Surgery For Diabetic Retinopathy Research Articles

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross- Sectional Survey [Response to Letter

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross- Sectional Survey [Response to Letter

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey.

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD. Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines. In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD. DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey [Letter

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey [Letter

Vitrectomy for diabetic retinopathy: A review of indications, techniques, outcomes, and complications

Abstract Diabetic retinopathy is one of the most severe forms of retinopathy and a leading cause of blindness all over the world. Of a greater concern is proliferative diabetic retinopathy which leads to vitreous haemorrhage and tractional retinal detachment in such cases. A majority of these cases require a surgical intervention to improve vision and prevent further vision loss. Surgical manouevers in these cases require a complex combination of vitrectomy, membrane dissection, judious usage of endodiathermy, endolaser, vital dyes, bimanual dissection and usage of intraoperative and post-operative tamponades. Each case presents a unique challenge and necessitates an appropriate combination of the steps mentioned above. In the current review we present the current understanding of the need for surgery in diabetic retinopathy, various surgical approaches and a summary of current literature on the same. Multiple surgical video clips demonstrating these steps are also included in this review.

Deep Learning of Diabetic Retinopathy Classification in Fundus Images

Diabetic retinopathy is an eye disease in diabetic patients due to damage to the small blood vessels in the retina due to high and low blood sugar levels. Accurate detection and classification of Diabetic Retinopathy is an important task in computer-aided diagnosis, especially when planning for diabetic retinopathy surgery. Therefore, this study aims to design an automated model based on deep learning, which helps ophthalmologists detect and classify diabetic retinopathy severity through fundus images. In this work, a deep convolutional neural network (CNN) with transfer learning and fine tunes has been proposed by using pre-trained networks known as Residual Network-50 (ResNet-50). The overall framework of the proposed classification model is divided into three major phases, including pre-processing, training the Resnet-50 network, and classification with evaluation. In the first phase, pre-processing techniques are applied to the APTOS2019 fundus images dataset to find the best features and highlight some fine details of these images. The resnet-50 network was trained in the second phase using the training set and saved the best model obtained that gives high accuracy during the training process. Finally, this saved model has been implemented on the testing dataset for classification DR grades. The proposed model shows good and best classification performance, which was obtained with an accuracy of 98.3%, a precision of 98.4%, an F1-Score of 98.5 % and the recall of 98.4%.

Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery

Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery

Enhancing surgical precision and efficiency: a study and comparison of a three-dimensional surgical video system in proliferative diabetic retinopathy surgery.

This study aimed to investigate the safety and efficacy of three-dimensional (3D) surgical video systems for proliferative diabetic retinopathy (PDR). This retrospective clinical case study included 30 patients (30 eyes) with PDR. Patients were divided into two groups: one underwent surgery using a 3D surgical video system (14 cases, 14 eyes), while the other underwent traditional microscope surgery (16 cases, 16 eyes). Safety and efficacy were assessed through predetermined surgical parameters, including surgical duration, intraoperative membrane removal rate, and occurrences during intraoperative and postoperative phases. Our study revealed noteworthy differences in various aspects between the 3D surgical video system group and the traditional microscope surgery group. Specifically, the mean surgical time was 30.25 ± 14.43 mins in the 3D surgical video system group, while it was 38.56 ± 18.71 mins in the traditional microscope surgery group (p = 0.051). Furthermore, the mean membrane removal time was significantly shorter in the 3D group at 2.53 ± 1.52 mins, as compared to 3.23 ± 1.76 mins in the traditional group (p = 0.042). Importantly, the membrane removal rate also displayed a significant difference, with the 3D group at 0.55 ± 0.07 and the traditional group at 0.41 ± 0.11 (p = 0.018). However, no notable differences were observed between the two groups in terms of intraoperative and postoperative incidences. The safety and efficacy obtained using the 3D surgical video system in PDR surgery were comparable to those obtained in traditional microscopic surgery.

