Significant Macular Edema Research Articles

Effects of Hydroxychloroquine on Progression of Diabetic Retinopathy in Subjects with Rheumatoid Arthritis and Type 2 Diabetes Mellitus.

The study was conducted to investigate the effects of hydroxychloroquine, an anti-inflammatory drug, which was recently approved and used as an add on oral antidiabetic drug for uncontrolled Type 2 Diabetes Mellitus (DM) on an adequate dose of sulfonylurea and metformin on the progression of diabetic retinopathy (DR) in subjects with Rheumatoid Arthritis and Type 2 Diabetes Mellitus. The primary objective was to evaluate the effect of hydroxychloroquine on the onset of Diabetic Retinopathy (DR) and progression of the disease. Best-corrected visual acuity (BCVA) charts with 3 or more lines worsening of visual acuity and the development of clinically significant macular edema (CSME) were added as secondary objectives as described in the Early Treatment Diabetic Retinopathy Study (ETDRS). This retrospective analysis was done from medical records of all Rheumatoid Arthritis (RA) patients who also had T2DM and were treated with hydroxychloroquine (HCQ) 400 mg OD or 200 mg BID (N=65) and received ophthalmologic care at an endocrinology clinic in India up to a mean follow-up of 3.5±0.5 years and matched subjects taking any other disease-modifying antirheumatic drugs (DMARD) and pioglitazone (N=34). Baseline characteristics were similar in both the groups, with matched glycated haemoglobin (9.1 % and 9.2 % respectively, p=0.127). In both groups, over 3.5 years, HbA1c was reduced significantly. No new cases of DR were detected in the HCQ group, whereas 2 patients had developed DR in the pioglitazone group. At the base line visit, mild non-proliferative Diabetic Retinopathy (NPDR) was present in 18 eyes and 14 eyes in the HCQ and pioglitazone groups, respectively. Progression to moderate NPDR over 3.5 years occurred in 2 out of 18 (11 %) eyes in the HCQ group and 8 out of 14 (57 %) eyes in the pioglitazone group, respectively, representing a significant relative risk reduction (p=.001). No patients had progressed from mild NPDR to severe NPDR in the HCQ group, whereas 2 eyes had progressed from mild NPDR to severe NPDR in the pioglitazone group. None of the patients in either arm developed diabetic macular oedema. Progression of DR from mild to moderate NPDR or severe NPDR may be delayed by HCQ. Large scale randomised prospective clinical trial is required to establish the risk-benefit profiles of HCQ in T2DM.ct.

Telemedicine Screening of the Prevalence of Diabetic Retinopathy Among Type 2 Diabetic Filipinos in the Community

Purpose: To determine the feasibility of telemedicine screening for diabetic retinopathy in a community setting and to determine the prevalence of diabetic retinopathy among Filipino patients with type 2 diabetes in the community. Study Design: Cross-sectional study among patients with type 2 diabetes in six community health centers in an urban city in the Philippines. Materials and methods: Subjects were examined from November 2018 to December 2018. A three-field non-mydriatic 45’ fundus photographs were taken for each patient and photographs were uploaded in cloud storage and read by a retina specialist in a tertiary hospital for assessment of diabetic retinopathy and grading of the fundus photographs. The results were sent back to local health centers. Results: A total of 387 eyes of 195 persons were examined. Overall, 288 out of 387 eyes (95.36%) had gradable quality fundus photo (grade 3 and higher) and did not need eye dilation. Prevalence of diabetic retinopathy among the respondents was 25.26% - 3.16% had mild diabetic retinopathy, 15.79% had moderate diabetic retinopathy, 3.68% had severe diabetic retinopathy, and 3.68% had proliferative diabetic retinopathy. Other fundus findings noted include hypertensive retinopathy glaucomatous optic nerve, age-related macular degeneration, posterior vitreous detachment, clinically significant macular edema, and epiretinal membrane. Conclusion: Due to the significant number of patients with diabetic retinopathy among type 2 diabetics in the community, telemedicine screening was a feasible alternative to dilated fundus examination and may be considered as part of the local health program to prevent blindness due to diabetes.

