Stage Of Proliferative Diabetic Retinopathy Research Articles

ANTI-VEGF IN COMPLICATIONS OF PROLIFERATIVE DIABETIC RETHINOPATHY

This paper has the purpose to analyse the relevance of the use of angiogenesis inhibitors (anti-VEGF drugs) in the treatment of the proliferative stage of diabetic retinopathy. The literature review was carried out using the search engines PubMed, the Library, and the analysis of literature sources, 30 in number, published from 2000 to 2024. In patients with complicated cases of proliferative diabetic retinopathy, pre-intravitreal injection of angiogenesis inhibitors provides the most gentle approach to surgical treatment, which improves the anatomical and functional results of vitreoretinal surgery and helps reduce the number of intra- and postoperative complications.

Correlation of Central Corneal Thickness and Keratometry Findings With the Severity of Diabetic Retinopathy and Glycosylated Hemoglobin (HbA1c) Levels in Type II Diabetes Mellitus Patients.

Diabetes today is a global health issue, posing a risk to several organ systems. Besides complications like cataracts, diabetic retinopathy (DR), glaucoma and refractive errors, anatomical parameters like central corneal thickness (CCT), which is a crucial indicator of corneal endothelium function and keratometry parameters, have also been noticed to be altered in diabetes. Variations in these parameters may affect the accuracy of applanation tonometry in measuring intraocular pressure. This study aims to investigate variations in CCT and keratometry across different stages of DR, as prior research has yielded inconsistent results. The study also intends to explore the relationship between glycosylated hemoglobin (HbA1C) levels and changes in keratometry and CCT. This observational cross-sectional study was conducted from July 2022 to June 2024. A total of 204 subjects, aged 35-70 years, were included in the study. All participants were evaluated for DR, and those showing fundus findings were graded into five classes based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. CCT, keratometry parameters (K1 and K2) and HbA1C levels were measured for all participants. The clinical parameters were correlated across different grades of diabetes mellitus and compared using StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBMCorp., Version 23.0, Armonk,NY) software. The patient population consisted of 130 males (63.7%) and 74 females (36.3%). It was found that there was a trend indicating that the presence of DR increased with age, which was statistically significant (p=0.036). However, the differences in the mean duration of diabetes across DR groups were not statistically significant. Findings suggested that individuals with DR generally possess a higher CCT compared to the control group, particularly in the earlier stages of the disease, i.e. noDRand mild non-proliferative diabetic retinopathy (NPDR). However, as the severity of DR increases, the CCT tends to decrease slightly in moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR) stages. The study notes that the variations in CCT across these groups were not statistically significant (p-value of 0.29). The study also found that changes in corneal curvature, as indicated by keratometry values, were more pronounced in the proliferative stage of DR, with a statistically significant increase in k2 values of the left eye (p-value = 0.025). The study concluded that there was no statistically significant relationship between CCT and keratometry values of both eyes with HbA1c levels. While there were some clear patterns, especially concerning age, most variations in ocular parameters were not statistically significant, suggesting that other factors might need an in-depth study in the development of DR and its correlation with ocular parameters. Similarly, while HbA1c has often been stated to be a prognostic factor in diabetes mellitus, significant correlations were neither noted with ocular parameters like CCT and keratometry, nor the stage of retinopathy.

Classification Features of Severe Stages of Proliferative Diabetic Retinopathy (Clinical Cases)

Purpose: analysis of clinical cases illustrating the classification features of severe stages of proliferative diabetic retinopathy (PDR).Patient and methods. Three clinical cases of PDR are presented, in which ophthalmoscopic signs (according to the classification of the Early Treatment Diabetic Retinopathy Study, 1991) corresponded to severe PDR (high risk 1, high risk 2) and advanced PDR. The ophthalmological status was assessed using standard methods based on measuring the best corrected distance visual acuity, performing ultrasound (Opticon 2000, Italy), photographic recording of the condition of the fundus (Carl Zeiss Visucam 500, Germany) and optical coherence tomography of the macular region (on an RTVue-100 tomograph, OptoVue, USA).Results and conclusion. The presented clinical examples will provide the ophthalmologist with a more complete understanding of the clinical picture of pathological changes in the retina in diabetes mellitus, which will ultimately increase the level of diagnosis and tactics of surgical intervention both during the initial (preoperative) examination and after vitrectomy.

