Types Of Macular Edema Research Articles

Stroke incidence increases with diabetic retinopathy severity and macular edema in type 1 diabetes

BackgroundAs the retina is suggested to mirror the brain, we hypothesized that diabetic retinopathy and macular edema are indicative of stroke risk in type 1 diabetes and sought to assess this association in individuals with type 1 diabetes.MethodsWe included 1,268 adult FinnDiane Study participants with type 1 diabetes (age 38.7 ± 11.8 years, 51.7% men vs. 48.3% women, and 31.5% had diabetic kidney disease), data on baseline diabetic retinopathy severity, and first stroke during our observational follow-up. Retinopathy was graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and macular edema as clinically significant (CSME) or not. Strokes identified from registries were confirmed from medical files. Adjusted hazard ratios (HR) for stroke by retinopathy severity and CSME were calculated by Cox models adjusted for clinical confounders, including diabetic kidney disease.ResultsDuring median 18.0 (14.1–19.3) follow-up years, 130 strokes (96 ischemic, 34 hemorrhagic) occurred. With no–very mild (ETDRS 10–20) retinopathy as reference, the adjusted HR for stroke was 1.79 (95%CI 1.02–3.15) in non-proliferative (ETDRS 35–53), and 1.69 (1.02–2.82) in proliferative (ETDRS 61–85) retinopathy. Corresponding adjusted HR for ischemic stroke was 1.68 (0.91–3.10) in non-proliferative and 1.35 (0.77–2.36) in proliferative retinopathy. The adjusted HR for hemorrhagic stroke was 2.84 (0.66–12.28) in non-proliferative and 4.31 (1.16–16.10) in proliferative retinopathy. CSME did not increase HR for any stroke type after adjustment for clinical confounders (data not shown).ConclusionsStroke incidence increases with the severity of diabetic retinopathy independently of comorbid conditions, including diabetic kidney disease.

Are optical coherence tomography and fluorescein angiography comparable for detection of macular edema in Behçet uveitis?

To investigate the role and agreement of spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) for macular edema (ME) diagnosis in Behçet uveitis (BU). Eyes with ME detected by SD-OCT and/or FA were enrolled. Type of ME by SD-OCT and grade of macular leakage (ML) by FA were investigated. Eyes were divided into three groups according to the agreement of tests. Three groups and factors that could affect the compatibility of tests were statistically analyzed. Sixty-one eyes of 61 patients were included. Both imaging methods detected ME in 42.6% of eyes (group 1). In 47.5% of eyes, ME was revealed by OCT (group 2). The remaining 9.8% of the eyes had ME, detected only by FA (group 3). Grade 2 ML by FA was more common in group 1 (p = 0.01). The grade of ML by FA was similar in groups 2 and 3. In group 2, most of the eyes showed diffuse ME by OCT (p < 0.001). Epiretinal membrane was detected more frequently in group 3 (p = 0.005). Duration and activity of uveitis were similar between groups. SD-OCT was able to detect ME in 90% of the eyes with BU. Duration and activity of uveitis were not related to the compatibility of imaging methods.

Blood selectin levels as a predictive factor for diabetic retinopathy and diabetic macular edema in type 2 diabetes

