Prognosis Of Diabetic Retinopathy Research Articles

The Effect of Cardiometabolic Control and Malnutrition on the Prevalence and Prognosis of Diabetic Retinopathy in Type 2 Diabetes

Purpose:It is estimated that type 2 diabetes mellitus affects 530 million people worldwide and 10.5 per cent of these patients have diabetic retinopathy. This study aims to investigate the predictive value of cardiometabolic control, GGT and malnutrition-related inflammation markers for predicting Diabetic retinopathy prevalence and prognosis.
 Materials and Methods:Type 2 Diabetes Mellitus patients who were consecutively admitted to Internal and Ophthalmology outpatient clinics were included in this study. Clinical, haematological and biochemical data were recorded. Cut-off values of GGT, PNI, NRI and HALP scores were determined by receiver operator characteristic curve analysis. Univariate and multivariate analyses were performed to determine the association of all variables with Diabetic retinopathy. As a result, we evaluated which of these tests were predictive and prognostic for the development of diabetic retinopathy.
 Results:This study included 166 patients. Fasting blood glucose(p

Association of vitamin B6 intake with the risk and prognosis of diabetic retinopathy: a NHANES-based study.

Investigating the role of dietary vitamin B6 intake in the risk and prognosis of diabetic retinopathy (DR) could facilitate the management of DR. This study aimed to assess the association between dietary vitamin B6 intake and the risk of DR and further explore the association between vitamin B6 intake and mortality in patients with DR. This retrospective cohort study gained data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008. The intake of dietary vitamin B6 was assessed by two 24-h dietary recall interviews. Mortality information in the National Death Index was recorded from the date of survey participation through 31 December 2019. Multivariate regression analyses were employed to assess the association between vitamin B6 intake and the risk of DR, and the association between vitamin B6 intake and the risk of mortality in patients with DR. A total of 5559 subjects were included, of which 693 (12.47%) had DR. Among these patients with DR, 429 (61.90%) were survivors. Multivariate analyses showed that the intake of vitamin B6 was negatively associated with the risk of DR (odds ratio = 0.81, 95% confidence level: 0.69-0.95, p = 0.012), and patients with DR with an increased intake of vitamin B6 had a significantly decreased risk of all-cause death (hazard ratio = 0.81, 95% confidence level: 0.66-0.99, p = 0.041) or cardiovascular disease-related death (hazard ratio = 0.76, 95% confidence level: 0.58-0.98, p = 0.037). The intake of vitamin B6 was negatively associated with the risk of DR, and in patients with DR, a higher intake of vitamin B6 was associated with a lower risk of all-cause death and cardiovascular disease-related death, indicating the possible protective role of increased vitamin B6 intake.

Peripheral retinal lesions in diabetic retinopathy on ultra-widefield imaging

Abstract: Peripheral retinal imaging plays a crucial role in the diagnosis, management, and prognosis of diabetic retinopathy (DR). Traditional fundus imaging techniques have limited coverage of the retina, resulting in missed peripheral lesions. The advent of ultra-widefield (UWF) imaging has revolutionized the assessment of the peripheral retina. UWF imaging modalities provide comprehensive visualization of the retina, enabling the detection of peripheral lesions without the need for mydriasis. Integration of UWF imaging with other modalities, including fluorescein angiography (FA), indocyanine green angiography, pseudocolor imaging, and fundus autofluorescence, further enhances our understanding of peripheral retinal lesions. UWF imaging has demonstrated improved detection of DR lesions and presumably more accurate management of DR compared to traditional fundus photography and dilated fundus examination. UWF-FA and UWF-optical coherence tomography angiography have emerged as valuable tools for assessing retinal and choroidal vascular abnormalities, nonperfusion areas, neovascularization, and microvascular abnormalities. The presence and increasing extent of predominantly peripheral lesions detected using UWF FA are associated with a higher risk of DR progression and proliferative DR. UWF imaging provides a comprehensive evaluation of DR severity, aiding in more accurate risk stratification and treatment decision-making. Overall, UWF imaging modalities have significantly advanced our understanding of peripheral retinal lesions in DR, facilitating early detection and targeted management for better visual outcomes.

