Significant Macular Edema Research Articles

To evaluate the effect of intravitreal bevacizumab on intraocular pressure

Introduction: To assess intraocular pressure variation after intravitreal bevacizumab injection in patients with diabetic macular edema. Materials and Methods: Our prospective study included 20 eyes of patients who received intravitreal injection of 0.05 ml bevacizumab as treatment option for diabetic macular edema. IOP was recorded before the injection, at 3 days, 1week, 1month and 2 months after the intravitreal injection. Results: The mean intraocular pressure before injection was 17.28±3.04 mmHg. The mean IOP post bevacizumab at 3 days, 1 week, 1month and 2 months were 19.98± 3.23mmHg, 18.99±3.67 mmHg, 17.31±3.19 and 17.15±3.10 respectively. There was statistically significant elevation in IOP at 3 days post bevacizumab injection, which reinstated to baseline levels at final follow-up. Conclusion: Our study indicate that intravitreal injection of bevacizumab is associated with short term IOP elevation. Keywords: Bevacizumab, Clinically significant macular edema, Diabetic macular edema, GAT, IOP.

Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

To describe the retinal imaging characteristics, retinopathy management strategies and visual outcomes in cases of diabetes with chronic myeloid leukaemia. Retrospective observational study. Patients with diabetes and chronic myeloid leukaemia managed at our tertiary eye care centre from January 2015 to December 2017. Detailed ophthalmic and systemic evaluation, treatment and follow-up records were reviewed. The main measures studied were visual acuity, intra-ocular pressure, retinopathy severity, and surgical indications and techniques. Of the six patients studied, three had diabetes and chronic myeloid leukaemia at presentation, while in three cases chronic myeloid leukaemia was diagnosed following evaluation for proliferative retinopathy. The visual acuity ranged from 20/20 to perception of light. All eyes had marked proliferative retinopathy out of proportion to the exudation. None of the eyes had significant macular oedema. Pan-retinal photocoagulation (10/12, 83.33%), intravitreal anti-vascular endothelial growth factor injection (8/12, 66.67%), vitrectomy (2/12, 16.67%), cataract surgery (2/12, 16.67%) and trabeculectomy followed by cryoablation (2/12, 16.67%) was performed for management of the ocular disease as indicated. Median follow-up was 16.5 months (range: 6-24 months). Final visual acuity ranged from PL to 20/20 with acuity ⩾ 20/100 in eight eyes. Four eyes had advanced optic neuropathy from neovascular glaucoma. Accelerated proliferative retinopathy can be seen in cases of diabetes with chronic myeloid leukaemia at the very initial ophthalmic evaluation. Thus, there is a need to alter screening guidelines for retinopathy in cases of diabetes with chronic myeloid leukaemia. Early detection and aggressive management may help preserve visual acuity in such cases.

Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study

Research questionThe current population-based study aimed to investigate the prevalence of diabetic retinopathy (DR) and risk factors among residents over 40 years old in the rural area of Dongguan, southern...

Incidence of Irvine Gass Syndrome after Phacoemulsification with Spectral-Domain Optical Coherence Tomography

ABSTRACTPurpose: Incidence of significant and non-significant macular edema found using spectral-domain optical coherence tomography (SD-OCT) following cataract surgery.Methods: Prospective, cohort series conducted at the Croix Rousse University Hospital. Significant macular edema (SME) was defined as the presence of fluid with an increase of 30% or more in central subfield macular thickness compared to baseline on SD-OCT at 6 weeks and non-significant macula edema (NSME) as an increase of less than 30%.Results: Nine hundred and twenty-eight eyes in 638 patients were included in the study. Incidence of Irvine Gass (IG) syndrome was 9%, 2.3% of patients presented SME, 6.8% NSME. Epiretinal membrane, diabetes, and capsular rupture were significantly associated with a risk of IG. The risk of developing IG in the fellow eye was 23% in cases of IG in the first eye. In total 8.4% of all included patients developed chronic IG (duration of more than 6 months).Conclusion: This study reports the incidence of IG during 6 months of surgical activity at a French university hospital center.