Background: Diabetes mellitus (DM) is still a noninfectious global pandemic. Diabetic retinopathy (DR) is one of the most common and socially significant complications of both type 1 and type 2 diabetes. Predicting the probability of DR progression and potential diabetic macular edema (DME) development is still important. Currently available predictive models include a wide number of predictors, and such predictors as blood selectin levels seem to be promising. Purpose: To determine relationships between blood levels of selectins and DR progression and DME development in patients with T2DM, and to develop particular predictive models. Material and Methods: Of the 124 patients (124 eyes) involved into this study, 95 (95 eyes) had T2DM and retinopathy (group 1 of 29 eyes with mild non-proliferative DR (NPDR); group 2 of 35 eyes with moderate or severe non-proliferative NPDR; and group 3 of 31 eyes with proliferative DR (PDR)), and 29 (29 eyes) had no diabetes (controls). Patients underwent a routine eye examination and spectral domain optical coherence tomography (SD-OCT) to determine central retinal thickness (CRT). The presence of DME was based on an increased macular thickness in the Early Treatment Diabetic Retinopathy Study (ETDRS) subfields compared to the upper limit of normal for patient's age and gender. Enzyme-linked immunosorbent assay (ELISA) kits from Invitrogen Thermo Fisher Scientific (USA) were used to determine selectin levels in blood. Statistical analyses were conducted using MedStat and MedCalc v.15.1 (MedCalc Software bvba) software. Results: There was a statistically significant tendency for an increase in progression of DR to be accompanied by an increase in blood selectin levels. In the presence of DME, blood LS levels were statistically significantly increased in mild NPDR; blood PS levels, in PDR; and blood ES levels, in all stages of DR. A regression model for predicting the progression of DR was built. In the model developed, diabetes duration and blood selectin levels were positively correlated, while HbA1c level was inversely correlated with DR progression. The model was found to be adequate R2adjust = 0.84; F = 97.9, p less 0.001, demonstrating high correlation of the selected independent variables with the stage of DR. The calculated Y index may be considered a quantitative reflection of the severity of DR. A patient is predicted to have mild NPDR (with a prediction accuracy of 86.2%) if Y less 1.5, moderate of severe NPDR (with a prediction accuracy of 88.6%) if 1.5 less equal Y less 2.35, and PDR (with a prediction accuracy of 100%) if Y more equal 2.35. A regression model for predicting the development of DME was built, with CRT and blood ES level found to increase the risk of the development of DME. A high AUC value for the ROC curve (AUC = 0.97; 95% CI, 0.92-0.99) indicated a very strong correlation of the risk of DME development with the levels of selected independent variables. In addition, sensitivity and specificity values at the optimal cut-off point were 93.2% (95% CI, 83.5%-98.1%) and 92.3% (95% CI, 83.0%-97.5%), respectively. Conclusion: Our findings confirmed the current view that high blood selectin levels are important in the presence of T2DM and related to major pathogenetic mechanisms of microvascular complications, and blood selectin levels can be considered predictors of the progression of DR as well as the development of DME.

109-OR: Prior Cerebrovascular Disease Was Positively Associated with Severe Diabetic Retinopathy and Diabetic Macular Edema in Type 2 Diabetes

Background and Purpose: Although it is well established that diabetic retinopathy (DR) and diabetic macular edema (DME) are risk factors for incident cerebrovascular disease (CVD), whether the CVD history could be a predictor of severe DR or DME remains unknown among people with type 2 diabetes. Also, the effects of aging or systolic blood pressure on incident severe DR or DME in individuals with a history of CVD remains unknown. Methods: Severe DR and DME were defined as vision-threatening treatment-required diabetic eye diseases (TRDED). Enrolled were 31,638 Japanese patients with type 2 diabetes. We longitudinally explored the existence of such an association not only overall but also according to various factors. Results: The main outcome of TRDED was observed in 854 (2.7%) patients during a mean follow-up of 5.3 years (5.1/1,000 person-years). Prior CVD was present in 694 of 31,638 (2.2%) patients at baseline. In a multivariate adjusted Cox regression model, prior CVD was positively associated with incident TRDED in analysis of the study population (hazard ratio, 1.63 [95% confidence interval, 1.11-2.37] overall; 1.47 [0.54, 3.99] for age ≤49 y; 1.69 [1.12, 2.55] for age ≥50 y; 1.46 [0.89, 2.39] for SBP ≤139 mmHg; 1.97 [1.09, 3.58] for SBP ≥140 mmHg). All results, including several stratified analyses, correlated with visual inspection of the corresponding Kaplan-Meier analysis with log-rank tests indicating gaps between curves for those with and without prior CVD. Conclusions: These results indicate that CVD is a predictor of vision-threatening severe retinopathy, and suggested that they shared a common background pathophysiology. It also contributed to preventing severe visual impairment and further deterioration of the quality of life after stroke. Disclosure M.Yamamoto: None. M.Iwanaga: None. T.Yamada: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. H.Hasebe: None. H.Shiozaki: None. R.Kodera: None. T.Sato: None. Y.Yaguchi: None. T.Osawa: None. Y.Matsubayashi: None. Funding Japan Society for the Promotion of Science (JP21K11569, JP22K16212)

Study of changes in choroidal thickness with severity of diabetic retinopathy and diabetic macular edema in type 2 diabetic patients

