Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

Yan; Gao; Yan; Zhang; Yu-Sha; Ru; Xiao-Wu; Wang; Ji-Zhong; Yang; Chun-Hui; Li; Hong-Xing; Wang; Xiao-Rong; Li; Bing; Li

2015-01-01

AIM: To detect and analyze the changes on ocular surface and tear function in type II diabetic patients with proliferative diabetic retinopathy(PDR), an advanced stage of diabetic retinopathy(DR), using conventional ophthalmic tests and the high-resolution laser scanning confocal microscopy.METHODS: Fifty-eight patients with type II diabetes were selected. Based on the diagnostic criteria and stage classification of DR, the patients were divided into the non-DR(NDR) group and the PDR group. Thirty-six patients with cataract but no other ocular and systemic disease were included as non-diabetic controls. All the patients were subjected to the conventional clinical tests of corneal sensitivity, Schirmer I test, and corneal fluorescein staining. The non-invasive tear film break-up time(NIBUT) and tear interferometry were conducted by a Tearscope Plus. The morphology of corneal epithelia and nerve fibers was examined using the high-resolution confocal microscopy.RESULTS: The NDR group exhibited significantly declined corneal sensitivity and Schirmer I test value, as compared to the non-diabetic controls(P <0.001). The PDR group showed significantly reduced corneal sensitivity, Schirmer I test value, and NIBUT in comparison to the non-diabetic controls(P <0.001).Corneal fluorescein staining revealed the progressively injured corneal epithelia in the PDR patients. Moreover,significant decrease in the corneal epithelial density andmorphological abnormalities in the corneal epithelia and nerve fibers were also observed in the PDR patients.CONCLUSION: Ocular surface changes, including blunted corneal sensitivity, reduced tear secretion, tear film dysfunction, progressive loss of corneal epithelia and degeneration of nerve fibers, are common in type II diabetic patients, particularly in the diabetic patients with PDR. The corneal sensitivity, fluorescein staining scores,and the density of corneal epithelial cells and nerve fibers in the diabetic patients correlate with the

Determining diabetic retinopathy screening interval based on time from no retinopathy to laser therapy.

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Hughes, Daniel; Nair, Sunil; Harvey, John N

2017-12-01

Objectives To determine the necessary screening interval for retinopathy in diabetic patients with no retinopathy based on time to laser therapy and to assess long-term visual outcome following screening. Methods In a population-based community screening programme in North Wales, 2917 patients were followed until death or for approximately 12 years. At screening, 2493 had no retinopathy; 424 had mostly minor degrees of non-proliferative retinopathy. Data on timing of first laser therapy and visual outcome following screening were obtained from local hospitals and ophthalmology units. Results Survival analysis showed that very few of the no retinopathy at screening group required laser therapy in the early years compared with the non-proliferative retinopathy group ( p retinopathy at screening group required laser therapy, and at three years 0.2% (cumulative), lower rates of treatment than have been suggested by analyses of sight-threatening retinopathy determined photographically. At follow-up (mean 7.8 ± 4.6 years), mild to moderate visual impairment in one or both eyes due to diabetic retinopathy was more common in those with retinopathy at screening (26% vs. 5%, p diabetes occurred in only 1 in 1000. Conclusions Optimum screening intervals should be determined from time to active treatment. Based on requirement for laser therapy, the screening interval for diabetic patients with no retinopathy can be extended to two to three years. Patients who attend for retinal screening and treatment who have no or non-proliferative retinopathy now have a very low risk of eventual blindness from diabetes.

Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: results from the Gutenberg Health Study (GHS).

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Ponto, Katharina A; Koenig, Jochem; Peto, Tunde; Lamparter, Julia; Raum, Philipp; Wild, Philipp S; Lackner, Karl J; Pfeiffer, Norbert; Mirshahi, Alireza

2016-09-01

Individuals with type 2 diabetes mellitus may experience an asymptomatic period of hyperglycaemia, and complications may already be present at the time of diagnosis. We aimed to determine the prevalence of diabetic retinopathy in patients with newly diagnosed (screening-detected) type 2 diabetes. The Gutenberg Health Study is a population-based study with 15,010 participants aged between 35 and 74 years. We determined the weighted prevalence of diabetic retinopathy by assessing fundus photographs. Screening-detected type 2 diabetes was defined as an HbA1c concentration of 6.5% (47.5 mmol/mol) or more, no medical diagnosis of diabetes and no intake of insulin or oral glucose-lowering agents. Of 14,948 participants, 1377 (9.2%) had diabetes mellitus. Of these, 347 (25.2%) had newly diagnosed type 2 diabetes detected by the screening. Overall, the weighted prevalence of screening-detected type 2 diabetes was 2.1%. Fundus photos were evaluable for 285 (82.1%) participants with newly diagnosed diabetes. The weighted prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13.0%; 12% of participants had a mild non-proliferative diabetic retinopathy and 0.6% had a moderate non-proliferative diabetic retinopathy. Diabetic retinopathy was proliferative in 0.3%. No cases of severe non-proliferative diabetic retinopathy or diabetic maculopathy were found. Thirty (14.9%) of 202 and six (7.2%) of 83 individuals with and without concomitant arterial hypertension, respectively, had diabetic retinopathy (OR 2.54, 95% CI 1.06, 7.14). Visual acuity did not differ between individuals with and without diabetic retinopathy . In this large European study, the prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13%. Only a very small proportion of participants with detected diabetic retinopathy needed treatment.

Coordination Skills during Vitrectomy in Treatment of Proliferative Diabetic Retinopathy

Institute of Scientific and Technical Information of China (English)

Xuehong Chen; Shanshan Luo; Yanchan Liu

2014-01-01

Purpose:.To discuss effective nursing and coordination skills for vitrectomy in the treatment of diabetic retinopathy. Methods: Fifty patients (51 eyes) with diabetic retinopathy required vitrectomy were enrolled in this study..Individual nursing service was delivered by strengthening preoperative preparation, providing psychological nursing, and intraopera-tive observation of the severity of diseases by circulating nurses;meticulous nursing was given postoperatively. Results:All 50 patients underwent surgery successfully..Intra-operatively,.patients had stable physical signs..Five patients had postoperative visual acuity0.3..No complicated infection was seen. Conclusion: For patients diagnosed with proliferative diabetic retinopathy requiring vitrectomy,.full preparations should be made and psychological nursing should be delivered preopera-tively, the severity of diseases and clinical reactions should be closely observed intraoperatively,.and proper processing and nursing measures should be taken postoperatively,.which col-lectively enhance surgical success rate,.decrease surgical com-plications,.and attain favorable treatment efficacy.(Eye Science 2014; 29:55-58).

[Prader-Willi syndrome case with proliferative diabetic retinopathy in both eyes treated by early vitrectomy under local anesthesia].

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Hori, Hideyuki; Sato, Yukihiro; Nakashima, Motohiro; Nakajima, Motohiro

2012-02-01

Although patients with Prader-Willi syndrome have a high rate of diabetes, to date, there have been only 4 reported cases (6 eyes) undergoing vitrectomy for proliferative diabetic retinopathy. Herein, we report a case of Prader-Willi syndrome with proliferative diabetic retinopathy that was treated by early vitrectomy OU under local anesthesia. A 30-year-old man was diagnosed as having Prader-Willi syndrome at the age of 2 years and diabetes at age 17. He was referred to our hospital as diabetic retinopathy had been detected in his first ophthalmological examination at age 29. Visual acuity was 0.6 bilaterally. Proliferative retinopathy, with cataract and macular edema, was identified in both eyes. Panretinal photocoagulation was performed on both eyes. However, proliferative membranes developed bilaterally, and vitreous hemorrhage occurred OS. Visual acuity decreased to 0.3 OU. The patient was hospitalized at our internal medicine department for blood glucose control. Subsequently, with an anesthesiologist on standby, a hypnotic sedative was injected intramuscularly, achieving retro-bulbar anesthesia. Combined cataract and vitreous surgery was performed on the left eye. One week later, a similar operation was performed on the right eye. The patient was discharged four days later. In the two years since these operation, visual acuity has been maintained at 0.8 OU. Patients with Prader-Willi syndrome should be examined for early detection and treatment of diabetic retinopathy.

Ocular pulse amplitude after panretinal photocoagulation in normotensive eyes with proliferative diabetic retinopathy.

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Bozic, Marija M; Karadzic, Jelena B; Kovacevic, Igor M; Marjanovic, Ivan S

2017-06-26

To assess the effect of panretinal laser photocoagulation on ocular pulse amplitude (OPA) in normotensive eyes with proliferative diabetic retinopathy. Prospectively, we performed unilateral argon laser panretinal photocoagulation (PRP) in 30 patients with diabetes mellitus type II and previously untreated bilateral proliferative diabetic retinopathy. Before and 7 and 30 days after the treatment, OPA was measured using dynamic contour tonometer. Compared with the untreated contralateral eyes, laser photocoagulation led to a reduction of OPA. Ocular pulse amplitude did not significantly differ in photocoagulated eyes 7 days after the treatment, but there was a significant difference in OPA 30 days after the treatment. The decrease in OPA values was 15% 7 days after PRP and 40% 30 days after PRP. Ocular pulse amplitude reduction after PRP indirectly informs us about choriocapillary closure, already reported in previous studies.

Proliferative Retinopathy in Type 1 Diabetes Is Associated With Cerebral Microbleeds, Which Is Part of Generalized Microangiopathy

NARCIS (Netherlands)

Woerdeman, J.P.; van Duinkerken, E.; Wattjes, M.P.; Barkhof, F.; Snoek, F.J.; Moll, A.C.; Klein, M.; de Boer, M.P.; IJzerman, R.G.; Serne, E.H.; Diamant, M.

2014-01-01

OBJECTIVE: We investigated whether proliferative diabetic retinopathy in type 1 diabetic patients can be generalized to cerebral small vessel disease and whether it is associated with impaired peripheral microvascular function. RESEARCH DESIGN AND METHODS: Thirty-three patients with proliferative

Predicted impact of extending the screening interval for diabetic retinopathy: the Scottish Diabetic Retinopathy Screening programme.

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Looker, H C; Nyangoma, S O; Cromie, D T; Olson, J A; Leese, G P; Philip, S; Black, M W; Doig, J; Lee, N; Briggs, A; Hothersall, E J; Morris, A D; Lindsay, R S; McKnight, J A; Pearson, D W M; Sattar, N A; Wild, S H; McKeigue, P; Colhoun, H M

2013-08-01

The aim of our study was to identify subgroups of patients attending the Scottish Diabetic Retinopathy Screening (DRS) programme who might safely move from annual to two yearly retinopathy screening. This was a retrospective cohort study of screening data from the DRS programme collected between 2005 and 2011 for people aged ≥12 years with type 1 or type 2 diabetes in Scotland. We used hidden Markov models to calculate the probabilities of transitions to referable diabetic retinopathy (referable background or proliferative retinopathy) or referable maculopathy. The study included 155,114 individuals with no referable diabetic retinopathy or maculopathy at their first DRS examination and with one or more further DRS examinations. There were 11,275 incident cases of referable diabetic eye disease (9,204 referable maculopathy, 2,071 referable background or proliferative retinopathy). The observed transitions to referable background or proliferative retinopathy were lower for people with no visible retinopathy vs mild background retinopathy at their prior examination (respectively, 1.2% vs 8.1% for type 1 diabetes and 0.6% vs 5.1% for type 2 diabetes). The lowest probability for transitioning to referable background or proliferative retinopathy was among people with two consecutive screens showing no visible retinopathy, where the probability was <0.3% for type 1 and <0.2% for type 2 diabetes at 2 years. Transition rates to referable diabetic eye disease were lowest among people with type 2 diabetes and two consecutive screens showing no visible retinopathy. If such people had been offered two yearly screening the DRS service would have needed to screen 40% fewer people in 2009.

Proliferative diabetic retinopathy after vitrectomy early factors affect IOP

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Shi-Bo Liu

2013-05-01

Full Text Available AIM:To explore possible causes of early postoperative elevated intraocular pressure caused by proliferative diabetic retinopathy(PDRvitrectomy. METHODS:Totally 72 cases(100 eyeswhich have performed vitrectomy for proliferative diabetic retinopathy were retrospectively analyzed to observe the incidence of postoperative ocular hypertension, and the relevant factors that caused postoperative high intraocular pressure were statistically analyzed. Early postoperative ocular hypertension diagnostic criteria: any time after 2 weeks of non-contact tonometer measured IOP> 25mmHg(1mmHg=0.133kPa. RESULTS:High intraocular pressure after vitrectomy occurred in 27 eyes(27%, the incidence of male and female were 27.27%, 26.79%, the difference was not statistically significant(P>0.05. Eyes filled with balanced liquid filling incidence rate of 30.95%, 6.25%, and the difference was statistically significant(P0.05. Incidences of intraoperative panretinal photocoagulation and additional retinal photocoagulation group were 41%, 20%, and the difference was statistically significant(P<0.05. Preoperative retinopathy of four, five, six groups of incidence were 9.52%, 23.81%, 40.56%, and the groups were statistically significant(P<0.05. Unconsolidated preoperative retinal detachment and retinal detachment incidence rate of 19%, 41%, and the difference was statistically significant(P<0.05. Surgery in the united lens resection with intraoperative unfederated lens the resection group's incidence rate of 34%, 15%, the difference was statistically significant(P<0.05. Logistic regression analysis showed that retinal detachment preoperative and intraoperative intraocular filling were independent risk factors that caused early postoperative ocular hypertension after vitrectomy. CONCLUSION:Post-operative ocular hypertension after PDR vitrectomy is related to preoperative retinal detachment, intraoperative lensectomy, intraoperative intraocular filling, and intraoperative

Frequency of diabetic retinopathy in karachi, pakistan: a hospital based study

International Nuclear Information System (INIS)

Alkhairy, S.; Rasheed, A.

2015-01-01

This study was conducted to determine the prevalence of diabetic retinopathy in diabetes patients presenting to the National Institute of Diabetes and Eye out patient department of Dow University Hospital (Ohja campus), Dow University of Health Sciences. Materials and Methods: This was a cross sectional study in which known diabetics were recruited between the period of 1st July 2011 till 31st July 2012.They were then referred to the Ophthalmology unit for eye examination. Subjective refraction was done with Snellens chart, anterior segment examination and fundus examined was done using a TopCon PS-61E Slit lamp BioMicroscope. All patients were dilated with eye drop tropicamide 1% instilled every ten minutes for thirty minutes and the fundus was examined with Volk 90D lens. Classification of diabetic retinopathy was done using the International clinical diabetic retinopathy disease severity scale study. The data was analyzed using Statistical package for social Science (SPSS version 20) and a p value of < 0.05 was taken as statistically significant. Results: There were a total number of 570 patients included in this study. Amongst them 325 were males and 245 were females. Out of these patients those that who were found to have diabetic retinopathy were 315 (55.3%).The age range was between 25 and 75 years and the mean age was 52.30 ± 9.333.Patients that were found to have mild non proliferative diabetic retinopathy were 231(40.5% ) while 33 (5.8%) had moderate non-proliferative diabetic retinopathy,11(1.9%) had severe non-proliferative diabetic retinopathy and 40 (7.0)% had proliferative diabetic retinopathy. Diabetic Maculopathy was seen in a total number of 72(12.6%) of patients. Conclusions: Diabetic retinopathy is highly prevalent in Karachi, Pakistan thus it is vital to detect as well as manage the disease early so as to prevent the onset of blindness in relation to it. (author)

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

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Célia Regina Farias de Araújo Lucena

2013-02-01

Full Text Available PURPOSE: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. METHODS: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group. In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2, and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-µm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection. Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums. RESULTS: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM was 4.7 ± 2.1 and was significantly lower (p<0.0001 than mean panretinal photocoagulation pain (60.8 ± 7.8. Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. CONCLUSION: In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment

VISUALIZATION FROM INTRAOPERATIVE SWEPT-SOURCE MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY IN VITRECTOMY FOR COMPLICATIONS OF PROLIFERATIVE DIABETIC RETINOPATHY.

Science.gov (United States)

Gabr, Hesham; Chen, Xi; Zevallos-Carrasco, Oscar M; Viehland, Christian; Dandrige, Alexandria; Sarin, Neeru; Mahmoud, Tamer H; Vajzovic, Lejla; Izatt, Joseph A; Toth, Cynthia A

2018-01-10

To evaluate the use of live volumetric (4D) intraoperative swept-source microscope-integrated optical coherence tomography in vitrectomy for proliferative diabetic retinopathy complications. In this prospective study, we analyzed a subgroup of patients with proliferative diabetic retinopathy complications who required vitrectomy and who were imaged by the research swept-source microscope-integrated optical coherence tomography system. In near real time, images were displayed in stereo heads-up display facilitating intraoperative surgeon feedback. Postoperative review included scoring image quality, identifying different diabetic retinopathy-associated pathologies and reviewing the intraoperatively documented surgeon feedback. Twenty eyes were included. Indications for vitrectomy were tractional retinal detachment (16 eyes), combined tractional-rhegmatogenous retinal detachment (2 eyes), and vitreous hemorrhage (2 eyes). Useful, good-quality 2D (B-scans) and 4D images were obtained in 16/20 eyes (80%). In these eyes, multiple diabetic retinopathy complications could be imaged. Swept-source microscope-integrated optical coherence tomography provided surgical guidance, e.g., in identifying dissection planes under fibrovascular membranes, and in determining residual membranes and traction that would benefit from additional peeling. In 4/20 eyes (20%), acceptable images were captured, but they were not useful due to high tractional retinal detachment elevation which was challenging for imaging. Swept-source microscope-integrated optical coherence tomography can provide important guidance during surgery for proliferative diabetic retinopathy complications through intraoperative identification of different complications and facilitation of intraoperative decision making.

Risk factors for diabetic retinopathy in Kuwaiti type 2 diabetic patients

International Nuclear Information System (INIS)

Al-Adsani, Afaf M.S.

2007-01-01

To determine the risk factors associated with diabetic retinopathy in Kuwaiti subjects with type 2 diabetes. Kuwaiti subjects with type 2 diabetes (n=165) attending the Diabetic Clinic at Al-sabah Hospital, Kuwait between October 2000 and March 2005 were screened for diabetic retinopathy. Any diabetic retinopathy was found in 40% while 20.6% had sight threatening retinopathy. Mild NPDR was present in 21.2%, moderate to severe non-proliferative diabetic retinopathy (NPDR) in 7.9%, and proliferative diabetic retinopathy in 3.0%. Maculopathy was present in 10.3% and 7.9 % pf patients were photocoagulated. Compared to those without retinopathy, diabetic patients with any retinopathy were significantly older (51.7+-10.3 versus 47.2+-9.5 years; p<0.005), had longer duration of diabetes (13.1+-6.3 versus 4.7 +-5.4 years; p<0.0001), higher systolic blood pressure (142.9+-23.0 versus 130.3+-20.2; p<0.0001) and poor glycemic control (Hemoglobin A1c=10.1+-2.4 versus 8.9+-2.3; p<0.005). The prevalence of hypertension and nephropathy was significantly higher in patients with any retinopathy than those without retinopathy (70.8% versus 49.5%; p<0.01 and 64.4% versus 30.8%; p<0.0001) respectively. Longer duration of diabetes and presence of nephropathy was the most significant independent factors associated with any retinopathy and sight-threatening retinopathy. Treatment with sulphonylurea or insulin, and poor glycemic control were other significant independent factors associated with any retinopathy. Longer duration of diabetes, presence of nephropathy, glycemic control and mode of treatment were the most significant independent factors of diabetic retinopathy. However, population-based study is warranted to identify the risk factors, as well as the prevalence of diabetic retinopathy. (author)

Evaluation the index of ophthalmic arteries in diabetic patients with retinopathy compared to diabetic patients without retinopathy using color Doppler ultrasound

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Mohammad Ghasem Hanafi

2016-12-01

Full Text Available Diabetic retinopathy is the most common eye complication in diabetic patients that early detection of this complication is essential. The aim of this study was to evaluate ophthalmic artery index in diabetic retinopathy by Doppler ultrasound. . In this cross-sectional study, 64 patients were studied in 4 groups (healthy, diabetic without retinopathy, background retinopathy and proliferative retinopathy. Resistance index (RI and Pulsatile Index (PI were assessed by color Doppler ultrasound. The obtained data were analyzed by ANOVA and chi-square test and ROC curve. RI in diabetic patients with proliferative retinopathy has the highest mean (0.83 and the lowest mean was observed in healthy subjects (0.54 (P <0.001 as well as in PI, the highest rate was in diabetic patients with proliferative retinopathy (1.41 and the lowest was in healthy subjects (0.92 (P <0.001. The results of our study showed that the sensitivity, specificity, positive and negative predictive values and overall accuracy of RI and PI in diabetic patients with proliferative retinopathy in the best cut-off points (0.645 and 1.0175 respectively were 100%.Ophthalmic artery index RI and PI was significantly increased in patients with diabetic retinopathy and the sensitivity and specificity for detection retinopathy was 100%. Color Doppler ultrasound method is more efficient for screening diabetic patients with retinopathy.

PREVALENCE OF DIABETIC RETINOPATHY IN PATIENTS WITH NEWLY DIAGNOSED TYPE II DIABETES MELLITUS

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A. Bostak

2006-11-01

Full Text Available Diabetic retinopathy is a common complication of type II diabetes mellitus and carries with it the threat of blindness. Accurate information regarding the incidence of diabetic retinopathy and associated risk factors is important in the prevention of its development and of the visual impairment caused by this complication. This study was designed to determine the prevalence of diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus. We have also evaluated the association of diabetic retinopathy with clinical and biochemical variables. In a cross-sectional study, 152 consecutive patients with newly diagnosed type II diabetes mellitus were referred from two outpatient clinics in Tehran for ophthalmologic exam to detect retinopathy. Indirect ophthalmoscopy was performed and data regarding risk factors were extracted from routine medical records. Chi square and Mann Whitney U tests were used to analyze the data. The overall prevalence of diabetic retinopathy was 13.8 %( 21 cases: three cases with microaneurysm only, 10 with mild, 5 with moderate and 2 with severe non proliferative diabetic retinopathy. Only one patient had advanced proliferative retinopathy. The prevalence of diabetic retinopathy was positively associated with age, duration of disease, fasting plasma glucose, HbA1c, and systolic blood pressure. Diabetic retinopathy is common in newly diagnosed type II diabetes mellitus patients. Ophthalmologic consultation is essential at the time of diagnosis for all patients.

Diabetic Retinopathy: Nature and Extent.

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Coughlin, W. Ronald; Patz, Arnall

1978-01-01

The authors discuss the incidence and prevalence of diabetic retinopathy in juvenile and maturity onset diabetics, background and proliferative retinopathy, and current modalities of treatment. (Author)

Automated detection of neovascularization for proliferative diabetic retinopathy screening.

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Roychowdhury, Sohini; Koozekanani, Dara D; Parhi, Keshab K

2016-08-01

Neovascularization is the primary manifestation of proliferative diabetic retinopathy (PDR) that can lead to acquired blindness. This paper presents a novel method that classifies neovascularizations in the 1-optic disc (OD) diameter region (NVD) and elsewhere (NVE) separately to achieve low false positive rates of neovascularization classification. First, the OD region and blood vessels are extracted. Next, the major blood vessel segments in the 1-OD diameter region are classified for NVD, and minor blood vessel segments elsewhere are classified for NVE. For NVD and NVE classifications, optimal region-based feature sets of 10 and 6 features, respectively, are used. The proposed method achieves classification sensitivity, specificity and accuracy for NVD and NVE of 74%, 98.2%, 87.6%, and 61%, 97.5%, 92.1%, respectively. Also, the proposed method achieves 86.4% sensitivity and 76% specificity for screening images with PDR from public and local data sets. Thus, the proposed NVD and NVE detection methods can play a key role in automated screening and prioritization of patients with diabetic retinopathy.

Early diagnosis of diabetic retinopathy in primary care.

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Jimenez-Baez, Maria Valeria; Marquez-Gonzalez, Horacio; Barcenas-Contreras, Rodolfo; Morales Montoya, Carlos; Espinosa-Garcia, Laura Fatima

2015-01-01

To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México. Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed. In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women. The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.

DIABETIC RETINOPATHY AND THE EFFECT OF PREGNANCY

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SYED ALWI SAR

2010-01-01

Full Text Available Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR. Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease inpregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.

Lack of relationship between an insertion/deletion polymorphism in the angiotensin I-converting enzyme gene and diabetic nephropathy and proliferative retinopathy in IDDM patients

DEFF Research Database (Denmark)

Tarnow, L; Cambien, Francois; Rossing, P

1995-01-01

Genotypic abnormalities of the renin-angiotensin system have been suggested as a risk factor for the development of diabetic nephropathy and proliferative retinopathy. We studied the relationship between an insertion(I)/deletion (D) polymorphism in the angiotensin-converting enzyme (ACE) gene...... (40%) had proliferative retinopathy, and 67 patients (17%) had no diabetic retinopathy. There was no difference in genotype distribution between IDDM patients with diabetic nephropathy and those with normalbuminuria: 63 (32%)/95 (48%)/40 (20%) vs. 67 (35%)/77 (41%)/46 (24%) had DD/ID/II genotypes...... by ACE/ID polymorphism, mean arterial blood pressure, and glomerular filtration rate (r2 = 0.30, P retinopathy and those without diabetic retinopathy: 52 (34%)/74 (48%)/29 (19%) vs. 26 (39%)/25 (37...

