PDR Group Research Articles

Change in tear protein profile in diabetic retinopathy with duration of diabetes

AimsTo study change in tear protein profile with duration of diabetes and severity of diabetic retinopathy (DR) in type 2 diabetes patients. Materials and methodsTear protein profile was ascertained by SDS PAGE method in 30 patients with DR (group A) and 37 patients without DR (group B). ResultsSix distinct bands of proteins were identified; these proteins are as follows: 91kDa (P1), 66kDa (P2), 60kDa (P3), 30kDa (P4), 18.4kDa (P5) and 14.4kDa (P6). Prevalence of P3 was significant (p=0.036) in group A, especially in cases with diabetes ≤8 years compared with diabetes >8 years (p=0.0107). In group B, P2 was significantly prevalent (p<0.0013) in cases with diabetes ≤8 years compared to diabetes >8 years. Considering the changes in terms of duration of diabetes in general, patients with diabetes of ≤8 years, P3 was significantly prevalent in group A compared to group B (p=0.004); and when the duration of diabetes is >8 years, P2 was found significantly more in group A compared to group B (p=0.01). No significant difference in P3 (p=0.025), P4 (p=0.2877), P5 (p=0.4801), P6 (p=0.0985) was observed in mild to moderate NPDR group compared to severe NPDR to PDR group. P1 and P2 were present only in severe NPDR and PDR. ConclusionVariable protein expression was observed with duration of diabetes and severity of diabetic retinopathy.

CHOROIDAL THICKNESS IN DIABETIC RETINOPATHY

To analyze the effect of anti-vascular endothelial growth factor agents (anti-VEGF) in submacular choroidal thickness (CT) of diabetic retinopathy (DR) patients. Cross-sectional study, which included 25 DR patients (50 eyes) divided in 2 groups, according to DR stage and previous treatments: nonproliferative DR and diffuse diabetic macular edema in both eyes, submitted to macular laser in both eyes and anti-VEGF injection only in 1 eye (nonproliferative diabetic retinopathy + diabetic macular edema group, n = 11); and proliferative DR in both eyes, treated with panretinal photocoagulation in both eyes and anti-VEGF injection only in 1 eye (proliferative diabetic retinopathy group, n = 14). In the study visit, all patients underwent optical coherence tomography with enhanced depth imaging protocol. Choroidal segmentation was performed manually. The medium CT in central macular area (CCT) and the CT in centrofoveal B-scan were obtained automatically. The 25 eyes treated with anti-VEGF showed a reduction on CCT (P = 0.002) and subfoveal CT (P = 0.004), compared with the fellow eyes treated with laser only. Independent evaluation of PDR group revealed similar results (CCT, P = 0.02; subfoveal CT, P = 0.03). In nonproliferative diabetic retinopathy + diabetic macular edema group, CCT was also significantly thinner in eyes treated with anti-VEGF (P = 0.04). A correlation between the number of injections and a thinner CT was found in this group (P = 0.03) and in the evaluation of all eyes together (P = 0.03). Diabetic eyes treated with anti-VEGF agents have reduced CT.

English

To establish a relation between diabetic retinopathy and diabetic nephropathy in type II diabetes mellitus. To find out the relation between level of glycosylated haemoglobin (HbA1c) with diabetic retinopathy and diabetic nephropathy. An observational clinical study where 50 patients with diabetic retinopathy included. HbA1C, blood urea and serum creatinine levels of these patients were measured and the correlation between these values with the severity of retinopathy was assessed. Among 50 patients, 31 were males and 19 females. Mean age of patients was 62 years. Mean duration of diabetes mellitus was 6.9 years. None of the patients with severe NPDR and PDR had HbA1C under very good control. 64.3% with mild NPDR, 78.2% with moderate NPDR, 87.5% with severe NPDR and 100% patients with PDR had HbA1C under poor control. In mild NPDR group 14.3%, in severe NPDR group 50% and in PDR group 40% had blood urea >40. In mild NPDR group 14.3%, in severe NPDR group 50% and in PDR group 60% had serum creatinine>1. Glycosylated haemoglobin showed increasing trend as severity of diabetic retinopathy increased. Blood urea and serum creatinine also showed a positive correlation with diabetic retinopathy.