Effect of Posterior Subtenon Triamcinolone Acetonide in Refractory Diabetic Macular Edema

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME).
 Study Design: Quasi-Experimental Study.
 Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018.Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) >300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient’s best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months.
 Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm after six months. Similar results were observed for IOP and BCVA.
 Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy.

Association of Dyslipidemia with Clinically Significant Macular Edema (CSME) in Type – II Diabetes Mellitus

Aim: To observe the association between dyslipidemia and CSME in Type – II diabetes mellitus. Method: With convenience type of sampling technique 36 patients of diabetic retinopathy (DR) with CSME (Group–I) and another 35 patients of DR without CSME (Group – II) aged > 40 years were selected in Bangabandhu Sheikh Mujib Medical University (BSMMU) for this case control study from March’2013 to March’2014. Diagnosis of DR and CSME were carried out by history, clinical examination, fasting blood glucose (FBG), blood glucose 2 hours after breakfast, HbA1c (glycated hemoglobin), color fundus photograph (CFP) and optical coherence tomography (OCT) of macula as per ETDRS (Early treatment diabetic retinopathy study) criteria. Then fasting lipid profile was measured and compared between the groups. Result: Between two groups age, sex and occupation were matched. Dyslipidemia was present in 32 (88.9%) cases in Group–I and in 18 (51.4%) cases in Group – II, (p =0.001). Mean Total Cholesterol(TC) (211.8 mg/dl), Low Density Lipoprotein(LDL) (141.6 mg/dl) and Triglyceride(TG) (207 mg/dl) in Group – I were significantly higher than mean Total Cholesterol (183.3 mg/dl), Low Density Lipoprotein (118.5 mg/dl) and Triglyceride (143.5 mg/dl) in Group –II (p = < 0.05). But High Density Lipoprotein (HDL) was significantly lower in group- I (35.8 mg/dl) than group -II (41.1 mg/dl). Conclusion: Diabetic retinopathy with CSME has close association with dyslipidemia.

Effect of the COVID-19 Pandemic Lockdown on the Management of Diabetic Retinopathy: A Cross-Sectional Study.

IntroductionWorldwide, diabetic retinopathy (DR) is one of the leading causes of vision loss. Early treatment and screening for DR have a major role in reducing the rate of the disease and the coronavirus disease 2019 (COVID-19) pandemic-related restrictions have altered real-world practice patterns in managing DR.Aims and objectivesTo evaluate the impact of the COVID-19 pandemic on the management of DR amongst patients presenting to a tertiary eye care center in Gujarat, India.MethodsThis is a cross-sectional study comparison of ophthalmic findings of 72 patients who presented to a tertiary care hospital with the manifestation of DR before and after the COVID-19 outbreak and subsequent lockdown. All the patients underwent detailed ophthalmic examinations, including optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).ResultsThe mean age of participants was 54.5 years, with the mean duration of diabetes being five years since first detected. Diabetes was present in 26 patients out of 72. The number of follow-up visits to an ophthalmologist before COVID-19 was at least every one to three months, which significantly decreased after the lockdown of COVID-19. We found a significant progression of DR and clinically significant macular edema (CSME) in patients with diabetes. Before COVID-19, there were two mild non-proliferative diabetic retinopathy (NPDR), seven moderate NPDR, 15 severe NPDR, and 15 very severe NPDR, which were increased post lockdown to three, nine, 27, and 21, respectively. The proliferative diabetic retinopathy (PDR) vitreous hemorrhage (VH) and tractional retinal detachment (TRD) were also increased to 12 after lockdown as compared to only six before the COVID-19 lockdown. The causes for progression are inability to attend regular check-ups, inability to take proper treatment of diabetes and DR, poor control of diabetes, episode of COVID-19, history of high dose of steroid use, poor kidney function, and not knowing that there is a progression of the disease. A common reason for not visiting an ophthalmologist was fear of the unknown due to COVID-19.ConclusionsCOVID-19 has severely impacted the routine follow-up of DR and, in the subsequent years, there might be an increased incidence of severe outcomes due to DR. The second wave of COVID-19 and its lockdown have had very significant effects on the visual outcome of untreated DR patients.