New Approaches to Surgical Treatment of Patients with Advanced Stage of Proliferative Diabetic Retinopathy

Purpose. Development and evaluation of the clinical effectiveness and safety of a vitrectomy (VE) technique for patients with advanced stage proliferative diabetic retinopathy (ASPDR).Materials and methods. We observed 132 patients (mean age 62.8 ± 2.4 years) with the following criteria for inclusion in the study, corresponding to the classification criteria of ASPDR: it is impossible to estimate the area of neovascularization; the fundus of the eye is partially ophthalmoscoped or not ophthalmoscoped in the posterior pole; preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs; retinoschisis in the macular zone. All patients were divided into the following two groups, equal in age, gender and visual status of the “healthy” eye: the main group (MG, 69 patients, 69 eyes), who underwent VE was performed according to the developed method and a control group (CG, 63 patients, 63 eyes), in which VE was performed according to the traditional method.Results. The incidence of intraoperative complications in patients in the MG (5.8 %) was 8.1 % (p < 0.05) lower than in the CG (13.9 %). The incidence of postoperative complications in patients from the MG (5.5 ± 0.5 %) was 4.2 % (p < 0.01) lower than in the CG (9.7 ± 1.0 %). The increase in best-corrected visual acuity after surgery in patients from the MG was significantly (by 0.13 rel. units, p < 0.001) higher than in the CG. The value of the average decrease in the developed qualitative criteria for the condition of the fundus in patients in the MG (1.6 ± 0.1) was 23.1 % (p < 0.05), higher than in the CG (1.3 ± 0.1).Conclusion. Surgical treatment of patients with ASPDR using the developed technique provides (compared to the traditional approach) a higher level of safety and clinical effectiveness. The main advantage of the developed technique is an integrated approach to surgical intervention, including the improvement of ophthalmological “techniques” (use of one-stage combined surgery, endolaser coagulation technology, etc.) and drug support (administration of ranibizumab at a dose of 0.05 mg 3–5 days before surgery) and the choice of intravenous sedation as the optimal anesthetic aid.

Quality of life of patients with an advanced stage of proliferative diabetic retinopathy after application of various vitrectomy technologies

Purpose: A comparative assessment of quality of life (QL) after the use of various vitrectomy (VE) technologies in patients with an advanced stage of proliferative diabetic retinopathy (ASPDR).Material and methods. We examined 132 patients aged 42 to 76 (average age 62.8 ± 2.4 years) who met the classification criteria of ASPDR: impossibility to estimate the area of neovascularization; the fundus of the eye in the posterior pole cannot be seen or can only partialy be seen using an ophthalmoscope; evidence of preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs and retinoschisis in the macular zone. All patients were divided into two groups, comparable in age, gender and visual status of the “healthy” eye: the main group (69 eyes), in which VE was performed according to the technique developed by the authors, and the control (63 eyes), in which the traditional VE technique was used. QL was assessed before surgery and 3 months after it using the VFQ-25 and QL-20 questionnaires.Results. QL was found to be higher when the new surgery technique was used: the data of VFA-25 showed a 12.9% increase (p < 0.05) and QL-20 showed a 29.2% increase (p < 0.01), which points to a higher clinical effectiveness of the newly developed surgical treatment technique than that of the traditional technique.Conclusion. The results obtained are related to the ophthalmological features of the developed surgical treatment of ASPDR: combined (phacoemulsification of cataracts + IOL + vitrectomy) one-stage intervention, lack of drainage of subretinal fluid, etc.), medication support (preliminary intravitreal administration of an angiogenesis inhibitor) and anesthesia (intervention under local anesthesia with intravenous sedation). The differences are most effectively identified using the special QL-20 questionnaire.

