-10.5), P=0.006. While frequency of the TT genotype was significantly higher in cases than controls. Theses Associations for MnSOD 47C/T SNP rs4880, increased risk after correction for multiple testing (OR = 5.31, 95% CI = 1.91-14.75, p= 0.001). The C allele is observed in 47% of the cases while the T allele – risky allele- observed in 73% of the cases, OR= 0.150(0.079-0.285), P=0.001 (Table 6).&#x0D; Conclusion: The study concludes that there is a significant association between MnSOD-47C/T (rs 4880) gene polymorphism and the occurrence of diabetic retinopathy in Sudanese population. There is a significant decrease in MnSOD levels and glycemic control in patients with the mutant allele T.

Periodontal Disease May be Associated With the Occurrence of Diabetic Retinopathy: A Subgroup Analysis of The Survey of the Diabetes Coordination Notebook in Gifu.

A questionnaire survey of the prevalence of diabetic retinopathy was recently conducted in Japan. A subgroup analysis to examine the association of periodontal disease with diabetic retinopathy in subjects with diabetes and prediabetes was conducted. The association of the presence of periodontal disease with the occurrence of diabetic retinopathy was examined using multivariate logistic regression analysis. Of 27 016 subjects who completed a survey at 217 community pharmacies, 5 572 had diabetes or prediabetes, among whom 522 and 1 421 had retinopathy or periodontal disease, respectively. Therapy duration≥10 years (OR: 2.73, 95% CI: 2.17-3.43, P<0.001), periodontal disease (OR: 2.10, 95% CI: 1.68-2.62, P<0.001) and glycated hemoglobin (HbA1c) ≥ 7.0% (OR: 1.64, 95% CI: 1.32-2.04, P<0.001) were significantly associated with the occurrence of retinopathy, while retinopathy (OR: 2.11, 95% CI: 1.: 69-2.63, P<0.001) and therapy duration ≥10 years (OR: 1.24, 95% CI: 1.06-1.46, P=0.007) were significantly associated with the occurrence of periodontal disease. The prevalence of retinopathy was much higher in diabetic subjects with periodontal disease than in those without it (15.1% vs. 7.8%, P<0.001). Notably, the difference of prevalence of retinopathy between subjects with and without periodontal disease was statistically significant even at HbA1c 6.0-6.9% (15.2% vs. 7.3%, P<0.01). These findings indicate that the target HbA1c level for diabetes patients with periodontal disease may be set lower than for those without it, and that regular dental visits should be prescribed for the management of periodontal disease and the prevention of diabetic retinopathy.

Association between endoplasmic reticulum stress and risk factors of diabetic retinopathy.

Diabetic retinopathy (DR) is one of the most common and challenging ocular complications of diabetes mellitus. As a chronic, progressive ocular disease that poses a serious threat to vision, DR has gradually become a leading cause of blindness worldwide. Emerging evidence points to an important role of endoplasmic reticulum (ER) stress in not only maintaining the steady-state equilibrium in the body, but also in intracellular synthesis, protein folding, and other essential functions. Recent studies have demonstrated clear associations between ER stress-related physiological functions and the pathogenesis of DR. When cells are stimulated by external stimuli, UPR pathway is activated firstly to protect it. However, long-term harmful factors can induce ER stress. which interferes with the physiological metabolism of retinal cells and participates in the occurrence of DR via the ATF6 pathway, PERK pathway and IRE1 pathway. At present, ER stress blocker is expected to become a new anti-DR therapy. Thus, understanding the relationship between ER stress and DR will help to develop new effective preventative treatments. In this review, we summarize the risk factors of DR pathogenesis induced by ER stress toward revealing potentially new therapeutic targets.

Serum microRNA-211 as a biomarker for diabetic retinopathy via modulating Sirtuin 1