The Relationship Between Macular Cyst Formation and Ischemia in Diabetic Macular Edema

Objectives:To evaluate the relationship between cyst characteristics and macular and peripheral ischemia in diabetic macular edema (DME).Materials and Methods:We retrospectively reviewed eyes with DME and included those with clinically significant macular edema as defined by ETDRS (Early Treatment Diabetic Retinopathy Study) and cystoid spaces in optical coherence tomography scans in this study. Central subfield thickness (CSFT), horizontal and vertical diameters of the largest cyst, cyst area, and the remaining retinal thickness outside the cyst were determined. The presence and number of hyperreflective foci in the cyst wall and the internal reflectivity of the cyst were analyzed. Outer retinal damage was graded. Fluorescein angiography was used to determine the areas of macular and peripheral ischemia, which were graded as mild or severe. Correlations between macular and peripheral ischemia and cyst-related measurements and structural changes in the retina were evaluated.Results:This retrospective study included 250 eyes of 186 patients with DME. Mean CSFT was significantly greater in eyes with macular ischemia (510.4±144.7 μm) compared to eyes without macular ischemia (452.1±114.6 μm) (p=0.001). Horizontal and vertical diameter of the largest cyst increased with the presence and severity of macular ischemia (p=0.045 and p=0.016, respectively). Remaining retinal thickness increased with the presence and severity of peripheral ischemia (p=0.009). There was a statistically significant relationship between the number of the hyperreflective foci in the cyst wall and internal reflectivity of the cyst (p=0.007). Patients with greater CSFT had a 1.04-times higher odds of having macular ischemia and 0.25-times higher odds of having outer retinal damage.Conclusion:The likelihood of macular ischemia increases with larger cyst diameter, CSFT, and extent of outer retinal damage. Thickness of the noncystic area is increased in the presence of peripheral ischemia.

Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis.

Purpose To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.Methods Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. ResultsA total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI ( < 0.001), density of specialists ( = 0.004), subspecialists ( < 0.001), and sampling site ( = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.

Screening eye exams in youth with type 1 diabetes under 18 years of age: Once may be enough?

Case series and registry data suggest that diabetic retinopathy requiring treatment is rare in youth with type 1 diabetes (T1D) prior to 18 years of age. We evaluated this question in the standardized clinical trial setting by retrospectively reviewing diabetic retinopathy examinations from participants in the Diabetes Control and Complications Trial (DCCT) who were 13 to <18 years of age at randomization. Standardized stereoscopic 7-field fundus photographs were obtained every 6 months during DCCT (1983-1993). Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Transitions in diabetic retinopathy status over time were described. A total of 195 participants with median baseline glycated hemoglobin (HbA1c) of 9.3% (103 in the conventional and 92 in the intensive treatment groups) had an average of 5.3 diabetic retinopathy assessments during 2.3 years of follow-up (range 1-11) while under 18 years of age during the DCCT. No participant developed severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy and only one participant (in the intensive group) reached clinically significant macular edema (CSME) while less than 18 years of age. In this incident case, baseline characteristics included diabetes duration 9.3 years, HbA1c 10.3%, LDL 131 mg/dL, and mild non-proliferative diabetic retinopathy (35/35 ETDRS scale); CSME resolved without treatment. Similar analyses using age cut-offs of <19, 20, or 21 years showed a slight rise in diabetic retinopathy requiring treatment over late adolescence. Clinical trial evidence suggests that frequent eye exams may not be universally necessary in youth <18 years of age with T1D.

CORRELATION BETWEEN VISUAL FUNCTIONS AND OPTICAL COHERENCE TOMOGRAPHY, FUNDUS AUTO FLUORESCENCE AND FUNDUS FLUORESCEIN ANGIOGRAPHY FINDINGS IN TREATMENT-NAIVE DIABETIC MACULAR EDEMA