The expression of the Slit-Robo signal in the retina of diabetic rats and the vitreous or fibrovascular retinal membranes of patients with proliferative diabetic retinopathy.

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Zhou, Weiyan; Wang, Hongya; Yu, Wenzhen; Xie, Wankun; Zhao, Min; Huang, Lvzhen; Li, Xiaoxin

2017-01-01

The Slit-Robo signal has an important role in vasculogenesis and angiogenesis. Our study examined the expression of Slit2 and its receptor, Robo1, in a rat model of streptozotocin-induced diabetes and in patients with proliferative diabetic retinopathy. Diabetes was induced in male Sprague-Dawley rats via a single, intraperitoneal injection of streptozotocin. The rats were sacrificed 1, 3 or 6 months after the injection. The expression of Slit2 and Robo1 in retinal tissue was measured by real-time reverse transcription polymerase chain reaction (RT-PCR), and protein levels were measured by western blotting and immunohistochemistry. Recombinant N-Slit2 protein was used to study the effects of Slit2 on the expression of VEGF in vivo. The concentration of Slit2 protein in human eyes was measured by enzyme-linked immunosorbent assay in 27 eyes with proliferative diabetic retinopathy and 28 eyes in control group. The expression of Slit2, Robo1 and VEGF in the excised human fibrovascular membranes was examined by fluorescence immunostaining and semi-quantitative RT-PCR. The expression of Slit2 and Robo1 in the retina was altered after STZ injection. Recombinant N-Slit2 protein did not increase the retinal VEGF expression. Vitreous concentrations of Slit2 were significantly higher in the study group than in the control group. In the human fibrovascular membranes of the study group, the co-localization of VEGF with the markers for Slit2 and Robo1was observed. The expression of Slit2 mRNA, Robo1 mRNA, and VEGF mRNA was significantly higher in human fibrovascular proliferative diabetic retinopathy membranes than in the control membranes. The alteration of Slit2 and Robo1 expression in the retinas of diabetic rats and patients with proliferative diabetic retinopathy suggests a role for the Slit-Robo signal in the various stages diabetic retinopathy. Further studies should address the possible involvement of the Slit-Robo signal in the pathophysiological progress of diabetic

Serum MiRNA Biomarkers serve as a Fingerprint for Proliferative Diabetic Retinopathy

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Shao Qing

2014-11-01

Full Text Available Background: Diabetic retinopathy (DR is a retinopathy resulting from diabetes mellitus (DM which was classified into non-proliferative DR (NPDR and proliferative DR (PDR. Without an early screening and effective diagnosis, patients with PDR will develop serious complications. Therefore, we sought to identify special serum microRNAs (miRNAs that can serve as a novel non-invasive screening signature of PDR and test its specificity and sensitivity in the early diagnosis of PDR. Methods: In total, we obtained serum samples from 90 PDR cases, 90 matched NPDR patients and 20 controls. An initial screening of miRNA expression was performed through TaqMan Low Density Array (TLDA. The candidate miRNAs were validated by individual reverse transcription quantitative real-time PCR (RT-qPCR arranged in an initial and a two-stage validation sets. Moreover, additional double-blind testing was performed in 20 patients clinically suspected of having DR to evaluate the diagnostic value and accuracy of the serum miRNA profiling system in predicting PDR. Results: Three miRNAs were significantly increased in patients with PDR compared with NPDR after the multiple stages. The areas under the receiver operating characteristic (ROC curves of the validated three-serum miRNAs signature were 0.830, 0.803 and 0.873 in the initial and two validation sets, respectively. Combination of miR-21, miR-181c, and miR-1179 possessed a moderate ability to discrimination between PDR and NPDR with an area under ROC value of 0.89. The accuracy rate of the three-miRNA profile as PDR signature was 82.6%. Conclusions: These data provide evidence that serum miRNAs have the potential to be sensitive, cost-effective biomarkers for the early detection of PDR. These biomarkers could serve as a dynamic monitoring factor for detecting the progression of PDR from NPDR.

[Effect of internal limiting membrane peeling on morpho-functional state of the retina in patients with proliferative diabetic retinopathy (preliminary report)].

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Bikbov, M M; Fayzrakhmanov, R R; Kalanov, M R

2018-01-01

To compare morpho-functional parameters of retina during vitrectomy with and without internal limiting membrane (ILM) peeling in patients with proliferative diabetic retinopathy. The study included 55 patients (55 eyes) that had underwent vitreoretinal surgery in the setting of antivasoproliferative therapy for proliferative diabetic retinopathy. Patients of the 1 st group (n=27) underwent vitrectomy with silicone tamponade, 2 nd group (n=28) received similar treatment with the addition of ILM peeling. Three months after the treatment, all patients had silicone oil removed. Best Corrected Visual Acuity before treatment was 0.06±0.02 in both groups; after the treatment it improved to 0.1±0.05 (ppeeling during vitrectomy with following silicone oil tamponade eliminates the risk of ERM formation in patients with proliferative diabetic retinopathy in the follow-up period of up to 6-month and results in better morpho-functional parameters in comparison with patients who received similar treatment but without peeling.

Vitrectomy for proliferative diabetic retinopathy

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Chao Peng

2013-10-01

Full Text Available AIM:To observe the clinical effect of vitrectomy for proliferative diabetic retinopathy(PDR.METHODS: The clinical data of 55 cases(65 eyes, underwent vitrectomy, membrane peeling, endolaser photocoagulation and silicone oil or C3F8 injection, were retrospectively studied. During 6 months to 1 year follow-up period, visual acuity, intraocular pressure, retinal conditions and complications were observed.RESULTS: All 65 eyes received vitrectomy, of which silicone oil was tamponaded in 32 eyes, C3F8 was injected in 8 eyes, BBS was filled in 25 eyes. Visual improvement achieved in 42 eyes. Two eyes were manually vision, form count fingers to 0.05 in 18 eyes, >0.05-0.1 in 28 eyes, >0.1-0.3 in 12 eyes and >0.3 in 5 eyes. Retinal hole was occurred in 7 eyes, limitations fibrosis membrane remained in 8 eyes, retinal detachment appeared in 5 eyes, IOP increased in 18 eyes, vitreous hemorrhage relapsed in 12 eyes, 36 eyes received supplemental photocoagulation treatment 1-3 times after operation.CONCLUSION:Vitrectomy combined endophotocoagulation is an effective treatment for PDR. Silicone oil tamponade can limit the hemorrhage.

Regional differences in the prevalence of diabetic retinopathy: a multi center study in Brazil.

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Drummond, Karla Rezende Guerra; Malerbi, Fernando Korn; Morales, Paulo Henrique; Mattos, Tessa Cerqueira Lemos; Pinheiro, André Araújo; Mallmann, Felipe; Perez, Ricardo Vessoni; Leal, Franz Schubert Lopes; de Melo, Laura Gomes Nunes; Gomes, Marília Brito

2018-01-01

Diabetic retinopathy has a significant impact in every healthcare system. Despite that fact, there are few accurate estimates in the prevalence of DR in Brazil's different geographic regions, particularly proliferative DR and diabetic macular edema. This study aims to determine the prevalence of diabetic retinopathy in Brazil's five continental regions and its determinant factors. This multi center, cross-sectional, observational study, conducted between August 2011 and December 2014, included patients with type 1 diabetes from the 5 Brazilian geographic regions (South, Southeast, North, Northeast and Midwest). During a clinical visit, a structured questionnaire was applied, blood sampling was collected and each patient underwent mydriatic binocular indirect ophthalmoscopy evaluation. Data was obtained from 1644 patients, aged 30.2 ± 12 years (56.1% female, 54.4% Caucasian), with a diabetes duration of 15.5 ± 9.3 years. The prevalence of diabetic retinopathy was 242 (36.1%) in the Southeast, 102 (42.9%) in the South, 183 (29.9%) in the North and Northeast and 54 (41.7%) in the Midwest. Multinomial regression showed no difference in the prevalence of non-proliferative diabetic retinopathy in each geographic region, although, prevalence of proliferative diabetic retinopathy (p = 0.022), and diabetic macular edema (p = 0.003) was higher in the Midwest. Stepwise analyses reviled duration of diabetes, level of HbA1c and hypertension as independent variables. The prevalence of non proliferative diabetic retinopathy in patients with type 1 diabetes was no different between each geographic region of Brazil. The Midwest presented higher prevalence of proliferative diabetic retinopathy and diabetic macular edema. Duration of DM and glycemic control is of central importance to all. Hypertension is another fundamental factor to every region, at special in the South and Southeast. Glycemic control and patients in social and economic vulnerability deserves

Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.

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Sellman, A; Katzman, P; Andreasson, S; Löndahl, M

2018-05-23

To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (Pdiabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; Pdiabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to diabetic retinopathy was linked to worse visual acuity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Is there any correlation between vitamin D insufficiency and diabetic retinopathy?

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Shokoufeh; Bonakdaran; Nasser; Shoeibi

2015-01-01

AIM: To determine a relation between vitamin D level,which is an inhibitor of angiogenesis, and diabetic retinopathy and its risk factorsMETHODS: In a clinic-based cross sectional study two hundred and thirty-five type 2 diabetic patients older than 20 y were selected. Patients were classified according to ophthalmologic examination as following:no diabetic retinopathy(NDR)(n =153), non-proliferative diabetic retinopathy(NPDR)(n =64) and proliferative diabetic retinopathy(PDR)(n =18). Study subjects were tested for fasting blood glucose, glycated hemoglobin A1C(Hb A1C), lipid profile, microalbuminuria, Hs CRP,IGF1, insulin(in patients without history of insulin taking)and 25 hydroxy vitamin D [25(OH) D] levels. Vitamin D insufficiency was defined according to 25(OH) D level less than 30 ng/m L. The relationship between diabetic retinopathy and serum 25(OH) D insufficiency was evaluated.RESULTS: The prevalence of diabetic retinopathy was34.8% in our patients. Long duration of diabetes,hypertension, poor glycemic control, diabetic nephropathy, hyperinsulinemia and insulin resistance were risk factors for diabetic retinopathy but 25(OH) D level was not significant different between NDR, NPDR and PDR groups. Correlation between 25(OH) D level and other known risk factors of diabetic retinopathy was not significant.CONCLUSION: This study did not find any association between diabetic retinopathy and its severity and vitamin D insufficiency. Vitamin D insufficiency is not related to risk factors of diabetic retinopathy.

Surgical management of retinal diseases: proliferative diabetic retinopathy and traction retinal detachment.

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Cruz-Iñigo, Yousef J; Acabá, Luis A; Berrocal, Maria H

2014-01-01

Current indications for pars plana vitrectomy in patients with proliferative diabetic retinopathy (PDR) include vitreous hemorrhage, tractional retinal detachment (TRD), combined tractional and rhegmatogenous retinal detachment (CTRRD), diabetic macular edema associated with posterior hyaloidal traction, and anterior segment neovascularization with media opacities. This chapter will review the indications, surgical objectives, adjunctive pharmacotherapy, microincision surgical techniques, and outcomes of diabetic vitrectomy for PDR, TRD, and CTRRD. With the availability of new microincision vitrectomy technology, wide-angle microscope viewing systems, and pharmacologic agents, vitrectomy can improve visual acuity and achieve long-term anatomic stability in eyes with severe complications from PDR. © 2014 S. Karger AG, Basel

Observations on the relationship between the levels of serum IL-6 and TNF-α and the severity of diabetic retinopathy and curative effect in cataract extraction with intraocular lens implantation in diabetics

International Nuclear Information System (INIS)

Wang Yumin; Ma Xinying; Song Yuebing; Liang Yong; Zhang Xiaoguang

2001-01-01

Objective: To determine the sequential changes of blood levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in diabetics with extracapsular extraction and posterior chamber intraocular lens implantation and to study their correlation with curative effects and pos-operative complications. Methods: The serum concentrations of IL-6 and TNF-α in 39 diabetics and non-diabetics were measured by radioimmunoassay at preoperative, post-operative and on days 7, 14 and 90 postoperatively. Results: There was significant difference in the levels of the two factors between the diabetic group and non-diabetic group preoperatively (P<0.05). The serum levels of the two factors in patients with proliferative diabetic retinopathy were higher than those in non-diabetic retinopathy, and simple diabetic retinopathy post-operative (P<0.01). Post-operative complication rate was higher in patients with proliferative diabetic retinopathy than those without retinopathy and those having simple diabetic retinopathy. Conclusion: The levels of the two factors correlate with complications and curative effect of patients with proliferative diabetic retinopathy undergoing intraocular lens implantation

APPROACHES TO THE CONSTRUCTION OF THE VITRECTOMY RISK MANAGEMENT SYSTEM IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY

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A. M. Ruban

2016-08-01

Full Text Available The article presents the some approaches to create a system support of making decision during vitrectomy in patients with diabetic proliferative retinopathy, promotes objective assessment of individual risk-management for patient and allows optimize ophthalmological care for them.

The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal.

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Mishra, S K; Pant, B P; Subedi, P

2016-01-01

Background The worldwide prevalence of diabetic retinopathy (DR) was found to be 34.6%. WHO estimates that DR is responsible for 4.8% of the 37 million cases of blindness throughout the world. In a study undertaken in urban population in Nepal, M.D. Bhattarai found the prevalence of diabetes among people aged 20 years and above to be 14.6% and the prevalence among people aged 40 years and above to be 19%. Studies on DR, to our knowledge, have mostly been hospital based in Nepal. Little information is available about prevalence of DR at the community level in Nepal. Objective To investigate the prevalence of diabetic retinopathy and associated risk factors among known diabetic population of Nepal. Method A descriptive cross sectional study was conducted among individuals aged 30 and more using cluster sampling method. The study sites were Kathmandu metropolitan city and Birgunj sub-metropolitan city. A sample size of 5400 was calculated assuming 5% prevalence rate with 95% confidence level, 5% worst acceptable level and 1.5 cluster sampling design effect. Study participants were interviewed, anthropometric measurements and fundus photograph was taken from participants with diabetes. Fundus photographs were used to grade retinopathy. Result Around 12% of the respondents were diabetic, mean age 55.43±11.86 years, of which slightly more than half were females (50.2%). Among these diabetic respondents 9.9% had some forms of diabetic retinopathy, mean age 54.08±10.34 years, 56.7% were male. When severe grade of retinopathy in any eye was considered as overall grade of retinopathy for the individual, prevalence of Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy and complete vision loss was found to be 9.1%, 0.5% and 0.3%. Prevalence of Diabetic Macular Edema was 5.5%. Duration of diabetes, family history of diabetes and blood pressure at the day of survey was found to be associated with having any retinopathy. Conclusion Diabetic retinopathy

Relation of retinopathy in patients with type 2 diabetes mellitus to other diabetic complications

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Shu-Hui Chen

2016-02-01

Full Text Available AIM: To investigate the correlation between systemic complications and diabetic retinopathy in the patients with type 2 diabetes mellitus.METHODS: Seven hundred and two hospitalized patients with type 2 diabetes were included. All patients were divided into two groups according to with or without retinopathy: NDR group and DR group. DR group was divided into group non-proliferative diabetic retinopathy(NPDRand group proliferative diabetic retinopathy(PDR. The relation between DR and other complications of diabetes, including diabetic macrovascular complications, diabetic nephropathy(DN, diabetic peripheral neuropathy(DPN, peripheral vascular disease of diabetes mellitus(PVD, diabetic foot(DF, diabetic ketoacidosis(DKA, was analyzed.RESULTS: The development of DR was related to hypertension, hyperlipemia, carotid atherosclerosis and plaque, lower extremity arteriosclerosis and plaque, DN, DPN, DF and PVD. PDR was closely associated with hypertension and DPN. CONCLUSION: The prevalence of DR increased in the diabetic patients with systemic complications, especially, the increase of prevalence of PDR in the patients with hypertension and DPN. Vascular endothelial injury and microcirculatory disturbance are the common pathologic base for DR and other complications. Therefore, it is important to carry out the regular fundus examination in the diabetic patients, especially in those with systemic complication, in order to decrease the rate of blindness.

Role of direct funduscopy in screening for diabetic retinopathy in communities

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Li-Hua Guo

2016-03-01

Full Text Available AIM:To observe the application of direct funduscopy in screening for diabetic retinopathy in communities. METHODS:After mydriasis, 265 patients with diabetes mellitus(DMin communities were examined for fundus by direct funduscopy. The patients with diabetic retinopathy(DRwere further received fluorescence fundus angiography(FFAafter referral to superior hospitals.RESULTS:Within the 265 patients with DM, 79 patients were diagnosed as DR and the positive rate of DR was 29.8%. Among the patients with DR, there were 46 patients with non- proliferative diabetic retinopathy(NPDRand 33 patients with proliferative diabetic retinopathy(PDR; the positive rate was respectively 17.4% and 12.5%. All patients with DR were further diagnosed by FFA after referral. Three patients with NPDR were diagnosed with PDR, and 22 patients received laser treatment.CONCLUSION:Ordinary application of direct funduscopy in patients with DM in communities would early detect the DR. It is very necessary to master direct funduscopy for general practitioners.

Levels of serum vascular endothelial growth factor in type 2 diabetics with retinopathy

International Nuclear Information System (INIS)

Parveen, N.; Rahman, S.; Khan, Q.

2012-01-01

Background: Ischemic retina in diabetic patients releases a number of chemical substances including vascular endothelial growth factor which leads to retinal vascular proliferation and blindness following rupture and bleeding of vessels. Strategies to control this action can considerably halt this process. Objectives: To determine the relationship of various stages of diabetic retinopathy with the levels vascular endothelial growth factor in the serum of type 2 diabetic patients. Study type, settings and duration: This cross sectional analytical study was done over one year (2010-2011) in three major public sector hospitals of Peshawar. Patients and Methods: Adult patients of either gender having type 2 diabetes mellitus with proliferative or non proliferative retinopathy and those without retinopathy were selected for the study. Retinopathy was diagnosed on fundoscopy. Non-diabetic patients without retinopathy were selected as controls. Serum levels of vascular endothelial growth factor were done in patients and controls using ELISA. Results: Serum vascular endothelial growth factor levels were significantly higher in all cases having retinopathy as compared to controls. These levels progressively increased with the grades of retinopathy. Levels were higher in females. Conclusions: Levels of vascular endothelial growth factor are raised in diabetic retinopathy and rising levels can alert the clinician in worsening of retinopathy so that preventive and therapeutic measures can be taken promptly. Policy message: Further larger scale studies are recommended on national level to pave way for the establishment of appropriate management paradigms for diabetic retinopathy through anti-VEGF treatment. (author)

Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project.

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Brazionis, L; Jenkins, A; Keech, A; Ryan, C; Brown, A; Boffa, J; Bursell, S

2018-05-01

To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and

Prevalence of diabetes mellitus and diabetic retinopathy in Filipino vs Caucasian Americans: a retrospective cross-sectional epidemiologic study of two convenience samples.

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Sáles, Christopher S; Lee, Roland Y; Agadzi, Anthony K; Hee, Michael R; Singh, Kuldev; Lin, Shan C

2012-01-01

To compare the prevalence of diabetic retinopathy in Filipino and Caucasian Americans in two clinic populations. Retrospective cross-sectional epidemiologic study of two convenience samples. Five hundred twelve Filipino and 600 Caucasian patients aged 40 years or older examined by two community-based comprehensive ophthalmology clinics during a one-year period. The prevalence of self-reported type 2 diabetes mellitus among Filipino (F) and Caucasian Americans (C) was 40.6% and 24.8%, respectively (PFilipino; 149 Caucasian), there was a statistically insignificant higher prevalence of diabetic retinopathy among Filipino diabetics compared to Caucasians (F vs C: all forms of diabetic retinopathy, 24.5% vs 16.8%, P=.08; non-proliferative retinopathy, 17.3% vs 12.8%, P=.24; proliferative retinopathy, 7.2% vs. 4.0%, P=.21). In multivariate analyses of the diabetic subpopulation, Filipino ethnicity was not a significant predictor of diabetic retinopathy. Filipino Americans may have a higher prevalence of type 2 diabetes mellitus and diabetic retinopathy than Caucasian Americans. Among those with type 2 diabetes, however, Filipino Americans were not found to be more likely to show manifestations of diabetic retinopathy than Caucasian Americans.

Is Smoking a Risk Factor for Proliferative Diabetic Retinopathy in Type 1 Diabetes?

DEFF Research Database (Denmark)

Gaedt Thorlund, Mie; Borg Madsen, Mette; Green, Anders

2013-01-01

were asked about their smoking habits. The level of retinopathy was evaluated by ophthalmoscopy at baseline and by nine 45-degree colour field fundus photos at the follow-up. Results: In multivariate analyses there was a trend that current smokers at baseline were more likely to develop PDR......Aim: The aim was to evaluate if smoking was a risk factor for proliferative retinopathy (PDR) in a 25-year follow-up study. Methods: 201 persons from a population-based cohort of Danish type 1 diabetic patients were examined at baseline and again 25 years later. At both examinations the patients...... at the follow-up (odds ratio 1.90, 95% confidence interval 0.88-4.11, p = 0.10). Neither smoking status at the follow-up nor pack-years of smoking were associated with PDR. Conclusions: We found neither a beneficial nor a harmful effect of smoking on long-term incidence. Selective mortality among smokers...

DIAGNOSIS OF DIABETIC RETINOPATHY USING MACHINE LEARNING TECHNIQUES

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R. Priya

2013-07-01

Full Text Available Diabetic retinopathy (DR is an eye disease caused by the complication of diabetes and we should detect it early for effective treatment. As diabetes progresses, the vision of a patient may start to deteriorate and lead to diabetic retinopathy. As a result, two groups were identified, namely non-proliferative diabetic retinopathy (NPDR and proliferative diabetic retinopathy (PDR. In this paper, to diagnose diabetic retinopathy, three models like Probabilistic Neural network (PNN, Bayesian Classification and Support vector machine (SVM are described and their performances are compared. The amount of the disease spread in the retina can be identified by extracting the features of the retina. The features like blood vessels, haemmoraghes of NPDR image and exudates of PDR image are extracted from the raw images using the image processing techniques and fed to the classifier for classification. A total of 350 fundus images were used, out of which 100 were used for training and 250 images were used for testing. Experimental results show that PNN has an accuracy of 89.6 % Bayes Classifier has an accuracy of 94.4% and SVM has an accuracy of 97.6%. This infers that the SVM model outperforms all other models. Also our system is also run on 130 images available from “DIARETDB0: Evaluation Database and Methodology for Diabetic Retinopathy” and the results show that PNN has an accuracy of 87.69% Bayes Classifier has an accuracy of 90.76% and SVM has an accuracy of 95.38%.

Frequency of diabetic retinopathy in patients after ten years of diagnosis of type 2 diabetes mellitus

International Nuclear Information System (INIS)

Shaikh, M.A.; Yakta, D.E.

2010-01-01

Background: Diabetic retinopathy is one of the most common and serious complications of type 2 diabetes mellitus and a leading cause of blindness not only in Pakistan but also worldwide. So we conducted this study to record the frequency of diabetic retinopathy in known diabetic patients ten years after diagnosis of type 2 diabetes mellitus. Methods: The study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan for a period of 1 year from January 2008 to January 2010. The study group comprised of 200 patients of type 2 diabetes mellitus attending the medical clinic. All patients who were diagnosed as type 2 diabetes mellitus since ten years duration were included in the study. Retinopathy was graded into background, pre proliferative and proliferative retinopathy. Type 2 diabetes was diagnosed using the WHO criteria. Statistical analysis was carried out using the SPSS-11. Results: Diabetic retinopathy was found in 25.5% of the total Type 2 patients after ten years of diagnosis, and of these 4% of patients had proliferative retinopathy. Conclusion: Type 2 diabetic patients should be screened as early as possible to prevent permanent visual loss by timely management of diabetic retinopathy because diabetes is one of most common preventable cause of blindness in the world. (author)

Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis

DEFF Research Database (Denmark)

Wong, Tien Y; Mwamburi, Mkaya; Klein, Ronald

2009-01-01

This meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends.......This meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends....

MicroRNA-126:a promising novel biomarker in peripheral blood for diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

Li-Li; Qin; Mei-Xia; An; Yan-Li; Liu; Han-Chun; Xu; Zhi-Qing; Lu

2017-01-01

AIM:To investigate the content of serum micro RNA-126(mi R-126) and its role in screening retinal endothelial injury and early diagnosis of proliferative diabetic retinopathy.METHODS:The study included 184 serum samples,59 samples from healthy individuals,44 samples from diabetes mellitus(DM) patients without diabetic retinopathy(NDR),42 from non-proliferative diabetic retinopathy(NPDR) patients and 39 samples from proliferative diabetic retinopathy(PDR) patients.The expression of mi R-126 was evaluated using a real-time quantitative polymerase chain reaction.RESULTS:The serum content of mi R-126 declined as the damage degree in the retina.There was significant difference between the two retinopathy groups(P0.05).Receiver operating characteristic curve(ROC) analyses indicated that serum mi R-126 had significant diagnostic value for PDR.It yielded an area under the curve(AUC) of ROC of 0.976 with 81.21% sensitivity and 90.34% specificity in discriminating PDR from healthy controls,and an AUC of ROC of 0.919 with 84.75% sensitivity and 94.41% specificity in discriminating NDR and NPDR from healthy controls.When the diagnostic threshold was greater than or equal to 8.43,there was an increase in the possibility of NPDR.When the content of mi R-126 was less than or equal to 5.02,the possibility of the occurrence of PDR increased.CONCLUSION:Serum mi R-126 can serve as a non-invasive biomarker for screening retinal endothelial injury and early diagnosis PDR.

Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

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Burgess, P I; MacCormick, I J C; Harding, S P; Bastawrous, A; Beare, N A V; Garner, P

2013-01-01

Abstract Aim To summarize findings from studies reporting the prevalence and incidence of diabetic retinopathy and diabetic maculopathy in African countries in light of the rising prevalence of diabetes mellitus. Methods Using a predefined search strategy, we systematically searched MEDLINE, EMBASE, Science Citation index and Conference Proceedings Citation index, African Index Medicus and the grey literature database ‘OpenSIGLE’ for studies published between January 1990 and February 2011. Included studies reported prevalence or incidence of diabetic retinopathy or diabetic maculopathy of subjects with diabetes resident in African countries. Results Sixty-two studies from 21 countries were included: three population-based surveys; two cohort studies; five case–control studies; 32 diabetes clinic-based, nine eye clinic-based and 11 other hospital-based surveys. Included studies varied considerably in terms of patient selection, method of assessing the eye and retinopathy classification. In population-based studies, the reported prevalence range in patients with diabetes for diabetic retinopathy was 30.2 to 31.6%, proliferative diabetic retinopathy 0.9 to 1.3%, and any maculopathy 1.2 to 4.5%. In diabetes clinic-based surveys, the reported prevalence range for diabetic retinopathy was 7.0 to 62.4%, proliferative diabetic retinopathy 0 to 6.9%, and any maculopathy 1.2 to 31.1%. No obvious association between prevalence and income level of the country was detected. Conclusions Large, community-based cross-sectional and cohort studies are needed to investigate rates and determinants of prevalence of diabetic retinopathy, incidence and progression in Africa. Consensus is needed on the most appropriate methods of identification and classification of retinopathy for research and clinical practice. Estimates of prevalence of diabetic retinopathy, proliferative diabetic retinopathy and maculopathy are comparable with recent European and American studies. PMID:22817387

Ultrastructure of neurovascular changes in human diabetic retinopathy.

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Fehér, János; Taurone, Samanta; Spoletini, Marialuisa; Biró, Zsolt; Varsányi, Balázs; Scuderi, Gianluca; Orlando, Maria Patrizia; Turchetta, Rosaria; Micera, Alessandra; Artico, Marco

2018-01-01

The previous concept regarding diabetic retinopathy assigned a primary role to hyperglycemia-induced microvascular alterations, while neuronal and glial abnormalities were considered to be secondary to either ischemia or exudation. The aim of this study was to reveal the potential role of neuronal and glial cells in initial and advanced alterations of the retinopathy in human type 2 diabetes. Electron microscopy and histochemical studies were performed on 38 surgically removed human eyes (28 obtained from diabetic patients and 10 from non-diabetic patients). Morphometric analysis of basement membrane material and lipids was performed. An accumulation of metabolic by-products was found in the capillary wall with aging: this aspect was significantly more pronounced in diabetics. Müller glial cells were found to contribute to alterations of the capillary wall and to occlusion, as well as to the development of proliferative retinopathy and cystoid degeneration of the retina. Our results showed morphological evidence regarding the role of neuronal and glial cells in the pathology of diabetic retinopathy, prior and in addition to microangiopathy. These morphological findings support a neurovascular pathogenesis at the origin of diabetic retinopathy, thus the current treatment approach should be completed by neuroprotective measures.

Fundus fluorescence Angiography in diagnosing diabetic retinopathy.

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Wang, Shuhui; Zuo, Yuqin; Wang, Ning; Tong, Bin

2017-01-01

To investigate the manifestation characteristics of fundus fluorescence angiography (FFA) and its values in diagnosing diabetic retinopathy through comparing direct ophthalmoscopy. Two hundred fifty patients (500 eyes) who were suspected as diabetic retinopathy and admitted to the hospital between February 2015 and December 2016 were selected. They underwent direct ophthalmoscopy and FFA. The manifestation characteristics of FFA in the diagnosis of diabetic retinopathy were summarized. The two examination methods were compared. In the diagnosis with direct ophthalmoscopy, 375 eyes out of 500 eyes were diagnosed as diabetic retinopathy (75%); there were 74 eyes at stage I, 88 eyes at stage II, 92 eyes at stage III, 83 eyes of stage IV, 28 eyes of stage V and 10 eyes of stage VI. In the diagnosis with FFA, 465 eyes out of 500 eyes were diagnosed as diabetic retinopathy (93%); there were 94 eyes at stage I, 110 eyes at stage II, 112 at stage III, 92 eyes at stage IV, 41 eyes at stage V and 16 eyes at stage VI. The detection rate of diabetic retinopathy using FFA was significantly higher than that using direct ophthalmoscopy (Pretinopathy (67.96%), 75 eyes had pre-proliferative lesions (16.13%), 149 eyes had proliferative lesions (32.04%), 135 eyes had diabetic maculopathy (29.03%) and 31 eyes had diabetic optic disc lesions (6.67%). The detection rate of diabetic retinopathy using FFA is higher than that using direct ophthalmoscopy. FFA could accurately determine clinical stage. Therefore, it is an important approach in treatment efficacy evaluation and treatment guidance, suggesting a significant application value.

The North Jutland County Diabetic Retinopathy Study (NCDRS). Population characteristics

DEFF Research Database (Denmark)

Knudsen, L.L.; Lervang, H.H.; Lundbye-Christensen, Søren

Abstract Purpose: Several population based studies have reported blood glucose levels and blood pressure to be risk factors for the development of proliferativ retinopathy and diabetic maculopathy. Despite their importance, these studies were initiated more than two decades ago and may therefore...... reflect the treatment and population composition of a previous era. Studies of the present diabetic population are therefore in demand. Methods: The present cross–section study included 656 type 1 and 328 type 2 diabetic subjects undergoing diabetic retinopathy screening. Crude prevalence rates...... for proliferative diabetic retinopathy, maculopathy, several specific lesions and non–ophthalmic findings were assessed together with their association to a simplified and internationally approved retinal grading. Results: The crude prevalence of proliferative retinopathy was found to be 5.6 % and 0.9 % for type 1...

Disrupted subject-specific gray matter network properties and cognitive dysfunction in type 1 diabetes patients with and without proliferative retinopathy

NARCIS (Netherlands)

van Duinkerken, Eelco; Ijzerman, Richard G.; Klein, Martin; Moll, Annette C.; Snoek, Frank J.; Scheltens, Philip; Pouwels, Petra J. W.; Barkhof, Frederik; Diamant, Michaela; Tijms, Betty M.

2016-01-01

Type 1 diabetes mellitus (T1DM) patients, especially with concomitant microvascular disease, such as proliferative retinopathy, have an increased risk of cognitive deficits. Local cortical gray matter volume reductions only partially explain these cognitive dysfunctions, possibly because volume

Neurotrophins and Neurotrophin Receptors in Proliferative Diabetic Retinopathy

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Abu El-Asrar, Ahmed M.; Mohammad, Ghulam; De Hertogh, Gert; Nawaz, Mohd Imtiaz; Van Den Eynde, Kathleen; Siddiquei, Mohammad Mairaj; Struyf, Sofie; Opdenakker, Ghislain; Geboes, Karel

2013-01-01

Neurotrophins (NTs) are emerging as important mediators of angiogenesis and fibrosis. We investigated the expression of the NTs nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4) and their receptors TrkA, TrkB, and TrkC in proliferative diabetic retinopathy (PDR). As a comparison, we examined the expression of NTs and their receptors in the retinas of diabetic rats. Vitreous samples from 16 PDR and 15 nondiabetic patients were studied by Western blot analysis and enzyme-linked immunosorbent assay (ELISA). Epiretinal membranes from 17 patients with PDR were studied by immunohistochemistry. Rats were made diabetic with a single high dose of streptozotocin and retinas of rats were examined by Western blot analysis. Western blot analysis revealed a significant increase in the expression of NT-3 and NT-4 and the shedding of receptors TrkA and TrkB in vitreous samples from PDR patients compared to nondiabetic controls, whereas NGF and BDNF and the receptor TrkC were not detected with the use of Western blot analysis and ELISA. In epiretinal membranes, vascular endothelial cells and myofibroblasts expressed NT-3 and the receptors TrkA, TrkB and TrkC in situ, whereas NT-4 was not detected. The expression levels of NT-3 and NT-4 and the receptors TrkA and TrkB, both in intact and solubilized forms, were upregulated in the retinas of diabetic rats, whereas the receptor TrkC was not detected. Co-immunoprecipitation studies revealed binding between NT-3 and the receptors TrkA and TrkB in the retinas of diabetic rats. Our findings in diabetic eyes from humans and rats suggest that the increased expression levels within the NT-3 and NT-4/Trk axis are associated with the progression of PDR. PMID:23762379

Clinical and experimental study on angiopoietin-like protein 8 associated with proliferative diabetic retinopathy

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Chang-Xia Dong

2017-12-01

Full Text Available AIM: To confirm the role of angiopoietin-like protein 8 (Angptl 8 in proliferative diabetic retinopathy (PDR. METHODS: The sera and aqueous humor of 10 PDR patients and 10 non-diabetic retinopathy (NDR patients (idiopathic macular hole patients were collected and the expression of Angptl 8 was detected by enzyme linked immune-sorbent assay (ELISA. Experimental diabetes mice model was induced with streptozotocin. The expression of glycosylated hemoglobin and Angptl 8 in sera was detected. Recombinant Angptl 8 was re-infused into wild type (WT diabetic mice and spatial frequency threshold and contrast sensitivity were measured. In vitro retinal pigment epithelium (RPE were stimulated by recombinant Angptl 8 for 24h. MMT assay were used to detect cell proliferation. At the same time, qRT-PCR and Western blot was used to measure the expression of proliferation-related factors in PRE cells. RESULTS: The expression of Angptl 8 was markedly increased in the sera and aqueous humor of PDR patients (F=99.02, P<0.0001 in sera; t=10.42, P<0.0001 in aqueous. After successfully establishing the diabetic mice model, we found that glycosylated hemoglobin and Angptl 8 expression levels were increased. Re-infusion of recombinant Angptl 8 into WT diabetic mice could further decrease spatial frequency threshold and contrast sensitivity (P<0.01. In vitro, RPE cells stimulated by recombinant Angptl 8 could increase the relative absorbance of MMT assay (1.486±0.042 vs 1.000±0.104, P<0.05 and proliferating cell nuclear antigen (PCNA expression (0.55±0.01 vs 0.29±0.03, P<0.05. The proliferative effect of Angptl 8 is mainly mediated by increasing the expression of proliferation-activating factors cyclin A1 (4.973±0.205 vs 2.720±0.197, P<0.05, cyclin F (5.690±0.219 vs 4.297±0.292, P<0.05 and E2F2 (2.297±0.102 vs 1.750±0.146, P<0.05, and reducing the expression of proliferation-inhibiting factors cdkn1 (2.370±0.074 vs 3.317±0.135, P<0.05 and cdkn2 (4.793±0

Proliferative and inflammatory factors in the vitreous of patients with proliferative diabetic retinopathy

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V V Chernykh

2015-01-01

Full Text Available Purpose: The purpose was to measure the concentrations of various cytokines and growth factors (including vascular endothelial growth factor [VEGF] and pigment epithelium-derived factor [PEDF] in the vitreous of patients with proliferative diabetic retinopathy (PDR and to investigate interaction between inflammatory and proliferative factors in the genesis of PDR. Materials and Methods : Vitreous samples from 32 eyes with PDR and 25 eyes without diabetes mellitus and signs of DR (control were collected. Vitreous concentrations of VEGF, PEDF, monocyte chemotactic protein-1 (MCP-1, interleukin-4 (IL-4, IL-6, IL-8, IL-10, IL-17A, and secretory immunoglobulin A (sIgA were simultaneously measured using enzyme-linked immunoassay. Results : Vitreous levels of VEGF, PEDF, IL-17A, IL-6, IL-8, IL-4, and sIgA were significantly (Π < 0.05 higher in eyes with PDR compared to control. The concentration of VEGF was more than 17-times higher than in control, and the concentration of PEDF was not changed oppositely and was also higher (1.45-times compared to control, that may indicate disturbances of compensatory mechanisms in angiogenesis regulation in PDR. Significant (Π < 0.05 positive correlations were observed between vitreous concentrations of VEGF and IL-17ΐ (r = 0.45, VEGF and IL-8 (r = 0.48, VEGF and IL-4 (r = 0.51, PEDF and IL-17ΐ (r = 0.48, PEDF and IL-8 (r = 0.59, MCP-1 and PEDF (r = 0.72, MCP-1 and IL-8 (r0 = 0.45, IL-4 and IL-17ΐ (r = 0.65, IL-4 and IL-8 (r = 0.71, IL-8 and IL-17ΐ (r = 0.59. Conclusions: Significantly raised levels of inflammatory and proliferative factors and numerous positive correlations between them may demonstrate a significant role of activation of vascular proliferation and local inflammation in the pathogenesis of PDR.

Prospects for angiotensin receptor blockers in diabetic retinopathy

DEFF Research Database (Denmark)

Sjølie, Anne Katrin

2007-01-01

Retinopathy is the most common microvascular complication of diabetes mellitus, and is an important cause of blindness worldwide. Clinical trials have demonstrated that tight metabolic control inhibits the progression of retinopathy. Good blood pressure control has been shown to be protective...... in type 2 diabetes, and it may also reduce proliferative retinopathy in type 1 diabetes. However, such control is often difficult to achieve in clinical practice, and may be associated with problems such as hypoglycaemia. New therapies are therefore needed to reduce the risk of retinopathy....... There is growing evidence that the renin-angiotensin system (RAS) plays an important role in the pathogenesis of diabetic retinopathy, and this has led to interest in RAS inhibitors as agents to prevent retinopathy. Several trials have suggested that ACE inhibitor therapy can inhibit progression of retinopathy...

The North Jutland County Diabetic Retinopathy Study (NCDRS): population characteristics

DEFF Research Database (Denmark)

Knudsen, Lars Loumann; Lervang, Hans-Henrik; Lundbye-Christensen, Søren

2006-01-01

Background: Several population-based studies have reported blood glucose levels and blood pressure to be risk factors for the development of diabetic retinopathy. These studies were initiated more than two decades ago and may therefore reflect the treatment and population composition of a previous...... era, suggesting new studies of the present population with diabetes. Aim and methods: This cross-section study included 656 people with type 1 diabetes and 328 with type 2 diabetes. Crude prevalence rates of proliferative diabetic retinopathy, clinically significant macular oedema and several specific...... retinal lesions were assessed, together with their association to a simplified and internationally approved retinal grading. Results: The point prevalence of proliferative retinopathy was found to be 0.8% and 0.3% for type 1 and type 2 diabetes. Equivalent prevalence rates of clinically significant...

Effect of doxycycline vs placebo on retinal function and diabetic retinopathy progression in patients with severe nonproliferative or non-high-risk proliferative diabetic retinopathy

DEFF Research Database (Denmark)

Scott, Ingrid U; Jackson, Gregory R; Quillen, David A

2014-01-01

IMPORTANCE: Inflammation may contribute to the pathogenesis of diabetic retinopathy (DR). OBJECTIVES: To investigate, in a proof-of-concept clinical trial, whether low-dose oral doxycycline monohydrate can (1) slow the deterioration of, or improve, retinal function or (2) induce regression or slow......: We conducted a randomized, double-masked, 24-month proof-of-concept clinical trial. Thirty patients (from hospital-based retina practices) with 1 or more eyes with severe NPDR or PDR less than Early Treatment Diabetic Retinopathy Study-defined high-risk PDR. INTERVENTIONS: Patients were randomized...... adaptation, visual acuity, and quality of life) and anatomic factors (Early Treatment Diabetic Retinopathy Study DR severity level, area of retinal thickening, central macular thickness, macular volume, and retinal vessel diameters). RESULTS: From baseline to month 24, mean FDP foveal sensitivity decreased...

Diabetic retinopathy - ocular complications of diabetesmellitus

Institute of Scientific and Technical Information of China (English)

Martin M Nentwich; Michael W Ulbig

2015-01-01

In industrialized nations diabetic retinopathy is the mostfrequent microvascular complication of diabetes mellitusand the most common cause of blindness in the workingagepopulation. In the next 15 years, the number ofpatients suffering from diabetes mellitus is expected toincrease significantly. By the year 2030, about 440 millionpeople in the age-group 20-79 years are estimated to besuffering from diabetes mellitus worldwide （prevalence7.7%）, while in 2010 there were 285 million people withdiabetes mellitus （prevalence 6.4%）. This accounts foran increase in patients with diabetes in industrialized nations by 20% and in developing countries by 69% until the year 2030. Due to the expected rise in diabetic patients, the need for ophthalmic care of patients （i.e. , exams and treatments） will also increase and represents a challenge for eye-care providers. Development of optimized screening programs, which respect available resources of the ophthalmic infrastructure, will become even more important. Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy. Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels. Additionally, regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy. In this way, the risk of blindness can considerably be reduced. In advanced stages of diabetic retinopathy, pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment. In recent years, the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema.

Comparing carotid intima-media thickness in type 2 diabetes between patients with and without retinopathy

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Naroi Nejad M

2012-06-01

Conclusion: Diabetic retinopathy seems to be associated with increased intima-media thickness of carotid arteries in T2DM. It may be a common denominator of pathogene-sis of microvascular complications and atherosclerosis in T2DM. Evaluations of carotid arteries are to be done by non-invasive methods such as color Doppler sonography for screening and preventing prospective cereberovascular accidents in patients with diabetic retinopathy, especially proliferative retinopathy, in routine ophthalmological examination of patients with T2DM.

Lack of differences in the regional variation of oxygen saturation in larger retinal vessels in diabetic maculopathy and proliferative diabetic retinopathy.

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Jørgensen, Christina Mørup; Bek, Toke

2017-06-01

Diabetic retinopathy is characterised by morphological lesions in the ocular fundus related to disturbances in retinal blood flow. The two vision threatening forms of retinopathy show specific patterns of distribution of retinal lesions with proliferative diabetic retinopathy (PDR) developing secondary to ischaemia and hypoxia in the retinal periphery and diabetic maculopathy (DM) developing secondary to hyperperfusion and increased vascular permeability in the macular area. These differences in the distribution of retinal lesions might be reflected in regional differences in oxygen saturation in the larger retinal vessels. Dual-wavelength retinal oximetry was performed in 30 normal persons, 30 patients with DM and 30 patients with PDR, and the oxygen saturation was measured in peripapillary vessels supplying the four retinal quadrants and in branches from the upper temporal arcades supplying, respectively, the macular area and the retinal periphery. The overall oxygen saturation was significantly higher in diabetic patients than in normal persons and the arteriovenous (AV) saturation difference significantly lower in the patients with DM. The regional variation in oxygen saturation was similar in the three studied groups with a decreasing saturation from the upper nasal through the lower nasal, lower temporal and the upper temporal peripapillary vessels, and with a significantly higher oxygen saturation in venules draining the macular area than in venules draining the retinal periphery. The regional differences in retinal lesions in vision threatening diabetic retinopathy are not reflected in regional differences in the oxygen saturation of larger retinal vessels. The development of vision threatening diabetic retinopathy depends on other factors, such as, for example, regional differences in the retinal microcirculation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Diabetic Retinopathy Is Associated With Elevated Serum Asymmetric and Symmetric Dimethylarginines

OpenAIRE

Abhary, Sotoodeh; Kasmeridis, Nicholas; Burdon, Kathryn P.; Kuot, Abraham; Whiting, Malcolm J.; Yew, Wai Ping; Petrovsky, Nikolai; Craig, Jamie E.

2009-01-01

OBJECTIVE Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and l-arginine directly influence nitric oxide production. Our objective was to test whether serum ADMA, SDMA, or l-arginine levels correlate with diabetic retinopathy subtype or severity. RESEARCH DESIGN AND METHODS A total of 162 subjects with type 1 diabetes and 343 with type 2 diabetes, of whom 329 subjects had no diabetic retinopathy, 27 had nonproliferative diabetic retinopathy (NPDR), 101 had proliferative...

Myeloid-Related Protein-14/MRP-14/S100A9/Calgranulin B is Associated with Inflammation in Proliferative Diabetic Retinopathy.

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Abu El-Asrar, Ahmed M; Alam, Kaiser; Siddiquei, Mohammad M; Van den Eynde, Kathleen; Mohammad, Ghulam; De Hertogh, Gert; Opdenakker, Ghislain

2018-01-01

To investigate the expression of the leukocyte proteins myeloid-related protein (MRP)-8 and MRP-14 in proliferative diabetic retinopathy (PDR) and the effect of MRP-8/MRP-14 (calprotectin) heterodimer on induction of proinflammatory factors in human retinal microvascular endothelial cells (HRMEC). Epiretinal membranes from 20 patients with PDR and 10 patients with proliferative vitreoretinopathy (PVR), vitreous fluid samples from PDR and non-diabetic subjects and HRMEC were studied by immunohistochemistry and Western blot analysis. MRP-14 expression was localized in endothelial cells, leukocytes and myofibroblasts in all PDR membranes. MRP-8 expression was limited to intravascular leukocytes in 42% of the studied membranes. In PVR membranes, MRP-14 was expressed in leukocytes and myofibroblasts, whereas MRP-8 immunoreactivity was limited to leukocytes. MRP-14 was significantly upregulated in vitreous from PDR patients. MRP-8/MRP-14 (calprotectin) increased expression of intercellular adhesion molecule-1, but attenuated vascular cell adhesion molecule-1 expression in HRMEC. Increased MRP-14 levels are associated with inflammation in PDR.

Retrieving clinically relevant diabetic retinopathy images using a multi-class multiple-instance framework

Science.gov (United States)

Chandakkar, Parag S.; Venkatesan, Ragav; Li, Baoxin

2013-02-01

Diabetic retinopathy (DR) is a vision-threatening complication from diabetes mellitus, a medical condition that is rising globally. Unfortunately, many patients are unaware of this complication because of absence of symptoms. Regular screening of DR is necessary to detect the condition for timely treatment. Content-based image retrieval, using archived and diagnosed fundus (retinal) camera DR images can improve screening efficiency of DR. This content-based image retrieval study focuses on two DR clinical findings, microaneurysm and neovascularization, which are clinical signs of non-proliferative and proliferative diabetic retinopathy. The authors propose a multi-class multiple-instance image retrieval framework which deploys a modified color correlogram and statistics of steerable Gaussian Filter responses, for retrieving clinically relevant images from a database of DR fundus image database.

Proteomic analysis of plasma proteins in diabetic retinopathy patients by two dimensional electrophoresis and MALDI-Tof-MS.

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Gopalakrishnan, Vidhya; Purushothaman, Parthiban; Bhaskar, Anusha

2015-01-01

Diabetic retinopathy is a highly specific vascular complication of diabetes mellitus and progresses from mild non-proliferative abnormalities characterized by increased vascular permeability to moderate and severe proliferative diabetic retinopathy characterized by the growth of blood vessels on the retina. The aim of the study was to identify the differentially expressed proteins in diabetic retinopathy using two-dimensional electrophoresis. Blood sample was drawn from subjects with diabetes mellitus (without retinopathy) who served as controls and patients with diabetic retinopathy in tubes containing EDTA as anticoagulant. Albumin and immunoglobulin IgG collectively removed to enrich proteins of lower abundance. 2de was carried out to see if there are any differentially expressed proteins. Approximately 48 and 61 spots were identified in control and diabetic retinopathy respectively, of which three protein spots RBP1 (retinol-binding protein 1), NUD10 (Diphosphoinositol polyphosphohydrolase 3 alpha), NGB (neuroglobin) were down regulated and HBG2 (hemoglobin) and BY55 (CD 160 antigen) were upregulated in diabetic retinopathy. These five protein spots were excised and were subjected to in-gel tryptic digestion, and their identities were determined by ultraflex MALDI-TOF-MS. We report a comprehensive patient-based plasma proteomic approach to the identification of potential biomarkers for diabetic retinopathy screening and detection. We identified 5 different proteins that were differentially expressed in the plasma of control diabetic patients (without retinopathy). Among these five proteins the expression of neuroglobin (NGB) protein varied significantly and may be a potential biomarker in diabetic retinopathy. Copyright © 2015 Elsevier Inc. All rights reserved.

PLVAP in diabetic retinopathy: A gatekeeper of angiogenesis and vascular permeability

NARCIS (Netherlands)

Wiśniewska-Kruk, J.

2014-01-01

Nowadays, approximately 4 million people worldwide experience blindness or severe vision loss caused by diabetic retinopathy. Diabetic retinopathy is a multifactorial disease that can progress from minor changes in vascular permeability, into a proliferative retinal disorder. The increasing

Combined Phacoemulsification, Vitrectomy and Endolaser Photocoagulation in Patients with Diabetic Retinopathy and Cataract

International Nuclear Information System (INIS)

Wahab, S; Hargun, L. D.