Diabetic retinopathy (DR) is a progressive microvascular complication associated with diabetes, and remains the leading cause of preventable blindness worldwide. Recent studies have revealed that microRNAs (miRNAs) were involving in the physiological and pathophysiological processes of diabetes and its microvascular and macrovascular complications. The purpose of the current investigation is to identify the candidate miR-211 as a novel biomarker for occurrence and progression of DR in clinical study and experimental research. Firstly, miR-211 was considered as a candidate miRNA identifying by miRNA microarray analysis, Venn diagram analysis, real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and receiver operating characteristic curve in clinical study. Then, the predicted Sirtuin 1 (SIRT1) may be the target gene of miR-211 searching by TargetScan 7.2. Moreover, miR-211 was significantly up-regulated, while SIRT1 mRNA significantly down-regulated measuring by qRT-PCR, meanwhile, SIRT1 protein was significantly down-regulated in coincidence with SIRT1 mRNA detecting by western blot, and even aggravated associated with diabetes duration in diabetic retinal tissues of vivo experiment. Additionally, miR-211 was directly targeted SIRT1 confirming by dual-luciferase reporter assay. Furthermore, with transfection of antagomiR-211, the apoptosis of HUVECs was significantly suppressed employing by flow cytometry analysis, nevertheless the viability of HUVECs was significantly promoted exploiting by Cell Counting Kit-8 assay. Finally, SIRT1 mRNA and SIRT1 protein were significantly up-regulated testing by qRT-PCR and western blot respectively in hyperglycemic HUVECs transfected with antagomiR-211 of vitro experiment. Consequently, the current clinical study and experimental research imply that serum miR-211 as a novel biomarker with high sensitivity and specificity could be associated with occurrence and progression of DR via targeting SIRT1.

Prevalence and Associated Risk Factors for Diabetic Retinopathy among in-patients Diagnosed with Diabetes Mellitus: A Retrospective Study Conducted in Nobel Medical College and Teaching Hospital, Biratnagar

Background: Diabetes mellitus (DM) being disease of modern world occurrence of Diabetic retinopathy (DR) has become more frequent. Knowledge on the prevalence and associated risk factors of diabetic retinopathy helps to detect the disease in its early course. The objective of the study was to establish the prevalence and to analyze the associated risk factors and help to screen the disease as early as possible so as to prevent and /or to delay the onset as well as progression of DR. Materials and Methods: A hospital based retrospective study conducted among 213 in-patients of Nobel Medical College, Biratnagar diagnosed with DM. Result: The prevalence of diabetic retinopathy was 32.39% and prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR, proliferative diabetic retinopathy and clinically significant macular edema was 12.7%, 8.9%, 6.1%, 5%, 1.9% &amp; 2.3% respectively. There was statistically significant relation of diabetic retinopathy with duration of diabetes (p value 0.004) and the mean duration was 8.704 years. Conclusions: The prevalence of diabetic retinopathy among in-patients was 32.39%. Though there was no significant relation with occurrence of DR with type of diabetes, age, sex, alcoholism, smoking and drug intake history, the duration of diabetes and hyperlipidemia, poor hyperglycemic control were highly significantly associated with DR while high BP showed marginally insignificant relation with the same. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 50-55

Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study.

Bariatric surgery improves glycemic control in patients with type 2 diabetes mellitus (T2DM), but less is known about microvascular outcomes. To investigate the relationship between bariatric surgery and incident microvascular complications of T2DM. Retrospective matched cohort study from 2005 to 2011 with follow-up through September 2015. 4 integrated health systems in the United States. Patients aged 19 to 79 years with T2DM who had bariatric surgery (n= 4024) were matched on age, sex, body mass index, hemoglobin A1c level, insulin use, diabetes duration, and intensity of health care use up to 3 nonsurgical participants (n= 11059). Bariatric procedures (76% gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) compared with usual care. Adjusted Cox regression analysis investigated time to incident microvascular disease, defined as first occurrence of diabetic retinopathy, neuropathy, or nephropathy. Median follow-up was 4.3 years for both surgical and nonsurgical patients. Bariatric surgery was associated with significantly lower risk for incident microvascular disease at 5 years (16.9% for surgical vs. 34.7% for nonsurgical patients; adjusted hazard ratio [HR], 0.41 [95% CI, 0.34 to 0.48]). Bariatric surgery was associated with lower cumulative incidence at 5 years of diabetic neuropathy (7.2% for surgical vs. 21.4% for nonsurgical patients; HR, 0.37 [CI, 0.30 to 0.47]), nephropathy (4.9% for surgical vs. 10.0% for nonsurgical patients; HR, 0.41 [CI, 0.29 to 0.58]), and retinopathy (7.2% for surgical vs. 11.2% for nonsurgical patients; HR, 0.55 [CI, 0.42 to 0.73]). Electronic health record databases could misclassify microvascular disease status for some patients. In this large, multicenter study of adults with T2DM, bariatric surgery was associated with lower overall incidence of microvascular disease (including lower risk for neuropathy, nephropathy, and retinopathy) than usual care. National Institute of Diabetes and Digestive and Kidney Diseases.