Comprehensive metabolic profiling of diabetic retinopathy

Diabetic retinopathy (DR) is an important complication of diabetes mellitus and a prevalent blind-causing ophthalmic disease. Despite years of efforts, rapid and accurate diagnosis of DR remains a challenging task. Metabolomics has been used as a diagnostic tool for disease progression and therapy monitoring. In this study, retinal tissues were collected from diabetic mice and age-matched non-diabetic mice. An unbiased metabolic profiling was performed to identify the altered metabolites and metabolic pathways in DR. 311 differential metabolites were identified between diabetic retinas and non-diabetic retinas under the criteria of variable importance in projection (VIP) > 1 and P < 0.05. These differential metabolites were highly enriched in purine metabolism, amino acid metabolism, glycerophospholipid metabolism, and pantaothenate and CoA biosynthesis. We then evaluated the sensitivity and specificity of purine metabolites as the candidate biomarkers for DR through the area under the receiver-operating characteristic curves (AUC-ROCs). Compared with other purine metabolites, adenosine, guanine, and inosine had higher sensitivity, specificity, and accuracy for DR prediction. In conclusion, this study sheds new light on the metabolic mechanism of DR, which can facilitate clinical diagnosis, therapy, and prognosis of DR in the future.

Stem cells and diabetic retinopathy: From models to treatment.

Diabetic retinopathy is a common yet complex microvascular disease, caused as a complication of diabetes mellitus. Associated with hyperglycemia and subsequent metabolic abnormalities, advanced stages of the disease lead to fibrosis, subsequent visual impairment and blindness. Though clinical postmortems, animal and cell models provide information about the progression and prognosis of diabetic retinopathy, its underlying pathophysiology still needs a better understanding. In addition to it, the loss of pericytes, immature retinal angiogenesis and neuronal apoptosis portray the disease treatment to be challenging. Indulged with cell loss of both vascular and neuronal type cells, novel therapies like cell replacement strategies by various types of stem cells have been sightseen as a possible treatment of the disease. This review provides insight into the pathophysiology of diabetic retinopathy, current models used in modelling the disease, as well as the varied aspects of stem cells in generating three-dimensional retinal models. Further outlook on stem cell therapy and the future directions of stem cell treatment in diabetic retinopathy have also been contemplated.

Diabetic macular ischemia.

Since its relevance on diagnosis and prognosis of diabetic retinopathy (DR), this review will examine a multimodal imaging approach to detect diabetic macular ischemia (DMI). A PubMed engine search was carried out using the term "macular ischemia" paired with "diabetes," and "diabetic macular ischemia" paired to "fluorescein angiography," "ultra-wide field fluorescein angiography," "optical coherence tomography angiography," "octa," "2D octa," "ultra-wide field octa," "3D octa," "visual acuity." All studies published in English up to October 2021 irrespective of their publication status were reviewed, and relevant publications were included in this review. Recently, new technologies have been proposed as an alternative to fluorescein angiography (FA), which is an actual diagnostic gold standard technique. Nowadays, optical coherence tomography angiography (OCTA) has emerged as the most promising and reliable procedure able to provide a qualitative and quantitative description of DMI. Newer three-dimensional (3D) OCTA approach will be discussed too. Moreover, we will discuss how OCTA might identify preclinical alterations before the onset of DR and allow prediction about the progression of disease. OCTA has significantly expanded our knowledge on diabetic macular ischemia.

An Optimized Deep Learning based Technique for Grading and Extraction of Diabetic Retinopathy Severities

The prognosis of Diabetic Retinopathy (DR) requires regular eye examinations, as ophthalmologists depends on fundus segmentation to treat DR pathologies. Automated approaches for detection, segmentation and classification have developed as an imperative area of research for the effective diagnosis of DR for the treatment of serious eye conditions that prevent visual impairment. Diagnosis of various DR lesions, as well as different severities, helping the ophthalmologists to analyze variations in fundus images and take the necessary measures before the disease progresses. Deep learning techniques have evolved as a recent advent to combat the issues of conventional machine leaning based methods. An optimized deep learning framework is proposed in this article for grading and extraction of diabetic retinopathy severities. This involves various steps like background segmentation, feature set extraction, feature optimization using Cuckoo search and Convolutional Neural Network (CNN) severity grade classification. The method was validated on two standard datasets MESSIDOR and IDRiD. The proposed method yields an accuracy value of 97.55%, cross entropy loss of 0.367 and time intricacy of 20 mins and 15 secs for MESSIDOR and 98.02% cross entropy loss of 0.345 and time intricacy of 22 mins and 21 secs for IDRiD dataset; respectively. The state-of-the-art comparison depicts that the proposed CNN based method provides a maximum accuracy improvement of 10.46% comparative to the existing methodology. The proposed framework yields better accuracy by procurement of the investigative outcomes acquired exhibits proficient DR determination.