2014-01-01

Objective: To determine the outcomes of early vitrectomy and endolaser photocoagulation effects during phacoemulsification in cataractous eyes with diabetic retinopathy. Study Design: Descriptive study. Place and Duration of Study: Ophthalmology Department Unit-II, DUHS, Civil Hospital, Karachi, and Al-Noor Eye Clinic, Karachi, from February 2009 to December 2010. Methodology: Consecutive 54 patients with 7 - 15 years duration of type II diabetes with severe non-proliferative diabetic retinopathy (NPDR) and early proliferative diabetic retinopathy (PDR) who had cataract grade I and II underwent vitrectomy, endolaser photocoagulation and phacoemulsification with IOL implantation. Best corrected visual acuity was main outcomes measure assessed till 6 months follow-up. Results: Out of 54 eyes, 32 patients were females and 22 were males. Majority 47 (87%) eyes gained significant (p < 0.001) improvement of best corrected visual acuity of four lines or better while 5 (9.3%) eyes retained stable visual acuity. In only 2 eyes, vision declined to 3/60 or less. Conclusion: Early vitrectomy with phacoemulsification in severe NPDR and early PDR patients, if assisted or augmented with endolaser photocoagulation, maximizes, early visual rehabilitation with less morbidity and may retard progression of retinopathy. (author)

[Population-based study of diabetic retinopathy in Wolfsburg].

Science.gov (United States)

Hesse, L; Grüsser, M; Hoffstadt, K; Jörgens, V; Hartmann, P; Kroll, P

2001-11-01

Since November 1997 the complete documentation of an ophthalmological examination of diabetics has been annually subsidized by the Volkswagen Corporation Health Maintenance Organization (VW-HMO). The results of an annual ophthalmological examination were recorded in a standardised history sheet developed by the Initiative Group for Early Detection of Diabetic Eye Diseases. These data included visual acuity, intraocular pressure, lens status and a description of fundus abnormalities. Within 26 months ophthalmological examinations of 2,801 patients were completed which represented 4.5% of all VW-HMO insured patients. On average, patients suffered from diabetes for 9.6 years (SD +/- 8.3), artificial intraocular lenses were present in 357 eyes (6.4%) and 1,216 eyes (12.0%) were diagnosed with cataract or posterior capsule opacification impairing visual acuity. Out of 263 patients younger than 40 years old, 18.8% had a mild or moderate and 3.3% a severe non-proliferative diabetic retinopathy (NPDR). A proliferative diabetic retinopathy (PDR) was found in 2.2% of the younger patients. Of 2,228 patients aged 40 years and older, 11.9% had a mild or moderate and 2.6% a severe NPDR. In 0.9% of this group PDR was diagnosed. An annual ophthalmological screening based on a survey sheet of the Initiative Group was successfully introduced. For the first time a population-based evaluation on the prevalence of diabetic retinopathy was carried out for inhabitants of a German city. The prevalence of PDR was found to be lower than previously published in comparable studied.

Systemic factors related to soluble (prorenin receptor in plasma of patients with proliferative diabetic retinopathy.

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Keitaro Hase

Full Text Available (Prorenin receptor [(PRR], a new component of the tissue renin-angiotensin system (RAS, plays a crucial role in inflammation and angiogenesis in the eye, thus contributing to the development of proliferative diabetic retinopathy (PDR. In this study, we investigated systemic factors related to plasma levels of soluble form of (PRR [s(PRR] in patients with PDR. Twenty type II diabetic patients with PDR and 20 age-matched, non-diabetic patients with idiopathic macular diseases were enrolled, and plasma levels of various molecules were measured by enzyme-linked immunosorbent assays. Human retinal microvascular endothelial cells were stimulated with several diabetes-related conditions to evaluate changes in gene expression using real-time quantitative PCR. Of various systemic parameters examined, the PDR patients had significantly higher blood sugar and serum creatinine levels than non-diabetic controls. Protein levels of s(PRR, prorenin, tumor necrosis factor (TNF-α, complement factor D (CFD, and leucine-rich α-2-glycoprotein 1 (LRG1 significantly increased in the plasma of PDR subjects as compared to non-diabetes, with positive correlations detected between s(PRR and these inflammatory molecules but not prorenin. Estimated glomerular filtration rate and serum creatinine were also correlated with plasma s(PRR, but not prorenin, levels. Among the inflammatory molecules correlated with s(PRR in the plasma, TNF-α, but not CFD or LRG1, application to retinal endothelial cells upregulated the mRNA expression of (PRR but not prorenin, while stimulation with high glucose enhanced both (PRR and prorenin expression. These findings suggested close relationships between plasma s(PRR and diabetes-induced factors including chronic inflammation, renal dysfunction, and hyperglycemia in patients with PDR.

Retinitis pigmentosa reduces the risk of proliferative diabetic retinopathy: a nationwide population-based cohort study.

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Yuh-Fang Chen

Full Text Available PURPOSE: To study the association between retinitis pigmentosa (RP and the progression of diabetic retinopathy (DR. METHODS: Using the Longitudinal Health Insurance Database 2000 of Taiwan, we identified individuals with an initial diagnosis for RP during the period of 1997-2008. A non-RP comparison group, 10-fold frequency matched by sex, age, index year and the year of diabetes diagnosed, were randomly selected from the same database. The occurrence of DR was observed for all subjects until the end of 2009. The Kaplan-Meier curves were used to illustrate the cumulative probability of developing DR for the RP group and comparison groups. The hazard ratio (HR of DR for the RP group relative to the comparison group was estimated using Cox proportional hazards model after adjusting for potential confounders. RESULTS: The Kaplan-Meier curves were not statistically significant different between the RP group and the comparison group. However, the RP group had a higher cumulative probability of developing DR during the first six to seven years. The cumulative probability kept increasing and became higher in the comparison group but remained unchanged in the RP group. The HR for the RP patients comparing with the comparison group was 0.96 (95% confidence interval (CI = 0.43-2.14. Stratified by severity, RP was associated with a non-statistically significant reduced risk of proliferative DR (PDR (HR = 0.70, 95% CI = 0.16-3.14. The HR for non-proliferative DR (NPDR was 1.08 (95% CI = 0.40-2.86. CONCLUSION: In this study, RP was not statistically significant associated with the incidence of DR.

Identification of Diabetic Retinopathy Genes through a Genome-Wide Association Study among Mexican-Americans from Starr County, Texas

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Yi-Ping Fu

2010-01-01

Full Text Available To identify genetic loci for severe diabetic retinopathy, 286 Mexican-Americans with type 2 diabetes from Starr County, Texas, completed physical examinations including fundus photography for diabetic retinopathy grading. Individuals with moderate-to-severe non-proliferative and proliferative diabetic retinopathy were defined as cases. Direct genotyping was performed using the Affymetrix GeneChip Human Mapping 100 K Set, and SNPs passing quality control criteria were used to impute markers available in HapMap Phase III Mexican population (MXL in Los Angeles, California. Two directly genotyped markers were associated with severe diabetic retinopathy at a P-value less than .0001: SNP rs2300782 (P=6.04×10−5 mapped to an intron region of CAMK4 (calcium/calmodulin-dependent protein kinase IV on chromosome 5, and SNP rs10519765 (P=6.21×10−5 on chromosomal 15q13 in the FMN1 (formin 1 gene. Using well-imputed markers based on the HapMap III Mexican population, we identified an additional 32 SNPs located in 11 chromosomal regions with nominal association with severe diabetic retinopathy at P-value less than .0001. None of these markers were located in traditional candidate genes for diabetic retinopathy or diabetes itself. However, these signals implicate genes involved in inflammation, oxidative stress and cell adhesion for the development and progression of diabetic retinopathy.

ULTRAHIGH SPEED SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL AND CHORIOCAPILLARIS ALTERATIONS IN DIABETIC PATIENTS WITH AND WITHOUT RETINOPATHY.

Science.gov (United States)

Choi, WooJhon; Waheed, Nadia K; Moult, Eric M; Adhi, Mehreen; Lee, ByungKun; De Carlo, Talisa; Jayaraman, Vijaysekhar; Baumal, Caroline R; Duker, Jay S; Fujimoto, James G

2017-01-01

To investigate the utility of ultrahigh speed, swept source optical coherence tomography angiography in visualizing retinal microvascular and choriocapillaris (CC) changes in diabetic patients. The study was prospective and cross-sectional. A 1,050 nm wavelength, 400 kHz A-scan rate swept source optical coherence tomography prototype was used to perform volumetric optical coherence tomography angiography of the retinal and CC vasculatures in diabetic patients and normal subjects. Sixty-three eyes from 32 normal subjects, 9 eyes from 7 patients with proliferative diabetic retinopathy, 29 eyes from 16 patients with nonproliferative diabetic retinopathy, and 51 eyes from 28 diabetic patients without retinopathy were imaged. Retinal and CC microvascular abnormalities were observed in all stages of diabetic retinopathy. In nonproliferative diabetic retinopathy and proliferative diabetic retinopathy, optical coherence tomography angiography visualized a variety of vascular abnormalities, including clustered capillaries, dilated capillary segments, tortuous capillaries, regions of capillary dropout, reduced capillary density, abnormal capillary loops, and foveal avascular zone enlargement. In proliferative diabetic retinopathy, retinal neovascularization above the inner limiting membrane was visualized. Regions of CC flow impairment in patients with proliferative diabetic retinopathy and nonproliferative diabetic retinopathy were also observed. In 18 of the 51 of eyes from diabetic patients without retinopathy, retinal mircrovascular abnormalities were observed and CC flow impairment was found in 24 of the 51 diabetic eyes without retinopathy. The ability of optical coherence tomography angiography to visualize retinal and CC microvascular abnormalities suggests it may be a useful tool for understanding pathogenesis, evaluating treatment response, and earlier detection of vascular abnormalities in patients with diabetes.

Deregulation of ocular nucleotide homeostasis in patients with diabetic retinopathy.

Science.gov (United States)

Loukovaara, Sirpa; Sandholm, Jouko; Aalto, Kristiina; Liukkonen, Janne; Jalkanen, Sirpa; Yegutkin, Gennady G

2017-02-01

Clear signaling roles for ATP and adenosine have been established in all tissues, including the eye. The magnitude of signaling responses is governed by networks of enzymes; however, little is known about the regulatory mechanisms of purinergic signaling in the eye. By employing thin-layer chromatographic assays with 3 H-labeled substrates, this study aimed to evaluate the role of nucleotide homeostasis in the pathogenesis of vitreoretinal diseases in humans. We have identified soluble enzymes ecto-5'-nucleotidase/CD73, adenylate kinase-1, and nucleoside diphosphate kinase in the vitreous fluid that control active cycling between pro-inflammatory ATP and anti-inflammatory adenosine. Strikingly, patients with proliferative form of diabetic retinopathy (DR) had higher adenylate kinase activity and ATP concentration, when compared to non-proliferative DR eyes and non-diabetic controls operated for rhegmatogenous retinal detachment, macular hole, and pucker. The non-parametric correlation analysis revealed positive correlations between intravitreal adenylate kinase and concentrations of ATP, ADP, and other angiogenic (angiopoietins-1 and -2), profibrotic (transforming growth factor-β1), and proteolytic (matrix metalloproteinase-9) factors but not erythropoietin and VEGF. Immunohistochemical staining of postmortem human retina additionally revealed selective expression of ecto-5'-nucleotidase/CD73 on the rod-and-cone-containing photoreceptor cells. Collectively, these findings provide novel insights into the regulatory mechanisms that influence purinergic signaling in diseased eye and open up new possibilities in the development of enzyme-targeted therapeutic approaches for prevention and treatment of DR. Ecto-5'-nucleotidase/CD73 and adenylate kinase-1 circulate in human vitreous fluid. Adenylate kinase activity is high in diabetic eyes with proliferative retinopathy. Diabetic eyes display higher intravitreal ATP/ADP ratio than non-diabetic controls. Soluble adenylate

Diabetic Retinopathy Grading by Digital Curvelet Transform

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Shirin Hajeb Mohammad Alipour

2012-01-01

Full Text Available One of the major complications of diabetes is diabetic retinopathy. As manual analysis and diagnosis of large amount of images are time consuming, automatic detection and grading of diabetic retinopathy are desired. In this paper, we use fundus fluorescein angiography and color fundus images simultaneously, extract 6 features employing curvelet transform, and feed them to support vector machine in order to determine diabetic retinopathy severity stages. These features are area of blood vessels, area, regularity of foveal avascular zone, and the number of micro-aneurisms therein, total number of micro-aneurisms, and area of exudates. In order to extract exudates and vessels, we respectively modify curvelet coefficients of color fundus images and angiograms. The end points of extracted vessels in predefined region of interest based on optic disk are connected together to segment foveal avascular zone region. To extract micro-aneurisms from angiogram, first extracted vessels are subtracted from original image, and after removing detected background by morphological operators and enhancing bright small pixels, micro-aneurisms are detected. 70 patients were involved in this study to classify diabetic retinopathy into 3 groups, that is, (1 no diabetic retinopathy, (2 mild/moderate nonproliferative diabetic retinopathy, (3 severe nonproliferative/proliferative diabetic retinopathy, and our simulations show that the proposed system has sensitivity and specificity of 100% for grading.

Association between high risk foot, retinopathy and HBA1c in Saudi diabetic population

International Nuclear Information System (INIS)

Mehmood, K.; Aziz, A.

2010-01-01

Background: One of the important complications of diabetes is diabetic-foot-ulcer, also reported in Saudi Arabia, like other countries. Similarly, the complications, like retinopathy and nephropathy are also occurring in diabetic patients of this region. Apart from the care and monitoring of these patients, it is important to find out association between these complications and their relation with common factors, like HbA1c levels. Such relation is not yet reported in literature. Objective: Therefore, this study was planned to find out association between neuropathy (leading to high risk foot) and retinopathy by the estimation of HbA1c levels in Saudi population. Methods: After exclusion of the cases of gestational diabetes and children with type-1 diabetes, 333 Patients having age 21 to 97 years were examined in the Diabetology Clinic of Diabetes Centre, Aseer Central Hospital, Abha. All patients were screened for neuropathy (High risk of the foot) and retinopathy (by Fundus Photography). HbA1c levels were determined, using standardised procedure. The obtained data was analysed statistically by SPSS-12 for Windows. Results: HbA1c levels of less than or equal to have been found to be associated with neuropathy, high risk foot, and as well as non- proliferative and proliferative retinopathy. Pearson chi square test has demonstrated association between progressive retinopathy and development of high risk foot. Conclusion: The observed data indicate poor glycemic or diabetes control on the basis of higher HbA1c levels and strong association between high risk foot and the development of progressive retinopathy. (author)

Vitreous vascular endothelial growth factor concentrations in proliferative diabetic retinopathy versus proliferative vitreoretinopathy.

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Citirik, Mehmet; Kabatas, Emrah Utku; Batman, Cosar; Akin, Kadir Okhan; Kabatas, Naciye

2012-01-01

To assess vitreous vascular endothelial growth factor (VEGF) concentrations in proliferative diabetic retinopathy (PDR) in comparison to proliferative vitreoretinopathy (PVR). Vitreous samples were collected from 69 eyes of 69 patients with traumatic lens dislocation (n = 10), grade B PVR with rhegmatogenous retinal detachment (n = 13), grade C PVR with rhegmatogenous retinal detachment (n = 14), PDR with vitreous hemorrhage (n = 18), and PDR with vitreous hemorrhage and tractional retinal detachment (n = 14). Vitreous fluid samples were obtained at vitrectomy, and the levels of VEGF were measured by enzyme-linked immunosorbent assay. The mean vitreous level of VEGF was 15.14 ± 5.22 pg/ml in eyes with grade B PVR, 99.15 ± 38.58 pg/ml in eyes with grade C PVR, 4,534.01 ± 1,193.28 pg/ml in eyes with vitreous hemorrhage secondary to PDR, 5,157.29 ± 969.44 pg/ml in eyes with vitreous hemorrhage and tractional retinal detachment secondary to PDR, and 16.19 ± 5.76 pg/ml in eyes of the control group with traumatic lens dislocation. Vitreous VEGF concentrations were significantly higher in the patients with grade C PVR, PDR with vitreous hemorrhage and PDR with vitreous hemorrhage and tractional retinal detachment in comparison to the control patients (p < 0.05). A significant alteration was not observed in patients with grade B PVR (p = 0.55). Vitreous VEGF concentrations are increased in PDR and grade C PVR. The high VEGF concentrations could suggest a possible effect of VEGF on advanced PVR. Copyright © 2011 S. Karger AG, Basel.

Influencing factors on compliance of timely visits among patients with proliferative diabetic retinopathy in southern China: a qualitative study

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Duan, Fang; Liu, Yuhong; Chen, Xiang; Congdon, Nathan; Zhang, Jian; Chen, Qianyun; Chen, Lingling; Chen, Xi; Zhang, Xiulan; Yu, Chengpu; Liu, Yizhi

2017-01-01

Objective To identify the reasons for low adherence among patients with diabetic retinopathy (DR) in southern China using a qualitative method. Methods Exploratory indepth interviews were conducted in 27 diabetic patients with proliferative diabetic retinopathy who required vitrectomy surgery at Zhongshan Ophthalmic Centre, Sun Yat-sen University, from March to August 2015. Qualitative data analysis and research software (ATLAS.ti7) was used for data processing and analysis. Results Factors influencing the occurrence of timely visits included lack of DR related knowledge, fear and worries about insulin, interactions between patients and society combined with the complexity of emotions and social culture, and the economic burden of treatment. Conclusions Although the reasons for low adherence involved social, emotional, cultural and economic factors, the key issue was the lack of awareness and knowledge of DR. Our findings have several practical implications for health policymakers and programme planners in China. PMID:28348188

Risk factors of diabetic retinopathy in type 2 diabetic patients

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CAI Xiao-ling; WANG Fang; JI Li-nong

2006-01-01

Background Advances in treatment have greatly reduced the risk of blindness from this disease, but because diabetes is so common, diabetic retinopathy remains an important problem. The purpose of this study is to investigate the risk factors of diabetic retinopathy (DR) in Chinese type 2 diabetic patients.Methods Totally 746 type 2 diabetic patients were selected for biochemical and clinical characteristics test and examined by the retina-camera for diabetic retinopathy and the average age was 55.9 years old.Results A total of 526 patients was classified as non-DR, 159 patients as non-proliferative-DR and 61 patients as proliferative-DR. Duration of diabetes [(66.09±72.51) months vs (143.71 ±93.27) months vs (174.30±81.91)months, P=0.00], systolic blood pressure [(131.95±47.20) mmHg vs (138.71 ±21.36) mmHg vs (147.58±24.10)mmHg, P=0.01], urine albumin [(32.79± 122.29) mg/L vs (190.96±455.65) mg/L vs (362.00±552.51) mg/L,P=0.00], glycated hemoglobin (HbA1c) [(8.68 ± 2.26)% vs (9.42±1.84)% vs (9.42±1.96)%, P=0.04],C-reactive protein (CRP) [(3.19±7.37) mg/L vs (6.36± 23.59) mg/L vs (3.02±4.34) mg/L, P=0.03],high-density lipoprotein cholesterol (HDL-C) [(1.23±0.37) mmol/L vs (1.33±0.35) mmol/L vs (1.24±0.33)mmol/L, P=0.01], uric acid (UA) [(288.51 ±90.85) mmol/L vs (300.29±101.98) mmol/L vs (337.57±115.09)mmol/L, P=0.00], creatinine (CREA) [(84.22±16.31) μmol/L vs (89.35±27.45) μmol/L vs (103.28±48.64)μmol/L, P=0.00], blood urine nitrogen (BUN) [(5.62± 1.62) mmol/L vs (6.55±2.74) mmol/L vs (8.11±3.60)mmol/L, P=0.00] were statistically different among the three groups. Logistic regression analysis showed that diabetic duration and urine albumin were two independent risk factors of DR (the OR values were 1.010 and 1.003 respectively).Conclusions Diabetic duration and urine albumin are two independent risk factors of diabetic retinopathy in elderly type 2 diabetic patients.

Diabetic retinopathy

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Wong, Tien Y; Cheung, Chui Ming Gemmy; Larsen, Michael

2016-01-01

Diabetic retinopathy (DR) is a common complication of diabetes mellitus and is a major cause of vision loss in middle-aged and elderly people. One-third of people with diabetes have DR. Severe stages of DR include proliferative DR, caused by the abnormal growth of new retinal blood vessels......, and diabetic macular oedema, in which there is exudation and oedema in the central part of the retina. DR is strongly associated with a prolonged duration of diabetes, hyperglycaemia and hypertension. It is traditionally regarded as a microvascular disease, but retinal neurodegeneration is also involved...... (VEGF). Optimal control of blood glucose and blood pressure in individuals with diabetes remains the cornerstone for preventing the development and arresting the progression of DR. Anti-VEGF therapy is currently indicated for diabetic macular oedema associated with vision loss, whereas laser...

Rehabilitation effect of oral drug on the patients with proliferative diabetic retinopathy after operation

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Wei Zu

2014-08-01

Full Text Available AIM:To observe the rehabilitation effect of oral Calcium Dobesilate Tablets and Epalrestat Tablets on the proliferative diabetic retinopathy(PDRpatients after vitrectomy.METHODS: After vitrectomy patients informed consent, they were randomly divided into intervention group and control group, and their vision and fundus were followed up and compared at 2d; 3, 6, 9, 12mo after operation.RESULTS: The recovery and sustainment of visual acuity, and subsiding of macular edema of patients in drug intervention group were significantly better than that in control group.CONCLUSION: PDR patients after vitrectomy actively orally take medicine to protect retina, which can improve vision and fundus rehabilitation.

Extracellular matrix metalloproteinase inducer (EMMPRIN) is a potential biomarker of angiogenesis in proliferative diabetic retinopathy.

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Abu El-Asrar, Ahmed M; Ahmad, Ajmal; Alam, Kaiser; Siddiquei, Mohammad Mairaj; Mohammad, Ghulam; Hertogh, Gert De; Mousa, Ahmed; Opdenakker, Ghislain

2017-11-01

Extracellular matrix metalloproteinase inducer (EMMPRIN) promotes angiogenesis through matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) production. We investigated the expression levels of EMMPRIN and correlated these levels with VEGF, MMP-1 and MMP-9 in proliferative diabetic retinopathy (PDR). In addition, we examined the expression of EMMPRIN in the retinas of diabetic rats and the effect of EMMPRIN on the induction of angiogenesis regulatory factors in human retinal microvascular endothelial cells (HRMECs). Vitreous samples from 40 PDR and 19 non-diabetic patients, epiretinal membranes from 12 patients with PDR, retinas of rats and HRMECs were studied by enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, Western blot analysis, zymography analysis and RT-PCR. We showed a significant increase in the expression of EMMPRIN, VEGF, MMP-1 and MMP-9 in vitreous samples from PDR patients compared with non-diabetic controls (p EMMPRIN and the levels of VEGF (r = 0.38; p = 0.003), MMP-1 (r = 0.36; p = 0.005) and MMP-9 (r = 0.46; p = 0.003). In epiretinal membranes, EMMPRIN was expressed in vascular endothelial cells and stromal cells. Significant increase of EMMPRIN mRNA was detected in rat retinas after induction of diabetes. EMMPRIN induced hypoxia-inducible factor-1α, VEGF and MMP-1 expression in HRMEC. These results suggest that EMMPRIN/MMPs/VEGF pathway is involved in PDR angiogenesis. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Clinical study on the expression differences of biochemical indicators between Uygur and Han patients with diabetic retinopathy

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Jing-Li Han

2016-02-01

Full Text Available AIM:To detect the related biochemical indicators of the Uygur and Han patients with diabetic retinopathy,to judge progression of diabetic retinopathy and evaluate the relation between ethnic and progression. So as to give a more accurate guide for regional clinical treatment, early detection, early prevention, reduce concurrency disease and improve quality of life. METHODS:One hundred and twenty patients with diabetic retinopathy aged 38～70 were diagnosed by fundus fluorescein angiography, including 60 patients with non-proliferative diabetic retinopathy(NPDR, 30 Uygur and Han respectively(devided into Uygur group 1, Han group 1; 60 patients with proliferative diabetic retinopathy(PDR, 30 Uygur and Han respectively(devided into Uygur group 2, Han group 2. All patients were detected for high-sensitivity C-reactive protein(hs-CRP, serum total bilirubin(TBIL, fibrinogen(FIB, D-dimer(DDindicators using fasting blood. RESULTS:Regardless of ethnic, NPDR group and PDR group were significant differences in the four indicators; there was no significant difference between the Han and the Uygur group on the hs-CRP. But for the TBIL, FIB and DD, it was significantly different between the two ethnical groups, and it was more obvious in Uygur group. CONCLUSION:Diabetic retinopathy generally was more severe in Xinjiang Uygur groups, more attention should be paid in clinical practice.

Effect of pregnancy on diabetic nephropathy and retinopathy

International Nuclear Information System (INIS)

Irfan, S.; Arain, M.; Shahid, A.; Shaukat, A.

2004-01-01

Objective: To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. Subject and Methods: Thirty-five patients (aged 20-36 years) identified with diabetic nephropathy and moderate to severe renal dysfunction (creatinine Cr) - > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. Results: Mean serum Cr rose from 1.8 mg/dl pre pregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% pre pregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. Conclusion: Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy. (author)

New Therapeutic Approaches in Diabetic Retinopathy

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Vaziri, Kamyar; Schwartz, Stephen G.; Relhan, Nidhi; Kishor, Krishna S.; Flynn Jr, Harry W.