The roles of uric acid in the pathogenesis of diabetic retinopathy

Uric acid (UA) is the final product of human purine metabolism. As one of the main antioxidants in the body, it can scavenge oxidative radicals. Under the action of oxidative-antioxidant shuttle mechanism, the antioxidant activity of UA can be reversed, causing inflammation and oxidative stress of vascular endothelial cells. Hyperuricemia (HUA) is considered to be one of the major risk factors for diabetes and diabetic nephropathy. The study of HUA in diabetic retinopathy (DR) is also a hot topic. UA can cause retinal vascular sclerosis, and affect the occurrence and development of DR by promoting oxidative stress and inducing neovascularization. Key words: Uric acid; Diabetic retinopathy; Hyperuricimia; Review

Genetic association of AKR1B1 gene polymorphism rs759853 with diabetic retinopathy risk: A meta-analysis

ObjectiveThe study aimed to ascertain the correlation between AKR1B1 polymorphism rs759853 and the risk of diabetic retinopathy (DR) through a meta-analysis. MethodsCrude odds ratios (ORs) and the corresponding 95% confidence interval (95% CIs) were calculated to assess the association of AKR1B1 rs759853 polymorphism with DR risk. Stratification analyses were further conducted based on ethnicity, diabetes mellitus (DM) type, Hardy-Weinberg equilibrium (HWE) status, and genotyping method. Heterogeneity was detected by Q test. Sensitivity analysis was implemented to check the robustness of final results. Additionally, Begg's funnel plot and Egger's test were used to evaluate underlying publication bias. ResultsOur meta-analysis ultimately incorporated 21 eligible publications with 22 independent case-control studies. The overall results demonstrated that AKR1B1 rs759853 polymorphism had no association with DR risk under all genetic models. However, after subgroup analysis by DM type, the rs759853 polymorphism was a protective factor against the DR onset in patients with type 1 DM (TT vs. CC: OR = 0.33, 95% CI = 0.17–0.67; TT + CT vs. CC: OR = 0.49, 95% CI = 0.36–0.68; TT vs. CC + CT: OR = 0.48, 95% CI = 0.28–0.83; allele T vs. allele C: OR = 0.56, 95% CI = 0.44–0.72; CT vs. CC: OR = 0.52, 95% CI = 0.37–0.74). Furthermore, subgroup analysis by genotyping method suggested that rs759853 genotyped using MassARRAY assay was significantly correlated with decreased risk of DR under dominate model (TT + CT vs. CC: OR = 0.71, 95%CI = 0.52–0.96). ConclusionAKR1B1 polymorphism rs759853 may inhibit the occurrence of DR in patients with type 1 DM.

Diabetic retinopathy among Brazilian Xavante Indians

BackgroundTo describe the frequency of diabetic retinopathy (DR) and its associated variables in Brazilian Xavante Indians.MethodsA population-based survey carried out in two Xavante Reservations between 2008 and 2012, included 948 Indians aged 20 years or more, identified 246 individuals with type 2 diabetes. A non-probabilistic cluster sample of 140 diabetic individuals were submitted to ophthalmologic examination. Due to operational conditions and to optimize the field work, only the larger Xavante villages were included. Ophthalmologic examinations were performed during one trip to each reservation, in their villages and consisted of measurement visual acuity, anterior segment biomicroscopy, applanation tonometry, and direct and indirect ophthalmoscopy.ResultsThe frequency of DR was 19.3%, distributed as follows: mild non-proliferative retinopathy in nine (33.3%) subjects, moderate in nine (33.3%), severe in six (22.3%), very severe in two (7.4%), and high-risk proliferative DR in one (3.7%). The occurrence of DR was higher among those with a longer duration of diabetes, higher levels of glycated hemoglobin (HbA1c) and fasting glucose, papillary excavation ≥ 0.5, and among individuals in older age group. Using the log-binomial regression model, diabetes duration > 24 months and HbA1c ≥ 6.5% were significantly associated with the occurrence of DR.ConclusionsThe presence of DR (19.3%) in Xavante Indians is an alert for health care providers for this population, since diabetes is a new disease among them. Its association with disease duration, high levels of HbA1c and blood glucose calls attention for the necessity of more actions to improve diabetes control in this recently contacted ethnic group that needs particular attention.