Background: Diabetic macular edema (DME) is a sightthreatening consequence of diabetic retinopathy. So, identifyingreliable methods for DME prognosis is actually very helpful. Multimodal retinal imaging tools provide us with these predictive prognostic biomarkers Aim of the Work: To correlate between visual functions (visual acuity and color vision) with macular features of OCT, FAF and FFA in patients with untreated (treatment naive) DME as a guide for visualprognosis of these patients. Patients and Methods: Fifty eyes of35 diabetic patients with untreated clinically significant macular edema (CSME)underwent best corrected visual acuity (BCVA) determination (logMAR), fluoresce in angiography(FFA;FAZ size, macular leakage pattern, areas of capillary dropout)optical coherence tomography (OCT; central point foveal thickness [CPFT], volume, outer and inner retinal layers integrity[ONL,INL],hyper-reflective foci[HRF], subfoveal choroidal thickness[SFCT]); fundus auto fluorescence (Hyper FAF; absent or increased (FAF, single or multiple spots). Linear correlation and three-way analysis of covariance were used for statistics. Results: In OCT, we found that CPFT & ORL integrity is significantly well correlated to visual function (BCVA, color vision).However, CSFT was only correlated to visual acuity but not color vision. Regarding FFA parameters, especially (FAZ size, areas of capillary drop out), we found that these parameters are correlated significantly to visual acuity but not color vision. On the other hand,we found that the presence of hyper FAF spots was not related significantly to visual acuity but related to a significant level to color vision. However, a number of spots were not correlated to visual acuity or color vision. There was significant correlation between retinal thickness in OCT and type of leakage in FFA. Also, large cystoid spaces and FAF spots in the fovea were significantly correlated together. Conclusions: Integration between different retinal imaging tools in DME helps to find alternative and less invasive way in diagnosis.FAF is new, simple non-invasive imaging mode to assess RPE function with evolving application in DME.

Ocular Risk Factors in the Primary Formation of Diabetic Macular Edema in Patients with Type 2 Diabetes Mellitus

Purpose. Revealing of the ocular risk factors in the formation of diabetic macular edema (ME) in type 2 diabetes mellitus (DM2).Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospect compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p &lt; 0.01). AL was less than 23.5 mm in 66 % of the eyes in the main group and only in 22 % of the eyes in the comparison group (p &lt; 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p &lt; 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % of the eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p &lt; 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume with high degree of probability a high risk of the primary formation of diabetic ME in patients with DM2.

Ranibizumab w leczeniu cukrzycowego obrzęku plamki

Diabetes is an important social problem. Epidemiological studies show a worldwide increase in the incidence of type 1 and 2 diabetes. Increasing duration of diabetes significantly raises the risk of the retinal vascular changes and the development of the macular edema. Ranibizumab in intravitreal injection has revolutionized the treatment of ocular complications of diabetes. It is used as part of the first-line treatment for clinically significant macular edema with occlusion and worsening of visual acuity. Numerous studies have demonstrated greater efficacy of the treatment with ranibizumab (both in monotherapy and in combination with laser therapy) compared to laser therapy, which was the gold standard of therapy

Pro Re Nata Dexamethasone Implant for Treatment-Naive Phakic Eyes with Diabetic Macular Edema: A Prospective Study

To determine the utility and safety of the intravitreal dexamethasone implant as primary therapy (pro re nata [PRN]) in phakic eyes with early treatment-naive diabetic macular edema (DME). Prospective, case series. Patients with diabetes mellitus whose eyes were phakic and had early treatment-naive clinically significant macular edema. Patients whose eyes were phakic with DME (<3 months) were included if the central subfield thickness (CST) was >300 μm and corrected distance visual acuity (CDVA) between 0.3 and 1.0 logarithm of minimum angle of resolution. A comprehensive ocular and systemic examination was performed and the implant injected PRN using a standardized technique. Patients had follow-up at least monthly for 2 years. Descriptive statistics were used to analyze categorical variables in terms of size and proportions. The repeated-measures analysis of variance test was used to determine the change in CDVA, CST, intraocular pressure, and hard exudate area over time. The primary outcome measure was the determination of the change in CDVA at month 24 from baseline. Secondary outcome measures included determining the change in CST, median number of injections, proportion gaining 15 letters, and complications, if any. A total of 153 patients (85 males) were included. At 2 years, mean CDVA improved from 0.62 to 0.4 logarithm of minimum angle of resolution, and median CST improved from 397 to 236 μm. The median number of injections was 1.6. Cataract developed in 3 patients with a clear lens, and 31 patients required topical antiglaucoma therapy. Proliferative disease developed in 4 patients, which was managed with panretinal photocoagulation. None of the study patients required rescue therapy. In patients with treatment-naive phakic eyes who had DME, primary therapy with the intravitreal dexamethasone implant PRN (for 2 years) resulted in significantly improved mean CDVA. A fifth of the patients required control of intraocular pressure, and new-onset cataract developed in 3 of 153 patients.