2015-01-01

Diabetic retinopathy is a common microvascular complication of diabetes mellitus. It affects a substantial proportion of US adults over age 40. The condition is a leading cause of visual loss. Much attention has been given to expanding the role of current treatments along with investigating various novel therapies and drug delivery methods. In the treatment of diabetic macular edema (DME), intravitreal pharmacotherapies, especially anti-vascular endothelial growth factor (anti-VEGF) agents, have gained popularity. Currently, anti-VEGF agents are often used as first-line agents in center-involved DME, with recent data suggesting that among these agents, aflibercept leads to better visual outcomes in patients with worse baseline visual acuities. While photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), recent FDA approvals of ranibizumab and aflibercept in the management of diabetic retinopathy associated with DME may suggest a potential for pharmacologic treatments of PDR as well. Novel therapies, including small interfering RNAs, chemokines, kallikrein-kinin inhibitors, and various anti-angiogenic agents, are currently being evaluated for the management of diabetic retinopathy and DME. In addition to these strategies, novel drug delivery methods such as sustained-release implants and refillable reservoir implants are either under active evaluation or have recently gained FDA approval. This review provides an update on the novel developments in the treatment of diabetic retinopathy. PMID:26676668

Endothelial perturbation: a link between non-dipping and retinopathy in type 2 diabetes?

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Knudsen, Søren Tang; Jeppesen, Peter; Frederiksen, Christian Alcaraz

2007-01-01

-six subjects, stratified to 4 gender-, age-, and duration-matched groups of 19 subjects each, were studied (group A: non-diabetic subjects; group B to D, type 2 diabetic subjects; group B: no retinopathy; group C: minimal background retinopathy; group D: diabetic maculopathy). All subjects underwent a 24-hour......Reduced diurnal blood pressure (BP) variation ("non-dipping") is associated with both micro- and macrovascular complications in patients with type 2 diabetes. The relation between endothelial perturbation and diurnal BP variation in diabetic subjects has not previously been studied. Seventy...... to endothelial cell activation as well as with retinopathy in subjects with type 2 diabetes. This finding suggests a possible mechanism linking non-dipping with microvascular complications in these subjects....

Observation of clinical effect of krypton laser in the treatment of diabetic retinopathy with non-proliferative%多波长氪激光光凝治疗非增殖期糖尿病视网膜病变临床疗效观察

Institute of Scientific and Technical Information of China (English)

韩凤芹; 刘守丽

2014-01-01

Objective:To observe the clinical effect of krypton laser in the treatment of diabetic retinopathy with non-proliferative. Methods:54 patients(104 eyes) of diabetic retinopathy with non-proliferative were treated with krypton laser,and the clinical effect was observed.Results:78 eyes(75%)had visual acuity improved and 20 eyes(19.2%)had no change in visual acuity,with 6 eyes(6%) having visual acuity decreased.96 eyes had retinal neovascularization,non perfusion area and macular edema and partial regression and 4 eyes were invalid,with 4 eyes macular edema worse.Conclusion:The effect of krypton laser photocoagulation in the treatment of diabetic retinopathy with non-proliferative is significantly.%目的：观察多波长氪激光光凝治疗非增殖期糖尿病视网膜病变的临床疗效。方法：2012年5月-2013年12月收治采用多波长氪激光治疗的非增殖期糖尿病视网膜病变患者54例(104眼)，观察治疗效果。结果：视力提高78眼(75%)，视力无变化20眼(19.2%)，视力下降6眼(6%)。视网膜血管新生、无灌注区和黄斑水肿消退及部分消退96眼，治疗无效4眼，黄斑水肿恶化4眼。结论：多波长氪激光治疗糖尿病视网膜病变增殖期疗效显著。

Diabetic retinopathy in acromegaly

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Said Azzoug

2014-01-01

Full Text Available Introduction: Although growth hormone (GH has been implicated in the pathogenesis of diabetic retinopathy (DR, DR is deemed to be rare in patients with GH excess. Our aim was to study its prevalence in subjects with acromegaly suffering from diabetes mellitus (DM, to analyze its characteristics, and to look for predictive factors such as age at diagnosis, GH concentration and duration, DM duration, DM control, and family background. Materials and Methods: Forty patients with acromegaly and DM (21 males, 19 females, median age = 50 years, underwent a systematic ophthalmological examination with dilated funduscopy to seek diabetic retinopathy. Results: Among this population, 05 (12.5% had DR. It was at an early stage or background retinopathy in 3 cases and at a more advanced stage or proliferative retinopathy in 2 cases. We did not find any correlation with age at diagnosis, GH levels and duration, DM duration and family history of DM, but poor glycemic control seems to play a role although statistical analysis showed borderline significance. Conclusion: From this study, we conclude that prevalence of DR in patients with acromegaly is 12.5%, and it is slight or moderate. Among studied factors, only poor glycemic control seems to be implicated in its development.

Prevalence of diabetic retinopathy among self-reported adult diabetics in districts of Eastern Nepal in a community based study.

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Agarwal, Lalit T; Agarwal, Nisha

2017-07-01

Diabetic retinopathy (DR) is the leading cause of blindness among working age adults around the world. Each year more and more people live with this condition, which can result in life-changing complications. To determine the prevalence and risk factors of diabetic retinopathy (DR) in a large community based screening programme, in order to estimate the future burden of the disease. A cross sectional community based study was conducted between 1st January and 31st December 2014 in a purposive sample of adults with selfreported diabetes mellitus (DM) from Morang and Sunsari district of Nepal. A structured questionnaire was used to collect patient data. Ophthalmological evaluation was done and fundus was examined for grading DR using direct and indirect ophthalmoscope. Among the 698 diabetic patients, mean age was 55.02±11.8 years (ranging from 24 to 91 years). 12.3% of diabetic were not under any treatment. Only 69.3% of patients had visited eye specialist for diabetic retinopathy screening. Prevalence of DR was found to be 15.3%; 13.9% had non-proliferative DR and 1.4% had proliferative DR. Prevalence of diabetic macular edema was 2.1%. In Morang district prevalence of DR was 14.2% and in Sunsari district it was 16.2%. In the binary-logistic regression analysis, duration of diabetes was associated with significantly increased risk of DR (OR: 1.13; 95% confidence interval (CI), 1.09 to 1.17; p<0.001). History of absence of arterial hypertension decreased the risk of DR (OR: 0.56; 95% CI, 0.36 to 0.87; p=0.01). One sixth of the patients with diabetes in the Eastern region of Nepal have retinopathy. Diabetic retinopathy risk increased with duration of diabetes and decreased with history of no co-existing arterial hypertension. © NEPjOPH.

A Review on Recent Developments for Detection of Diabetic Retinopathy

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Javeria Amin

2016-01-01

Full Text Available Diabetic retinopathy is caused by the retinal micro vasculature which may be formed as a result of diabetes mellitus. Blindness may appear as a result of unchecked and severe cases of diabetic retinopathy. Manual inspection of fundus images to check morphological changes in microaneurysms, exudates, blood vessels, hemorrhages, and macula is a very time-consuming and tedious work. It can be made easily with the help of computer-aided system and intervariability for the observer. In this paper, several techniques for detecting microaneurysms, hemorrhages, and exudates are discussed for ultimate detection of nonproliferative diabetic retinopathy. Blood vessels detection techniques are also discussed for the diagnosis of proliferative diabetic retinopathy. Furthermore, the paper elaborates a discussion on the experiments accessed by authors for the detection of diabetic retinopathy. This work will be helpful for the researchers and technical persons who want to utilize the ongoing research in this area.

A Review on Recent Developments for Detection of Diabetic Retinopathy.

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Amin, Javeria; Sharif, Muhammad; Yasmin, Mussarat

2016-01-01

Diabetic retinopathy is caused by the retinal micro vasculature which may be formed as a result of diabetes mellitus. Blindness may appear as a result of unchecked and severe cases of diabetic retinopathy. Manual inspection of fundus images to check morphological changes in microaneurysms, exudates, blood vessels, hemorrhages, and macula is a very time-consuming and tedious work. It can be made easily with the help of computer-aided system and intervariability for the observer. In this paper, several techniques for detecting microaneurysms, hemorrhages, and exudates are discussed for ultimate detection of nonproliferative diabetic retinopathy. Blood vessels detection techniques are also discussed for the diagnosis of proliferative diabetic retinopathy. Furthermore, the paper elaborates a discussion on the experiments accessed by authors for the detection of diabetic retinopathy. This work will be helpful for the researchers and technical persons who want to utilize the ongoing research in this area.

Comparison between Early Treatment Diabetic Retinopathy Study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy

DEFF Research Database (Denmark)

Rasmussen, Malin L; Broe, Rebecca; Frydkjaer-Olsen, Ulrik

2015-01-01

AIMS: To compare non-mydriatic, mydriatic and steered mydriatic widefield retinal images with mydriatic 7-field Early Treatment Diabetic Retinopathy Study (ETDRS)-standards in grading diabetic retinopathy (DR). METHODS: We examined 95 patients (190 eyes) with type 1 diabetes. A non...

Mitochondrial Haplogroups Modify the Effect of Diabetes Duration and HbA1c on Proliferative Diabetic Retinopathy Risk in Patients With Type 2 Diabetes.

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Mitchell, Sabrina L; Neininger, Abigail C; Bruce, Carleigh N; Chocron, Isaac M; Bregman, Jana A; Estopinal, Christopher B; Muhammad, Ayesha; Umfress, Allison C; Jarrell, Kelli L; Warden, Cassandra; Harlow, Paula A; Wellons, Melissa; Samuels, David C; Brantley, Milam A

2017-12-01

We previously demonstrated an association between European mitochondrial haplogroups and proliferative diabetic retinopathy (PDR). The purpose of this study was to determine how the relationship between these haplogroups and both diabetes duration and hyperglycemia, two major risk factors for diabetic retinopathy (DR), affect PDR prevalence. Our population consisted of patients with type 2 diabetes with (n = 377) and without (n = 480) DR. A Kruskal-Wallis test was used to compare diabetes duration and hemoglobin A1c (HbA1c) among mitochondrial haplogroups. Logistic regressions were performed to investigate diabetes duration and HbA1c as risk factors for PDR in the context of European mitochondrial haplogroups. Neither diabetes duration nor HbA1c differed among mitochondrial haplogroups. Among DR patients from haplogroup H, longer diabetes duration and increasing HbA1c were significant risk factors for PDR (P = 0.0001 and P = 0.011, respectively). Neither diabetes duration nor HbA1c was a significant risk factor for PDR in DR patients from haplogroup UK. European mitochondrial haplogroups modify the effects of diabetes duration and HbA1c on PDR risk in patients with type 2 diabetes. In our patient population, longer diabetes duration and higher HbA1c increased PDR risk in patients from haplogroup H, but did not affect PDR risk in patients from haplogroup UK. This relationship has not been previously demonstrated and may explain, in part, why some patients with nonproliferative DR develop PDR and others do not, despite similar diabetes duration and glycemic control.

The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary to proliferative diabetic retinopathy

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Rao Muhammad Rashad Qamar

2013-10-01

Full Text Available AIM: To evaluate the outcomes of pars plana vitrectomy (PPV without the use of an ocular tamponade in patients having tractional retinal detachment (TRD secondary to proliferative diabetic retinopathy (PDR.METHODS: It was an interventional study conducted at the Department of Ophthalmology, B.V. Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes having TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a tractional retinal detachment secondary to proliferative diabetic retinopathy but didn’t have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months.RESULTS:Successful retinal reattachement was observed in 78 of the operated eyes (92.8%. In these patients, the retina remained attached till the end of the one year follow-up period. Improvement in best corrected visual acuity (BCVA was seen in 63 eyes (75%. The visual acuity remained unchanged in 9 eyes (10.7%. Mean improvement in BCVA was 2.00+1.24 at baseline to 1.24+1.22 (PCONCLUSION: In the absence of the retinal breaks, a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.

Using Markov Chains to predict the natural progression of diabetic retinopathy.

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Srikanth, Priyanka

2015-01-01

To study the natural progression of diabetic retinopathy in patients with type 2 diabetes. This was an observational study of 153 cases with type 2 diabetes from 2010 to 2013. The state of patient was noted at end of each year and transition matrices were developed to model movement between years. Patients who progressed to severe non-proliferative diabetic retinopathy (NPDR) were treated. Markov Chains and Chi-square test were used for statistical analysis. We modelled the transition of 153 patients from NPDR to blindness on an annual basis. At the end of year 3, we compared results from the Markov model versus actual data. The results from Chi-square test confirmed that there was statistically no significant difference (P=0.70) which provided assurance that the model was robust to estimate mean sojourn times. The key finding was that a patient entering the system in mild NPDR state is expected to stay in that state for 5y followed by 1.07y in moderate NPDR, be in the severe NPDR state for 1.33y before moving into PDR for roughly 8y. It is therefore expected that such a patient entering the model in a state of mild NPDR will enter blindness after 15.29y. Patients stay for long time periods in mild NPDR before transitioning into moderate NPDR. However, they move rapidly from moderate NPDR to proliferative diabetic retinopathy (PDR) and stay in that state for long periods before transitioning into blindness.

Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients

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Afkhami-Ardekani Mohammad

2008-06-01

Full Text Available Abstract Background This study was performed to assess the prevalence of dry eye syndrome and diabetic retinopathy (DR in type 2 diabetic patients and their contributing factors. Methods 199 type 2 diabetic patients referred to Yazd Diabetes Research Center were consecutively selected. All Subjects were assessed by questionnaire about other diseases and drugs. Dry eye syndrome was assessed with Tear break up time tests and Schirmer. All the subjects underwent indirect ophthalmoscopy and retinal color photography. DR was graded according to early Treatment Diabetic Retinopathy (ETDRS criteria. Results Of 199 subjects, 108 patients (54.3% suffer from dry eye syndrome. Although dry eye syndrome was more common in older and female patients, this association was not significant. But there was significantly association between dry eye syndrome and duration of diabetes (P = 0.01. Dry eye syndrome was more frequent in diabetic patients with DR (P = 0.02. DR was found in 140 patients (70.35%, which included 34 patients (17.1% with mild non proliferative DR (NPDR, 34 patients (17.1% with moderate NPDR, 22 patients (11.1% with severe NPDR and 25 patients (25.1% with proliferative DR (PDR. There were significant relation between age, sex and duration of diabetes and DR. Conclusion In this study the prevalence of dry eye syndrome was 54.3%. Diabetes and dry eyes appear to have a common association. Further studies need to be undertaken to establish an etiologic relationship. However, examination for dry eye should be an integral part of the assessment of diabetic eye disease.

Detection of serum antibodies cross-reacting with Mycobacterium avium subspecies paratuberculosis and beta-cell antigen zinc transporter 8 homologous peptides in patients with high-risk proliferative diabetic retinopathy.

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Pinna, Antonio; Masala, Speranza; Blasetti, Francesco; Maiore, Irene; Cossu, Davide; Paccagnini, Daniela; Mameli, Giuseppe; Sechi, Leonardo A

2014-01-01

MAP3865c, a Mycobacterium avium subspecies paratuberculosis (MAP) cell membrane protein, has a relevant sequence homology with zinc transporter 8 (ZnT8), a beta-cell membrane protein involved in Zn++ transportation. Recently, antibodies recognizing MAP3865c epitopes have been shown to cross-react with ZnT8 in type 1 diabetes patients. The purpose of this study was to detect antibodies against MAP3865c peptides in patients with high-risk proliferative diabetic retinopathy and speculate on whether they may somehow be involved in the pathogenesis of this severe retinal disorder. Blood samples were obtained from 62 type 1 and 80 type 2 diabetes patients with high-risk proliferative diabetic retinopathy and 81 healthy controls. Antibodies against 6 highly immunogenic MAP3865c peptides were detected by indirect ELISA. Type 1 diabetes patients had significantly higher rates of positive antibodies than controls. Conversely, no statistically significant differences were found between type 2 diabetes patients and controls. After categorization of type 1 diabetes patients into two groups, one with positive, the other with negative antibodies, we found that they had similar mean visual acuity (∼ 0.6) and identical rates of vitreous hemorrhage (28.6%). Conversely, Hashimoto's thyroiditis prevalence was 4/13 (30.7%) in the positive antibody group and 1/49 (2%) in the negative antibody group, a statistically significant difference (P = 0.016). This study confirmed that type 1 diabetes patients have significantly higher rates of positive antibodies against MAP/ZnT8 peptides, but failed to find a correlation between the presence of these antibodies and the severity degree of high-risk proliferative diabetic retinopathy. The significantly higher prevalence of Hashimoto's disease among type 1 diabetes patients with positive antibodies might suggest a possible common environmental trigger for these conditions.

Proliferative sickle cell retinopathy associated with sickle cell trait and gestational diabetes: case report Retinopatia falciforme proliferativa associada a traço falciforme e diabetes gestacional: relato de caso

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Jefferson Augusto Santana Ribeiro

2009-06-01

Full Text Available Proliferative sickle cell retinopathy is an uncommon complication in individuals with sickle cell trait (AS. However, the risk for proliferative retinopathy development is increased in patients with AS hemoglobinopathy associated with systemic conditions or ocular trauma. A case of a patient with AS hemoglobinopathy who developed proliferative sickle cell retinopathy after the occurrence of gestational diabetes and pregnancy-induced hypertension is reported. Hemoglobin electrophoresis revealed presence of A2 5.0%, S 35.0% and A 53.2%. The present case emphasizes the importance of evaluating systemic comorbidities in patients with sickle cell trait during pregnancy since sickle cell retinopathy can progress rapidly, as well as the importance of regular eye fundus examination in these patients.Retinopatia falciforme proliferativa é uma complicação incomum em indivíduos com traço falciforme, havendo, porém, risco aumentado de desenvolver retinopatia proliferativa em pacientes com hemoglobinopatia AS associada a condições sistêmicas ou trauma ocular. Neste artigo será apresentado um caso de paciente com diabetes gestacional, hipertensão arterial sistêmica associada à gravidez e traço falciforme. Eletroforese de hemoglobinas revelou a presença de A2 5,0%, S 35,0% e A 53,2%. Este caso ressalta a importância da avaliação de comorbidades sistêmicas em pacientes com traço falciforme no período gestacional, uma vez que pode ocorrer rápida progressão da retinopatia falciforme, devendo-se realizar também exames regulares do fundo de olho nestes pacientes.

A shift in the balance of vascular endothelial growth factor and connective tissue growth factor by bevacizumab causes the angiofibrotic switch in proliferative diabetic retinopathy

NARCIS (Netherlands)

van Geest, Rob J.; Lesnik-Oberstein, Sarit Y.; Tan, H. Stevie; Mura, Marco; Goldschmeding, Roel; van Noorden, Cornelis J. F.; Klaassen, Ingeborg; Schlingemann, Reinier O.

2012-01-01

Introduction In proliferative diabetic retinopathy (PDR), vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) may cause blindness by neovascularisation followed by fibrosis of the retina. It has previously been shown that a shift in the balance between levels of CTGF

Quantitative analysis of macular retinal thickness and macular volume in diabetic retinopathy

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Ying Zhao

2017-12-01

Full Text Available AIM: To evaluate and characterize the macular thickness and macular volume in patients of different stages of diabetic retinopathy with special-domain optical coherence tomography(SD-OCT. METHODS: Totally 40 patients(78 eyeswith diabetic retinopathy were recruited in the study from January 2016 to January 2017 in our hospital. According to the international clinical classification of diabetic retinopathy, 20 cases(40 eyeswere categorized as non-proliferative diabetic retinopathy(NPDRgroup and 20 cases proliferative diabetic retinopathy(PDRgroup(38 eyes. All subjects were examined and analyzed with Early Treatment Diabetic Retinopathy Study(ETDRSsubfields, which were embedded in HS(Haag-Streitwith diameter of 1, 3 and 6mm.The changes of retinal thickness and volume of the macular center were measured. RESULTS: The thickness of macular foveolar in NPDR group and PDR group were 252.57±31.36μm, 362.47±20.81μm. The retinal thickness of inner superior subfield(ISMand inner nasal subfield(INMwere the thickest; that of inner inferior subfield(IIMwas next to ISM and INM, and that of inner temporal subfield was the thinnest. Of the outer subfields, the retinal thickness of outer superior subfield(OSMwas the thickest; that of outer nasal subfield(ONMwas next to OSM, and that of outer temporal subfield(OTMand outer inferior subfield(OIMwas the thinnest. The value of macular central concave thickness and retinal thickness in each quadrant of the NPDR group were less than those of the PDR group, the difference was statistically significant(P3, 0.28±0.16mm3, the upper and nasal sides of the middle part of the partition were the largest, the inferior and the temporal side were the smallest. The nasal side of the outer loop was the largest, the upper was the second, the temporal side and the inferior were the smallest. The volume of macular central fovea and the retinal volume in each quadrant of the NPDR group were smaller than those of the PDR group, the

Analysis of the Anxiety and Depression for Patients with Type 2 Diabetic Retinopathy in Different Period%不同时期2型糖尿病视网膜病变患者焦虑抑郁分析

Institute of Scientific and Technical Information of China (English)

刘奎香; 贺庆娟; 李廷

2014-01-01

Objective To study the anxiety and depression status of patients with type 2 diabetic retinopathy in different period. Methods Experimental group (patients with proliferative diabetic retinopathy)and control group (patients with non-proliferative diabetic retinopathy ) were all patients to our hospital,each group had 50 people. Cross-sectional survey about Hamilton rating scalefor anxiety (HAMA) and depression self-rating scale (HAMD)were carried out,then do statistical analysis. Results Patients with proliferative diabetic retinopathy got higher scores higher in anxiety depression test than that who with non-proliferative diabetic retinopathy. And the dif erence has statistical significance.Conclusion Higher at ention should be paid to psychological treatment for patients with proliferative diabetic retinopathy,and early intervention treatment of diabetic retinopathy for patients with non-proliferative diabetic retinopathy.%目的探讨非增殖期与增殖期糖尿病病变患者的焦虑抑郁心理状态。方法试验组及对照组均取于我院就诊的患有增殖期及非增殖期糖尿病视网膜病变的患者，各50例，对其进行焦虑及抑郁自评量表调查并对结果进行统计分析。结果增殖期糖尿病视网膜病变患者焦虑抑郁得分较非增殖期患者明显增高，差异有统计学意义。结论应重视对增殖期糖尿病视网膜病变患者的心理治疗及非增殖期糖尿病视网膜病变患者的早期干预治疗。

The 16-year incidence, progression and regression of diabetic retinopathy in a young population-based Danish cohort with type 1 diabetes mellitus

DEFF Research Database (Denmark)

Broe, Rebecca; Rasmussen, Malin Lundberg; Frydkjaer-Olsen, Ulrik

2014-01-01

The aim was to investigate the long-term incidence of proliferative diabetic retinopathy (PDR), and progression and regression of diabetic retinopathy (DR) and associated risk factors in young Danish patients with Type 1 diabetes mellitus. In 1987-89, a pediatric cohort involving approximately 75...... % of all children with Type 1 diabetes in Denmark diabetic parameters assessed. Of those, 185 (54.6 %) were evaluated again in 2011 for the same clinical parameters. All retinal images...... were graded using modified early treatment of DR study for 1995 and 2011. In 1995, mean age was 21.0 years and mean diabetes duration 13.5 years. The 16-year incidence of proliferative retinopathy, 2-step progression and 2-step regression of DR was 31.0, 64.4 and 0.0 %, respectively, while...

Detection of Glutamate and γ-aminobutyric Acid in Vitreous of Patients with Proliferative Diabetic Retinopathy

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Juan Deng; De-Zheng Wu; Rulong Gao

2000-01-01

Purpose: To study the levels of glutamate and γ-aminobutyric acid (GABA) in vitreous of patients with proliferative diabetic retinopathy(PDR) and to investigate their roles in retinal ischemia.Method: Vitreous samples were collected from 25 patients (27 eyes) with PDR and 14patients ( 14 eyes) with idiopathic macular hole. Glutamate and GABA detection were performed by high-performance liquid chromatography (HPLC).Results: Patients with PDR had significantly higher concentrations of glutamate and GABA than the control group. The glutamate level has a significantly positive correlation with GABA level.Conclusion: Detection of glutamate and GABA in vitreous provides biochemical support for the mechanism and treatment of ischemic retinal damage in patients with PDR.

The application of intravitreal bevacizumab for proliferative diabetic retinopathy%玻璃体腔注射贝伐单抗治疗增生性糖尿病视网膜病变

Institute of Scientific and Technical Information of China (English)

佟莉杨; 李甦雁

2014-01-01

糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病的严重并发症,尤其是增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)是工作年龄人群中首位致盲性眼病.近年来采用血管内皮生长因子抑制剂贝伐单抗(Bevacizumab,商品名Avastin)治疗PDR取得一定成效,其可促进玻璃体积血吸收,视网膜新生血管消退,减轻黄斑水肿,降低视网膜脱离的发生率,甚至使PDR患者避免玻璃体手术.%Diabetic retinopathy is a serious complication of diabetes mellitus,especially proliferative diabetic retinopathy(PDR),which is a leading cause of visual impairment and blindness among working-age people.In recent years,the efficacy of vascular endothelial growth factor inhibitor (Bevacizumab) has been recognized for the treatment of PDR.Intravitreal bevacizumab can accelerate absorption of vitreous hemorrhage and inhibit neovascularization,alleviate macular edema and vascular leakage and decrease the incidence of retinal detachment.