Hybrid threshold laser to treat diabetic macular edema: A retrospective analysis single center cohort study

BackgroundDiabetic patients suffers from reduction of vision that one of its main causes is clinically significant macular edema (CSME).The purpose of this study to determine if hybrid threshold can reduce macular thickness in Diabetic Macular Edema. Materials and methodsThis study is a retrospective analysis single center cohort study. 12 eyes in 10 patients diagnosed with diabetic macular edema using SD-OCT treated with Hybridthreshold laser as the leaking microaneurysms were treated with threshold laser on the 5% duty cycle settings.A complete fundus exam, including best-corrected visual acuity changes, and monthly measuring retinal thickness using SD-OCT for 24 weeks follow up. ResultsReduction of retinal thickness from 336.58 ± 86.26 μm to 264.33 ± 61.41 μm (p = 0.02) at 24 weeks follow up without significant changes of best-corrected visual acuity from 0.16 LogMAR to 0.08 LogMAR (p = 0.2) with minimal scar formation in 24 weeks follow up. Conclusion532 nm Hybridthreshold laser reduces macular thickness up to 20% and stabilizes diabetic macular edema for 24 weeks follow up.

Severe Macular Edema after Traumatic Head Injury: A Case of Whiplash Maculopathy.

Whiplash or "traumatic" maculopathy is associated with retinal concussion, typically following the rapid acceleration/deceleration experienced in motor vehicle collisions. It has rarely been discussed in the literature, likely given the spontaneous and relatively rapid nature with which the acute macular edema resolves. A focused clinical history around the trauma, as well as characteristics signs and structural features on retinal imaging, help to distinguish this condition from other sequelae of concussive retinal injury. We report a case of whiplash maculopathy following a blunt injury to the head, which presented with unilateral and substantial macular edema in the left eye. Case report. A 38 year old male presented with complaint of a central scotoma in his left eye following a blunt trauma to his head. Comprehensive ophthalmological evaluation and retinal imaging with optical coherence tomography (OCT) confirmed whiplash maculopathy, with acute macular edema in his left eye. Management with observation and close follow-up showed rapid improvement in his visual symptoms over the course of days, and improvements in the severity of macular edema. One month following his injury, macular edema had resolved with only mild irregularities, the patient's vision had improved and he was asymptomatic. When observing patients with significant macular edema following concussive head injury, whiplash maculopathy should be considered, regardless of the history of motor vehicle collision. The condition can present with significant asymmetry of disease. The diagnosis generally carries a good prognosis for vision; however, there are cases of persistent central visual disturbances.

Study of association of diabetic retinopathy with dyslipidemia in type II diabetes mellitus

Diabetic retinopathy is the leading cause of visual disability in the working-age population of industrialized countries. It is considered the hallmark of generalized microangiopathy occurring in a diabetic patient.
 The aim: association of Diabetic Retinopathy and CSME with mean values of lipids and Association of the pattern of hard exudates in the fundus in patients with Diabetic retinopathy with or without CSME with mean values of lipids.
 Materials and methods: 320 eyes of 160 urban diabetic patients who were seen at the OPD, at Pushpagiri Eye Institute, Secunderabad having diabetic retinopathy were included in the study. Detailed history was taken to note the duration of diabetes, hypertension, history of CAD, CVA, CKD. Patients with duration of diabetes >=5 years were enrolled. Thorough work up was done with slit lamp and indirect ophthalmoscope and posterior segment was examined to evaluate the stage of diabetic retinopathy and presence or absence of CSME. Patients with DR were investigated for Fasting Lipid Profile and HbA1c.
 Results: a total of 320 eyes of 160 patients were included in the study. In patients with CSME, mean values of Total Cholesterol, Triglycerides, LDL, HDL, VLDL were higher in the plaque pattern of hard exudates in the macula compared to Discrete and Circinate. There was a statistically significant difference between the mean values of total cholesterol (p=0.00), triglycerides (p =0.035), ldl(p=0.00) in discrete and plaque patterns. There was slightly higher prevalence of PDR among hypertensives compared to non-hypertensives. There was no significant association between DR stage and hypertension(p=0.628). The correlation between CSME and BCVA could not be determined accurately due to the presence of cataract in most of the patients.
 Conclusion: this study demonstrated that, diabetic retinopathy is not associated with lipid profile whereas there is statistically significant correlation between mean values of total cholesterol, triglycerides, LDL, VLDL and clinically significant macular edema (CSME)

Macular Thickness Measurement in Diabetic Patients Using Optical Coherence Tomography in Yaounde

85 diabetic patients were included (165 eyes). The mean age was 57.4 ± 9.4 years. The mean central macular thickness was 229.6 ± 53.8 µm. Optical coherence tomography detected a retinal abnormality in 78.2% of the eyes compared with 8.5% on fundoscopy. Abnormalities of macular thickness included perifoveolar thickening, macular thinning, subclinical macular edema and significant macular edema.