37-LB: Diabetic Retinopathy (DR) Screening Performance of an Artificial Intelligence (AI) System: Analysis from a Pivotal Multicenter Prospective Clinical Trial

A prospective study (NCT03112005) evaluated DR screening using the EyeArt AI eye screening system against the ETDRS clinical reference standard (CRS). A total of 893 subjects with diabetes were enrolled at 15 U.S. clinical centers and completed 2-field fundus photography for analysis by the EyeArt system and dilated 4-wide field stereo fundus photography for adjudicated expert grading to establish CRS. The EyeArt system provided eye-level results for referable DR (rDR) [moderate non-proliferative DR (NPDR) or higher on the International Clinical DR (ICDR) severity scale or clinically significant diabetic macular edema (CSDME)] and for vision-threatening DR (vtDR) [severe NPDR or higher on the ICDR scale or CSDME]. Out of 1718 eyes with gradable CRS for rDR, 1392 eyes were negative and 326 were positive. Out of 1702 eyes with gradable CRS for vtDR, 1588 were negative and 114 were positive. The EyeArt system was evaluated against CRS for identifying rDR and vtDR under an undilated protocol and a dilate-if-needed protocol (where dilated images were used for subjects with ungradable EyeArt results on undilated images). Results (Table) indicate that the EyeArt AI system compares favorably with the clinical reference standard and meets the predetermined study endpoints for the detection of referable and vision-threatening DR in people with diabetes. Disclosure B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. E. Ipp: Research Support; Self; Eyenuk Inc., Novartis Pharmaceuticals Corporation. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. S.R. Sadda: Consultant; Self; Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Optos. Other Relationship; Self; Nidek. Other Relationship; Spouse/Partner; Topcon. Funding National Institutes of Health (EY027241, EY026864)

1541-P: Association between Urine Free Advanced Glycation End Products (AGEs) at Three Time Points during the DCCT/EDIC and Subsequent Risk of Microvascular Complications in Type 1 Diabetes

Using banked urines from 156 DCCT participants of the former skin biopsy cohort (Diabetes 48:870,1999) we tested whether free AGEs measured at DCCT year 4 (Timepoint TP1), year 8(TP2) and EDIC year 17 (TP3) are associated with risk of microvascular complications progression. Methods: Fructose-lysine(FL), glucosepane(GSPN), carboxymethyl-lysine(CML), methylglyoxal (MG-H1) and 10 other markers were measured by LC/MS/MS. Data were analyzed using correlation coefficients, while associations with risk of complications using Cox proportional hazards (PH) models without adjustment for multiplicity. Results: FL (P&amp;lt;0.005) and GSPN (P&amp;lt;0.004) were significantly lower in the intensive therapy group at TP2. At all 3 TPs, mean A1C correlated with FL (r=0.31) and GSPN (r=0.30) (P&amp;lt;0.0001). In unadjusted Cox PH models, higher GSPN levels were associated with sustained eGFR&amp;lt;60 (P=0.007), cardiac autonomic neuropathy (CAN) (P=0.008) and borderline with confirmed clinical neuropathy (CCN) (P=0.05, NS). FL and CML were associated with sustained microalbuminuria (SA) both before (P≤0.001, 0.012) and after (P≤0.034) adjustment for A1C. Upon adjustment for A1c, age and gender using all 3 TPs, methionine sulfoxide/MetSOX (P=0.001), 3-nitrotyrosine (P=0.003), and FL and G-H1 (P&amp;lt;0.027) were associated with PDR; pentosidine (P=0.041) with clinically significant macular edema; MetSOX (P=0.013) and GSPN (P&amp;lt;0.034) with sustained eGFR&amp;lt;60; FL (P=0.015), CML (P=0.028) and MG-H1 (P=0.042) with SA. LW-1/glucuronidine was associated with CCN both before (P&amp;lt;0.001) and after adjustment for A1C (P&amp;lt;0.001). Chi square statistics were larger than A1c for GSPN with CAN, MetSOX with sustained eGFR&amp;lt;60 and LW-1/glucuronidine for CCN, suggesting stronger associations. Conclusions: FL, GSPN, and CML in urine consistently emerge as the AGEs most significantly associated with risk of subsequent microvascular complications. Disclosure D. Sell: None. J. Lachin: Board Member; Self; Tolerion, Inc. I. Bebu: None. V.M. Monnier: Consultant; Self; Juvenescence Ltd. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK101123)