Temporal changes in retinal vascular parameters associated with successful panretinal photocoagulation in proliferative diabetic retinopathy

DEFF Research Database (Denmark)

Torp, Thomas Lee; Kawasaki, Ryo; Wong, Tien Yin

2018-01-01

PURPOSE: We aimed to investigate changes in retinal vascular geometry over time after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR). METHODS: Thirty-seven eyes with PDR were included. Wide-field fluorescein angiography (Optomap, Optos PLC., Dunfermline......, Scotland, UK) was used to diagnose PDR at baseline and to assess activity at follow-up month three and six. At each time-point, a trained grader measured retinal vessel geometry on optic disc (OD) centred images using semiautomated software (SIVA, Singapore I Vessel Assessment, National University...... of Singapore, Singapore) according to a standardized protocol. RESULTS: At baseline, the mean age and duration of diabetes were 52.8 and 22.3 years, and 65% were male. Mean HbA1c was 69.9 mmol/mol, and blood pressure was 155/84 mmHg. Of the 37 eyes with PDR, eight (22%) eyes had progression at month three...

Role of frequency doubling technology perimetry in screening of diabetic retinopathy.

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Parikh Rajul

2006-01-01

Full Text Available Purpose: To study the ability of frequency-doubling technology perimetry (FDT to detect sight-threatening diabetic retinopathy. Method: Fifty-eight eyes of fifty-eight patients with established diagnosis of diabetes mellitus with diabetic retinopathy, fifty-five eyes of fifty-five diabetic patients without retinopathy, and forty-one eyes of forty-one normals underwent FDT and dilated stereo-biomicroscopic fundus examination. The sensitivity and specificity of FDT in identification of "sight-threatening retinopathy" (severe and very severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy and clinically significant macular edema (CSME were determined. Results: For the detection of sight-threatening retinopathy, two abnormal adjacent points depressed to any level on the 20-1 screening program had a sensitivity of 90.5% and specificity of 97.6%. At (assuming a 10% prevalence of sight-threatening retinopathy in a diabetic clinic, two abnormal adjacent points anywhere in the field depressed to any level has a positive predictive value (PPV of 48% with a negative predictive value of 98.8%. Sensitivity and specificity for the detection of CSME was poor. Conclusions: The 20-1 screening program of the FDT is useful in the detection of sight-threatening diabetic retinopathy (PPV 48%. A normal 20-1 test rules out sight-threatening retinopathy. FDT was not useful in the detection of CSME.

Relationship between C-Reactive Protein Level and Diabetic Retinopathy: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Song, Jian; Chen, Song; Liu, Xiaoting; Duan, Hongtao; Kong, Jiahui; Li, Zedong

2015-01-01

To date, the relationship between C-reactive protein (CRP) level and diabetic retinopathy (DR) remains controversial. Therefore, a systematic review and meta-analysis was used to reveal the potential relationship between CRP level and DR. A systematic search of PubMed, Embase.com, and Web of Science was performed to identify all comparative studies that compared the CRP level of two groups (case group and control group). We defined that diabetic patients without retinopathy and/or matched healthy persons constituted the control group, and patients with DR were the case group. Two cross sectional studies and twenty case control studies including a total of 3679 participants were identified. After pooling the data from all 22 studies, obvious heterogeneity existed between the studies, so a subgroup analysis and sensitivity analysis were performed. Removing the sensitivity studies, the blood CRP levels in the case group were observed to be higher than those in the control group [SMD = 0.22, 95% confidence interval (CI), 0.11-0.34], and the blood CRP levels in the proliferative diabetic retinopathy (PDR) group were also higher than those in the non-proliferative diabetic retinopathy (NPDR) group [SMD = 0.50, 95% CI, 0.30-0.70]. The results from this current meta-analysis indicate that the CRP level might be used as a biomarker to determine the severity of DR.

Relationship between C-Reactive Protein Level and Diabetic Retinopathy: A Systematic Review and Meta-Analysis.

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Jian Song

Full Text Available To date, the relationship between C-reactive protein (CRP level and diabetic retinopathy (DR remains controversial. Therefore, a systematic review and meta-analysis was used to reveal the potential relationship between CRP level and DR.A systematic search of PubMed, Embase.com, and Web of Science was performed to identify all comparative studies that compared the CRP level of two groups (case group and control group. We defined that diabetic patients without retinopathy and/or matched healthy persons constituted the control group, and patients with DR were the case group.Two cross sectional studies and twenty case control studies including a total of 3679 participants were identified. After pooling the data from all 22 studies, obvious heterogeneity existed between the studies, so a subgroup analysis and sensitivity analysis were performed. Removing the sensitivity studies, the blood CRP levels in the case group were observed to be higher than those in the control group [SMD = 0.22, 95% confidence interval (CI, 0.11-0.34], and the blood CRP levels in the proliferative diabetic retinopathy (PDR group were also higher than those in the non-proliferative diabetic retinopathy (NPDR group [SMD = 0.50, 95% CI, 0.30-0.70].The results from this current meta-analysis indicate that the CRP level might be used as a biomarker to determine the severity of DR.

Using Markov Chains to predict the natural progression of diabetic retinopathy

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Priyanka Srikanth

2015-02-01

Full Text Available AIM: To study the natural progression of diabetic retinopathy in patients with type 2 diabetes. METHODS: This was an observational study of 153 cases with type 2 diabetes from 2010 to 2013. The state of patient was noted at end of each year and transition matrices were developed to model movement between years. Patients who progressed to severe non-proliferative diabetic retinopathy (NPDR were treated. Markov Chains and Chi-square test were used for statistical analysis. RESULTS: We modelled the transition of 153 patients from NPDR to blindness on an annual basis. At the end of year 3, we compared results from the Markov model versus actual data. The results from Chi-square test confirmed that there was statistically no significant difference (P=0.70 which provided assurance that the model was robust to estimate mean sojourn times. The key finding was that a patient entering the system in mild NPDR state is expected to stay in that state for 5y followed by 1.07y in moderate NPDR, be in the severe NPDR state for 1.33y before moving into PDR for roughly 8y. It is therefore expected that such a patient entering the model in a state of mild NPDR will enter blindness after 15.29y. CONCLUSION: Patients stay for long time periods in mild NPDR before transitioning into moderate NPDR. However, they move rapidly from moderate NPDR to proliferative diabetic retinopathy (PDR and stay in that state for long periods before transitioning into blindness.

Using Markov chains to predict the natural progression of diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

Priyanka; Srikanth

2015-01-01

AIM: To study the natural progression of diabetic retinopathy in patients with type 2 diabetes.METHODS: This was an observational study of 153 cases with type 2 diabetes from 2010 to 2013. The state of patient was noted at end of each year and transition matrices were developed to model movement between years. Patients who progressed to severe non-proliferative diabetic retinopathy(NPDR) were treated.Markov Chains and Chi-square test were used for statistical analysis.RESULTS: We modelled the transition of 153 patients from NPDR to blindness on an annual basis. At the end of year 3, we compared results from the Markov model versus actual data. The results from Chi-square test confirmed that there was statistically no significant difference(P =0.70) which provided assurance that the model was robust to estimate mean sojourn times. The key finding was that a patient entering the system in mild NPDR state is expected to stay in that state for 5y followed by 1.07 y in moderate NPDR, be in the severe NPDR state for 1.33 y before moving into PDR for roughly8 y. It is therefore expected that such a patient entering the model in a state of mild NPDR will enter blindness after 15.29 y.CONCLUSION: Patients stay for long time periods in mild NPDR before transitioning into moderate NPDR.However, they move rapidly from moderate NPDR to proliferative diabetic retinopathy(PDR) and stay in that state for long periods before transitioning into blindness.

Does bariatric surgery prevent progression of diabetic retinopathy?

Science.gov (United States)

Chen, Y; Laybourne, J P; Sandinha, M T; de Alwis, N M W; Avery, P; Steel, D H

2017-08-01

PurposeTo assess the changes in diabetic retinopathy (DR) in type 2 diabetes (T2DM) patients post bariatric surgery and report on the risk factors that may be associated with it.Patients and methodsRetrospective observational study of T2DM patients who underwent bariatric surgery in a UK specialist bariatric unit between 2009 and 2015. Preoperative and postoperative weight, HbA1c, and annual DR screening results were collected from medical records. Patients with preoperative retinal screening and at least one postoperative retinal screening were eligible for analysis. Multivariate analysis was used to explore significant clinical predictors on postoperative worsening in DR.ResultsA total of 102 patients were eligible for analysis and were followed up for 4 years. Preoperatively, 68% of patients had no DR compared to 30% with background retinopathy, 1% pre-proliferative retinopathy, and 1% proliferative retinopathy. In the first postoperative visit, 19% of patients developed new DR compared to 70% stable and 11% improved. These proportions remained similar for each postoperative visit over time. Young age, male gender, high preoperative HbA1c, and presence of preoperative retinopathy were the significant predictors of worsening postoperatively.ConclusionBariatric surgery does not prevent progression of DR. Young male patients with pre-existing DR and poor preoperative glycaemic control are most at risk of progression. All diabetic patients should attend regular DR screening post bariatric surgery to allow early detection of potentially sight-threatening changes, particularly among those with identifiable risk factors. Future prospective studies with prolonged follow-up are required to clarify the duration of risk.

Bilateral proliferative retinopathy in B-cell acute lymphoblastic leukemia

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Devesh Kumawat

2018-01-01

Full Text Available A 4-year-old child with B-cell acute lymphoblastic leukemia presented with vitreous hemorrhage due to proliferative retinopathy in both eyes. Pars plana vitrectomy was performed in both eyes to clear nonresolving vitreous hemorrhage after systemic stabilization. Visual recovery was limited by the disc drag in the right eye and subfoveal exudation in the left eye. Etiopathogenesis and management of proliferative retinopathy in acute leukemias are discussed.

Diabetic Retinopathy

Science.gov (United States)

... pregnancy may have rapid onset or worsening of diabetic retinopathy. Symptoms and Detection What are the symptoms of diabetic retinopathy and ... with diabetes protect their vision? Vision lost to diabetic retinopathy is ... However, early detection and treatment can reduce the risk of blindness ...

Study of serum soluble vascular cell adhesion molecule-1 levels in type 2 diabetic patients with diabetic retinopathy

International Nuclear Information System (INIS)

Li Fangdu; Chu Qiaomei

2002-01-01

To study the change and the correlation of serum soluble vascular cell adhesion molecule-1 (sV-CAM-1) levels with diabetic retinopathy in type 2 diabetic patients, serum sVCAM-1 levels were measured in duplicate by ELISA in 85 type 2 diabetic patients; fundus examination was performed by an ophthalmologist using ophthalmoscope or fundus fluorescein angiography, and the findings were graded as: no signs of diabetic retinopathy (NDR), background diabetic retinopathy (BDR) and proliferative diabetic retinopathy (PDR). Serum sVCAM-1 levels were significantly higher in the PDR and BDR groups than those in the control and NDR groups respectively (P<0.01). NDR group showed significantly increased serum sVCAM-levels compared with control group (P<0.01). In contrast, serum sVCAM-1 levels were not related to the presence of blood glucose, serum insulin levels or known diabetic duration. Authors' results suggest that serum sVCAM-1 might be implicated in the development of the diabetic retinopathy, and could assess the severity of diabetic retinopathy. The measurement of serum sVCAM-1 levels in 2 type diabetic patients may be clinically useful for early diagnosis or treatment of diabetic retinopathy

Automated detection of diabetic retinopathy in three European populations

DEFF Research Database (Denmark)

Hansen, M; Hansen, Morten B.; Tang, H L

2016-01-01

photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR). Method: Forty eyes from 38 newly diagnosed patients with PDR were included and followed for 6 months. All patients received standard PRP treatment by a navigated laser (NAVILAS®; OD-OS GmbH, Berlin, Germany) at baseline...... to month 6 (group 1 p=0.71, group 2 p=0.62). Conclusion: In our cohort, retinal vascular fractal dimension does not seem to be a valid marker for prediction of activity in patients with proliferative diabetic retinopathy 6 months after panretinal photocoagulation....... of diabetes were 52±14 years and 21±11 years, respectively, and 75% were male. HbA1c was 68 ±16 mmol/mol, and the mean blood pressure was 183/84 mmHg. Groups 1 and 2 did not differ according to the mean number of laser spots (1581 vs. 1573, p=0.84) or the total laser energy delivered (13.67 joule vs. 13...

Study on the correlation of serum lipid metabolism and central retinal artery hemodynamics with diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

Ran-Yang Guo

2016-01-01

Objective:To explore the correlation of serum lipid metabolism and central retinal artery (CRA) hemodynamics with diabetic retinopathy (DR).Methods:A total of 120 patients with type 2 diabetes who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into NDR group (non-diabetic retinopathy), NPR group (non-proliferative retinopathy), and PR group (proliferative retinopathy) with 40 cases in each group according to DR clinical staging. Moreover, 50 healthy individuals who came for physical examinations were served as the control group. The full automatic biochemical analyzer was used to detect the levels of TG, TC, LDL-C, and HDL-C. The color Doppler flow imaging (CDFI) was used to detect EDV, PSV, RI, and PI of CRA and OA.Results:The levels of TG, TC, and LDL-C in NDG, NPR, and PR groups were gradually increased with the aggravation of retinopathy, HDL-C was reduced, the comparison among the three groups was statistically significant, and the comparison with the control group was statistically significant. EDV, PSV, and PI of CRA and OA in NDG, NPR, and PR groups were gradually increased with the aggravation of retinopathy, RI was reduced, the comparison among the three groups was statistically significant, and the comparison with the control group was statistically significant. Conclusions: The lipid metabolism disorder can promote the occurrence and development of DR. The change of CRA and OA hemodynamics is an important pathological basis for developing DR. Clinical detection of serum lipid level and monitoring of the changes of fundus artery hemocynamic parameters are of great significance in early detecting DR.

Radiation retinopathy as an experimental model for ischemic proliferative retinopathy and rubeosis iridis

International Nuclear Information System (INIS)

Irvine, A.R.; Wood, I.S.

1987-01-01

We produced radiation retinopathy in capuchin monkeys and studied them with fluorescein angiography and light and electron microscopy. The animals were followed up from ten days to 3 1/2 years after radiation in order to determine whether this could provide an experimental model for other chronic ischemic-proliferative retinopathies, such as diabetes. The first change detected after radiation was the focal loss of capillary endothelial cells and pericytes. As the areas of acellular capillaries became confluent, cotton-wool spots became visible ophthalmoscopically. These increased in number and then faded away, leaving large areas of retinal capillary perfusion. Histologic studies showed occlusion first of the deeper, smaller retinal vessels and then gradually of the larger vessels. Intraretinal neovascularization as well as apparent recanalization then developed, but no new vessels extended through the internal limiting lamina into the vitreous. Rubeosis iridis with neovascular glaucoma developed 2 1/2 to 3 1/2 years postirradiation, and vitreous aspirate demonstrated a high level of angiogenic factor

Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy.

Science.gov (United States)

Healy, Rachel; Sallam, Ahmed; Jones, Vanessa; Donachie, Paul H J; Scanlon, Peter H; Stratton, Irene M; Johnston, Robert L

2014-01-01

To examine the level of agreement and reasons for disagreement between grading of diabetic retinopathy and maculopathy using mydriatic digital photographs in a diabetic retinopathy screening service (DRSS) and hospital eye service (HES). English NHS Diabetic Eye Screening Programme grades for diabetic retinopathy prospectively recorded on a hospital electronic medical record were compared to the grades from the DRSS event that prompted referral. In cases of disagreement, images were reviewed. Data for 1,501 patients (3,002 eyes) referred between 2008 and 2011 were analyzed. The HES retinopathy grades were R0 (no retinopathy) in 341 eyes, R1 (background retinopathy) in 1,712 eyes, R2 (pre-proliferative retinopathy) in 821 eyes, and R3 (proliferative retinopathy) in 128 eyes. The DRSS grades were in agreement in 2,309 eyes (76.9%), recorded a lower grade in 227 eyes, and recorded a higher grade in 466 eyes. Agreement was substantial (κ = 0.65). The commonest cause for disagreement was overgrading of R1 as R2 by hospital clinicians. The HES maculopathy grades were M0 (no maculopathy) in 2,267 eyes and M1 (maculopathy) in 735 eyes. The DRSS were in agreement in 2,111 eyes (70.2%), recorded a lower grade in 106 eyes, and recorded a higher grade in 785 eyes. Agreement was fair (κ = 0.39). The commonest cause for disagreement was hospital clinicians missing fine exudates. This study establishes a benchmark standard for agreement between HES and DRSS grading. Review of DRSS and grading reports images for newly referred patients is likely to improve levels of agreement, particularly for diabetic retinopathy, and should be strongly encouraged.

Diabetic Retinopathy in Europe Initial Results of the E3 Consortium Diabetes Group

DEFF Research Database (Denmark)

Hansen, Morten B.; Coolen, Ton; Peto, Tunde

2015-01-01

Design of study: Cross-sectional image grading study. Purpose: Panretinal photocoagulation (PRP) is the gold-standard treatment for proliferative diabetic retinopathy (PDR). Fundus fluorescein angiography leakage (FFAL) is often used as a marker of disease activity, but evaluation of the difference...

Diabetic retinopathy in Tanzania: prevalence and risk factors at entry into a regional screening programme.

Science.gov (United States)

Cleland, Charles R; Burton, Matthew J; Hall, Claudette; Hall, Anthony; Courtright, Paul; Makupa, William U; Philippin, Heiko

2016-03-01

The number of adults with diabetes in sub-Saharan Africa (SSA) is expected to almost double by 2035. This study investigated the prevalence of diabetic retinopathy (DR) and its risk factors at entry into a community-based screening programme. All persons with diabetes screened for retinopathy at entry into a screening programme in Kilimanjaro Region, Tanzania between November 2010 and December 2014 were included. Fundus photographs were taken with a Topcon retinal camera following pupil dilation. Data were collected on BP, random blood sugar, duration of diabetes, BMI and visual acuity on entry. A total of 3187 persons were screened for DR. The prevalence of any DR was 27.9% (95%CI 26.4-29.5%) with background diabetic retinopathy (BDR), pre-proliferative diabetic retinopathy (PPDR) and proliferative diabetic retinopathy (PDR) having a prevalence of 19.1% (95% CI 17.7-20.4%), 6.0% (95%CI 5.2-6.8%) and 2.9% (95%CI 2.3-3.5%), respectively. Maculopathy was present in 16.1% (95%CI 14.8-17.4%) of participants. Multivariable logistic regression analysis for the presence of any DR found independent associations with duration of diabetes (P planning of DR screening and treatment services in the African region. The study highlights the importance of managing comorbidities within DR screening programmes. © 2015 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Structural Changes of the Macula on Optical Coherence Tomography after Vitrectomy for Proliferative Diabetic Retinopathy.

Science.gov (United States)

Im, Jong Chan; Kim, Jong Ho; Park, Dong Ho; Shin, Jae Pil

2017-01-01

This study aimed to evaluate the relationship between macular structural changes and visual prognosis after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy. The study included 60 eyes that had undergone PPV. Macular optical coherence tomography (OCT) findings were classified into 5 groups preoperatively and 10 groups postoperatively. Best-corrected visual acuity (BCVA) were analyzed according to pre- and postoperative OCT. From the preoperative OCT, normal fovea with/without traction, normal fovea with preretinal hemorrhage, and tractional retinal detachment involving fovea showed an increase in BCVA after PPV (all p 20/50). Subfoveal fibrosis, macular hole, loss of foveal depression, and serous foveal detachment showed poor visual prognosis (BCVA <20/100). Macular structural changes were various after PPV, and visual prognosis correlated with these changes. © 2017 S. Karger AG, Basel.

Relationship between serum levels of oxidation and inflammatory factors in type 2 diabetic patients with retinopathy and its clinical significance

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Fang Xu

2018-02-01

Full Text Available AIM: To investigate the relationship between serum levels of oxidation and inflammatory factors in type 2 diabetic patients with retinopathy and its clinical significance. METHODS: Totally 54 cases of patients with diabetic retinopathy was selected as subjects, including 31 patients with diabetes and non-proliferative retinopathy(NPDR groupand 23 patients with diabetes and proliferative retinopathy(PDR group. Another 30 cases of diabetes patients without DR(DM groupand 30 normal people(NC groupwas selected as control. The level of fasting blood glucose(FPG, 2h postprandial blood glucose(2hPG, glycosylated hemoglobin(HbA1c, serum malondialdehyde(MDAand heme oxygenase -1(HO-1, tumor necrosis factor α(TNF-αand interleukin-6(IL-6and C reactive protein(CRPwas detected, and variance test detect the difference between 4 groups, and SNK-Q was used to multiple comparison. Pearson correlation analysis was used to compare the correlation between oxidation markers(MDA and Ho-1and the level of inflammatory factors(TNF-α, IL-6 and CRP. COX multivariate analysis was used to investigate the risk and protective factors of diabetic retinopathy. RESULTS: The levels of FPG, 2hPG, HbA1c, MDA, TNF-α, IL-6 and CRP in DM group, PDR group and NPDR group were significantly higher than that in NC group(PPPPPPPPCONCLUSION: Oxidative stress is closely related to the expression of inflammatory factors in serum of patients with diabetes mellitus, and is an important risk factor of DR, and related indicators can be used as markers for DR diagnosis.

Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside

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Søren Leer Blindbæk

2017-01-01

Full Text Available The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber and fractals with micro- and macrovascular dysfunction in diabetes. Likewise, the retinal metabolism can be evaluated by retinal oximetry, and higher retinal venular oxygen saturation has been demonstrated in patients with diabetic retinopathy. So far, most studies have been cross-sectional, but these can only disclose associations and are not able to separate cause from effect or to establish the predictive value of retinal vascular dysfunction with respect to long-term complications. Likewise, retinal markers have not been investigated as markers of treatment outcome in patients with proliferative diabetic retinopathy and diabetic macular edema. The Department of Ophthalmology at Odense University Hospital, Denmark, has a strong tradition of studying the retinal microvasculature in diabetic retinopathy. In the present paper, we demonstrate the importance of the retinal vasculature not only as predictors of long-term microvasculopathy but also as markers of treatment outcome in sight-threatening diabetic retinopathy in well-established population-based cohorts of patients with diabetes.

Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside

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Blindbæk, Søren Leer; Torp, Thomas Lee; Lundberg, Kristian; Soelberg, Kerstin; Vergmann, Anna Stage; Poulsen, Christina Døfler; Frydkjaer-Olsen, Ulrik; Broe, Rebecca; Rasmussen, Malin Lundberg; Wied, Jimmi; Lind, Majbrit; Vestergaard, Anders Højslet; Peto, Tunde

2017-01-01

The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber and fractals with micro- and macrovascular dysfunction in diabetes. Likewise, the retinal metabolism can be evaluated by retinal oximetry, and higher retinal venular oxygen saturation has been demonstrated in patients with diabetic retinopathy. So far, most studies have been cross-sectional, but these can only disclose associations and are not able to separate cause from effect or to establish the predictive value of retinal vascular dysfunction with respect to long-term complications. Likewise, retinal markers have not been investigated as markers of treatment outcome in patients with proliferative diabetic retinopathy and diabetic macular edema. The Department of Ophthalmology at Odense University Hospital, Denmark, has a strong tradition of studying the retinal microvasculature in diabetic retinopathy. In the present paper, we demonstrate the importance of the retinal vasculature not only as predictors of long-term microvasculopathy but also as markers of treatment outcome in sight-threatening diabetic retinopathy in well-established population-based cohorts of patients with diabetes. PMID:28491870

Levels of adhesion molecules in peripheral blood correlat with stages of diabetic retinopathy and may serve as bio markers for microvascular complications.