Evaluation of Hypoxia and Microcirculation Factors in the Progression of Diabetic Retinopathy.

The purpose of this study was to evaluate comparatively the changes in HIF-1ɑ, EPO, sICAM-1, hemodynamic, and electrophysiological parameters during the progression of non-proliferative diabetic retinopathy (NPDR). This retrospective longitudinal study included 82 patients with NPDR, who were divided into 2 groups: group I (n=40) consisted of patients without progression of NPDR after 1 year and group II (n=42) included patients with the transition of NPDR to proliferative diabetic retinopathy (PDR). The hemodynamics of the eye was assessed by Doppler ultrasonography. The glial hypoxia index Cg was calculated using ERG. The serum levels of hypoxia-inducible factor 1-a (HIF1-α), soluble intercellular adhesion molecule-1 (sICAM-1), and erythropoietin (EPO) were determined by ELISA method. In group II, resistive index (RI), short posterior ciliary arteries (SPCAs) increased significantly from 0.62 ± 0.005 to 0.65 ± 0.007 (P=0.003), being higher than the corresponding parameter in group I (P=0.013). In group II, there was an increase in the hypoxia index Cg (5.56 ± 0.05) relative to the primary indicators and in group I (P<0.001). In group II, HIF1-ɑ, EPO, and sICAM-1 levels after a year significantly increased (0.213 ± 0.02 ng/mL, 37.7 ± 2.4mIU/mL, and 576.3 ± 11.9 ng/mL, respectively) both relative to the main indicators and the values in group I (P<0.001). When EPO exceeds 27.5mIU/mL, a high risk of progression of NPDR to the initial stages of PDR is predicted. The glial Cg index and the level of HIF1-a, EPO in the serum of patients with progression of NPDR were initially higher than in patients without progression of NPDR and have increased during the year, indicating the development of PDR due to more severe hypoxia.

Deep learning for automated detection of neovascular leakage on ultra-widefield fluorescein angiography in diabetic retinopathy

Diabetic retinopathy is a leading cause of blindness in working-age adults worldwide. Neovascular leakage on fluorescein angiography indicates progression to the proliferative stage of diabetic retinopathy, which is an important distinction that requires timely ophthalmic intervention with laser or intravitreal injection treatment to reduce the risk of severe, permanent vision loss. In this study, we developed a deep learning algorithm to detect neovascular leakage on ultra-widefield fluorescein angiography images obtained from patients with diabetic retinopathy. The algorithm, an ensemble of three convolutional neural networks, was able to accurately classify neovascular leakage and distinguish this disease marker from other angiographic disease features. With additional real-world validation and testing, our algorithm could facilitate identification of neovascular leakage in the clinical setting, allowing timely intervention to reduce the burden of blinding diabetic eye disease.

Влияние степени адгезии внутренней пограничной мембраны на результаты хирургии тракционного диабетического макулярного отека

Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy

Глюкозні транспортери сімейства GLUT у патогенезі проліферативної діабетичної ретинопатії пацієнтів із цукровим діабетом 2-го типу

The supply of glucose to neurons of the brain and retina is carried out by a specific, facilitated transport with the participation of sodium-independent glucose transporters of the GLUT family. Studying the mechanisms of glucose transport with pharmacological or genetic inhibition of transporters is considered as a promising way to reduce glucose-toxic damage to the retina to prevent diabetic retinopathy. We studied the content of GLUT1, GLUT3, GLUT4 and Hypoxia inducible factor 1 alpha (HIF-1α) in the plasma of patients with different stages of proliferative diabetic retinopathy (PDR), duration of type 2 diabetes (T2D) was up to 20 and over 20 years, and control group. Research on the level of transporters in the blood plasma was carried out by the method of immuno-enzymatic analysis using Elabscience kits (USA). No significant difference in the GLUT1 and GLUT4 blood plasma content was found between patients with PDR and control individuals, and the GLUT3 content was 2-fold higher. Also, the content of HIF-1α was 25% higher. No significant fluctuations in the content of transporters GLUT1, GLUT3, GLUT4, HIF-1α were found depending on the duration of T2DM, the degree of deepening of PDR and the level of hyperglycemia. Correlation analysis revealed a significant two-way correlation of the GLUT3 index with blood glucose level (r = 0.581), HbA1C (r = 0.553), GLUT1 (r = 0.440) and GLUT4 (r = 0.372). The conservatism of GLUT1 transporter content in the studied groups gives a reason to consider protein expression as genetically determined for the basic maintenance of homeostasis. The GLUT3 content increase in patients with PDR, which does not depend on the retinal damage degree, duration of T2D and glucose concentration, defines this mechanism of transport as the main pathogenetic link of glucose toxicity in neurons against the background of chronic hyperglycemia. Insulin-dependent transporter GLUT4 is probably not involved in the occurrence of PDR under of T2D.