: Diabetic retinopathy (DR) is one of the long-term microvascular complications of Diabetes mellitus. Chronic hyperglycemia cause microvascular abnormalities to both retina and choroid. Optical coherence tomography (OCT) is a non-invasive fundus imaging modality, which plays a vital role in revealing the pathogenesis and development of retinal–choroidal diseases.This prospective observational study included 128 eyes of 64 subjects diagnosed with type 2 diabetes and out of 128 eyes, 113 (88%) eyes were found to have DR. Collected data included age, gender, duration of diabetes, glycemic control, comprehensive ocular examination, fundus photography, and CT measurement on OCT.Mean age in the study group was 53.71 ± 9.37 years (45–70 years). Out of 113 eyes, 19 (17%) eyes were diagnosed as mild NPDR, 21 (19%) eyes had moderate NPDR, 36 (31%) eyes had severe NPDR and 37 (33%) eyes had PDR. The average SFCT in MILD NPDR was 310 ± 14.70 μm at 95% CI (1.86), MODERATE NPDR was 316 ± 17.97 μm at 95% CI (2.70), SEVERE NPDR was 326.02 ± 14.05 μm at 95% CI (4.59) and PDR was 298.55 ± 18.75μm at 95% CI. (1.41). The presence of DME significantly affects average SFCT. It was observed that choroidal thickness tends to increase as the severity DR with DME progress.The average SFCT was thicker in patients with increase in severity of DR, and then SFCT decreased in patients with PDR. As the severity of NPDR increased from mild to moderate to severe NPDR, there was increase in sub foveal choroidal thickness. (p&amp;#60;0.05). PDR showed decrease in sub foveal choroidal thickness in comparison to NPDR which is highly statistically significant. p=0.01 (p&amp;#60;0.05). The presence of DME significantly affects average SFCT (p&amp;#60;0.05). It was observed that choroidal thickness tends to increase as the severity DR with DME progress. Thus, Choroidal thickness measurement can help in assessment of DR pathogenesis.

A simple technique for suprachoroidal space injection of triamcinolone acetonide in treatment of macular edema.

To introduce a simple resistance controlled suprachoroidal space (SCS) injection technique using a disposable 30-gauge needle connected to a 1 mL syringe and evaluate the effectiveness and applicability of this technique in the treatment of macular edema. A total of 20 patients with various types of macular edema were subjected to a resistance controlled SCS injection of triamcinolone acetonide (TA) with a disposable 30-gauge needle connected to a 1 mL syringe. This technique allows the easy and smooth injection of the TA only once the tip of the needle reached the potential SCS which was indicated by the lower resistance on the plunger. The main outcome measures were anterior segment spectral-domain optical coherence tomography (AS-OCT) measurements post-operation immediately and central subfield thickness (CST), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements at 3mo post-operation. AS-OCT examination showed the expansion of the SCS near the injection site immediately after SCS injection. At three months of follow-up, as compared to the baseline, the mean CST was significantly decreased from 535.0±157.24 to 319.55±127.30 µm (P<0.001), the mean BCVA was significantly improved from 1.05±0.41 to 0.73±0.41 logMAR (P<0.001), and the mean IOP was not significantly different, from 15.05±2.54 to 15.85±3.60 mm Hg (P=0.185). Any complication related to the injection procedure including cataract, choroidal and retinal hemorrhage, retinal detachment, or endophthalmitis was not observed in this study. The simple and minimally invasive technique of SCS injection of TA with a disposable 30-gauge needle connected to a 1 mL syringe is useful and applicable for macular edema.

Peripheral white blood cell subtypes and the development/progression of diabetic macular edema in type 2 diabetic patients: a comparative study.