Retinal Arterial and Venous Oxygen Saturation Is Altered in Diabetic Patients

To determine the retinal oxygen saturation trend with onset of diabetes and increasing severity of diabetic retinopathy by comparing diabetic groups with and without retinopathy to controls. A fundus camera-based dual-wavelength snapshot oximeter imaged retinas of healthy subjects and patients with and without diabetic retinopathy. The images were analyzed to determine oxygen saturation in major retinal arteries and veins, which is inversely proportional to optical density ratio. Control retinal oxygen saturation (n = 14) in arteries was 92.3 ± 4.2% and in veins, 57.2 ± 6.0%. Retinal oxygen saturation for diabetic patients with no signs of diabetic retinopathy (NDR, n = 45) in arteries was 96.3 ± 8.6% (P = 0.662) and in veins, 58.7 ± 7.5% (P = 0.998). Retinal oxygen saturation for diabetics with mild to moderate nonproliferative diabetic retinopathy (NPDR, n = 23) in arteries was 97.7 ± 5.8% (P = 0.590) and in veins, 61.1 ± 7.6% (P = 0.658). Retinal oxygen saturation for diabetics with severe NPDR (n = 12) in arteries was 102 ± 10.2% (P = 0.023) and in veins, 66.8 ± 8.4% (P < 0.001). Retinal oxygen saturation for patients with proliferative diabetic retinopathy (PDR, n = 13) in arteries was 103.6 ± 8.7% (P = 0.003) and in veins, 66.6 ± 10.2% (P = 0.026). Retinal oxygen saturation for all diabetics with retinopathy combined (all DR, n = 48) in arteries was 100.4 ± 7.6% (P = 0.004) and in veins, 64.2 ± 8.4% (P = 0.007). A trend of increasing retinal oxygen saturation was found from controls to NDR group to increasing levels of diabetic retinopathy, though significance was only reached for the comparison of controls to severe-NPDR, PDR, and all-DR groups.

Association of serum lipid levels with diabetic retinopathy.

To assess the association between serum lipids and diabetic retinopathy (DR). Sixty-one diabetic patients without retinopathy(NDR), 55 diabetic patients with non-proliferative retinopathy(NPDR) and 75 diabetic patients with proliferative retinopathy (PDR) according to ETDRS grading scale were enrolled in this study. Total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglyceride values were compared between the groups. The groups were well-balanced in terms of age and gender (P=0.071, P=0.265 respectively). The mean HbA1c values were significantly lower in NDR group than the NPDR and PDR groups (P=0.004, P=0.009 respectively). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the groups (P=0.693, P=0.774, P=0.644, P=0.910 and P=0.967 respectively, one way ANOVA). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the patients with ME and patients without ME (P=0.622, P=0.113, P=0.955, P=0.735 and P=0.490 respectively, t-test). The mean blood glucose significantly correlated with total cholesterol (r=0.173, P=0.017) and LDL (r=0.190, P=0.008). The mean HbA1c significantly correlated with total cholesterol (r=0.158, P=0.030) and triglyceride (r=0.148, P=0.042). Serum lipid levels were not significantly associated with the severity of DR or existence of ME despite the significant correlation between the mean blood glucose, HbA1c and total cholesterol.

Evaluation of the effect of intravitreal ranibizumab on choroidal thickness in eyes treated for diabetic macular edema