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Blum, Arnon; Pastukh, Nina; Socea, Dorina; Jabaly, Hanin

2018-06-01

Proliferative diabetic retinopathy is a devastating complication of diabetes mellitus, developing within 15 years in 50% of patients with type 1 diabetes mellitus (DM) and in 10% of patients with type 2 DM. The correlation between levels of inflammatory markers in the peripheral blood and retinopathy staging has not been studied yet, and the purpose of this prospective study was to find a possible association between inflammation and staging of diabetic retinopathy. A prospective (pilot) study that measured level of adhesion molecules in the peripheral blood of 10 healthy subjects and 30 patients with type 2 diabetes mellitus. Patients were grouped by the degree of retinopathy: 10 without retinopathy, 10 with non-proliferative retinopathy [NPDR] and 10 with proliferative retinopathy [PDR]. After signing the consent form, an ophthalmologic examination was performed, and 10 mL of blood was drawn. In order to assess adhesion molecules' level serum samples were collected, frozen, and stored at a temperature of -80 °C until analysis was performed as one batch. 10 healthy volunteers and 30 patients were enrolled. Healthy volunteers were younger (36.6 ± 7.9 years) compared to patients (no retinopathy 64.5 ± 10.8 years, NPDR 71.4 ± 8.9 years, and PDR 63.3 ± 11.6 years) (p = .0003 for all groups of patients in comparison with the healthy subjects). VCAM-1 levels were increased by retinopathy staging - starting from 81.86 ± 3.80 ng/ml (healthy), 105.55 ± 1.37 ng/ml (no retinopathy), 111.78 ± 4.14 ng/ml (NPDR), and 123.45 ± 3.99 ng/ml (PDR), with a significant difference between healthy and patients without retinopathy (p = .03), between no retinopathy and NPDR (p = .001), and between NPDR and PDR (p < .0001). E selectin was increased in correlation with severity of the retinopathy, with a significant difference between groups of patients (p = .03 between healthy subjects and T2DM patients

The metabolic syndrome and severity of diabetic retinopathy

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Chen JJ

2015-04-01

Full Text Available John J Chen,1,2,* Lucas J Wendel,1,3,* Emily S Birkholz,1 John G Vallone,4 Anne L Coleman,5,6 Fei Yu,7 Vinit B Mahajan1,3,8 1Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA; 2Mayo Clinic, Rochester, MN, USA; 3Vitreoretinal Service, University of Iowa, Iowa City, IA, USA; 4Department of Pathology, University of Southern California, 5Department of Ophthalmology, 6Department of Epidemiology, School of Public Health, 7Department of Biostatistics, University of California, Los Angeles, CA, USA; 8Omics Laboratory, University of Iowa, Iowa City, IA, USA *These authors contributed equally to this work Background: While metabolic syndrome has been strongly implicated as a risk factor for macrovascular diseases, such as stroke and cardiovascular disease, its relationship with microvascular diseases, including diabetic retinopathy, has been less defined. The purpose of this pilot study was to investigate the association between metabolic syndrome and the presence and severity of diabetic retinopathy.Methods: A retrospective case–control chart review at the University of Iowa ophthalmology and primary care clinics included 100 patients with proliferative diabetic retinopathy (PDR, 100 patients with nonproliferative diabetic retinopathy (NPDR, 100 diabetic patients without diabetic retinopathy, and 100 nondiabetic patients who were randomly selected. Using the International Diabetes Foundation definition, the prevalence of metabolic syndrome and the number of components of metabolic syndrome were compared among these groups.Results: The prevalence of metabolic syndrome in patients with diabetes was 69.3%, which was significantly higher than that in patients without diabetes (27%; P<0.0001 (odds ratio [OR] =6.28; 95% confidence interval [CI]: 3.76–10.49; P=0.0004. However, there was no significant difference in the prevalence of metabolic syndrome between diabetics with and without diabetic retinopathy, with rates

Biomarkers in Diabetic Retinopathy.

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Jenkins, Alicia J; Joglekar, Mugdha V; Hardikar, Anandwardhan A; Keech, Anthony C; O'Neal, David N; Januszewski, Andrzej S

2015-01-01

There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat

Short wavelength automated perimetry can detect visual field changes in diabetic patients without retinopathy

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Othman Ali Zico

2014-01-01

Full Text Available Purpose: The purpose of the following study is to compare short wave automated perimetry (SWAP versus standard automated perimetry (SAP for early detection of diabetic retinopathy (DR. Materials and Methods: A total of 40 diabetic patients, divided into group I without DR (20 patients = 40 eyes and group II with mild non-proliferative DR (20 patients = 40 eyes were included. They were tested with central 24-2 threshold test with both shortwave and SAP to compare sensitivity values and local visual field indices in both of them. A total of 20 healthy age and gender matched subjects were assessed as a control group. Results: Control group showed no differences between SWAP and SAP regarding mean deviation (MD, corrected pattern standard deviation (CPSD or short fluctuations (SF. In group I, MD showed significant more deflection in SWAP (−4.44 ± 2.02 dB compared to SAP (−0.96 ± 1.81 dB (P = 0.000002. However, CPSD and SF were not different between SWAP and SAP. In group II, MD and SF showed significantly different values in SWAP (−5.75 ± 3.11 dB and 2.0 ± 0.95 compared to SAP (−3.91 ± 2.87 dB and 2.86 ± 1.23 (P = 0.01 and 0.006 respectively. There are no differences regarding CPSD between SWAP and SAP. The SWAP technique was significantly more sensitive than SAP in patients without retinopathy (p, but no difference exists between the two techniques in patients with non-proliferative DR. Conclusion: The SWAP technique has a higher yield and efficacy to pick up abnormal findings in diabetic patients without overt retinopathy rather than patients with clinical retinopathy.

Analysis of central corneal thickness in different degrees of diabetic retinopathy

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Shan Hua

2014-06-01

Full Text Available AIM: To study central corneal thickness(CCTand correlation in different degrees of diabetic retinopathy(DR.METHODS: A total of 65 cases(130 eyeswith different degrees of DR and 35 normal cases(70 eyesas the age-and gender-matched control group were examined by corneal endothelial microscope, to measure CCT and statistics RESULTS: Compared to control group, there were no significant difference of CCT both mild and medium nonproliferative diabetic retinopathy(NPDRgroups(P>0.05. While the CCT of severe NPDR group and proliferative diabetic retinopathy(PDRgroup were thicker than control group, and the differences were statistically significant(PPPr=0.173, PCONCLUSION: The CCT increases with severity of DR. Taking care of protecting corneal endothelium is very important in the time of therapeutic measure, especially intraocular operation, to decrease complication.

Gene Expression of IGF1, IGF1R, and IGFBP3 in Epiretinal Membranes of Patients with Proliferative Diabetic Retinopathy: Preliminary Study

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Dorota Romaniuk

2013-01-01

Full Text Available The molecular mechanism formation of secondary epiretinal membranes (ERMs after proliferative diabetic retinopathy (PDR or primary idiopathic ERMs is still poorly understood. Therefore, the present study focused on the assessment of IGF1, IGF1R, and IGFBP3 mRNA levels in ERMs and PBMCs from patients with PDR. The examined group comprised 6 patients with secondary ERMs after PDR and the control group consisted of 11 patients with idiopathic ERMs. Quantification of IGF1, IGF1R, and IGFBP3 mRNAs was performed by real-time QRT-PCR technique. In ERMs, IGF1 and IGF1R mRNA levels were significantly higher in patients with diabetes compared to control subjects. In PBMCs, there were no statistically significant differences of IGF1, IGF1R, and IGFBP3 expression between diabetic and nondiabetic patients. In conclusion, our study indicated IGF1 and IGF1R differential expression in ERMs, but not in PBMCs, of diabetic and nondiabetic patients, suggesting that these factors can be involved in the pathogenesis or progression of proliferative vitreoretinal disorders. This trial is registered with NCT00841334.

Roles of tissue plasminogen activator and its inhibitor in proliferative diabetic retinopathy

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Shu-Ling; Wu; Dong-Mei; Zhan; Shu-Hong; Xi; Xiang-Lian; He

2014-01-01

AIM:To investigate the role of tissue plasminogen activator(t-PA) and plasminogen activator inhibitor(PAI)in proliferative diabetic retinopathy(PDR) and to discuss the correlations among t-PA, PAI and vascular endothelial growth factor(VEGF) expressions.METHODS:A total of 36 vitreous samples were collected from 36 patients with PDR(PDR group), and 17 vitreous samples from 17 patients with idiopathic macular hole were used as control. The concentrations of t-PA, PAI and VEGF in samples were determined by ELISA method. The correlations among t-PA, PAI and VEGF expressions were discussed.RESULTS:The concentrations of t-PA, PAI and VEGF in the PDR group were significantly higher than those in the control group(P <0.001). The t-PA and PAI expressions were highly correlated with the VEGF expression(P <0.001).CONCLUSION:In addition to VEGF, a variety of bioactive substances, such as t-PA and PAI, are involved in the pathogenesis involved in the angiogenesis of PDR.VEGF can activate t-PA expression, resulting in collagen tissue degradation and angiogenesis. VEGF may also activate the mechanism for endogenous anti-neovascularization.

Role of ACE and PAI-1 Polymorphisms in the Development and Progression of Diabetic Retinopathy

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Saleem, Saba; Azam, Aisha; Maqsood, Sundus Ijaz; Muslim, Irfan; Bashir, Shaheena; Fazal, Nosheen; Riaz, Moeen; Ali, Syeda Hafiza Benish; Niazi, Muhammad Khizar; Ishaq, Mazhar; Waheed, Nadia Khalida; Qamar, Raheel; Azam, Maleeha

2015-01-01

In the present study we determined the association of angiotensin converting enzyme (ACE) and plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms with diabetic retinopathy (DR) and its sub-clinical classes in Pakistani type 2 diabetic patients. A total of 353 diabetic subjects including 160 DR and 193 diabetic non retinopathy (DNR) as well as 198 healthy controls were genotyped by allele specific polymerase chain reaction (PCR) for ACE Insertion/Deletion (ID) polymorphism, rs4646994 in intron 16 and PAI-1 4G/5G (deletion/insertion) polymorphism, rs1799768 in promoter region of the gene. To statistically assess the genotype-phenotype association, multivariate logistic regression analysis was applied to the genotype data of DR, DNR and control individuals as well as the subtypes of DR. The ACE genotype ID was found to be significantly associated with DR (p = 0.009, odds ratio (OR) 1.870 [95% confidence interval (CI) = 1.04–3.36]) and its sub-clinical class non-proliferative DR (NPDR) (p = 0.006, OR 2.250 [95% CI = 1.098–4.620]), while PAI polymorphism did not show any association with DR in the current cohort. In conclusion in Pakistani population the ACE ID polymorphism was observed to be significantly associated with DR and NPDR, but not with the severe form of the disease i.e. proliferative DR (PDR). PMID:26658948

Role of ACE and PAI-1 Polymorphisms in the Development and Progression of Diabetic Retinopathy.

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Saba Saleem

Full Text Available In the present study we determined the association of angiotensin converting enzyme (ACE and plasminogen activator inhibitor-1 (PAI-1 gene polymorphisms with diabetic retinopathy (DR and its sub-clinical classes in Pakistani type 2 diabetic patients. A total of 353 diabetic subjects including 160 DR and 193 diabetic non retinopathy (DNR as well as 198 healthy controls were genotyped by allele specific polymerase chain reaction (PCR for ACE Insertion/Deletion (ID polymorphism, rs4646994 in intron 16 and PAI-1 4G/5G (deletion/insertion polymorphism, rs1799768 in promoter region of the gene. To statistically assess the genotype-phenotype association, multivariate logistic regression analysis was applied to the genotype data of DR, DNR and control individuals as well as the subtypes of DR. The ACE genotype ID was found to be significantly associated with DR (p = 0.009, odds ratio (OR 1.870 [95% confidence interval (CI = 1.04-3.36] and its sub-clinical class non-proliferative DR (NPDR (p = 0.006, OR 2.250 [95% CI = 1.098-4.620], while PAI polymorphism did not show any association with DR in the current cohort. In conclusion in Pakistani population the ACE ID polymorphism was observed to be significantly associated with DR and NPDR, but not with the severe form of the disease i.e. proliferative DR (PDR.

Role of advanced glycation end products (AGEs) and oxidative stress in diabetic retinopathy.

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Yamagishi, Sho-ichi; Ueda, Seiji; Matsui, Takanori; Nakamura, Kazuo; Okuda, Seiya

2008-01-01

Diabetic retinopathy is a common and potentially devastating microvascular complication in diabetes and is a leading cause of acquired blindness among the people of occupational age. However, current therapeutic options for the treatment of sight-threatening proliferative diabetic retinopathy such as photocoagulation and vitrectomy are limited by considerable side effects and far from satisfactory. Therefore, to develop novel therapeutic strategies that specifically target diabetic retinopathy is actually desired for most of the patients with diabetes. Chronic hyperglycemia is a major initiator of diabetic retinopathy. However, recent clinical study has substantiated the concept of 'hyperglycemic memory' in the pathogenesis of diabetic retinopathy. Indeed, the Diabetes Control and Complications Trial-Epidemiology of Diabetes Interventions and Complications (DCCT-EDIC) Research, has revealed that the reduction in the risk of progressive retinopathy resulting from intensive therapy in patients with type 1 diabetes persisted for at least several years after the DCCT trial, despite increasing hyperglycemia. These findings suggest a long-term beneficial influence of early metabolic control on clinical outcomes in type 1 diabetic patients. Among various biochemical pathways implicated in the pathogenesis of diabetic retinopathy, the process of formation and accumulation of advanced glycation end products (AGEs) and their mode of action are most compatible with the theory 'hyperglycemic memory'. Further, there is a growing body of evidence that AGEs-RAGE (receptor for AGEs) interaction-mediated oxidative stress generation plays an important role in diabetic retinopathy. This article summarizes the role of AGEs and oxidative stress in the development and progression of diabetic retinopathy and the therapeutic interventions that could prevent this devastating disorder. We also discuss here the pathological crosstalk between the AGEs-RAGE and the renin-angiotensin system in

Pattern scan laser versus single spot laser in panretinal photocoagulation treatment for proliferative diabetic retinopathy

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Shu Zhang

2017-02-01

Full Text Available AIM: To investigate the efficacy of 577-nm pattern scan laser in panretinal photocoagulation(PRPtreatment in newly diagnosed proliferative diabetic retinopathy(PDR.METHODS:Prospective and comparative observation was performed in totally 32 patients with high-risk PDR. They were randomly divided into group 1(using pattern scan laser, PSLand 2(using single spot laser, SSL, each containing 16 subjects to which totally 20 eyes received PRP. Non-perfusion region was identified with fundus fluorescein angiography(FFAbefore and 3mo after final PRP. The advantage of PSL was verified in terms of the number and the duration of PRP sessions needed for satisfactory outcomes, and the pain score.RESULTS: Three PRP sessions were needed for each eye to complete the treatment using PSL, while 4 sessions were needed using SSL. The duration of each session with PSL in group 1 was 7.3±2.3min, which was significantly shorter than that with SSL in group 2(13.2±4.1, t38=5.596, PPCONCLUSION: PSL showed clear advantages over SSL in the PRP treatment of PDR, not only in the improved efficacy, but also in the reduction of pain and the improvement of effectiveness.

Clinical analysis of laser photocoagulation for diabetic retinopathy%糖尿病视网膜病变激光光凝治疗疗效分析

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张志红; 王媛媛; 曹江欣

2013-01-01

目的探讨激光光凝治疗糖尿病视网膜病变(DR)的疗效。方法 以DR患者54例108眼为研究对象，对增殖期(PDR)96眼行标准全视网膜光凝,非增殖期(NPDR)22眼行弥漫视网膜光凝。结果 视力提高或不变90眼，有效率83.3%。FFA检查示有效率86.1%。结论 激光光凝术是治疗DR 的一个有效方法，要把握光凝时机，争取早期发现并及时治疗DR，提高激光光凝的疗效。%Objective :To evaluate the efficacy of laser coagulation for diabetic retinopathy. Method :Total 54 patients (108 eyes) of diabetic retinopathy were as the object of this study. 96 eyes with proliferative diabetic retinopathy (PDR) were given panretinal photocoagulation. 22 eyes with non-proliferative diabetic retinopathy(NPDR)were given scatter photocoagulation.Results : the eyes of vision improve or no change are 90,totle effective rate is 83.3. totle effective rate of FFA examination is 86.1%. Conclusion: Laser photocoagulation is an effective method for diabetic retinopathy. It has different efficacy for the different stages of diabetic retinopathy. It can improve the efficacy of laser photocoagulation that we seize the opportunity of laser photocoagulation for diabetic retinopathy,early detecting and timely treating diabetic retinopathy.

Biomarkers in Diabetic Retinopathy

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Jenkins, Alicia J.; Joglekar, Mugdha V.; Hardikar, Anandwardhan A.; Keech, Anthony C.; O'Neal, David N.; Januszewski, Andrzej S.

2015-01-01

There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat

Study of diabetic retinopathy and Bone Mineral Density in type 2 Diabetes patient%2型糖尿病患者视网膜病变与骨密度的研究

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张春香; 赵全良

2014-01-01

目的：探讨2型糖尿病患者视网膜病变（ DR）与骨密度（ BMD）的关系。方法：检查了63例2型糖尿病患者视网膜，分为A组即正常组、B组单纯性视网膜病变组、C组增殖性视网膜病变组，并分别测定其L2～4椎体、双侧股骨Ward 区BMD 。结果：除A组患者BMD与对照组无明显差异（ p ＞0．05）；B、C组患BMD与对照组差异明显（ p ＜0．01）；糖尿病患者中， C组BMD明显低于A组（ p ＜0．01）。结论：糖尿病视网膜病变患者BMD 比正常人低，增殖性视网膜病变组BMD较其它组显著下降。%Objective:To study the relationship between diabetic retinopathy and bone mineral density with type 2 diabetic patients (T2DM) .Methods:Dual energy X -ray absorptiometry was used to measure the bone mineral density (BMD) of lumbar spines(L2 -4) , Ward's triangle in 63 patients with type 2 diabetes mellitus and 55 cases of normal control group .According to diabetic retinopathy were divided into groups with normal retina (group A), nonproliferative diabetic retinopathy (group B) and proliferative diabetic retinopa-thy ( group C) .Results:No significant differences were found in BMD between normal retina l diabetic patients and normal control group ( p >0.05) .BMD was significantly lower in diabetes patient with nonproliferative diabetic retinopathy group and proliferative diabetic retinopathy than the normal control group .In diabetes patient BMD was significantly lower in proliferative diabetic retinopathy group than in normal control groups ( p <0.01) .Conclusion:BMD in diabetes patient with nephropathy should be lower than normal control group.BMD in diabetes patient might be more remarkable in the group with proliferative diabetic retinopathy than in the groups with nor -mal retina and nonproliferative diabetic retinopathy .

TNF-Alpha Levels in Tears: A Novel Biomarker to Assess the Degree of Diabetic Retinopathy

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C. Costagliola

2013-01-01

Full Text Available We assess the level of tumour necrosis factor alpha (TNF-alpha in tear fluids and other serum parameters associated with diabetes in different degrees of diabetic retinopathy. We have performed a prospective, nonrandomized, observational study. Study population consisted of 16 healthy subjects (controls and 32 type 2 diabetic patients: 16 affected by proliferative diabetic retinopathy (PDR and 16 with nonproliferative retinopathy (NDPR, background/preproliferative. Body mass index, urinary albumin, blood glucose, HbA1c, and tear levels of TNF-alpha were measured in all subjects. The value of glycaemia, microalbuminurea, and Body mass index in diabetic retinopathy groups were higher than those in control group (. Glycemia in NPDR: 6.6 mmol/L (range: 5.8–6.3; in PDR: 6.7 mmol/L (range: 6.1–7.2; in control: 5.7 mmol/L (range: 4.9–6.1; microalbuminurea in NPDR: 10.6 mg/L (range: 5.6–20; in PDR: 25.2 mg/L (range: 17–40; in control: 5.3 mg/L (range: 2.6–10; Body mass index in NPDR: 26 Kg/m2 (range: 20.3–40; in PDR: 28 Kg/m2 (range 20.3–52; in control: 21 Kg/m2 (range 19–26. The TNF-alpha concentrations in tears increase with the severity of pathology and were lower in control group than in diabetic subjects. In the end, the level of TNF-alpha is highly correlated with severity of diabetic retinopathy and with nephropathy. Tear fluid collection may be a useful noninvasive method for the detection of proliferative diabetic retinopathy.

Laws of physics help explain capillary non-perfusion in diabetic retinopathy.

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Stefánsson, E; Chan, Y K; Bek, T; Hardarson, S H; Wong, D; Wilson, D I

2018-02-01

The purpose is to use laws of physics to elucidate the mechanisms behind capillary non-perfusion in diabetic retinopathy. In diabetic retinopathy, loss of pericytes weakens capillary walls and the vessel dilates. A dilated capillary has reduced resistance to flow, therefore increased flow in that vessel and decreased in adjoining capillaries. A preferential shunt vessel is thus formed from the dilated capillary and the adjacent capillaries become non-perfused. We apply the laws of Laplace and Hagen-Poiseuille to better understand the phenomena that lead to capillary non-perfusion. These laws of physics can give a foundation for physical or mathematical models to further elucidate this field of study. The law of Laplace predicts that a weaker vessel wall will dilate, assuming constant transmural pressure. The Hagen-Poiseuille equation for flow and the Ostwald-de Waele relationship for viscosity predict that a dilated vessel will receive a higher portion of the fluid flow than the adjoining capillaries. Viscosity will decrease in the dilated vessel, furthering the imbalance and resulting in a patch of non-perfused capillaries next to the dilated 'preferential' shunt vessel. Physical principles support or inspire novel hypotheses to explain poorly understood phenomena in ophthalmology. This thesis of pericyte death and capillary remodelling, which was first proposed by Cogan and Kuwabara, already agrees with histological and angiographical observations in diabetic retinopathy. We have shown that it is also supported by classical laws of physics.

Validation of Smartphone Based Retinal Photography for Diabetic Retinopathy Screening.

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Rajalakshmi, Ramachandran; Arulmalar, Subramanian; Usha, Manoharan; Prathiba, Vijayaraghavan; Kareemuddin, Khaji Syed; Anjana, Ranjit Mohan; Mohan, Viswanathan

2015-01-01

To evaluate the sensitivity and specificity of "fundus on phone' (FOP) camera, a smartphone based retinal imaging system, as a screening tool for diabetic retinopathy (DR) detection and DR severity in comparison with 7-standard field digital retinal photography. Single-site, prospective, comparative, instrument validation study. 301 patients (602 eyes) with type 2 diabetes underwent standard seven-field digital fundus photography with both Carl Zeiss fundus camera and indigenous FOP at a tertiary care diabetes centre in South India. Grading of DR was performed by two independent retina specialists using modified Early Treatment of Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined by the presence of proliferative DR(PDR) or diabetic macular edema. The sensitivity, specificity and image quality were assessed. The mean age of the participants was 53.5 ±9.6 years and mean duration of diabetes 12.5±7.3 years. The Zeiss camera showed that 43.9% had non-proliferative DR(NPDR) and 15.3% had PDR while the FOP camera showed that 40.2% had NPDR and 15.3% had PDR. The sensitivity and specificity for detecting any DR by FOP was 92.7% (95%CI 87.8-96.1) and 98.4% (95%CI 94.3-99.8) respectively and the kappa (ĸ) agreement was 0.90 (95%CI-0.85-0.95 p<0.001) while for STDR, the sensitivity was 87.9% (95%CI 83.2-92.9), specificity 94.9% (95%CI 89.7-98.2) and ĸ agreement was 0.80 (95%CI 0.71-0.89 p<0.001), compared to conventional photography. Retinal photography using FOP camera is effective for screening and diagnosis of DR and STDR with high sensitivity and specificity and has substantial agreement with conventional retinal photography.

Validation of Smartphone Based Retinal Photography for Diabetic Retinopathy Screening.

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Ramachandran Rajalakshmi

Full Text Available To evaluate the sensitivity and specificity of "fundus on phone' (FOP camera, a smartphone based retinal imaging system, as a screening tool for diabetic retinopathy (DR detection and DR severity in comparison with 7-standard field digital retinal photography.Single-site, prospective, comparative, instrument validation study.301 patients (602 eyes with type 2 diabetes underwent standard seven-field digital fundus photography with both Carl Zeiss fundus camera and indigenous FOP at a tertiary care diabetes centre in South India. Grading of DR was performed by two independent retina specialists using modified Early Treatment of Diabetic Retinopathy Study grading system. Sight threatening DR (STDR was defined by the presence of proliferative DR(PDR or diabetic macular edema. The sensitivity, specificity and image quality were assessed.The mean age of the participants was 53.5 ±9.6 years and mean duration of diabetes 12.5±7.3 years. The Zeiss camera showed that 43.9% had non-proliferative DR(NPDR and 15.3% had PDR while the FOP camera showed that 40.2% had NPDR and 15.3% had PDR. The sensitivity and specificity for detecting any DR by FOP was 92.7% (95%CI 87.8-96.1 and 98.4% (95%CI 94.3-99.8 respectively and the kappa (ĸ agreement was 0.90 (95%CI-0.85-0.95 p<0.001 while for STDR, the sensitivity was 87.9% (95%CI 83.2-92.9, specificity 94.9% (95%CI 89.7-98.2 and ĸ agreement was 0.80 (95%CI 0.71-0.89 p<0.001, compared to conventional photography.Retinal photography using FOP camera is effective for screening and diagnosis of DR and STDR with high sensitivity and specificity and has substantial agreement with conventional retinal photography.

The influence of background diabetic retinopathy in the second eye on rates of progression of diabetic retinopathy between 2005 and 2010.

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Scanlon, Peter H; Stratton, Irene M; Histed, Mark; Chave, Steve J; Aldington, Stephen J

2013-08-01

The Gloucestershire Diabetic Eye Screening Programme offers annual digital photographic screening for diabetic retinopathy to a countywide population of people with diabetes. This study was designed to investigate progression of diabetic retinopathy in this programme of the English NHS Diabetic Eye Screening Programme. Mydriatic digital retinal photographs of people with diabetes screened on at least 2 occasions between 2005 and 2010 were graded and included in this study if the classification at first screening was no DR (R0), background DR in one (R1a) or both eyes (R1b). Times to detection of referable diabetic retinopathy (RDR) comprising maculopathy (M1), preproliferative (R2) or proliferative retinopathy (R3) were analysed using survival models. Data were available on 19 044 patients, 56% men, age at screening 66 (57-74) years (median, 25th, 75th centile). A total of 8.3% of those with R1a and 28.2% of those with R1b progressed to any RDR, hazard ratios 2.9 [2.5-3.3] and 11.3 [10.0-12.8]. Similarly 7.1% and 0.11% of those with R1a progressed to M1 and R3, hazard ratios 2.7 [2.3-3.2] and 1.6 [0.5-5.0], compared to 21.8% and 1.07% of those with R1b, hazard ratio 9.1 [7.8-10.4] and 15.0 [7.1-31.5]. The risk of progression is significantly higher for those with background DR in both eyes than those with background retinopathy in only one or in neither eye. © 2013 The Authors Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by Blackwell Publishing Ltd.