Inflammation and immune dysregulation are involved in the pathogenesis of diabetic macular edema (DME). The progressive increase of neutrophils in peripheral blood can lead to the increase of the number of neutrophils in the retina, thus leading to the sustained damage of the retinal vascular system and the destruction of the blood retinal barrier (BRB); lymphocytes play a protective role in vascular diseases caused by type 2 diabetes mellitus (T2DM). The purpose of this study was to study the relationship between the changes of leukocytes and their classification in peripheral blood and the occurrence and progression of DME in patients with T2DM. A retrospective analysis was made on 81 patients with T2DM with DME (DME group) hospitalized in our hospital from January 2019 to December 2020. According to the morphological characteristics of macular edema in optical coherence tomography (OCT), they were divided into early DME group (n=33) and late DME group (n=48); 33 patients with diabetes retinopathy (DR) but without DME matched in age and course of disease served as the control group (NO-DME group). The clinical parameters assessed included eye examination, OCT results, WBCs and subtypes, blood glucose, and glycosylated hemoglobin. Compared with NO-DME group (n=33), Neutrophils% in DME group (n=81) was higher (57.37±9.52 vs. 63.27±7.85; P=0.001); Monocyte% (7.63±1.77 vs. 6.88±1.83; P=0.047) and lymphocyte% (30.35±9.51 vs. 27.26±6.59; P=0.032) were decreased. The optimal model was obtained with R 4.0.5 software. With other relevant variables being the same, females had a significantly increased risk of DME (b=1.273, P=0.015), %neutrophils was significantly associated with increased risk of DME (b=0.152, P=0.0006), and %lymphocytes was significantly associated with a reduced risk of DME (b=-0.027, P=0.179). However, in the early and late DME groups, no significant differences in biological markers were found, and a high-quality model was not obtained. In this preliminary study, %neutrophils is associated with increased risk of DME, whereas %lymphocytes is associated with a reduced risk of DME.

Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study

BackgroundThe treatment for diabetic macular edema (DME) has revolutionized during the last 15 years after the introduction of intravitreal anti-VEGF agents. The aim of the current study is to evaluate the real-world visual outcomes of diabetic macular edema (DME) treatment in patients with type 1 diabetes (T1D) in long-term follow-up.MethodsA real-world, descriptive, population-based cohort and follow-up of all patients with T1D and DME in 2006-2020 in 34 communities of the Northern Ostrobothnia Hospital District. The main outcome measures included age, gender, duration of T1D at the onset of DME, stage of retinopathy, treatment of DME (observation, laser, intravitreal treatments, combination), and visual outcomes.ResultsA total of 304 eyes of 206 T1D patients with DME were included. 75% (n=155) had non-proliferative diabetic retinopathy during the onset of DME. 15% of the cases were observed, 33% had macular laser, 41% intravitreal anti-VEGF and 12% combination of laser and intravitreal injections. Patients in anti-VEGF and in combination groups gained 4.9 and 5.5 ETDRS letters after the initial DME episode (p<0.001 and p<0.001), and the long-term visual improvements were 4.1 and 5.1 ETDRS letters (p<0.001 and p<0.001), respectively. In observation and laser groups the initial gain of 0.1 (p>0.90) and loss of 0.4 ETDRS letter (p=0.61), respectively, was noted. After the follow-up, a 3.7 ETDRS letter decrease was documented in the observation group (p>0.90) and a 1.1 (p=0.14) ETDRS letter decline in the laser group of patients. At the beginning of treatment, eyes subjected to anti-VEGF alone or in combination with laser had lower visual acuity compared to eyes subjected to observation or macular laser. The average of a 6.1±4.8 anti-VEGF injections were needed to dry DME. Visual impairment due to DME decreased from 2.4% to 1.0% during the 15-year period.ConclusionsAnti-VEGF alone or in combination with macular laser seems to be beneficial in terms of visual outcomes and treatment stability in T1D patients with central DME.Moreover, satisfying long-term visual outcomes were achieved with anti-VEGF treatment in a real-world setting.

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;

The effect of insulin on response to intravitreal anti-VEGF injection in diabetic macular edema in type 2 diabetes mellitus

ObjectivesTo assess whether insulin therapy impacts the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of diabetic macular edema (DME) in type 2 diabetes mellitus.MethodsThis was a retrospective multi-center analysis. The best-corrected visual acuity (BCVA) at 12 months, BCVA change, central macular thickness (CMT), CMT change, and cumulative injection number were compared between the insulin and the oral hypoglycemic agent (OHA) groups.ResultsThe mean final BCVA and CMT improved in both the insulin (N = 137; p < 0.001; p < 0.001, respectively) and the OHA group (N = 61; p = 0.199; p < 0.001, respectively). The two treatment groups were comparable for final BCVA (p = 0.263), BCVA change (p = 0.184), final CMT (p = 0.741), CMT change (p = 0.458), and the cumulative injections received (p = 0.594). The results were comparable between the two groups when stratified by baseline vision (p > 0.05) and baseline HbA1c (p > 0.05).ConclusionInsulin therapy does not alter treatment outcomes for anti-VEGF therapy in DME.

Diabetic Macular Edema Screened by Handheld Smartphone-based Retinal Camera and Artificial Intelligence.