Purpose: To evaluate the effect of intravitreal Ranibizumab on central choroidal thickness (CCT) in eyes treated for diabetic macular edema (DME). Materials and Methods: This prospective non-randomized interventional cohort study included 20 eyes of 20 diabetic patients, recruited between March 2013 and March 2014. Eyes with DME (thickness from 290 to 600 μm) underwent intravitreal injection of Ranibizumab (three consecutive injections, 1 month apart). Prior to injection, all patients had a complete ophthalmic examination, including manifest refraction, slit-lamp bio-microscopy, intraocular pressure measurement, and a detailed fundus examination. Prior to injection and 1 month from the third injection, the central macular thickness and CCT were assessed again by SD-OCT. After each injection, patients were followed to diagnose and treat any complications from injections. Results: Twenty eyes of 20 diabetic retinopathy (DR) patients, 9 females and 11 males with a mean age of 49.7 ± 4.1 years, were included. The pre-injection mean CCT was 234.35 ± 38.36 μm. In the NPDR group, it was 238.2 ± 41.36 μm; and in the PDR group, it was 228.5 ± 35.26 μm. This was not significantly different (P = 0.851). After injections, the mean CCT in all patients, in the NPRD group and in the PDR group showed a decrease to 215.5 ± 39.08, 224.9 ± 40.72 and 201.31 ± 34.02 μm, respectively (P = 0.362). There was a statistically significant difference between the pre-injection and the post-injection CCT (P < 0.001). The improvement in the CCT after treatment was not significantly correlated with the pre-injection CCT or the pre-injection CMT (P = 0.346, P = 0.096 respectively). No significant correlation was found between post-injection CCT and CMT in all patients (P = 0.436) or in the different groups separately (P = 0.191, P = 0.817, respectively). No injection-related complication was observed in either group. Conclusion: Intravitreal injection of Ranibizumab was effective in significantly decreasing the CCT as well as the CMT after three consecutive injections, 1 month apart regardless of the level of DR. Whether the number of injections can influence the amount of this reduction or not should be evaluated in future studies. No correlation was found between the reduction in CMT and that of the CCT after intravitreal injection with 0.5 mg of Ranibizumab.

Posterior Reconstruction and Outcomes of Laparoscopic Radical Prostatectomy in a High-Risk Setting

To detail the technique and evaluate the impact of a personal modified posterior reconstruction technique (PDR) on the outcomes of extrafascial laparoscopic radical prostatectomy (eLRP) in a consecutive series of 52 patients affected by high-risk prostate cancer (HRPCa). From October 2007 to March 2012, 52 patients underwent PDR during eLRP for HRPCa. Fifty-four patients who underwent eLRP for HRPCa with no PDR were considered as historical controls. Mean operative time (MOT), mean catheterization time (MCT), % continence and quality of life (QoL) at a scheduled follow-up, % anastomotic leakage, % adjuvant therapy were compared between the groups. Percentage of continence and QoL were prospectively assessed by self-administered validated questionnaires (ICI-Q-SF; SF-36) at 1, 3, 6, and 12 months. PDR was associated wither higher continence rates at 1 and 3 mo (P = .028, P = .006), a lower incidence of cystographic leakage (P = .002), and an increased adjuvant radiotherapy rate (P = .008). At 1- and 3-mo interval, in the PDR group, we found a higher number of patients reporting better general health, (P = .01, P = .03) reduced role limitations due to physical health, (P = .02, P = .001), and emotional problems (P = .001, P = .02). PDR is associated with a lower degree of anastomotic leakage, and it significantly enhances urinary continence at 1 and 3 mo. The increased adjuvant radiotherapy rate and quality of life after surgery observed with our technique suggest that in the high-risk setting an early functional recovery may substantially influence the oncologic outcome of eLRP.

Partial Removal of Carious Dentine: A Multicenter Randomized Controlled Trial and 18-Month Follow-Up Results

Aim: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. Methods: Inclusion criteria: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. Outcomes: success was defined as pulp sensitivity to cold test and absence of periapical alterations. Results: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR – 1 pulpitis; SW – 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. Conclusion: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

Association analysis of genetic variations of eNOS and &amp;alpha;2&amp;szlig;1 integrin genes with type 2 diabetic retinopathy