Evaluation of the prognostic significance of leptin, adiponectin and resistin in the development of diabetic retinopathy in type 2 diabetes mellitus patients

Background. There is evidence of the participation of adipose tissue hormones leptin, adiponectin and resistin in the formation of metabolic disorders in the retina, retinal neovascularization, and diabetic microangiopathy. The development of methods for the mathematical evaluation of the prognosis of diabetic retinopathy (DR) formation with the participation of adipokines is a relevant problem in modern diabetology. Aim. Elaboration of a mathematical model for assessing the prognostic significance of serum leptin, adiponectin and resistin to study the likelihood of developing and progressing DR in patients with type 2 diabetes mellitus (DM). Materials and methods. An open observational single-center one-stage selective study was conducted among patients with type 2 DM and DR. The blood serum concentration of leptin, adiponectin and resistin, HbA1с, lipid metabolism findings were determined, the results of an instrumental examination of the fundus were analyzed. The diagnostic predictive value of serum leptin, adiponectin and resistin was assessed using discriminant analysis. Statistical analyses were conducted using Statistica 9.0 (StatSoft, Tulsa, OK, USA) software. The differences were considered statistically significant at p &lt; 0.05. A model with linear combinations of the serum leptin, adiponectin and resistin, triglyceride (TG), HbA1с, type of antihyperglycemic therapy (oral anti-hyperglycemic medication or insulin therapy) were developed, and, subsequently, formulas for classification-relevant discriminant functions were derived. Results. Fifty-nine patients (107 eyes) with type 2 DM and DR (men and women; mean age, 58.20±0.18 years; mean diabetes duration, 9.19±0.46 years; mean HbA1с 9.10±0.17%) were assigned to the basic group and underwent the study. They were divided into three DR groups based on the stage of DR. When performing the ranking of patients for discriminant analysis, the stage 2 DR group was aggregated with the stage 3 DR group for convenience to form the stage 2 + 3 DR group based on the pathognomonic sign (portents of proliferation or actual proliferation). Anti-diabetic therapy (ADT) included metformin, either alone (type 1 ADT) or in combination with oral anti-hyperglycemic medication (metformin + OAHGM, type 2 ADT) or insulin therapy (metformin + IT, type 3 ADT). Inclusion criteria were informed consent, age above 18 years, presence of T2DM and DR. Exclusion criteria were endocrine or body system disorders leading to obesity (Cushing’s syndrome, hypothyroidism, hypogonadism, polycystic ovarian syndrome, or other endocrine disorders, including hereditary disorders, and hypothalamic obesity), type 1 DM, acute infectious disorders, history of or current cancer, decompensation of comorbidities, mental disorders, treatment with neuroleptics or antidepressants, proteinuria, clinically significant maculopathy, glaucoma or cataract. The study followed the ethical standards stated in the Declaration of Helsinki and was approved by the Local Ethics Committee. The formulas for classification-relevant discriminant functions were derived based on the results of physical examination, imaging and laboratory tests, and subsequent assessment of clinical signs of DM (HbA1с), DR stage and serum leptin, adiponectin, resistin, TG concentrations and taking into account the type of antihyperglycemic therapy. The classification functions (CF) computed based on the variables found from the above developed models provided the basis for predicting the development of DR. The formulas for CF from model are as follows: CF1=0.29•TG + 1.55•HbA1С + 1.81•ADT_Type + 0.04•Leptin + 0,34•Adiponectin + 0,91•Resistin– 13,82. CF2= 0.05•TG + 1.36•HbA1С + 3.01•ADT_Type + 0.08•Leptin + 0,35•Adiponectin + 1,01•Resistin – 15.95. Astep-by-step approach to a diagnostic decision should be used. First, blood samples are tested for serum leptin, adiponectin and resistin, TG, blood HbA1c, and the patient is assigned a code for ADT Type (metformin only, 1; metformin + OAHGM, 2; or metformin + IT, 3). Second, CF1 and CF2 values are calculated based on clinical and laboratory data. Finally, the two values are compared to determine which is greater. The predictive decision is made by selecting the classification function with the greater value. Thus, if CF1 &gt; CF2, the process can be stabilized at this stage given adequate glycemic control (through compensation of carbohydrate metabolism) and body mass control as well as patient compliance. If CF1 &lt; CF2, the pathological process may progress to the next stage or even within stage 3, and there is an urgent need to reduce BMI, and to correct the ADT and the blood lipid profile. Conclusions. The informative value and statistical significance of the model were 71.4% and p=0.040, respectively. Using the formulas, one can determine the probability of progression of DR.