Diabetic Macular Edema Among Diabetic Patients at The University of Gondar Tertiary Eye Care and Training Center, North West Ethiopia

Background: Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes mellitus. The prevalence of DME globally is around 6.8 % and in Ethiopia range from 5.7% to 11%. Different factors are associated with DME including poor glycemic control, longer duration, hypertension, dyslipidemia. Objective: To determine the prevalence and associated factors of diabetic macular edema among diabetic patients attending University of Gondar (UOG) hospital, tertiary eye care and training center, NW Ethiopia Methods:A hospital based cross-sectional study was conducted from March 2021 to October 2021. Socio-demographic, clinical and laboratory data of patients was gathered. The collected data was entered into epi-data 4.6 version, exported to SPSS version 20 and analyzed. Results: A total of 165 diabetic patients were enrolled with mean age of 54.71 ±13.66 years, 50.9% male, 85.5% urban dwellers, 79.9% type 2 DM,49.7% on oral hypoglycemic agents and the mean duration of diabetes was 7.93 years. Cataract was the commonest ocular morbidity and 42% of patients had at least mild vision impairment. The overall prevalence of DME was 17% and 5.5% of patients had clinically significant macular edema (CSME). The presence of proteinuria was 8.04 times more likely to have DME. Conclusion: The prevalence of DME among our patients was high. The presence of proteinuria was significantly associated with DME. Screening of diabetic patients for sight threatening retinopathy early and appropriate treatment is recommended.

Prevalence of Undiagnosed Diabetic Retinopathy among Inpatients with Diabetes at a Tertiary Care Hospital in Jammu Region (Jammu and Kashmir), India

Background: One of the most devastating consequences of diabetes is diabetic retinopathy (DR), a condition that poses significant financial and health-care burdens on individuals, health-care systems, and the global economy. This study aims to estimate the prevalence of DR in the inpatient diabetic population in the tertiary care hospital of the Jammu region (Jammu and Kashmir). Methods: This cross-sectional study had men and women over 18 years admitted to Government Medical College, Jammu with type 1 or type 2 diabetes based on a previous physician diagnosis or hemoglobin A1C ≥6.5% (48 mmol/mol) and were eligible to participate. The exclusion criteria included type 1 diabetes diagnosed within the past 5 years. In addition, data on secondary risk factors for retinopathy were collected, such as duration, hemoglobin A1C, and associated comorbidities. Results: Seventy-eight patients with a known diagnosis of diabetes mellitus were included in this study. The majority of the study participants, 56.4% (44/78) were male and were in the age group of 40–60 years. The majority, 57.7% (45/78) participants, were unaware that DR could affect their vision. The prevalence of proliferative DR and clinically significant macular edema was 3.8% (3/78 each). Conclusion: Our study suggests an increased prevalence of DR in the study population, which seems to be a concern.

Nomogram-based prediction of clinically significant macular edema in diabetes mellitus patients.

The aim of the study was to construct and validate a risk nomogram for clinically significant macular edema (CSME) prediction in diabetes mellitus (DM) patients using systemic variables. In this retrospective study, DM inpatients who underwent routine diabetic retinopathy screening were recruited and divided into training and validation sets according to their admission date. Ninety-three demographic and systemic variables were collected. The least absolute shrinkage and selection operator was used to select the predictive variables from the training set. The selected variables were used to construct the CSME prediction nomogram. Internal and external validations were performed. The C-index, calibration curve and decision curve analysis (DCA) were reported. A total of 349 patients were divided into the training set (240, 68.77%) and the validation set (109, 31.23%). The presence of diabetic peripheral neuropathy (DPN) symptoms, uric acid, use of insulin only or not for treatment, insulin dosage, urinary protein grade and disease duration were chosen for the nomogram. The C-index of the prediction nomogram was 0.896, 0.878 and 0.837 in the training set, internal validation and external validation, respectively. The calibration curves of the nomogram showed good agreement between the predicted and actual outcomes. DCA demonstrated that the nomogram was clinically useful. A nomogram with good performance for predicting CSME using systemic variables was developed. It suggested that DPN symptoms and renal function may be crucial risk factors for CSME. Moreover, this nomogram may be a convenient tool for non-ophthalmic specialists to rapidly recognize CSME in patients and to transfer them to ophthalmologists for early diagnosis and treatment.