BackgroundDiabetic retinopathy (DR) is classically defined as a microvasculopathy that primarily affects the small blood vessels of the inner retina as a complication of diabetes mellitus. It has been suggested that nitric oxide (NO) and α2β1 integrin (a platelet receptor for collagen) play an important role in the pathogenesis of microvascular complications in DR.AimThe aim of this study was to investigate the association of two candidate genes involved in the regulation of retinal vasculature, endothelial nitric oxide synthase (eNOS) and α2β1 integrin (ITGA2) genes, with the development of DR in Egyptian patients with type 2 diabetes mellitus and to investigate whether genetic variants will affect the type of retinopathy (proliferative or nonproliferative).MethodsIn this study, 70 patients were enrolled and categorized into two groups: (1) a DR group consisting of 50 patients with DR, which was further subclassified into 25 patients with nonproliferative DR (NPDR group) and 25 patients with proliferative DR (PDR group) and (2) a diabetes without retinopathy (DWR) group, comprising 20 patients with type 2 diabetes of more than 10 years’ duration who showed no signs of DR. Associations of the genetic polymorphisms of eNOS (G894T) and ITGA2 (BgI II) were studied. Polymerase chain reaction-restriction fragment length polymorphism analysis was performed for all samples to evaluate the genotypes and correlate with the phenotype of the disease.ResultsThe allele frequencies of both polymorphisms showed considerable differences between patients with and without DR. The GG genotype of G894T polymorphism of eNOS was associated with a 9.75-fold increased risk of DR (95% confidence interval 1.7–55.4) and the genotype ITGA2 BgI II (+/+) was associated with a 10.1-fold increased risk of DR (95% confidence interval 1.8–57.9), while the α2β1 integrin gene polymorphism of genotype distribution of both eNOS and ITGA2 polymorphisms did not differ significantly between the proliferative and nonproliferative DR groups.ConclusionA significant association between the G894T polymorphism of eNOS and BgI II polymorphism of ITGA2 genes and DR was observed, while there was no association between the genetic variants of those two polymorphisms and the type of retinopathy.

Association Between Thr21Met and Ser89Asn Polymorphisms of the Urotensin-II (UTS2) Gene, Diabetes Mellitus, and Diabetic Retinopathy

Purpose: To evaluate possible role of the UTS2 gene polymorphisms (Thr21Met and Ser89Asn) in the genetic susceptibility to diabetic retinopathy (DR) in a Turkish population.Methods: Total number of 280 patients with DR (nonproliferative DR 170 and proliferative DR 110), 291 nondiabetic healthy controls, and 113 diabetic controls (without DR) were included to this study. The detection of UTS2 gene polymorphisms was achieved with PCR-RFLP technique. The Discovery Studio 2.1 program was used for molecular modeling analysis.Results: Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms of the UTS2 gene were associated with the risk of developing diabetes and DR. M21M genotype frequencies were high in PDR (8.9% in diabetic control vs. 54.6% in PDR, P = 0.0092) group. Increases in 21M allele frequency (52.7% in diabetic control vs. 76.4% in PDR, P < 0.0001) frequency in PDR group were detected. However, there were no changes in genotype and allele frequencies for T21M in NPDR group. There were decreases in the S89N genotype (23.9% in diabetic control vs. 13.5%) and 89N allele frequencies (11.9% in diabetic control vs. 6.8%) in NPDR group. However, S89S genotype (76.1% in diabetic control vs. 86.4%) and 89S allele frequencies (88.1% in diabetic control vs. 93.2%) were high in NPDR group. Three haplotypes (MN, MS and TS) were associated with NPDR patients (P < 0.001), but only MN (P < 0.001) and TS haplotypes (P = 0.018) were associated in PDR group. Molecular modeling analysis showed that these two polymorphisms changed the 3D structure of UTS2, and provided interactions with neighboring residues.Conclusion: The associations between Thr21Met and Ser89Asn polymorphisms in the UTS2 gene and DR strongly suggest that these SNPs may be an important a risk factor for the development of DR in Caucasians, and could be candidate markers for earlier diagnosis and targets for DR therapy.