Results of monitoring diabetic retinopathy in patients after simultaneous pancreas and kidney transplantation

BACKGROUND: Very few studies have focused on the state of the fundus and visual functions before and after simultaneous transplantation of the pancreas and kidney. In addition, the results and conclusions of authors on this topic are contradictory. AIMS: To evaluate the ophthalmological status of patients with diabetic retinopathy before and after kidney and pancreas transplantation. MATERIALS AND METHODS: The patients were divided into three groups: group 1 included patients on the transplant waiting list receiving hemodialysis, group 2 were kidney transplant recipients, and group 3 included patients who had undergone simultaneous pancreas and kidney transplantation. The ophthalmological status of patients was assessed through standard ophthalmic diagnostic methods and measurements of photosensitivity, central retinal thickness, choroid thickness, density perfusion of the superficial and deep retinal capillary plexus, choriocapillary layer, and deep choroidal layer in the foveal and parafoveal zones of the macular region. RESULTS: The study involved 76 patients (152 eyes) (group 1, n=30 patients undergoing dialysis; group 2, n=24 kidney transplant recipients; group 3, n=22 kidney and pancreaticoduodenal post-transplant recipients). Signs of the active phase of the proliferative stage of diabetic retinopathy (group 1, 54.1%; group 2, 53.3%; and group 3, 25.9%, p 0.05) and diabetic macular edema (group 1, 26.4%; group 2, 31.8%; and group 3, 12.8%, p 0.05) were more common in groups 1 and 2 than in group 3. Moreover, group 3 needed laser therapy (group 1, 45.3%; group 2, 43.2%; and group 3, 20.5%, p 0.05) and antiangiogenic therapy to a lesser extent (group 1, 18.9%; group 2, 25.0%; and group 3, 5.1%, p 0.05) than patients undergoing dialysis and kidney recipients. The eyes of patients after simultaneous pancreas and kidney transplantation were characterized by the smallest retinal thickness, highest retinal and choroidal perfusion, and highest visual acuity and photosensitivity (p 0.05). CONCLUSIONS: A surgical method for restoring euglycemia through transplantation of physiologically active pancreatic tissue favorably affects the morphological and histological state of the retina and retinal and choroidal hemoperfusion and reduces the frequency of the active phase of proliferative diabetic retinopathy and diabetic macular edema.

Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy.

Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy.

State of the Retina and Visual Functions before and after Pancreatic Transplantation (Clinical Case)

In this report, we reflected a clinical case of the course of the proliferative stage of diabetic retinopathy in a patient suffering from type 1 diabetes mellitus (DM) and end-stage diabetic nephropathy (DN) before and after simultaneous pancreas and kidney transplantation. As a result of successful surgical treatment of DM and DN was achieved physiological normoglycemia (change in fasting blood glucose from 11 to 5.1 mmol/l, glycated hemoglobin level from 9.2 to 5.7 %) and relief of uremic syndrome (change in serum creatinine from 632 to 77,5 µmol/l, urea from 13 to 6 mmol/l, glomerular filtration rate from 7.1 to 83.5 ml/min/1.73 m2). By the end of the first year of the post-transplantation period according to ophthalmoscopy data on the fundus no regression of the initial and addition of new diabetic changes was recorded and according to special instrumental methods of research was recorded a partial improvement hemoperfusion in superficial (an increase in the whole perfusion density: OD — from 24 to 35 %; OS — from 23 to 33 %) and deep (increase in the whole perfusion density: OD — from 5 to 13 %; OS — from 4 to 6 %) capillary plexus, a decrease in the central thickness of the retina (OD — from 269 to 257 µm; OS — from 271 to 253 µm) with resorption of intraretinal fluid in the right eye, improvement of the visual acuity (OD — from 0.5 to 0.7; OS — 0.6 to 0.7) and light sensitivity (macula light sensitivity threshold: OD — from 16.5 to 21.8 dB; OS — from 22.1 to 25.4 dB) of both eyes.