Efficacy of Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema

Diabetic macular edema (ME) can be treated by intravitreal injection of Triamcinolone acetonide (TA). The scope of the study was to determine its efficacy in our setup in order to develop our local guidelines for its routine use in our setup. Objective: To determine the effect of intravitreal Triamcinolone(TA) for the management of diabetic macular edema(ME) Material and Methods: This descriptive case series carried out at Al-Shifa Trust Eye Hospital, Rawalpindi in 2019. Total 149 patients cases of either gender aged 40-75 years with history of DM of >10 years, VA<6/36 assessed by Snellen VA chart and who had clinically significant ME as assessed by indirect ophthalmoscopy were included in the study. 4mg/0.1 ml of TA was injected through pars plana under local anesthesia. Efficacy was determined at six week post treatment. Results: Treatment was found to be effective in overall 40.9%(n=61) cases, 44.7%(n=38) males, 35.9%(n=23) were females, 35.1%(n=20) were between 41-50 years age, 42.9%(n=30) between 51-60 years, 50%(n=11) had >60 years, 44.5%(n=49) at baseline VA of 6/36 and 30.8%(n=12) with baseline VA of 6/60 showed improvement in VA. Conclusion: Administration of triamcinolone acetonide(TA) intravitreal inj. is an effective modality for the treatment for diabetic macular edoema, and this treatment may lead to an improvement in visual acuity Keywords: Diabetic Retinopathy, Macular Edema(MA), Triamcinolone, Acetonide

Outcomes of 25-gauge pars plana vitrectomy alone with air tamponade for the management of rhegmatogenous retinal detachment with inferior breaks

BackgroundThis study was investigated the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRBs) that were repaired by 25-gauge pars plana vitrectomy (PPV) with air tamponade.MethodsThis retrospective review included 81 consecutive patients who had RRD with IRBs and underwent PPV with air tamponade in our hospital from January 2017 to January 2020. The main outcomes were single surgery anatomical success (SSAS) rate, postoperative best-corrected visual acuity (BCVA), and complications.ResultsThe patient population consisted of 29 women and 52 men (mean age, 52.12 years); the mean follow-up interval was 8.88 months. The mean number of affected quadrants was 1.65 (range, 1–4 quadrants) and the mean number of breaks was 3.25. A single break was present in 20 cases (24.7%); two to 10 breaks were present in 61 (75.3%) cases. The SSAS rate was 91.36% (74/81) and the final anatomical success rate was 96.30% (78/81). More than half of the patients had BCVA < 0.3 logarithm of the minimum angle of resolution at the last follow-up. Axial length and patient age were candidate risk factors for redetachment (axial length, p = 0.03; age, p = 0.002). Postoperative complications included macular epiretinal membrane formation in one patient, lens opacity in three patients, and clinically significant macular edema in one patient.ConclusionsPPV with air tamponade may be effective for the treatment of primary RRD with IRBs. Extensive preoperative discussion may be necessary for young patients and patients with particularly long axial length.