Our aim was to assess the tomographic presence of diabetic macular edema in type 2 diabetes patients screened for diabetic retinopathy with color fundus photographs and an artificial intelligence algorithm. Color fundus photographs obtained with a low-cost smartphone-based handheld retinal camera were analyzed by the algorithm; patients with suspected macular lesions underwent ocular coherence tomography. A total of 366 patients were screened; diabetic macular edema was suspected in 34 and confirmed in 29 individuals, with average age 60.5 ± 10.9 years and glycated hemoglobin 9.8 ± 2.4%; use of insulin, statins, and aspirin were reported in 44.8%, 37.9%, and 34.5% of individuals, respectively; systemic blood hypertension, dyslipidemia, abdominal obesity, chronic kidney disease, and risk for diabetic foot ulcers were present in 100%, 58.6%, 62.1%, 48.3%, and 27.5% of individuals, respectively. Proliferative diabetic retinopathy was present in 31% of patients with macular edema; severity level was associated with albuminuria (p = 0.028). Eyes with macular edema had average central macular thickness 329.89 ± 80.98 mmu; intraretinal cysts, sub retinal fluid, hyper-reflective foci, epiretinal membrane, and vitreomacular traction were found in 87.2%, 6.4%, 85.1%, 10.6%, and 6.4% of eyes, respectively. Diabetic retinopathy screening overwhelms health systems and is typically based on color fundus photographs, with high false-positive rates for the detection of diabetic macular edema. The present, semi-automated strategy comprising artificial intelligence algorithms integrated with smartphone-based retinal cameras could improve screening in low-resource settings with limited availability of ocular coherence tomography, allowing increased access rates and ultimately contributing to tackle preventable blindness.

Influence of serum lipids on clinically significant macular edema in type 2 diabetic retinopathy cases

Background: Diabetic retinopathy (DR), a paramount microvascular complication of diabetes mellitus (DM), has a significant impact on the world’s health system. Up to 30 percent of patients with clinically significant macular oedema (CSME) will develop moderate visual loss. Other than diabetes, several systemic factors like dyslipidemia play an important role in the pathogenesis of DME. Thus, addressing these additional risk factors, in addition to adequate control of blood glucose helps to prevent and reverse maculopathy to some extent, thereby preserving their vision. Materials and Methods: This study was done on 150 patients with type 2 diabetes mellitus, presenting to the outpatient department of ophthalmology of a tertiary care hospital, with CSME in either or both eye(s). A detailed history of each of these patients was taken and a comprehensive ophthalmic evaluation of anterior and posterior segments was done. Following Biochemical tests were carried out: 1. fasting blood glucose and post prandial blood glucose, 2. fasting lipid profile (serum total cholesterol, serum triglycerides, LDL-cholesterol, HDL-cholesterol, and VLDL-cholesterol). Dyslipidaemia was defined by using national cholesterol education program–adult treatment panel III (NCEP ATP III) guidelines. Accordingly, dyslipidemia was identified, when at least one of the Fasting lipid profile parameters crossed the desirable range. Statistical Analysis: Data obtained from Diabetic Retinopathy cases was analysed using chi-square test. Results: A total of 150 patients of either gender, between the age groups 30-70 years, were enrolled into the study after applying inclusion and exclusion criterias. Dyslipidemia was present in 101/150 (67.3%) patients. LDL-cholesterol level was significantly high, whereas Total Cholesterol, Triglycerides and VLDL showed borderline high values. Further, the occurrence of CSME showed a statistically significant correlation with LDL in majority of

A dynamic nomogram for predicting diabetic macular edema in type 2 diabetes patients based on plasma cytokines.

Objective: This study investigated changes of plasma cytokines and aimed to build a dynamic nomogram for diabetic macular edema (DME) in type 2 diabetes mellitus (T2DM).Methods: In a pilot cohort, plasma samples were selected from 9 T2DM patients and 9 DME patients to screen for cytokine differences. The screening cytokines were then validated by enzyme-linked immunoassay in a cohort, which contained 100 DME (DME group) and 100 T2DM patients without DME (T2DM group). A dynamic nomogram for predicting DME was developed, based on the plasma cytokines.Results: In the pilot cohort, 11 plasma cytokines were significantly increased in the DME group. In the validation cohort, platelet-derived growth factor (PDGF)-BB, tissue inhibitors of metalloproteinase (TIMP)-1, angiopoietin (ANG-1), and vascular endothelial cell growth factor receptor (VEGFR)-2 were confirmed to be significantly elevated in the DME group. The dynamic nomogram demonstrated good calibration and discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.88. In the test set, sensitivity, specificity, and AUC were 73.3%, 80.0%, and 0.84, respectively.Conclusion: Plasma cytokines were closely associated with DME. A novel dynamic monogram including ANG-1, PDGF-BB, TIMP-1, and VEGFR2 was a novel tool for predicting DME.

Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema

Purpose: To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018&#x0D; Methods: Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve &lt; 0.05 was accepted as statistically significant.&#x0D; Results: The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P &lt; 0.001). The decrease in macular edema thickness was more in group II than group I (P &lt; 0.001).&#x0D; Conclusion: Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up.&#x0D; Key Words: Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

Association of Body Mass Index, Blood Sugar and Glycated Hemoglobin Levels with Types of Macular Edema in Patients with Type-2 Diabetes Mellitus

Association of Body Mass Index, Blood Sugar and Glycated Hemoglobin Levels with Types of Macular Edema in Patients with Type-2 Diabetes Mellitus

Suspended scattering particles in motion using OCT angiography in branch retinal vein occlusion disease cases with cystoid macular edema

We aimed to investigate the clinical implication of suspended scattering particles in motion (SSPiM) using optical coherence tomography angiography (OCTA) among branch retinal vein occlusion disease (BRVO) cases with macular edema (ME). Medical records of BRVO patients were reviewed. Central retinal thickness (CRT), ME type, and cyst size on optical coherence tomography images were evaluated before and after intravitreal bevacizumab injection. Nonperfusion area, SSPiM, and microvascular abnormalities in OCTA images were evaluated using a Heidelberg machine. SSPiM was identified in 24 of 56 cases. There were no differences in baseline characteristics between groups with and without SSPiM. Disease duration, disease-free duration, previous injection number, microaneurysms in the superficial vascular complex, and microaneurysms in the deep vascular complex (DVC) (p = 0.003, 0.013, 0.028, 0.003, < 0.001, respectively) differed significantly between the two groups. After multivariate logistic analysis, microaneurysms in the DVC were the only different factor between the two groups (odds ratio [OR]: 0.091; p = 0.001). Furthermore, SSPiM in the DVC (OR 10.908; p = 0.002) and nonperfusion grade (OR 0.039; p < 0.001) were significantly associated with cyst response after intravitreal injection. SSPiM may be correlated with microaneurysms in the DVC and a poor anatomical response after intravitreal injection.

Prognostic Value of Hyperreflective Material on Visual Acuity in Treatment-Naïve BRVO.

To correlate between hyperreflective material (HRM) seen on optical coherence tomography (OCT) and visual outcomes in treatment-naïve acute branch retinal vein occlusion (BRVO). Demographic and OCT features of patients with acute BRVO were analyzed retrospectively. OCT parameters noted were macular edema type, HRM presence and location, and outer retinal layer integrity. Eyes were separated into two groups: Group 1 (BRVO without HRM) and Group 2 (BRVO with HRM). Forty-seven eyes (67%) were included in Group 1 and 23 eyes (33%) were included in Group 2. Mean presenting logMAR visual acuity in Groups 1 and 2 was 0.521 ± 0.428 (mean Snellen equivalent = 20/66) and 0.627 ± 0.427 (mean Snellen equivalent = 20/85), respectively. Poor vision at final visit was noted in the BRVO with HRM group (P = .027). More intravitreal injections were required for macular edema resolution in the HRM group (4.83 vs. 2.67). Presence of HRM in BRVO is associated with poorer vision. It can be a useful prognostic biomarker. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:320-327.].

Study about the association between diabetic macular edema and avascular foveal area, diameter and thickness of the superficial and deep retinal plexuses