Intelligent Application of Laser for Medical Prognosis: An Instance for Laser Mark Diabetic Retinopathy

ABSTRACT: Refractive laser surgery is all about the accuracy, whether screening or surgery, given the age and profile of the patient enduring these trials, there is no margin for error. Most of them are for aesthetic reasons, contact lens intolerance, or professional reasons, including athletes. In this article, the role of artificial intelligence and deep learning in laser eye surgeries has been introduced. The presence of lingering laser spots on the retina after refractive laser surgery in diabetic retinopathy poses a potential risk to visual integrity and ocular well-being. The hypothesis for the research paper is that the hybridized convolutional neural network models, including LeNet-1, AlexNet, VGG16, PolyNet, Inception V2, and Inception-ResNetV2, will yield varying levels of performance in classifying and segmenting laser spots in the retina after diabetic retinopathy surgery. The hypothesis predicts that Inception-ResNetV2 will demonstrate superior results compared to the other CNN versions. The research aims to provide a novel approach for laser therapies and treatments, facilitating the rapid classification, highlighting, and segmentation of laser marks on the retina for prompt medical precautions. The comparative analysis revealed that Inception-ResNetV2 exhibited exceptional performance in both training and validation, achieving the highest accuracy (96.54%) for classifying diabetic retinopathy images. Notably, VGG16 also demonstrated strong performance with a validation accuracy of 94%. Conversely, LeNet-1, AlexNet, PolyNet, and Inception V2 displayed comparatively lower accuracy rates, suggesting their architectures may be less optimized for this particular image classification task. This achievement holds immense promise for timely detection, precise localization, and optimal management of laser spots, fostering enhanced visual outcomes and elevating the standards of patient care in this context.

Visual Evoked Potentials for the Detection of Diabetic Retinal Neuropathy.

Visual evoked potentials (VEP) are visually evoked signals that extract electroencephalographic activity in the visual cortex that can detect retinal ganglion cells, optic nerves, chiasmal and retrochiasmal dysfunction, including optic radiations, and the occipital cortex. Because diabetes causes diabetic retinopathy due to microangiopathy and neuropathy due to metabolic abnormalities and intraneural blood flow disorders, assessment of diabetic visual pathway impairment using VEP has been attempted. In this review, evidence on the attempts to assess the visual pathway dysfunction due to abnormal blood glucose levels using VEP is presented. Previous studies have provided significant evidence that VEP can functionally detect antecedent neuropathy before fundus examination. The detailed correlations between VEP waveforms and disease duration, HbA1c, glycemic control, and short-term increases and decreases in blood glucose levels are evaluated. VEP may be useful for predicting postoperative prognosis and evaluating visual function before surgery for diabetic retinopathy. Further controlled studies with larger cohorts are needed to establish a more detailed relationship between diabetes mellitus and VEP.

Критерии успеха хирургии пролиферативной диабетической ретинопатии

Критерии успеха хирургии пролиферативной диабетической ретинопатии

Current Management of Combined Traction/Rhegmatogenous Retinal Detachments

Due to proliferative diabetic retinopathy (PDR) and related complications, 25% of diabetic patients experience significant visual impairment. Panretinal argon laser photocoagulation (PRP) and the use of vascular endothelial growth factors (VEGF) in recent years have reduced the frequency of visual loss and tractional retinal detachment (TRD) and combined tractional/rhegmatogenous retinal detachment (CTRD). TRD and CTRD are the primary indications for vitreoretinal surgery related to PDR. TRD and CTRD which elevate macula less than 6 months, rapidly progressive and threatening macula are the other important indications to vitreoretinal surgery in diabetic retinopathy. CTRD, which was almost inoperable in previous years, now it takes place in the indications to vitreoretinal surgery by the development of new surgical equipment (vertical and horizontal scissors, light systems, diamond knives, trocar systems, etc.) and new surgical techniques (segmentation, visco-dissection, en-block dissection). Small calibered (23, 25, 27 Gauge) vitrectomy probes shortened the duration of vitreoretinal surgery in TRD and CTRD cases. Preoperative anti-VEGF treatment inhibits the fibrovascular tissue activation in this way facilitates and enables safe surgery. As long as the vitreoretinal surgery equipment and techniques improved, the functional and anatomical success in CTRD and TRD will increase.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review.