To Evaluate the Prevalence, Risk Factors, and Awareness Associated with Diabetic Retinopathy among Admitted Diabetic Patients at a Tertiary Level Hospital in Bihar

Introduction: Diabetic retinopathy (DR) is an emerging cause of blindness in developing countries. Objectives: The study aims to evaluate the prevalence, risk factors, and awareness associated with DR among admitted diabetic patients. Materials and Methods: A noninterventional case series study was conducted among diabetic patients referred for ophthalmic consultation. The patients’ detailed demographics, awareness of DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment DR Study criteria. Main Outcome Measures: The prevalence, risk factors, and awareness of DR among the study participants were analyzed. Results: A total of 270 diabetic patients were enrolled in the study. The mean age was 62.20 ± 13.24 years. Only one-third (34.4%) of the cases were admitted for sugar control and newly diagnosed cases comprised 19.63%. Dilated fundus evaluation was done for the first time in 44.8%. DR was found in 41.11% of the cases and was diagnosed in 15% of the new cases. More than four-fifths diabetics patients (88%) had the disease for 16-20 years. Clinically significant macular edema was found in 5.19% and proliferative DR in 2.22%. DR was significantly associated with the duration of diabetes (P = 0.001) and concurrent hypertension (P = 0.004). Conclusion: DR is a common problem with diabetics in Bihar. The prevalence of DR was 41% among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for early DR detection.

Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6.

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema after cataract surgery in diabetic patients. 7 ophthalmology clinics in the Netherlands and Belgium. Prospective trial-based cost-effectiveness analysis using data from a European multicenter randomized clinical trial. Diabetic patients (n = 163) undergoing uneventful cataract surgery were randomized to perioperative subconjunctival triamcinolone acetonide (n = 36), perioperative intravitreal bevacizumab (n = 36), combination treatment (n = 45), or no additional treatment (control group, n = 46). The cost analysis was performed from a healthcare perspective within a 12-week postoperative time horizon. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER; cost per QALY). The mean total healthcare costs and QALYs were as follows: triamcinolone group €1827 (U.S. dollars [$] 2295)/0.166; bevacizumab group €2050 ($2575)/0.144; combination group €2027 ($2546)/0.166; and control group €2041 ($2564)/0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was €321 984 ($404 503) per QALY for the combination group compared with that of the triamcinolone group. Assuming the willingness-to-pay as €20 000 ($25 126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient who received triamcinolone developed clinically significant macular edema (CSME). A secondary cost-effectiveness analysis based on this outcome showed a clear preference for triamcinolone. In diabetic patients, subconjunctival triamcinolone was effective in preventing CSME after cataract surgery. The cost-effectiveness analysis showed that triamcinolone is also cost-effective.

RADIATION MACULOPATHY IS ANTICIPATED BY OCT HYPERREFLECTIVE RETINAL FOCI: A Large, Prospective, Confirmation Study.

To investigate, by means of spectral domain optical coherence tomography, retinal reflectivity changes as an early biomarker anticipating radiation-induced macular edema (ME) in patients treated by iodine-125 (I-125) brachytherapy. Thirty patients planned for I-125 brachytherapy because of uveal melanoma were prospectively included and followed every 4 months for five years. Reflectivity alterations, namely hyperreflective retinal foci, were characterized and counted by two independent masked examiners by means of spectral domain optical coherence tomography imaging. Hyperreflective retinal foci were defined as discrete intraretinal reflectivity changes ≤30 µm, with reflectivity similar to nerve fiber layer and without back shadowing. Macular edema occurred in 17 patients (24.2 ±15.1 months) (group 1) after irradiation. Thirteen patients showed no signs of ME at the 5-year follow-up (group 2). The number of hyperreflective retinal foci was statistically higher in sequential visits until the evidence of ME in group 1 vs group 2 (P < 0.0001). In group 1, hyperreflective retinal foci at the follow-up before the evidence of ME were significantly related to the OCT central subfield thickness at ME appearance (P = 0.0002, r2=0.6129). The intergrader agreement was almost perfect (intraclass correlation coefficient = 0.80). Hyperreflective retinal foci may be considered as an early in vivo imaging biomarker of retinal inflammatory response to ocular irradiation, anticipating the development of radiation maculopathy.

Importance of ellipsoid zone line in the treatment of diabetic macular edema.