Роль блокады ангиогенеза у пациентов с диабетической ретинопатией

Relevance. The proliferative stage of diabetic retinopathy is characterized by angiogenesis, which is largely mediated by the vascular endothelial growth factor. Peripheral retinal laser coagulation has been standard treatment for PDR for many years, providing control of ischemia and reduction of vascular endothelial growth factor levels with subsequent regression of neovascularization. However, it leads to serious functional deficits and anatomical complications. The advent of antivascular endothelial growth factor (anti-VEGF) agents has changed the future of PDR management and has provided an alternative to pan retinal photocoagulation. Their combination with panretinal photocoagulation may be effective for the treatment of proliferative diabetic retinopathy and concurrent diabetic macular edema. Anti-VEGF therapy also takes place in surgery of complicated PDR. Purpose. To analyze the relevance of the use of anti-VEGF drugs in the treatment of the proliferative stage of diabetic retinopathy. Material and methods. The literature review is written using PubMed, Сochrane Library, 29 literature references published up to 2021. Results. In patients with severe cases, preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Conclusion. Preoperative treatment is a gentle approach for the anatomic structures of the eye, it also contributes to the reduction in the number of intraoperative and postoperative complications. Key words: anti-VEGF, diabetic macular edema, proliferative diabetic retinopathy.

Proteome Changes Associated with the VEGFR Pathway and Immune System in Diabetic Macular Edema Patients at Different Diabetic Retinopathy Stages

Purpose Diabetic macular edema (DME) is a major cause of vision loss in all stages of diabetic retinopathy (DR). However, there is limited recognition of aqueous humor (AH) proteome profiles of DME patients at different DR stages. In this study, we aimed to investigate the AH proteome changes between DME patients at the nonproliferative diabetic retinopathy (NPDR) stage and those at the proliferative diabetic retinopathy (PDR) stage. Methods A label-free data-independent acquisition based liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis was performed to profile the abundances of AH proteins in 73 eyes from DME patients at different DR stages. Enzyme-linked immunosorbent assay (ELISA) was used to confirm the proteomics results with AH samples from non-diabetic patients and DME patients at the NPDR or PDR stage. Results LC-MS/MS results showed significantly changed expression of 308 proteins between DME patients in the NPDR and PDR groups. Compared to the NPDR group, the proteins relatively up-regulated in the PDR group are involved in the immune system and/or negative regulation of the cell cycle, while proteins relatively down-regulated in the PDR group are associated with the vascular endothelial growth factor receptor (VEGFR) pathway and/or metabolism. ELISA results further verified the proteomic result of down-regulated expression of the immune-associated protein cystatin C (CST3) in the PDR group compared to that in the NPDR and non-diabetic groups. Conclusions In this study, we reported for the first time the decreased abundances of AH proteins associated with the VEGFR pathway and both down- and up-regulated expression of AH proteins associated with the immune system in the PDR group compared to that in the NPDR group. Furthermore, we found negative correlations of immune-associated protein, CST3 concentration in AH with DR severity and central retinal thickness, suggesting CST3 as a promising target independent of the VEGFR pathway in DME-involved DR treatment.