Relationship between platelet-leukocyte aggregates and serum high sensitive-C reactive protein in type 2 diabetic patients with retinopathy

To investigate the relationship between platelet-leukocyte aggregates (PLA) and serum high sensitive C-reactive protein (hs-CRP)in type 2 diabetic patients with retinopathy (DR).The blood levels of platelet-neutrophil aggregates( PNA )and platelet-monocyte aggregates ( PMA ) were determined by flow cytometry and serum hs-CRP by ELISA in 30 patients with proliferative diabetic retinopathy( PDR group),30 patients with no-proliferative diabetic retinopathy( NPDR group),25 diabetic patients without DR( DM group),and 30 normal controls.The levels of PNA,PMA,and hs-CRP in PDR group were significantly higher than those in normal control,NPDR,and DM groups.The levels of PNA,PMA,and hs-CRP in NPDR group were significantly higher than those in normal control and DM group( P＜0.01 or P＜0.05 ).The PNA and PMA were correlated positively with hs-CRP in patients with DR ( r =0.587,0.576 ; P ＜ 0.05 ).The data showed that the levels of PLA and hs-CRP were raised significantly in patients with DR,and the levels of PLA were positively correlated with inflammatory response and the seriousness of DR,suggesting that these findings may play an important role in the development of DR. Key words: Diabetic retinopathy; Platelet-leukocyte aggregates; C reactive protein

The relationship of urine albumin creatinine ratio, serum inflammatory factors and diabetic retinopathy

ObjectiveTo investigate the relationship of urine albumin creatinine ratio (UACR), serum inflammatory factors and diabetic retinopathy.MethodsOne hundred and twenty five cases of type 2 diabetic patients age from 25 to...

Erythropoietin Receptor Positive Circulating Progenitor Cells and Endothelial Progenitor Cells in Patients with Different Stages of Diabetic Retinopathy

To investigate the possible involvement of erythr opoietin (EPO)/erythropoietin receptor (EPOR) system in neovascularization and vascular regeneration in diabetic retinopathy (DR). EPOR positive circulating progenitor cells (CPCs: CD34(+)) and endothelial progenitor cells (EPCs: CD34(+)KDR(+)) were assessed by flow cytometry in type 2 diabetic patients with different stages of DR. The cohort consisted of age- and sex-matched control patients with out diabetes ( n=7),non-proliferative DR (NPDR, n=7),non-proliferative DR (PDR, n=8), and PDR complicated with diabetic nephr opathy (PDR-DN, n=7). The numbers of EPOR(+) CPCs and EPOR(+) EPCs were reduced remarkably in NPDR compared with the control group (both Pü0.01), whereas rebounded in PDR and PDR-DN groups in varyingdegrees. Similar changes were observed in respect of the proportion of EPOR(+)CPCs in CPCs (NPDR vs. control, Pü0.01) and that of EPOR(+) EPCs in EPCs (NPDR vs. control, Pü0.05). Exogenous EPO, mediated via the EPO/EPOR system of EPCs, may alleviate the impaired vascular regeneration in NPDR, whereas it might aggravate retinal neovascularization in PDR due to a rebound of EPOR(+)EPCs associated with ischemia.

Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes

ObjectiveThe objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. Materials and methodsA total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. ResultsIn the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. ConclusionsComprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance.