1540-P: Plasma Advanced Glycation End Products (AGEs) at Three Time Points during the DCCT/EDIC Are Associated with Subsequent Risk of Microvascular Complications in Type 1 Diabetes

We previously showed that skin collagen AGEs at DCCT trial closeout were strongly associated with progression of microvascular disease even after adjustment for A1c (Glyconj. J. 33: 569, 2016). We now tested whether plasma protein AGEs are associated with subsequent progression of retinopathy, nephropathy and neuropathy. Methods: Fourteen AGEs were measured by LC/MS/MS in banked plasmas from 466 DCCT participants at three time points (TPs): DCCT year 4 (TP1), year 8 (TP2) and EDIC year 5/6 (TP3). Data were analyzed using correlation coefficients, while associations with risk of complications used Cox proportional hazards models were determined without adjustment for multiplicity. Results: Fructose-lysine (FL), glucosepane (GSPN) and carboxymethyl-lysine (CML) were lower in the former intensive glycemic control group at both TP1 and TP2 (P&amp;lt;0.0001) but not at TP3. At all 3 TPs, mean A1C was positively correlated with levels of FL (r=0.44), GSPN (r=0.33) and CML (r=0.35). In unadjusted Cox models using all three TPs, higher levels of FL, GSPN and CML were associated with subsequent risk of proliferative diabetic retinopathy (PDR, P&amp;lt;0.0001), clinically significant macular edema (CSME, P&amp;lt;0.0008) and confirmed clinical neuropathy (CCN, P&amp;lt;0.005). After adjustment for mean A1C, all three AGEs (FL, GSPN, CML) remained significantly associated with PDR (P&amp;lt;0.021), FL and GSPN remained significant for CCN (P≤0.005), and CML remained significant for CSME (P=0.033). Methylglyoxal hydroimidazolone (MG-H1) and methionine sulfoxide (MetSOX) were positively associated with sustained eGFR&amp;lt;60 and cardiac autonomic neuropathy before and after adjustment for A1C (P&amp;lt;0.05, P=0.031, respectively). In conclusion, after adjustment for A1C, FL, GSPN, CML and MG-H1 are the plasma AGEs most strongly associated with progression of microvascular complications in type 1 diabetes. Disclosure V.M. Monnier: Consultant; Self; Juvenescence Ltd. D. Sell: None. J. Lachin: Board Member; Self; Tolerion, Inc. I. Bebu: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK101123-01)

599-P: Diabetic Retinopathy (DR) Screening Performance of General Ophthalmologists, Retina Specialists, and Artificial Intelligence (AI): Analysis from a Pivotal Multicenter Prospective Clinical Trial