Background: Optical coherence tomography (OCT) has recently been introduced in the operating theatre. The aim of this review is to present the actual role of microscope-integrated optical coherence tomography (MI-OCT) in ophthalmology. Method: A total of 314 studies were identified, following a literature search adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. After full-text evaluation, 81 studies discussing MI-OCT applications in ophthalmology were included. Results: At present, three microscope-integrated optical coherence tomography systems are commercially available. MI-OCT can help anterior and posterior segment surgeons in the decision-making process, providing direct visualization of anatomic planes before and after surgical manoeuvres, assisting in complex cases, and detecting or confirming intraoperative complications. Applications range from corneal transplant to macular surgery, including cataract surgery, glaucoma surgery, paediatric examination, proliferative diabetic retinopathy surgery, and retinal detachment surgery. Conclusion: The use of MI-OCT in ophthalmic surgery is becoming increasingly prevalent and has been applied in almost all procedures. However, there are still limitations to be overcome and the technology involved remains difficult to access and use.

Association between disorganization of retinal inner layers and visual acuity after proliferative diabetic retinopathy surgery

We report to evaluate if disorganization of the retinal inner layers (DRIL) obtained by swept-source optical coherence tomography (SS-OCT) predicts the postoperative best-corrected visual acuity (BCVA) to treat proliferative diabetic retinopathy (PDR). Twenty-one eyes of 21 patients who underwent vitrectomy for PDR were studied retrospectively. BCVA and SS-OCT images were obtained until 6 months postoperatively. The associations between BCVA and SS-OCT parameters measured in a 1-mm central foveal area were evaluated. The DRIL length, external limiting membrane disruption, and ellipsoid zone (EZ) disruption 1 month postoperatively were associated positively with the postoperative logarithm of the minimum angle of resolution (logMAR) BCVA at 1, 3, and 6 months (1 month, p = 0.009, p = 0.013, p = 0.001; 3 months, p = 0.03, p = 0.021, p = 0.002; and 6 months, p = 0.021, p = 0.013, and p = 0.005, respectively). The eyes with a 500-µm or longer DRIL 1 month postoperatively (19%, 4/21 eyes) had significantly worse VA at 1, 3, and 6 months postoperatively (p = 0.007, p = 0.008, and p = 0.020, respectively). Multilinear regression analysis of all visits until 6 months postoperatively showed that the DRIL was correlated more significantly (p = 0.0004) with logMAR BCVA than the disrupted EZ length. The DRIL in the early postoperative period may predict the visual outcomes after treating PDR.

Abnormally low Bispectral index and severe hypoglycemia during maintenance of and recovery from general anesthesia in diabetic retinopathy surgery: two case reports

BackgroundHypoglycemia is one of the most fatal complications during the perioperative period. General anesthesia or sedation can mask a hypoglycemia-altered mental status. Acute hypoglycemia might result in permanent brain injury. There is no way to detect hypoglycemia during general anesthesia, except for intermittent blood glucose monitoring.Case presentationHypoglycemia is associated with changes in electroencephalogram readings. Here, we report two cases of patients with an abnormally low Bispectral Index (BIS) associated with diabetic retinopathy surgery, one in the recovery stage of general anesthesia and the other in the maintenance of general anesthesia. Hemodynamics were stable. Severe hypoglycemia (1.6 mmol/L and 2.2 mmol/L) was then detected. BIS increased with the correction of severe hypoglycemia.ConclusionsFor diabetic patients, when the intraoperative BIS value is abnormally low, hypoglycemia should be considered. Severe hypoglycemia may be presented in BIS monitoring during general anesthesia.

Investigation and analysis of patients′ self-perceived burden after diabetic retinopathy surgery

Objective To investigate the self-perceived burden (SPB) of diabetic retinopathy (DR) patients after diabetic retinopathy and its influencing factors, and analyze the correlation between them. Methods Self-designed general questionnaire and self-rating questionnaires including SPB scale, etc. were used in the survey. All survey information was imported into Excel database. SPSS 18.0 statistical software was used for the descriptive analysis, single-factor analysis and multiple-factor analysis. Results The average SPB score of DR patients after surgery was (28.22±7.11) points, and was in a mild level. Working condition, children condition, the time span since diagnosis and the knowledge of vitrectomy all had positive effect on SPB. Conclusions The SPB of DR patients after surgery is at a mild level. The SPB of patients after DR surgery is mainly influenced by their working condition, children condition, the time span since diagnosis and the knowledge of vitrectomy. Key words: Diabetic retinopathy (DR); Postoperative period; Self-perceived burden

Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

Purpose: To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy. Case summary: A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our out-patient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved. Conclusions: During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication. J Korean Ophthalmol Soc 2016;57(6):1004-1011

Erratum: Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Erratum: Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

The purpose of this study is to evaluate the efficacy of preoperative intravitreal bevacizumab (IVB) for improving outcomes in vitrectomy for diabetic retinopathy-related non-clearing vitreous haemorrhage and/or tractional retinal detachment. Medical record from patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) were retrospectively analysed (2003-2011). From 2007, IVB (1.25 mg 2-4 days before operating) was used on all eyes. Eyes receiving IVB were compared with those that did not receive IVB. Intraoperative complications, reoperation rates, and final visual acuity were the core outcome measures. Data were analysed for 88 patients (101 eyes). In all, 41 (41%) patients had received IVB, whereas 60 (59%) patients had not. Significant intraoperative haemorrhage occurred in six eyes (10%) in the non-IVB group and in one (2.4%) IVB eyes (P=0.24). Silicon oil was used in 29 (48%) non-IVB eyes and in 11 (27%) IVB eyes (P=0.03). The non-IVB eyes underwent significantly more vitreoretinal reoperations (P=0.01) and were significantly more likely to lose two or more lines of vision at the final follow-up (P=0.03). The numbers needed to treat (NNT) blindness (<3/60) was four for non-IVB eyes and two for the IVB group. IVB reduces surgical complications, the use of silicon oil, and the need for further retinal surgery. The NNT to restore useful vision (≥3/60) to a blind eye were significantly lower in the IVB group. Vitreoretinal surgery for the complications of PDR is effective in an East African context, and IVB should be considered a valuable adjunct.

Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy

BackgroundThe purpose of this study was to evaluate nepafenac ophthalmic suspension 0.1% (Nevanac®; Alcon Research Ltd) in the prevention of macular edema following cataract surgery in diabetic retinopathy patients.MethodsThis was a multicenter, randomized, double-masked, vehicle-controlled study of 263 adult diabetic patients with nonproliferative diabetic retinopathy requiring cataract surgery. Patients were randomized (1:1) to instill nepafenac or vehicle three times daily beginning 1 day prior to surgery through day 90. Efficacy included the percentage of patients who developed macular edema (≥30% increase in central subfield macular thickness from baseline) and the percentage of patients with decreases of more than five letters in best-corrected visual acuity from day 7 to 90.ResultsA significantly lower percentage of patients in the nepafenac group developed macular edema relative to patients in the vehicle group (3.2% versus 16.7%; P < 0.001). A significantly lower percentage of patients in the nepafenac group had best-corrected visual acuity decreases of more than five letters relative to patients in the vehicle group on day 30 (P < 0.001), day 60 (P = 0.002), and day 90 (P = 0.006). The mean central subfield macular thickness and mean percent change from baseline in macular volume were also significantly lower in the nepafenac group versus the vehicle group at days 14 through 90 (P ≤ 0.005). No safety issues or trends were identified when dosing was increased to 90 days that negatively impacted the favorable benefit/risk profile of nepafenac.ConclusionNepafenac demonstrated statistically significant and clinically relevant advantages compared with vehicle in preventing macular edema and maintaining visual acuity in diabetic patients following cataract surgery. These advantages were seen at multiple time points over the course of the 90-day therapy period. There was no clinically relevant increase in risk from 90 days dosing compared with 14 days. Therefore, with a similar safety profile and benefit in preventing macular edema and maintaining vision, the risk/benefit to the diabetic patient undergoing cataract surgery appears to be positive.

Intravitreal Anti-VEGF Drugs as Adjuvant Therapy in Diabetic Retinopathy Surgery

The use of intravitreal anti vascular endothelial growth factor (anti-VEGF) drugs such as pegaptanib, ranibizumab and bevacizumab has been widely reported to treat complications such as macular edema and rubeosis. During the past few years they have also been used as an adjuvant therapy to reduce intraocular bleeding during vitrectomy in eyes with proliferative diabetic retinopathy as well as to reduce the occurrence of vitreous haemorrhages in vitrectomized eyes and facilitate glaucoma surgery. In this paper we review the use of anti VEGF drugs in the surgical management of diabetic retinopathy related complications.