Correlation of diabetic corneal neuropathy and retinopathy

Abstract Purpose Corneal confocal microscopy is a rapid, non‐invasive and reiterative technique, suitable for the accurate detection and quantification of corneal subbasal nerve plexus. The aim of this study is to correlate corneal nerve fibre alterations with the abnormalities in the retina of diabetic patients and compare them with those of nondiabetic people Methods 278 diabetic corneas and 94 corneas of age‐matched control subjects were included in the study. Diabetic patients were further classified with respect to the stage of retinopathy, according to indirect fundoscopy, fundus photography and fluorescein angiography. The central corneas were scanned with HRT II and we estimated nerve fibre density (NFB) nerve branch density (NBD), nerve fibre length (NFL) and nerve fibre tortuosity (NFT). Finally, we made out the glycemic and lipidemic profile of patients. Results NFD values for control, NDR, NPDR and PDR groups were 31.27 ± 0.99, 27.35 ± 0.77, 23.67 ± 0.83 and 18.77 ± 0.77 respectively and NBD values were 45.12± 2.85, 39.86 ± 3, 30.56 ± 2.71 and 24.98 ± 2.08 respectively. NFL values for control, NDR, NPDR and PDR were 16.58 ± 0.55, 14.82 ± 0.56, 12.27 ± 0.49 and 10.41± 0.45 respectively and NFT values were 5.78 ± 0.28, 6.6 ± 0.52, 6.57 ± 0.22 and 7.02 ± 0.39 respectively. NFD, NBD, NFL were significantly reduced and NFT appeared to be higher in diabetic patients, according to the stage of diabetic retinopathy. The glycemic profile was analogue to the retina status, but the lipidemic one appeared to vary. Conclusion Alterations in corneal nerve plexus are apparent in diabetic patients and more pronounced in PDR.Corneal confocal microscopy could be a promising technique for the early diagnosis and treatment of diabetic neuropathy.

Corneal Subbasal Nerves Changes in Patients with Diabetic Retinopathy: An In Vivo Confocal Study

To study the subbasal corneal plexus (SCP) in patients with diabetic retinopathy (DR) treated or nontreated with panretinal Argon laser photocoagulation (ALP). Fifty consecutive patients with DR and 50 age- and sex-matched normal control subjects were examined with retinal tomography by a masked evaluator. The following subbasal plexus nerves parameters were considered: number per frame, tortuosity, and reflectivity. Diabetic patients were divided into two groups, according to the presence of proliferative versus nonproliferative retinopathy, according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. The number of fibers per frame and reflectivity were significantly lower in diabetic patients compared with control subjects (2.4 +/- 1 vs. 2.9 +/- 0.8, P = 0.01 and 2.3 +/- 0.9 vs. 2.6 +/- 0.9, P = 0.04, respectively). Tortuosity was significantly higher in diabetic patients (2.5 +/- 0.9 vs. 2.0 +/- 0.8, P = 0.002). Number per frame and reflectivity were significantly lower in diabetic patients with proliferative diabetic retinopathy (PDR; respectively, 2.0 +/- 0.9 vs. 2.9 +/- 0.9, P = 0.001, and 2.0 +/- 0.8 vs. 2.6 +/- 0.7, P = 0.003). Tortuosity was significantly higher in the PDR group (2.2 +/- 0.8 vs. 2.8 +/- 0.9, P = 0.008). The PDR group treated with ALP had significantly lower subbasal nerves number compared with the nontreated group (P = 0.01). DR may induce substantial changes in the SCP. There is a difference between proliferative and nonproliferative retinopathy and in the former group between ALP treated and nontreated patients.

Analysis of the Optic Nerve Head and RNFL Thickness Using Optical Coherence Tomography in Diabetes

Purpose: Retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) in diabetic patients with normal tension were analyzed using optical coherence tomography (OCT), which revealed that diabetes induce morphologic changes in optic disc and RNFL thickness. Methods: A total of 192 patients with type 2 diabetes were analyzed with fundus examination and classified as having normal retina, mild - moderate, severe nonproliferative retinopathy (NPDR), or proliferative retinopathy (PDR). These patients were evaluated with OCT and compared with normal control group. Results: The mean average thickness and nasal average thickness of RNFL in mild-moderate, and severe NPDR groups decreased compared with those of the other groups. There was an increase in the temporal average thickness of RNFL in the PDR group. As the duration of diabetes increased, the mean average and nasal average of RNFL thickness also decreased. The severity of diabetic retinopathy didn’t show statistically significant differences in a topographic analysis of the optic nerve head. Conclusions: The mean average thickness and nasal average of RNFL decreased in NPDR groups. Diabetic changes should be considered when diabetes patients are diagnosed with glaucoma or glaucoma progression. J Korean Ophthalmol Soc 49(6):935-941, 2008