Морфометричні та біохімічні кластери метаболічного синдрому у пацієнтів із цукровим діабетом 2-го типу на різних стадіях діабетичної ретинопатії

Мета дослідження: вивчити морфометричні і біохімічні кластери метаболічного синдрому (МС) у пацієнтів з цукровим діабетом (ЦД) 2-го типу на різних стадіях діабетичної ретинопатії (ДН). Матеріали і методи. Дослідження проведені у 83 пацієнтів (166 очей), розділених на дві групи. Результати. При дослідженні морфометричних і біохімічних кластерів МС у 59 пацієнтів з ЦД 2-го типу (середній вік — 58,20 ± 0,99 року, середня тривалість ЦД — 9,19 ± 0,16 року) на різних стадіях ДР за допомогою дисперсійного аналізу і закону біноміального розподілу показано, що ДР формується на тлі ожиріння у 83,4 % хворих (зі збільшенням окружності талії), артеріальної гіпертензії (АГ) — у 71,4 % хворих, гіперхолестеринемії — у 61,9 %, дисліпідемії — у 47,6 % хворих і гіпертригліцеридемії — у 52,3 %. Подальше прогресування ДР статистично значимо асоціюється з АГ, дисліпідемією на тлі андроїдного ожиріння, гіперхолестеринемії і гіпертригліцеридемії. Висновки. Пацієнти з ЦД 2-го типу на проліферативній стадії ДР перебувають у групі підвищеного ризику виникнення судинних подій, у тому числі і на очному дні, що необхідно враховувати при хірургічному, фізіотерапевтичному і медикаментозному лікуванні.

Рівень глікемії та інсулінорезистентності у хворих на цукровий діабет 2-го типу, діабетичну ретинопатію та ожиріння

Актуальність. Діабетична ретинопатія (ДР) є провідною причиною втрати зору у всьому світі. Мета дослідження: вивчити рівень глікемії та інсулінорезистентності у хворих на ДР на тлі цукрового діабету 2-го типу (СД2) і ожиріння. Матеріали та методи. Дослідження проведені в 137 пацієнтів (234 ока), розподілених на дві групи. Результати. Подано результати дослідження за допомогою двофакторного дисперсійного аналізу ступеня інсулінорезистентності як головного кластера метаболічного синдрому на різних стадіях ДР, а також показників вуглеводного обміну як одного з провідних чинників ризику прогресування ретинопатії при СД2 з урахуванням обтяжливих факторів перебігу СД2 (вік хворих, тривалість діабету, ступінь його компенсації) і виду цукрознижувальної терапії. Показано, що всі пацієнти з ДР, незалежно від досліджуваної групи, перебувають у стані хронічної гіперглікемії при декомпенсації СД2. Висновки. Показники вуглеводного обміну розпочинають поліпшуватися тільки в проліферативній стадії ДР, однак це трапляється на тлі тяжких гіпоглікемій. У проліферативній стадії ДР перебуває найбільша кількість хворих із несприятливими індексами інсулінорезистентності за індексом HOMA-IR і зниженою чутливістю до інсуліну за індексом QUICKI.

Оценка технических особенностей выполнения витреоретинальной хирургии при пролиферативной диабетической ретинопатии у пациентов молодого возраста

Aim. To investigate the technical difficulties of performing the stages of vitreoretinal surgery, the peculiarities of the surgical technique in young patients with the proliferative stage of diabetic retinopathy (DR). Methods. Twelve patients (12 eyes) with type 1 diabetes mellitus (DM) were selected. Their average age was 26±2 years (from 19 to 30 years). There were 4 men and 8 women. All patients had DM since childhood. Selection criteria: presence of indications for vitreoretinal surgery for proliferative DR, age of patients with type 1 DM not more than 30 years, onset of DM in childhood. Results. Initially, the clinical manifestations of proliferative DR in young people with type 1 DM were distinguished by the severity of neovascular and fibrous growths, a tendency to hemorrhages, and the complexity of preoperative preparation in the form of panretinal laser coagulation, at least partial. Surgical removal of vitreoretinal adhesions and elimination of neovascularization zones differed in technical difficulties associated with their higher density and the area of retinal tissue lesion. Conclusion. Surgical treatment of proliferative DR in young patients has a number of technical difficulties associated with the density and length of fibrovascular vitreoretinal growths, the difficulty of separating them due to the high tendency of newly formed vessels to hemorrhages. Key words: proliferative diabetic retinopathy; endovitreal surgery; type 1 diabetes mellitus; young age.