Prevalence and risk factors of diabetic retinopathy in hospital patients

Objective: To analyze the prevalence and risk factors of diabetic retinopathy (DR) in ophthalmic patients. Methods: A cross-sectional study was performed. Diabetic patients who were admitted to Department of Ophthalmology, Traditional Chinese Medicine Hospital of Muping between October 2012 and June 2013 were included. General information and medical history were obtained from each subject by questionaires. Laboratory and detailed ophthalmic examinations were performed during the study. DR was diagnosed and graded by mydriatic fundus photography. Prevalence of DR was calculated and logistic regression was used to analyze the relationship between DR and various factors. Results: A total of 676 diabetic patients were included, and 455 of them presented with DR at a morbidity rate of 67.31%. Among DR patients, the number of mild, moderate, severe non-proliferative diabetic retinopathy (NPDR) patients and proliferative diabetic retinopathy (PDR) patients were 211 (46.37%), 167 (36.70%), 57 (12.53%) and 20 (4.40%), respectively. There was no significant difference in the prevalence of DR among different age groups (χ(2)=6.527, P=0.089). However, there was a significant difference between different disease duration groups (χ(2)=39.401, P<0.001), as well as between insulin therapy group and non-insulin therapy group (χ(2)=7.378, P=0.007). The multivariate logistic regression analysis demonstrated the independent risk factors for DR occurrence were hemoglobin A1c (HbA1c) (OR=1.131, 95%CI: 1.022-1.252, P=0.011) and duration of diabetes (OR=1.077, 95%CI: 1.046-1.108, P<0.001). Conclusions: The prevalence of DR in ophthalmic patients was associated with duration of diabetes, HbA1c, obesity, smoke, nephropaty and insulin therapy. Increased HbA1c level and longer duration of diabetes were independent risk factors for DR in diabetic patients.

Hypermethylation in the promoter of the MTHFR gene is associated with diabetic complications and biochemical indicators

BackgroundDNA methylation is an epigenetic mechanism for regulating the transcription of many genes and has been linked to the development of various diseases. A promising gene to investigate is methylenetetrahydrofolate reductase (MTHFR), since the enzyme methylenetetrahydrofolate reductase (MTHFR) promotes methyl radical synthesis in the homocysteine cycle and can provide methyl groups for DNA methylation. In addition, several studies have correlated gene polymorphisms of this enzyme with a greater risk of diabetes, but little is known regarding the relationship between epigenetic changes in this gene and diabetes and its complications. The aim of this study was to investigate the relationship between methylation profile in the MTHFR gene promoter and biochemical, inflammatory and oxidative stress markers in individuals with type 2 diabetes (T2DM) who have been diagnosed for 5–10 years with or without diabetic retinopathy (DR) and nephropathy (DN).MethodsSpecific PCR for methylation (MSP) was used to analyze MTHFR methylation profile in leucocytes DNA. Biochemical markers (glycemia, glycated hemoglobin, total cholesterol, LDL, HDL, triglycerides, serum creatinine), inflammatory markers (C-reactive protein and alpha-1 acid glycoprotein) and oxidative stress (total antioxidant and malonaldehyde) were determined in peripheric blood samples and microalbuminuria in 24 h urine samples. The X2 and Mann–Whitney statistical tests were performed and p < 0.05 were considered significant.ResultsThe hypermethylated profile was most frequently observed in individuals with retinopathy (p < 0.01) and was associated with higher total cholesterol and LDL levels (p = 0.0046, 0.0267, respectively). Individuals with DN and hypermethylated profiles had higher levels of alpha-1 acid glycoprotein (p = 0.0080) and total antioxidant capacity (p = 0.0169) compared to subjects without complications.ConclusionsHypermethylation in the promoter of the MTHFR gene is associated with the occurrence of DR and with biochemical, inflammatory and oxidative stress parameters in the context of chronic complications

Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy.

To study the occurrence and level of diabetic retinopathy (DRP) before and after planned bariatric surgery and to investigate potential risk factors for deterioration of DRP. The Scandinavian Obesity Surgery Registry (SOReg) was used to identify diabetic patients who underwent gastric bypass (GBP) surgery at three centres in Sweden during 2008-2010. Information regarding DRP screening was obtained from ophthalmological patient charts. Patients who had DRP screening before and after GBP surgery were included in the study. The survey included 117 patients. Mean age was 50 (SD 10) years, body mass index (BMI) 43 (SD 8) kg/m2 and HbA1c 64 (SD 18) mmol/mol before surgery. One year post-GBP, BMI was reduced to 31 (SD 6) kg/m2 . HbA1c was 43 (SD 10) mmol/mol, and in 66% (77/117) treatment for diabetes had been discontinued. Occurrence of DRP before GBP was as follows: no DRP 62%, mild 26%, moderate 10%, severe 0% and proliferative DRP 2%. No significant changes in occurrence of DRP after surgery were observed. Twelve patients (16%) developed mild DRP. In seven patients with pre-existing DRP, deterioration was observed and two of these patients required treatment for sight-threatening DRP. No association between preoperative BMI, HbA1c or reduction in HbA1c and worsening of DRP was found. In a majority of patients, no deterioration of DRP following GBP was observed. Screening for DRP before planned surgery is recommended for all diabetic patients about to undergo bariatric surgery to identify any pre-existing DRP.