Antioxidant Enzymes and Diabetic Retinopathy

The aim of this study was to discuss the serum copper (Cu), zinc (Zn), nitric oxide (NO), glutathione (GSH), advanced oxidation protein products (AOPP) levels, and superoxide dismutase (SOD) activities with diabetic retinopathy severity. Twenty-five patients with proliferative diabetic retinopathy (PDR group 1), 25 patients with nonproliferative diabetic retinopathy (NPDR group 2), and 25 nondiabetic controls (control group) were included in the study. Patients who had macrovascular complications of diabetes (coronary arterial disease, periferic vascular disease) were excluded. The major finding of our study was that we did not observe any differences between group 1 and 2, which we aimed to discuss the severity of diabetic retinopathy. As the levels of SOD and Zn were not different between the groups, statistically significant differences were observed for GSH, NO, and Cu levels when compared to control group. AOPP levels were statistically increased in group 1 compared to control group. It can be suggested that hyperglycemia in DM is associated with accelerated nonenzymatic glycation and oxidative stress.

Relationship between polymorphisms 804C/A and 252A/G of lymphotoxin- α gene and −308G/A of tumor necrosis factor α gene and diabetic retinopathy in Japanese patients with type 2 diabetes mellitus

To clarify whether polymorphisms of the lymphotoxin- α (LTA) gene and tumor necrosis factor α (TNF- α) gene were related to diabetic retinopathy (DR), we performed a case-control study in 251 Japanese patients with type 2 diabetes mellitus participating in a multicenter research protocol. Genetic analyses were performed by using a fluorescent allele-specific DNA primer assay system. Diabetic retinopathy was diagnosed in a masked manner by an independent ophthalmologist using fundus photographs and was classified as nondiabetic retinopathy (NDR), nonproliferative retinopathy (NPDR), and proliferative retinopathy (PDR). The results showed that the genotype frequencies of 804C/A in exon 3 and 252A/G in intron 1 of the LTA gene were not significantly different among patients with NDR, NPDR, and PDR. A allelic frequency of the TNF- α gene (−302A/G in promoter) was also identical among NDR, NPDR, and PDR groups. Multivariate logistic regression analyses showed that significant associations with DR were glycosylated hemoglobin level and diabetes duration, but not polymorphisms of the LTA gene or TNF- α gene. In conclusion, the present study showed no association between polymorphisms 804C/A and 252A/G of the LTA gene and −302A/G of the TNF- α gene and DR in Japanese type 2 diabetic patients.

Association of intercellular adhesion molecule 1 polymorphisms with retinopathy in Chinese patients with Type 2 diabetes

To investigate the relationship of the K469E and G241R polymorphisms of the intercellular adhesion molecule 1 (ICAM-1) gene with diabetic retinopathy in Chinese patients with Type 2 diabetes mellitus. One hundred and seventy-two Chinese patients with Type 2 diabetes and 80 normal control subjects were recruited. Patients with diabetes were placed into two groups: the diabetic retinopathy (DR) group and the non-diabetic retinopathy (NDR) group. The DR group was subdivided into those with proliferative retinopathy (PDR) and non-proliferative retinopathy (NPDR). Genomic DNA was prepared using the hydroxybenzene-chloroform extraction method. Genotypes and alleles were detected by polymerase chain reaction-heteroduplex-single-strand conformation polymorphism (PCR-HA-SSCP) analysis combined with gene sequencing. The patients with retinopathy had an increased frequency of the K469K genotype compared with both the patients without retinopathy and the control subjects (61.4 vs. 40.0 and 35.0%, respectively; chi(2) = 8.280 and 13.952, respectively; P < 0.05). The frequency of the K allele in the DR group was higher than in the NDR group and control subjects (75.4 vs. 58.8 and 61.3%, respectively; chi(2) = 9.693 and 11.219, respectively; P < 0.05). Genotype and allele frequencies were similar in the NDR group and control subjects, and in the PDR and NPDR groups. The ICAM-1 gene K469E polymorphism is associated with diabetic retinopathy in Chinese patients with Type 2 diabetes. Patients with the K469K genotype were more likely to have diabetic retinopathy than patients with the K469E or E469E genotype.