Design of Density Clustering In Diabetic Retinopathy Based Eye Fundus Segmentation

In order to prevent further complications, we learned in this paper that earlier diagnosis is critical in Diabetic Retinopathy (DR). The disease can be classified into one of two stages (the early stage of non-proliferative and later stage of proliferative diabetic retinopathy) of Eye Fundus Images (EFI), diagnosed on the basis of the presence and quantities of a complex series of lesions such as microaneurysms, haemorrhages or exudates. Therefore it is important to properly segment regions of potential lesions to demonstrate and classify the lesions and the degree of DR. Density clustering approaches are promising candidates for the isolation of individual lesions, and can be used along with effective methods for vascular tree elimination, extraction and classification. In this article, our approach, findings, tradeoffs and assumptions for segmenting and detecting individual lesions are reported.

Upregulation of long non-coding RNA SNHG16 promotes diabetes-related RMEC dysfunction via activating NF-κB and PI3K/AKT pathways

Diabetic retinopathy (DR) is a severe diabetes-induced eye disease, in which its pathological phenomena basically include abnormal proliferation, migration, and angiogenesis of microvascular endothelial cells in the retina. Long non-coding RNAs (lncRNAs) have been proven to be important regulators in various biological processes, but their participation in DR remains largely undiscovered. In the present study, we aimed to unveil the role of lncRNA small nucleolar RNA host gene 16 (SNHG16) in regulating the functions of human retinal microvascular endothelial cells (hRMECs) under a high-glucose (HG) condition. We found that SNHG16 expression was significantly upregulated in hRMECs treated with HG. Functionally, SNHG16 could facilitate hRMEC proliferation, migration, and angiogenesis. Moreover, SNHG16 was associated with nuclear factor κB (NF-κB) and phosphatidylinositol 3-kinase (PI3K)/AKT pathways. Mechanistically, SNHG16 could promote hRMEC dysfunction by sequestering microRNA (miR)-146a-5p and miR-7-5p to act as a competing endogenous RNA (ceRNA) with interleukin-1 receptor-associated kinase 1 (IRAK1) and insulin receptor substrate 1 (IRS1). In conclusion, our results illustrated the potential role of SNHG16 in facilitating hRMEC dysfunction under HG treatment, providing a novel approach for DR therapy.

Blood vessel segmentation in retinal fundus images for proliferative diabetic retinopathy screening using deep learning

Diabetic retinopathy (DR) is also called diabetic eye disease, which causes damage to the retina due to diabetes mellitus and that leads to blindness when the disease reaches an extreme stage. The medical tests take a lot of procedure, time, and money to test for the proliferative stage of diabetic retinopathy (PDR). Hence to resolve this problem, this model is proposed to detect and identify the proliferative stages of diabetic retinopathy which is also identified by its hallmark feature that is neovascularization. In the proposed system, the paper aims to correctly identify the presence of neovascularization using color fundus images. The presence of neovascularization in an eye is an indication that the eye is affected with proliferative PDR. Neovascularization is the development of new abnormal blood vessels in the retina. Since the occurrence of neovascularization may lead to partial or complete vision loss, timely and accurate prediction is important. The aim of the paper is to propose a method to detect the presence of neovascularization which involves image processing methods such as resizing, green channel filtering, Gaussian filter, and morphology techniques such as erosion and dilation. For classification, the different layers of CNN have been used and modeled together in a VGG-16 net architecture. The model was trained and tested on 2200 images all together from the Kaggle database. The proposed model was tested using DRIVE and STARE data sets, and the accuracy, specificity, sensitivity, precision, F1 score achieved are 0.96, 0.99, 0.95, 0.99, and 0.97, respectively, on DRIVE and 0.95, 0.99, 0.9375, 0.96, and 0.95, respectively, on STARE.