The value of optical coherence tomography angiography in the diagnosis of diabetic retinopathy

Optical coherence tomography angiography (OCTA) base on OCT with an algorithm that can image a high-resolution picture of retinal circulation. OCTA has allowed quantifying the characteristic lesions of diabetic retinopathy (DR) in early stage, such as fovea avascular zone, retinal vascular density and the counts of retinal microaneurysm. In addition, OCTA can objectively evaluate the progression and prognosis of DR in late stage through imaging involved retinal neovascularization. Understanding OCT angiography features of DR lesions with different course of the disease may provide reference value for the diagnosis and treatment of DR. Key words: Diabetic retinopathy/diagnosis; Regional blood flow; Tomography, optical coherence; Review

Association of Glycated Haemoglobin and Serum Apolipoproteins with Diabetic Retinopathy: An Indian Overview.

India is presently facing an epidemic of diabetes mellitus and the risks of chronic complications from the disease are associated with the duration of the disease as well as the degree of hyperglycaemia. Diabetic retinopathy is a known microvascular complication of diabetes mellitus and is the most common cause of blindness in the western countries.Apolipoproteins are the protein component of lipoproteins. Apart from acting as structural proteins, they also act as cofactors to various enzymes. To measure the levels of serum apolipoproteins and glycated haemoglobin in cases of diabetic retinopathy and to assess their association with the stages of diabetic retinopathy. The 135 diabetic cases [with (110) and without (125) retinopathy] attending the Ophthalmology OPD of this tertiary care hospital were included in the present study. Following retinoscopy, the patients were classified as Non-Proliferative Diabetic Retinopathy (NPDR) (n=75) and Proliferative Diabetic Retinopathy (PDR) (n=35). The controls (n=100) were age and sex matched patients who did not have diabetes. The cases and controls were assessed for HbA1c, total cholesterol, triglycerides, HDL cholesterol, Apo A-I and Apo B-100. The HbA1c was found to be higher in diabetics without retinopathy (7.02%) as compared to controls (5.58%) (p<0.05) and the highest value was seen in the mild NPDR group (8.82%). The mean value of Apo A-I was found to be lowest in the diabetics without retinopathy at 88 mg/dl and the highest in severe NPDR at 167 mg/dL. The mean value of Apo B-100 was found to be highest in severe NPDR at 114 mg/dL. The mean value of HDL cholesterol was lowest in moderate NPDR at 36.6 mg/dl. Total cholesterol was highest in severe NPDR at 280.88mg/dl while triglyceride was highest in severe NPDR at 286.4mg/dl. In our study, the level of HbA1c was found to range from 5.58% in non-diabetic to 8.82% in mild NPDR. There was a clear association between Apo B-100 and total cholesterol, triglycerides with the highest value of each parameter seen in the severe NPDR group. There was a discordance noted in the levels of HDL and Apo A-I in various groups. Apo B-100 values may be of value in prognosis of diabetic retinopathy as higher values may result in progression of the disease. Further studies involving Lp(a) and homocysteine may be required in cases of diabetic retinopathy.