A prospective study (NCT03112005) evaluated DR screening using the EyeArt AI eye screening system and dilated ophthalmoscopy by board-certified ophthalmologists against the ETDRS clinical reference standard (CRS) of adjudicated expert grading of 4-wide field stereoscopic fundus photographs. A total of 497 subjects with diabetes from 10 U.S. clinical centers underwent undilated 2-field fundus photography for analysis by the EyeArt system, dilated ophthalmoscopy, and dilated 4-wide field stereo fundus photography for the CRS. Performance (Table) of dilated ophthalmoscopy against CRS for identifying referable DR [moderate non-proliferative or higher on the International Clinical Diabetic Retinopathy severity scale or clinically significant macular edema] indicates significant variability across retina specialists and general ophthalmologists. In a previous study, this AI system has been shown to achieve sensitivity 89.0% [95% CI: 87.7-90.2%] and specificity 91.6% [95% CI: 91.0-92.2%] against 7-field ETDRS reference standard. We await the results of the EyeArt system in this multicenter study to verify its ability to provide a more consistent performance for detection of referable DR to facilitate DR screening in primary care and endocrinology clinics. Disclosure E. Ipp: Research Support; Self; Eyenuk Inc., Novartis Pharmaceuticals Corporation. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. S.R. Sadda: Consultant; Self; Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Optos. Other Relationship; Self; Nidek. Other Relationship; Spouse/Partner; Topcon. Funding Eyenuk Inc.

1536-P: Parametric Survival Analysis of Complications from Type 1 Diabetes

Aim: To develop novel models of the risk of fatal and non-fatal complications for individuals with type 1 diabetes (T1D). Models used two 30 years’ follow-up studies: Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) and Epidemiology of Diabetes Complications (EDC). Method: Models were developed for: Microalbuminuria, Macroalbuminuria, End-Stage Renal Disease, Impaired Glomerular Filtration Rate, Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy, Clinically Significant Macular Edema, Ketoacidosis, Hypoglycemia, Ulcers, Diabetic Peripheral Neuropathy, Amputations, Cardiovascular (CVD) Major Adverse Cardiac Event (MACE), CVD non-MACE, Death after CVD MACE, Death after CVD non-MACE, and Death with no history of CVD. Each model considered 44 risk factors, including demographics, time-varying clinical measures, and other T1D complications. Bivariate associations, followed by stepwise regression, were used for variable selection. Interval-censored Weibull and Gompertz survival models were chosen for non-fatal and fatal complications, respectively. Final models combined optimal statistical prediction and expert knowledge for model interpretability. Results: All models included age, gender, diabetes duration, and HbA1C, with HbA1c significantly increasing the risk of most complications. Across all models, the highest predictor of a complication was history of another complication(s). Blood pressure (e.g., systolic, diastolic), pulse rate, and lipid variables (e.g., triglycerides, LDL, HDL, total cholesterol) were significantly predictive of most complications. Cumulative hazard plots comparing predicted and actual hazards indicated good accuracy of prediction for all models. Conclusion: Our risk equations highlight the importance of accounting for the time-varying nature of many risk factors and the impact that history of diabetes complications has on a different complication. Disclosure C. Barbosa: None. N. Mack: None. G. Bobashev: None. G.A. King: None. Y. Liu: None. R. Hilscher: None. S. Neuwahl: None. T.J. Hoerger: Research Support; Self; Sanofi. Funding Centers for Disease Control and Prevention

Validation of a novel diabetic retinopathy utility index using discrete choice experiments

Background/aimsTo validate a preference-based Diabetic Retinopathy Utility Index (DRU-I) using discrete choice experiment (DCE) methods and assess disutilities associated with vision-threatening DR (VTDR: severe non-proliferative DR, proliferative DR and clinically...

Retinal thickness in diabetic macular edema: A study using optical coherence tomography (OCT)

Introduction: Macular edema is the most frequent cause of visual impairment in patients with Nonproliferative Diabetic Retinopathy (NPDR). Clinically they are differentiated as focal and diffuse. Optical coherence tomography (OCT) can measure the retinal thickness and assess the response of surgery. This study was done to evaluate the efficacy of OCT as an investigative tool in diabetic macular edema. Materials and Methods: A prospective study was done among 30 consecutive eyes with Clinically Significant Macular Edema (CSME) over 8 months in our institution and divided into two groups with 15 each as focal and diffuse on the basis of fundus bio-microscopy and fluorescein angiography. Baseline measurements were done by OCT. Patients were followed up after surgery at 4 weeks and 12 weeks with repeat measurements. Data entered in excel sheet and analyzed using SPSS software. Data presented as tables and graphs with Spearman’s correlation and Paired t test. Results: Among 15 eyes with focal macular edema mean age of patients was 59.80 ± 5.13 years whereas among diffuse macular edema, it was 67.80 ± 3.76 years. There was negative correlation between BCVAb and FOVb among both the groups which was significant. (p=0.033, p Conclusion: Optical coherence tomography is a useful modality of investigation in patients with diabetic macular edema. Thus OCT can be used for quantitative assessment in response to surgery. Keywords: Diabetes, Investigative tool, Macular edema, Retinal thickness.