Introduction: Diabetic macular edema (DME) is a worst manifestation of diabetic retinopathy (DR). Current advanced techniques may reverse DME, usually evaluated by the improvement in visual acuity (VA). In clinical practice VA is not improved even after marked decrease in the macular thickness. Structures abnormalities for example to ellipsoid zone (EZ) may account for post treatment visual outcome.&#x0D; Objectives: To evaluate the relationship between Ellipsoid Zone line (EZ Line) and best corrected visual acuity (BCVA) after treating diabetic macular edema in type II diabetic patients.&#x0D; Methodology: For this prospective and observational study patients of type II diabetes mellitus with clinically significant macular edema (CSME) without proliferative diabetic retinopathy were recruited. The BCVA was recorded by Snellen Acuity Chart and discriminant values of macular thickness and EZ line defect were evaluated using Ocular Coherence Tomography at the time of presentation and during follow-up period. SPSS 22 version was used for results analysis&#x0D; Results: At 6th months follow-up, overall improvement in interruption of EZ line was good but statistically significant (P≤ 0.001) was found in sub class II a. The mean reduction in central sub foveal thickness (CSFT) was found significant (P≤ 0.001) in all class of EZ line but the mean value of BCVA in class I EZ line (70±SD18, P≤ 0.001) was better than class II (45±SD18, P-value = 0.021); and we did not find any correlation between the BCVA and level of interruption of EZ line after progressive decrease in CSFT (r = 0.210, P-value = 0.021).&#x0D; Conclusion: It has been concluded the by the quantitative measurement of retinal layer with OCT we can say that EZ line continuity is closely linked to visual outcome in eyes with macular edema.&#x0D; Keywords: Ellipsoid Zone Line, CME, Integrity of IS OS junction, CSFT&#x0D;

Prevalence and severity of diabetic retinopathy in pregnant women with diabetes-time to individualize photo screening frequency.

AimsTo evaluate the prevalence and severity of diabetic retinopathy including macular oedema in pregnant women with diabetes and to identify women in whom the frequency of retinal screening can be reduced to minimize the burden of health care visits.MethodsA cohort study of 348 women with pre‐existing diabetes were routinely screened with retinal photo in early (12 weeks) and late pregnancy (27 weeks). Diabetic retinopathy was classified in five stages in accordance with National Danish Guidelines based on the eye with the highest retinopathy level. Sight‐threatening retinopathy was defined as the presence of proliferative retinopathy and/or clinically significant macular oedema (CSMO).ResultsRetinopathy was present in 52% (116/223) vs. 14% (17/125), with sight‐threatening retinopathy in 16% (35/223) vs. 6% (7/125) of women with type 1 and type 2, respectively. Women without retinopathy in early and late pregnancy were characterized by shorter diabetes duration (p < 0.0001 and p = 0.008) and predominance of type 2 diabetes. Amongst the 50% (175/348) of the cohort having no retinopathy in early pregnancy and HbA1c<53 mmol/mol (7.0%), none developed sight‐threatening retinopathy and 94% (165/175) remained without any retinopathy during pregnancy. Development of sight‐threatening retinopathy was mainly observed in women with retinopathy in early pregnancy. Treatment for sight‐threatening retinopathy was given to a minority (2.7 and 2.4%, respectively).ConclusionGood glycaemic control and no retinopathy was seen in a large proportion of women in early pregnancy and none of these women developed sight‐threatening retinopathy. The frequency of retinal screening can probably be safely reduced during pregnancy in these women.

Prevalence of and risk factors for diabetic macular edema in a northeastern Chinese population.

To estimate the prevalence of diabetic macular edema (DME) and clinically significant macular edema (CSME), and to assess their risk factors in a population with type 2 diabetic mellitus (T2DM) located in northeast China. Patients were included from the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based study conducted in northeast China. The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of fundus photographs. The age-standardized prevalence of DME and CSME was estimated. The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis. A total of 292 (15.4%) and 166 (8.8%) patients were diagnosed as DME and CSME, yielding the age and sex standardized prevalence of 13.5% (95%CI: 11.9%-15.0%), and 7.1% (95%CI: 5.9%-8.3%), respectively. Female patients had a higher prevalence of DME compared to their male counterparts (15.7% vs 10.4%, P=0.03). Multivariable Logistic regression analysis showed that younger age, insulin use, proteinuria, longer duration of diabetes, and higher glycosylated hemoglobin A1c, were associated with the prevalence of DME and CSME. Patients with higher fasting plasma glucose, systolic blood pressure, and blood urea nitrogen were also found to be associated with DME. Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort, those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.