Effects of Chinese herbal medicines on the occurrence of diabetic retinopathy in type 2 diabetes patients and protection of ARPE-19 retina cells by inhibiting oxidative stress.

Diabetic retinopathy is a microvascular complication of type 2 diabetes and the leading cause of acquired blindness. In Taiwan, Chinese herbal medicine (CHM) is a popular adjunctive therapy. In this study, we investigated the CHM prescription patterns and their effects. We identified 23,701 subjects with type 2 diabetes in a database, and after matching for age and gender, 6,948 patients each were assigned to CHM and non-CHM groups. In the female subgroups, the cumulative retinopathy probability was lower for the CHM users than that for the CHM non-users (P < 0.001, log-rank test). Among the top 10 CHMs, Jia-Wei-Xiao-Yao-San (JWXYS; 52.9%), Shu-Jing-Huo-Xue-Tang (SJHXT; 45.1%), and Ge-Gen-Tang (GGT; 43.7%) were the most common herbal formulas. Yan-Hu-Suo (48.1%), Ge-Gen (42.1%), and Huang-Qin (HQin; 40.1%) were the most common single herbs. CHM network analysis showed that JWXYS was the core CHM of cluster 1. JWXYS, DS, XF, and SZRT exhibited both of the reductions of H2O2-induced phosphorylation of p38 MAPK and p44/42 MAPK (Erk1/2) in human ARPE-19 retina cells. In cluster 2, SJHXT was the core CHM. SJHXT and NX showed both of the phosphorylation reductions. In cluster 3, GGT was the core CHM, and it reduced the phosphorylation of both MAPKs. In cluster 4, HQin was the core CHM, and it also reduced the phosphorylation of both MAPKs. Our study suggests that adjunctive CHM therapy may reduce diabetic retinopathy via antioxidant activity of the herbs and provides information on core CHM treatments for further scientific investigations or therapeutic interventions.

Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study.

BackgroundCurrently 93 million people are estimated as living with diabetic retinopathy worldwide. The prevalence and risk factors of diabetic retinopathy in developed countries have been well documented; but in Ethiopia, data on prevalence and associated factors of diabetic retinopathy is lacking.ObjectiveTo determine prevalence and factors associated with development of diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia.MethodCross-sectional study design with record review of 400 diabetic patients was conducted at Arbaminch General Hospital from November to January 2015. Among 400 diabetic patients, 270 patients with baseline information and without history of hypertension at baseline were included in this study. But patients with gestational diabetes and with retinopathy at baseline were excluded from the study. Consecutive sampling technique was applied to select study participants. Data of cohorts was extracted from medical record using pre tested structured extraction check list. Data cleaning, coding, categorizing, merging and analysis carried out by STATA version 12. Descriptive statistics was done and presented accordingly. Bivariate binary logistic regression analysis was done to select potential candidates for the full model at P-value cutoff point ≤ 0.25 and multivariable binary logistic regression analysis was made to estimate the independent effect of predictors on the occurrence of diabetic retinopathy. Model diagnostic tests were done, final model fitness was checked using Hosmer and Lemeshow chi square test. Finally, statistical significance was tested at P-value <0.05.ResultPrevalence of diabetic retinopathy among diabetic patients at Arbaminch General Hospital was 13%. Adjusted analysis showed that the odds of diabetic retinopathy were statistically and significantly associated with baseline age (AOR = 6.06: 95%CI; 2.42, 15.21), baseline systolic blood pressure level (AOR = 4.38: 95%CI; 1.64, 11.68), family history of diabetes (AOR = 0.22: 95%CI; 0.08, 0.58) and duration of diabetes (AOR = 8.84: 95%CI; 3.56, 12.89).Conclusion and recommendationIn the current study, prevalence of diabetic retinopathy was 13%. Since baseline age ≥60 years, baseline systolic blood pressure level >140 mmhg, duration of diabetes ≥6 years and patients with family history of diabetes were statistically and significantly related with diabetic retinopathy, special care should be given in addition to routine care.