AbstractPurposeOur objective is to study in diabetic patients if there is an association between the presence of macular edema (diffuse or cystic) or not and the area of the foveal avascular zone (ZAF) in the superficial and deep retinal plexuses, diameters and the macular thicknesses measured with OCT and OCT‐A.MethodsWe performed a retrospective observational study with 13 diabetic patients (26 eyes). We have extracted general data of its history, characteristics about the evolution of its disease and ocular affectation, such as sex, age, time of evolution of diabetes, presence of diabetic retinopathy or not, treatments received and visual acuity. In each patient, on two images of OCT angiography (superficial plexus and deep plexus), we measured (with the “Triton” software) the area of the ZAF, as well as the larger diameter. In the classic OCT we have determined the central macular thickness and the type of macular edema: diffuse, cystic, or with neuroepithelial detachment at the foveal level due to the presence of subretinal fluid. We correlated the macular ischemia data of OCT‐A with the classical OCT data to see if there is any relationship.ResultsIt is verified that all parameters have a higher value in patients who do have macular edema and that in one of the measured characteristics (the diameter of the superficial plexus) this difference is statistically significant. Finally, when observing the values of the effect size, it is verified that there are three parameters (FAZ Plexus superficial, Diameter of superficial plexus superficial and Diameter of deep plexus) where a higher clinical significance is obtained.ConclusionsThere is a positive association between the area and diameter of the ZAF and the presence of macular edema in diabetic patients.

OCT angiography features associated with macular edema recurrence after intravitreal bevacizumab treatment in branch retinal vein occlusion

We aimed to evaluate the relationship between the capillary abnormalities including nonperfusion area (NPA) in optical coherence tomography angiography (OCTA) images and the recurrence of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF; bevacizumab). The records of 40 patients who underwent intravitreal bevacizumab injection for ME secondary to BRVO and had at least six months of follow-up were reviewed. Central retinal thickness (CRT; μm) and macular edema type were evaluated prior to treatment. After ME resolution, nonperfusion areas in the 1 mm (NPA1) and 1–3 mm (NPA3) zones on the Early Treatment Diabetic Retinopathy Study (ETDRS) circle within the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured using OCTA images. Furthermore, other microvascular abnormalities in the both SCP and DCP were compared between groups. ME recurred in 25 of 40 (62.5%) eyes. The NPA1 of the SCP and DCP (p = 0.002, 0.004, respectively), NPA3 of the SCP and DCP (p = 0.002, 0.008, respectively), and initial CRT (p = 0.022) differed significantly between eyes with and without ME recurrence. In multivariate logistic regression analyses, the NPA1 of the DCP (OR: 344.718; p = 0.029) and NPA3 of the SCP (OR: 4.072; p = 0.018) were significantly associated with ME recurrence. Other microvascular abnormalities were not significantly different between two groups. The central NPA and parafoveal NPA of the SCP in OCTA images correlated strongly with ME recurrence in BRVO patients after intravitreal anti-VEGF injection.

607-P: Hyperhomocysteinemia Is Closely Associated with Macular Edema in Type 2 Diabetes

Macular edema that impairs central vision is one of leading causes of blindness related to diabetes. Hyperhomocysteinemia is more common in type 2 diabetes, which may damage endothelium by excessive sulphation of connective tissues. In this study, we for the first time explored the relation of plasma total homocysteine concentration to diabetic macular edema in patients with type 2 diabetes. We enrolled 176 type 2 diabetic patients and 115 healthy subjects in a cross-sectional hospital-based study. Using fundus photographs documented retina statuses and using fluorescence polarization immunoassay measured homocysteine concentration. Risk factors for diabetic macular edema were obtained from fasting blood samples and interviewer- questionnaire. We found that diabetic patients had increased plasma homocysteine compared with normal control, and plasma homocysteine levels were higher in subjects with diabetic macular edema than without ((11.4 ± 2.7) vs. (8.5 ± 1.9) (μmol/l), p = 0.000). The association of homocysteine with diabetic macular edema was independent of major risk factors for diabetic macular edema (duration of diabetes, HbA1c, lipid) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, renal status, and biguanide use) (OR: 1.63 (1.02-2.14), p = 0.018). Furthermore, a 1 μmol/l increase in plasma homocysteine concentration was associated with a 0.5% to 2.2% increase of diabetic macular edema and per increase of 5.0 μmol/l plasma homocysteine was significantly related to macular edema (OR: 1.64 (1.04-2.16), p = 0.019) after adjusting for duration of diabetes per 5 year increase, HbA1c per 1% increase, serum folate per 10 nmol/l increase, serum B12 per 100 pmol/l increase, serum creatinine per 10 μmol/l increase and urinary ACR per 5 mg/g increase. We concluded that hyperhomocysteinemia is independently associated with occurrence of macular edema in type 2 diabetes. Future prospective studies are warranted to clarify the relationship. Disclosure J. Li: None. H. Zhang: None. Q. Lv: None. H. Lu: None. J. Zhou: None.