Role of matrix metalloproteinase 9 and its tissue inhibitor 1 in development and prognosis of diabetic retinopathy

The article presents the results of investigation of violations in the proteolysis system in patients with type 2 diabetes and diabetic retinopathy (DR). We studied the levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-I (TIMP-1) in the blood and in the intraocularfluid ofpatients with type 2 diabetes depending upon the stage of DR. We have established that the level of MMP-9 and TIMP- in the blood and in the intraocular fluid increased in patients with type 2 diabetes without signs of DR and with any stage of DR compared to the levels of these parameters in patients without diabetes. Increasing the levels of MMP-9 and TIMP-J took place with increasing of DR severity and reached its maximum levels at the proliferative stage of DR. It was found that the levels of MMP-9 in the intraocular fluid and type 2 diabetes duration affected theprobability of developing diabetic macular edema. At the level of MMP-9 105 ng/ml and 2 diabetes duration 10 years, the probability of developing macular edema was 100%. As a result of the construction ofpredictive models it was found that the level of MMP-9 in the intraocular fluid, stage of DR at the beginning of observation and type 2 diabetes duration had influence on the probability of the development ofproliferative DR over 4 years offollow-up. If the level of MMP-9 100 ng/ml, type 2 diabetes duration 10 years and absence of DR at the beginning of observation were observed the probability of developing proliferative DR would compose 85.9%.

The prognosis of diabetic retinopathy in patients with type 2 diabetes since 1996-1998: the Skaraborg Diabetes Register.

Diabetes mellitus is the main reason for visual impairment among patients of working ages. The aim of this paper was to investigate the prognosis of eye complications in patients with diabetes during 10 years of follow-up and contributing risk factors. Data from ophthalmological records (occurrence of retinopathy and laser treatment and visual acuity), and clinical data (blood pressure, glycosylated hemoglobin (HbA1c), body mass index (BMI), and antihypertensive treatment) from the Skaraborg Diabetes Register were retrieved in the Skaraborg Screening Program of 1,258 patients diagnosed during 1996-1998. Kaplan Meyer survival analysis and Log Rank test were used to analyze eye complications in 773 patients with type 2 diabetes and ≤70 years at diagnosis. Visual acuity was above the limit for driving license in 96 % of 548 patients and only nineteen patients were treated by laser. At diagnosis of diabetes, mean HbA1c was 6.7 ± 1.7 % (59 ± 7.1 mmol/mol), and systolic blood pressure was 142.9 ± 0.7 mmHg; neither changed significantly during follow-up. Retinopathy appeared about 1 year, and maculopathy 2 years earlier, if HbA1c ≥ 7 % (63 mmol/mol) at diagnosis (p < 0.001 and p < 0.006). Antihypertensive treatment, higher BMI, and higher age at diagnosis were associated with less retinopathy during follow-up. Most patients with diabetes develop little retinopathy for the first 10 years after diagnosis. High HbA1c at baseline was associated with retinopathy and maculopathy during follow-up. Antihypertensive treatment, probably a proxy for regular controls and early detection of diabetes, was associated with less retinopathy.

Lack of correlation between short-term dynamics of diabetic retinopathy lesions and the arterial blood pressure

Diabetic retinopathy is characterized by morphological lesions in the ocular fundus related to impairment of the retinal blood flow. The morphological lesions display a dynamic pattern of new formation and resorption of lesions, with a turn-over within days to weeks that may reflect basic pathophysiological mechanisms underlying the disease. However, a possible relationship between short-term fluctuations in diabetic retinopathy and risk factors for the long-term prognosis of diabetic retinopathy, such as the arterial blood pressure, has not been investigated. Five patients with moderate non-proliferative diabetic retinopathy were examined by fundus photography and measurement of the blood pressure at 1- to 2-week intervals for up to 1year. The numbers of microaneurysms/haemorrhages and hard exudates in the macular area were counted, and changes in these counts were related to changes in the arterial blood pressure. The five patients discontinued the study after 1-12months, which resulted in between 5 and 39 examinations per patient, and amounted to a total of 101 examinations. There was a significant covariation between microaneurysms/haemorrhages and hard exudates, whereas there was no significant covariation between the number of either type of lesion and the blood pressure. The cause of dynamic changes in diabetic retinopathy lesions occurring over days to weeks may involve other factors than changes in the arterial blood pressure.