Association 0f Gpx-198C/T Gene Polymorphism (rs1050450-198C/T) in Sudanese with Diabetic Retinopathy

Background: Diabetic retinopathy is the common micro-vascular complication of diabetes mellitus. It is the main cause of blindness among young adults worldwide. Poor glycemic control in addition to longer diabetic duration is the main risk factors for diabetic retinopathy. Many genes have been postulated as candidates for diabetic retinopathy. Little is known about anti-oxidative enzyme gene polymorphism and its association with diabetic retinopathy, mainly for catalase enzyme and manganese superoxide dismutase and glutathone genes. The study aims to assess the role of glutathone GPX-198C/T (rs1050450) gene polymorphism in diabetic retinopathy Sudanese patients and its relation with GPX level. In addition to determine the association of FBS, HbA1c and lipid in the pathogenesis of diabetic retinopathy. Methodology: The number of subjects involved were 130 which were classified into (n 60) clinically diagnosed as diabetic retinopathy and (n 70) diabetes mellitus without retinopathy as control group, age ranged from 22 to 80 years old, from Makkah Eye Complex. DNA was extracted and PCR product for GPX, gene segment were digested by Aba1 enzymes, moreover gene polymorphisms were determined. Serum GPX, activity and FBS, TG, CHOL and HbA1c level were analyzed using Cobas Int 400 using absorption photometer and immunoassay methods respectively. Results: The results revealed that, retinopathy is common in female than male by approximately 2 fold =1.9:1. Type II is more common in our population that type 1. The majority of the patients had type II diabetes (128, 98.5%) and only 2(1.5%) patients were type I diabetes mellitus. The activity of GPX, was significantly higher in DNR when compared with DR (p=0.003). Mean HbA1c and FBG concentration were significantly higher among DR than DNR p=0.001 and p=0.001 respectively. In contrast, mean serum CHOL and TG level revealed insignificant differences when compared DR with DNR. The genotyping for GPX-198C/T showed that, the frequency of CC was observed in 33(47%) in control higher than cases 13(22%), theses Associations for CCs, GPX-198C/T SNP rs1050450, decreased risk after correction for multiple testing (OR=0.310, 95% CI=0.176-0.486, p=0.001), While TT genotype was detected in 25(42%) cases and only 14(20%) in controls, these Associations for SNPs, TTs, GPX-198C/T SNP rs1050450, increased risk after correction for multiple testing (OR=2.4, 95% CI=1.10-5.90, p=0.004). The frequency of the allele C protective allele was found to be 48% among cases group while allele T-risky allele was higher among cases group 72%, OR=0.357 (0.216-0.433), p=0.001. Conclusion:The study concludes that there is a significant association between GPX-198C/T (rs1050450) gene polymorphism and the occurrence of diabetic retinopathy in Sudanese population. There is a significant decrease in GPX levels and glycemic control in patients with the mutant allele T.

Multimodal retinal imaging of diabetic macular edema: toward new paradigms of pathophysiology.

The pathophysiology of diabetic macular edema (DME) is multifactorial and partly still unknown. An increasing body of evidence suggests that neurodegeneration and retinal glial cells activation occur even before the earliest clinical manifestation of diabetic retinal vasculopathy. Nowadays, new non-invasive techniques are available to assess and characterize DME, not only in a quantitative perspective, but also making it possible to understand and quantify the pathogenic processes sustaining fluid accumulation. Optical coherence tomography (OCT) allows documenting not only parameters such as macular volume, central and sectorial retinal thickness, fluid localization, and integrity of retinal layers, but also new still poorly investigated reflectivity aspects. Hyperreflective intraretinal spots (HRS) have been detected on OCT scans through the retinal layers, with a presumptive migration pattern towards the external layers during the occurrence of diabetic retinopathy and DME. These HRS have been hypothesised to represent an in-vivo marker of microglial activation. Autofluorescence of the fundus (FAF) also offers a non-invasive imaging technique of DME. The area of increased FAF correlates with the presence of intraretinal fluid and probably retinal glial activation. Microperimetry allows the measurement of retinal sensitivity by testing specific selected retinal areas. Some studies have shown that increased macular FAF in DME correlates better with visual function assessed with microperimetry than with visual acuity, showing that new imaging and functional techniques may help to elucidate DME pathogenesis and to target therapeutical strategies.