Prophylaxis of Macular Edema with Peroperative Intravitreal Bevacizumab in Patients with Diabetic Retinopathy Undergoing Phacoemulsification

Purpose: To determine frequency of post-operative macular edema in patients with diabetic retinopathy receiving peroperative Intravitreal bevacizumab, as compared to controls after phacoemulsification cataract surgery.&#x0D; Study Design: Randomized control trial.&#x0D; Place and Duration of Study: Ophthalmology department holy family hospital Rawalpindi from July, 2016 to January, 2017.&#x0D; Materials and Methods: 60 patients who reported at the health care facility with diabetic retinopathy were included in the study. Out of these 30 were kept as control and 30 as cases. Data was collected and entered into SPSS version 19.0. Numerical variables were accounted for as mean and standard deviation whereas qualitative variables were accounted for as frequency and percentages. To compare the occurrence of macular edema at completion of 6 weeks in both study groups, Pearson’s chi-square test at 5% level of significance was applied. A p- value of 0.05 was considered as statistically significant. To control effect modifier by gender, and age, stratified analysis was also executed.&#x0D; Results: The participants of the study had mean age of 61.97 ± 5.7 years. Out of the 60 patients 33 (55%) were female. Analysis of both groups showed that macular edema was found in 4 (13.33%) patients in control group and 17 (56.67%) patients in group B. Most significant macular edema was seen in 11 patients in age group of 61-70 years. Gender wise stratification showed that 9 (56.5%) female patients reported with macular edema.&#x0D; Conclusion: Peroperative intravitreal bevacizumab is effective in prophylaxis of macular edema in patients with mild to moderate NPDR, as compared to controls,&#x0D; Keywords: NPDR, Intravitreal bevacizumab, Diabetic Retinopathy, Macular edema, Phacemulsification surgery.

Intraocular Risk Factors in the Primary Formation of Diabetic Macular Edema in Patients with Diabetes Mellitus Type II

Purpose. Revealing of the intraocular risk factors in the diabetic macular edema (ME) formatis in diabetes mellitus type II (DM2). Patients and methods. A 3.5-year research of 80 patients (160 eyes) with DM2 without signs of ME at the beginning of the research was performed. The main group consisted of 46 patients with ME symptoms on one or both eyes during the research period, the comparison group included 34 patients without ME symptoms to the end of the research. The initial ocular characteristics were retrospectively compared in groups.Results. The mean value of the axial lengths (AL) in the eyes of the main group was 23.12 ± 0.75 mm compared to 23.82 ± 0.62 mm in the comparison group (significant difference, p &lt; 0.01). AL was less than 23.5 mm in 66 % eyes in the main group and only in 22 % of the eyes in the comparison group (p &lt; 0.01). The mean value of the initial macular retina volume in the main group was significantly higher than in the comparison group — 7.51 ± 0.22 mm3 and 7.21 ± 0.12 mm3, respectively (p &lt; 0.01). Initial background diabetic retinopathy (DR) was noted in 73 % eyes in the main group, which significantly differed from the comparison group, where this index was noted only in 13 % of the eyes (p &lt; 0.01).Conclusion. Significant ocular risk factors for the formation of ME in patients with DM2 are: the initial macular retina volume more than 7.3 mm3, the value of the AL less than 23.5 mm; the initial background DR. The use of the detected morphometric parameters of eye and retina in combination with an adequate assessment of the risk factors in human organism makes it possible to assume a high risk of the primary formation of diabetic ME in patients with DM2 with high degree of probability.