Clinical application of OCTA in observation of macular blood flow density in patients with diabetic retinopathy

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Xiang Xiang

2017-07-01

Full Text Available AIM: Using optical coherence tomography angiography(OCTAto observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy(DR.METHODS: Totally 47 eyes(28 patientswith diabetic retinopathy(DRwere enrolled in the DR group. According to the international clinical grading criteria of diabetic retinopathy, 30 eyes(19 patientswith non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes(11 patientswith proliferative diabetic retinopathy were classified as PDR group. A total of 46(27 subjectshealthy eyes with matched age were enrolled in the control group. All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography(OCTA, obtaining 4 levels of macular blood flow density map. The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured. RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively. Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group. For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively. The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group(total PP=0.029, but not in the superficial retina layer and choroid capillary layer(P=0.236, 0.268. CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary

Mayombian ethnic, vegetables low intake, insulin treatment, diabetic nephropathy and severe diabetic retinopathy are determinants of blindness in diabetic Africans

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Moise, Mvitu Muaka; Benjamin, Longo-Mbenza; Enoch, Cibanda Yokobo; Igor, Longo Phemba

2013-01-01

AIM To determine the frequency and causes of blindness in diabetic Africans. METHODS The study was a cross-sectional survey carried out among known black diabetics consecutively admitted at the Teaching Hospital, University of Kinshasa, between 2005 and 2007. Examination methods included interviewer-administered structured questionnaire, eye examinations (visual acuity, tonometry, funduscopy), and fasting plasma glycaemia test. RESULTS Of the 227 patients examined, 15.9% had blindness. Univariate analyses showed significant association between female, severity of diabetic retinopathy, Mayombian ethnic group, use of insulin treatment, low intake of vegetables, diabetic nephropathy, open angle glaucoma and blindness in all diabetics. After logistic regression, only diabetic nephropathy, use of insulin treatment, macular oedema, Mayombian ethnic group and vegetables low intake were the independent risk factors of blindness in all diabetics. However, after logistic regression in the sub-group with diabetic retinopathy, only open angle glaucoma and proliferative diabetic retinopathy were the independent determinants of blindness. CONCLUSION The majority of the causes of blindness in these diabetic Africans are avoidable. It is recommended that appropriate diabetes care, nutrition education, periodic eye examination and laser photocoagulation facilities should be provided for treating diabetics in sub-Saharan Africa. PMID:24195057

Frequency of diabetic retinopathy in hypertensive diabetic patients in a tertiary care hospital of Peshawar, Pakistan

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Rahman, S.; Khan, G.J.; Aamir, A.H.

2011-01-01

Background: Diabetic retinopathy is a common microvascular complication of both type 1 and type 2 diabetes mellitus. If left untreated, it can progress to serious visual disability. Coexistence of hypertension with diabetes has been described as another risk factor adding to the problem. We designed this study to assess the occurrence of diabetic retinopathy in hypertensive diabetic patients of this region and to compare it with normotensive diabetic patients. Methods: This cross-sectional study was carried out on 200 previously diagnosed diabetic patients. Apart from routine examination and investigations, retinopathy and blood pressure assessment of each patient was done using standard techniques. Hypertensive diabetic subjects (Group-I, n=107) were compared with non-hypertensive diabetics (Group-II, n=93) for the presence of retinopathy. Results: Retinopathy and hypertension were observed in 51% and 53.5% of the total diabetic patients respectively. Hypertensive diabetic patients had significantly higher percentage of retinopathy compared to non-hypertensive diabetic patients (58 vs 43%; p<0.05). Conclusion: Retinopathy and hypertension are highly prevalent in our diabetic patients. The proportion of retinopathy is significantly more in hypertensive as compared to normotensive diabetics. (author)

Study on the expression of Dickkopf-3 protein in diabetic retinopathy%Dickkopf-3蛋白在糖尿病视网膜病变患者血浆中的表达

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李沭岩; 张磊; 张爱华

2016-01-01

目的：观察 Dickkopf-3在糖尿病视网膜病变( diabetic retinopathy,DR)患者循环血中的表达水平,研究Dickkopf-3在糖尿病视网膜病变发生发展中的变化,探讨其在糖尿病视网膜病变早期诊断中的意义。　　方法：选择2型糖尿病患者85例,其中非增殖期糖尿病视网膜病变( non-proliferative DR,NPDR)患者23例、增殖期糖尿病视网膜病变( proliferative DR,PDR)患者30例及无视网膜病变( non-diabetic retinopathy,NDR)患者32例。选择同期健康体检者为对照组(80例)。收集血清样本,采用酶联免疫吸附法( ELISA )双抗体夹心法检测循环血中Dickkopf-3的相对表达水平,并比较各组血浆Dickkopf-3的水平。　　结果：糖尿病视网膜病变患者血浆Dickkopf-3平均含量为430.16±198.11pg/mL,明显低于健康对照组(627.48±294.45pg/mL)及无视网膜病变患者(601.99±194.16pg/mL),差异有统计学意义(P　　结论：Dickkopf-3蛋白水平降低可能与糖尿病视网膜病变的发生发展有关,与增殖期糖尿病视网膜病变有显著相关性。循环血中Dickkopf-3蛋白对糖尿病视网膜病变具备一定的鉴别效能,有可能成为糖尿病视网膜病变患者外周血的检测指标。%AIM:To observe the effects of Dickkopf-3 ( Dkk-3 ) in diabetic retinopathy ( DR ) circulating blood in patients with the expression level, the Dkk - 3 development changes in the diabetic retinopathy of significance in the diagnosis of early DR. ● METHODS: Eighty - five type 2 diabetic patients, included the non - proliferative diabetic retinopathy ( NPDR ) 23 patients, proliferative diabetic retinopathy, proliferative DR ( PDR ) in patients with 30 and non-diabetic retinopathy ( NDR ) with 32 cases. The same period of healthy physical examination was selected as control group ( 80 cases ) . Serum samples were collected, and the relative expression level of Dkk-3 was detected by enzyme - linked immunosorbent assay ( ELlSA) double

Curative effect of Ranibizumab combined with laser photocoagulation for proliferative diabetic retinopathy

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Fan-Yi Meng

2018-04-01

Full Text Available AIM:To investigate the clinical efficacy of Ranibizumab combined with laser photocoagulation in the treatment of proliferative diabetic retinopathy(PDR. METHODS: Totally 80 patients(101 eyeswith PDR admitted to our hospital from October 2014 and October 2016 were selected and divided into the observation group and the control group, with 50 eyes and 51 eyes respectively. The patients in the control group(50 eyeswere treated with panretinal photocoagulation(PRP, and the patients in observation group(51 eyeswere treated with ranibizumab on the basis of PRP treatment. Best corrected visual acuity(BCVAwas compared before and after surgery 1, 3, and 6mo. Optical coherence tomography(OCTwas used to examine the central macular thickness(CMTand the area of neovascularization at each timepoints. Then the laser spot number, laser energy and energy density were compared between the two groups and the adverse reactions were recorded. RESULTS: Postoperative BCVA of the two groups significantly increased, and the BCVA of observation group were significantly higher than that of the control group after surgery 1, 3, 6mo, the difference was statistically significant(PPPCONCLUSION: Ranibizumab combined with laser in the treatment of PDR is an effective and safe way to improve BCVA, reduce CMT, and eliminate new blood vessels with less required laser energy.

Posterior subtenon triamcinolone acetonide in gas-filled eyes as an adjunctive treatment for complicated proliferative diabetic retinopathy.

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Lee, Yongeun; Kang, Seungbum; Park, Young-Hoon

2013-02-01

To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.

Detection of neovascularization based on fractal and texture analysis with interaction effects in diabetic retinopathy.

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Lee, Jack; Zee, Benny Chung Ying; Li, Qing

2013-01-01

Diabetic retinopathy is a major cause of blindness. Proliferative diabetic retinopathy is a result of severe vascular complication and is visible as neovascularization of the retina. Automatic detection of such new vessels would be useful for the severity grading of diabetic retinopathy, and it is an important part of screening process to identify those who may require immediate treatment for their diabetic retinopathy. We proposed a novel new vessels detection method including statistical texture analysis (STA), high order spectrum analysis (HOS), fractal analysis (FA), and most importantly we have shown that by incorporating their associated interactions the accuracy of new vessels detection can be greatly improved. To assess its performance, the sensitivity, specificity and accuracy (AUC) are obtained. They are 96.3%, 99.1% and 98.5% (99.3%), respectively. It is found that the proposed method can improve the accuracy of new vessels detection significantly over previous methods. The algorithm can be automated and is valuable to detect relatively severe cases of diabetic retinopathy among diabetes patients.

Detection of neovascularization based on fractal and texture analysis with interaction effects in diabetic retinopathy.

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Jack Lee

Full Text Available Diabetic retinopathy is a major cause of blindness. Proliferative diabetic retinopathy is a result of severe vascular complication and is visible as neovascularization of the retina. Automatic detection of such new vessels would be useful for the severity grading of diabetic retinopathy, and it is an important part of screening process to identify those who may require immediate treatment for their diabetic retinopathy. We proposed a novel new vessels detection method including statistical texture analysis (STA, high order spectrum analysis (HOS, fractal analysis (FA, and most importantly we have shown that by incorporating their associated interactions the accuracy of new vessels detection can be greatly improved. To assess its performance, the sensitivity, specificity and accuracy (AUC are obtained. They are 96.3%, 99.1% and 98.5% (99.3%, respectively. It is found that the proposed method can improve the accuracy of new vessels detection significantly over previous methods. The algorithm can be automated and is valuable to detect relatively severe cases of diabetic retinopathy among diabetes patients.

Prevalence of systemic co-morbidities in patients with various grades of diabetic retinopathy

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Pradeep Venkatesh

2014-01-01

Full Text Available Background & objectives : Though diabetes affects multiple organs, most studies highlight the occurence of only one complication in isolation. We conducted a hospital-based study to estimate the co-existence of significant systemic co-morbid conditions in patients with varying grades of diabetic retinopathy. Methods : A total of 170 consecutive patients with diabetic retinopathy were prospectively recruited for the study between June 2009 to June 2010 at a tertiary care eye centre in north India. Retinopathy was graded by fundus biomicroscopy and fundus photography and classified into three categories (mild-moderate nonproliferative retinopathy, proliferative retinopathy requiring only laser and proliferative retinopathy requiring surgery. Nephropathy was classified by calculating the six variable estimated glomerular filtration rate (eGFR for all patients. Nerve conduction studies and clinical assessment were used to determine presence of neuropathy. Co-existence of macrovascular disease and peripheral vascular disease was also ascertained. Results : The percentages of patients with overt nephropathy in the three groups were 19.2, 38.0 and 41.2, respectively. Significant linear trends were observed for serum creatinine (P=0.004, albumin (P=0.017 and eGFR (P=0.030. A higher per cent had abnormal nerve conduction on electrophysiology than that diagnosed clinically (65.4 vs. 44.2, 76.0 vs. 40.0 and 64.8 vs. 48.6, respectively. The odds ratio (95% CI for co-existence of nephropathy, neuropathy, CVA (cerebrovascular accidents and PVD (peripheral vascular disease was 2.9, 0.9, 4.8 and 3.5, respectively. Independent of retinopathy severity, patients with clinically significant macular oedema (CSME had a higher percentage of nephropathy ( p0 < 0.005. Interpretation & conclusions : The co-existence of overt nephropathy, nerve conduction based neuropathy and macrovascular co-morbidity in patients with early grades of diabetic retinopathy was significant

Association of Metformin Treatment with Reduced Severity of Diabetic Retinopathy in Type 2 Diabetic Patients

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Yue Li

2018-01-01

Full Text Available Purpose. To evaluate effects of long-term metformin on the severity of diabetic retinopathy (DR in high-risk type 2 diabetic (T2D patients. Methods. A retrospective chart review study was conducted involving 335 DR patients with T2D ≥ 15 years from 1990 to 2013. The severity of DR was determined by Early Treatment Diabetic Retinopathy Study scale. The associations between metformin and DR severity were evaluated. Comparison with stratification for the use of sulfonylurea and insulin was performed to identify possible confounding effects. Results. Severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy (SNPDR/PDR was more often diagnosed in nonmetformin users (67/142, 47% versus metformin users (48/193, 25% (p<0.001, regardless of gender and race of the patients. The odds ratio of metformin associated with SNPDR/PDR was 0.37 in all cases (p<0.001, 0.35 in sulfonylurea use cohort (p<0.05, 0.45 in nonsulfonylurea use cohorts (p<0.01, and 0.42 in insulin use cohort (p<0.01. Insulin users had a higher rate of SNPDR/PDR. Metformin had no influence on the occurrence of clinical significant diabetic macular edema. Conclusions. Long-term use of metformin is independently associated with a significant lower rate of SNPDR/PDR in patients with type 2 diabetes ≥ 15 years.

Role of macular xanthophylls in prevention of common neovascular retinopathies: retinopathy of prematurity and diabetic retinopathy.

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Gong, Xiaoming; Rubin, Lewis P

2015-04-15

Retinopathy of prematurity (ROP) and diabetic retinopathy (DR) are important causes of blindness among children and working-age adults, respectively. The development of both diseases involves retinal microvascular degeneration, vessel loss and consequent hypoxic and inflammatory pathologic retinal neovascularization. Mechanistic studies have shown that oxidative stress and subsequent derangement of cell signaling are important factors in disease progression. In eye and vision research, role of the dietary xanthophyll carotenoids, lutein and zeaxanthin, has been more extensively studied in adult onset macular degeneration than these other retinopathies. These carotenoids also may decrease severity of ROP in preterm infants and of DR in working-age adults. A randomized controlled clinical trial of carotenoid supplementation in preterm infants indicated that lutein has functional effects in the neonatal eye and is anti-inflammatory. Three multicenter clinical trials all showed a trend of decreased ROP severity in the lutein supplemented group. Prospective studies on patients with non-proliferative DR indicate serum levels of lutein and zeaxanthin are significantly lower in these patients compared to normal subjects. The present review describes recent advances in lutein and zeaxanthin modulation of oxidative stress and inflammation related to ROP and DR and discusses potential roles of lutein/zeaxanthin in preventing or lessening the risks of disease initiation or progression. Copyright © 2015 Elsevier Inc. All rights reserved.

Diabetic retinopathy in two patients with congenital IGF-I deficiency (Laron syndrome).

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Laron, Zvi; Weinberger, Dov

2004-07-01

Animal and clinical studies have shown that excessive amounts of growth hormone or insulin-like growth factor-I (IGF-I) promote the development of diabetes and diabetic retinopathy. Forthwith, we present two patients with congenital IGF-I deficiency who developed type II diabetes and subsequently retinopathy. Eighteen adult patients with classical Laron syndrome (8 males, 10 females, aged 20-62 years) were followed by us since childhood or underwent fundus photography with a Nikon NF 505 instrument. Three had been treated in childhood with IGF-I, the rest were never treated, including the two patients reported. Two never-treated patients were diagnosed with type II diabetes (DM) at ages 39 and 41 respectively. There was no diabetes in the families. Oral treatment was followed by insulin injections. Metabolic control was not optimal and one patient developed proliferative diabetic retinopathy, necessitating laser surgery. He also has nephropathy and severe neuropathy. The other patient has background diabetic retinopathy and has developed, progressively, exudates, microaneurisms, hemorrhages and clinically significant macular edema. He also has subacute ischemic heart disease. Our findings show that congenital IGF-I deficiency, similar to excess, causes vascular complications of DM, denoting also that vascular endothelial growth factor can induce neovascularization in the presence of congenital IGF-I deficiency.

Diabetic Retinopathy Analysis

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R. Sivakumar

2005-01-01

Full Text Available Diabetic retinopathy is one of the common complications of diabetes. Unfortunately, in many cases the patient is not aware of any symptoms until it is too late for effective treatment. Through analysis of evoked potential response of the retina, the optical nerve, and the optical brain center, a way will be paved for early diagnosis of diabetic retinopathy and prognosis during the treatment process. In this paper, we present an artificial-neural-network-based method to classify diabetic retinopathy subjects according to changes in visual evoked potential spectral components and an anatomically realistic computer model of the human eye under normal and retinopathy conditions in a virtual environment using 3D Max Studio and Windows Movie Maker.

Nogo-B Promotes Angiogenesis in Proliferative Diabetic Retinopathy via VEGF/PI3K/Akt Pathway in an Autocrine Manner

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Yuelu Zhang

2017-10-01

Full Text Available Background/Aims: Nogo-B, a conservative protein of endoplasmic reticulum, is a member of the reticulon family of proteins. Proliferative diabetic retinopathy (PDR is the major concerning problem of diabetic retinopathy. This study explored the role of Nogo-B in the regulation of angiogenesis in PDR patients and primary human retinal endothelial cells (HRMECs. Methods: Nogo-B was down-regulated through the use of Lentivirus-NogoB-RNAi, the effects of Nogo-B on angiogenesis under high glucose stimulation were evaluated via CCK-8 assay, wound closure assay, transwell assay, and tube formation assay. Expression of Nogo-B, VEGF, PI3K and Akt were determined by western blotting, immunofluorescence, enzyme-linked immunosorbent assay (ELISA. Co-culture systerm was used to explore cell communication. Results: Nogo-B was highly enriched in ocular tissues of PDR patients and in HRMECs exposed to high glucose. Down-regulation of Nogo-B attenuated high glucose induced cell migration and tube formation in HRMECs. Mechanistically, in comparison with the negative control group, Lentivirus-NogoB-RNAi group had exhibited reduced VEGF secretion, weakened PI3K and Akt activation. Besides, high glucose treatment promoted the secretion of Nogo-B and presented as a “long-term memory”. Conclusions: These data collectively indicated that Nogo-B promoted angiogenesis in HRMECs via VEGF/PI3K/Akt pathway in an autocrine manner.

Changes in retinal venular oxygen saturation predict activity of proliferative diabetic retinopathy 3 months after panretinal photocoagulation.

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Torp, Thomas Lee; Kawasaki, Ryo; Wong, Tien Yin; Peto, Tunde; Grauslund, Jakob

2018-03-01

Proliferative diabetic retinopathy (PDR) is a severe blinding condition. We investigated whether retinal metabolism, measured by retinal oximetry, may predict PDR activity after panretinal laser photocoagulation (PRP). We performed a prospective, interventional, clinical study of patients with treatment-naive PDR. Wide-field fluorescein angiography (OPTOS, Optomap) and global and focal retinal oximetry (Oxymap T1) were performed at baseline (BL), and 3 months (3M) after PRP. Angiographic findings were used to divide patients according to progression or non-progression of PDR after PRP. We evaluated differences in global and focal retinal oxygen saturation between patients with and without progression of PDR after PRP treatment. We included 45 eyes of 37 patients (median age and duration of diabetes were 51.6 and 20 years). Eyes with progression of PDR developed a higher retinal venous oxygen saturation than eyes with non-progression at 3M (global: +5.9% (95% CI -1.5 to 12.9), focal: +5.4%, (95% CI -4.1 to 14.8)). Likewise, progression of PDR was associated with a lower arteriovenular (AV) oxygen difference between BL and 3M (global: -6.1%, (95% CI -13.4 to -1.4), focal: -4.5% (95% CI -12.1 to 3.2)). In a multiple logistic regression model, increment in global retinal venular oxygen saturation (OR 1.30 per 1%-point increment, p=0.017) and decrement in AV oxygen saturation difference (OR 0.72 per 1%-point increment, p=0.016) at 3M independently predicted progression of PDR. Development of higher retinal venular and lower AV global oxygen saturation independently predicts progression of PDR despite standard PRP and might be a potential non-invasive marker of angiogenic disease activity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Evaluation of diabetic retinopathy screening using non-mydriatic fundus camera performed by physicians' assistants in the endocrinology service].

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Barcatali, M-G; Denion, E; Miocque, S; Reznik, Y; Joubert, M; Morera, J; Rod, A; Mouriaux, F

2015-04-01

Since 2010, the High Authority for health (HAS) recommends the use of non-mydriatic fundus camera for diabetic retinopathy screening. The purpose of this study is to evaluate the results of screening for diabetic retinopathy using the non-mydriatic retinal camera by a physician's assistant in the endocrinology service. This is a retrospective study of all diabetic patients hospitalized in the endocrinology department between May 2013 and November 2013. For each endocrinology patient requiring screening, a previously trained physician's assistant performed fundus photos. The ophthalmologist then provided a written interpretation of the photos on a consultant's sheet. Of the 120 patients screened, 40 (33.3%) patients had uninterpretable photos. Among the 80 interpretable photos, 64 (53.4%) patients had no diabetic retinopathy, and 16 (13.3%) had diabetic retinopathy. No patient had diabetic maculopathy. Specific quality criteria were established by the HAS for screening for diabetic retinopathy using the non-mydriatic retinal camera in order to ensure sufficient sensitivity and specificity. In our study, the two quality criteria were not achieved: the rates of uninterpretable photos and the total number of photos analyzed in a given period. In our center, we discontinued this method of diabetic retinopathy screening due to the high rate of uninterpretable photos. Due to the logistic impossibility of the ophthalmologists taking all the fundus photos, we proposed that the ophthalmic nurses take the photos. They are better trained in the use of the equipment, and can confer directly with an ophthalmologist in questionable cases and to obtain pupil dilation as necessary. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Delay in diabetic retinopathy screening increases the rate of detection of referable diabetic retinopathy.

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Scanlon, P H; Aldington, S J; Stratton, I M

2014-04-01

To assess whether there is a relationship between delay in retinopathy screening after diagnosis of type 2 diabetes and level of retinopathy detected. Patients were referred from 88 primary care practices to an English National Health Service diabetic eye screening programme. Data for screened patients were extracted from the primary care databases using semi-automated data collection algorithms supplemented by validation processes. The programme uses two-field mydriatic digital photographs graded by a quality assured team. Data were available for 8183 screened patients with diabetes newly diagnosed in 2005, 2006 or 2007. Only 163 with type 1 diabetes were identified and were insufficient for analysis. Data were available for 8020 with newly diagnosed type 2 diabetes. Of these, 3569 were screened within 6 months, 2361 between 6 and 11 months, 1058 between 12 and 17 months, 366 between 18 and 23 months, 428 between 24 and 35 months, and 238 at 3 years or more after diagnosis. There were 5416 (67.5%) graded with no retinopathy, 1629 (20.3%) with background retinopathy in one eye, 753 (9.4%) with background retinopathy in both eyes and 222 (2.8%) had referable diabetic retinopathy. There was a significant trend (P = 0.0004) relating time from diagnosis to screening detecting worsening retinopathy. Of those screened within 6 months of diagnosis, 2.3% had referable retinopathy and, 3 years or more after diagnosis, 4.2% had referable retinopathy. The rate of detection of referable diabetic retinopathy is elevated in those who were not screened promptly after diagnosis of type 2 diabetes. © 2013 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience.

Science.gov (United States)

Pareja-Ríos, A; Bonaque-González, S; Serrano-García, M; Cabrera-López, F; Abreu-Reyes, P; Marrero-Saavedra, M D

2017-02-01

To describe the results of a diabetic retinopathy screening program implemented in a primary care area. A retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. The number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. Diabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Automated Diabetic Retinopathy Image Assessment Software: Diagnostic Accuracy and Cost-Effectiveness Compared with Human Graders.

Science.gov (United States)

Tufail, Adnan; Rudisill, Caroline; Egan, Catherine; Kapetanakis, Venediktos V; Salas-Vega, Sebastian; Owen, Christopher G; Lee, Aaron; Louw, Vern; Anderson, John; Liew, Gerald; Bolter, Louis; Srinivas, Sowmya; Nittala, Muneeswar; Sadda, SriniVas; Taylor, Paul; Rudnicka, Alicja R

2017-03-01

With the increasing prevalence of diabetes, annual screening for diabetic retinopathy (DR) by expert human grading of retinal images is challenging. Automated DR image assessment systems (ARIAS) may provide clinically effective and cost-effective detection of retinopathy. We aimed to determine whether ARIAS can be safely introduced into DR screening pathways to replace human graders. Observational measurement comparison study of human graders following a national screening program for DR versus ARIAS. Retinal images from 20 258 consecutive patients attending routine annual diabetic eye screening between June 1, 2012, and November 4, 2013. Retinal images were manually graded following a standard national protocol for DR screening and were processed by 3 ARIAS: iGradingM, Retmarker, and EyeArt. Discrepancies between manual grades and ARIAS results were sent to a reading center for arbitration. Screening performance (sensitivity, false-positive rate) and diagnostic accuracy (95% confidence intervals of screening-performance measures) were determined. Economic analysis estimated the cost per appropriate screening outcome. Sensitivity point estimates (95% confidence intervals) of the ARIAS were as follows: EyeArt 94.7% (94.2%-95.2%) for any retinopathy, 93.8% (92.9%-94.6%) for referable retinopathy (human graded as either ungradable, maculopathy, preproliferative, or proliferative), 99.6% (97.0%-99.9%) for proliferative retinopathy; Retmarker 73.0% (72.0 %-74.0%) for any retinopathy, 85.0% (83.6%-86.2%) for referable retinopathy, 97.9% (94.9%-99.1%) for proliferative retinopathy. iGradingM classified all images as either having disease or being ungradable. EyeArt and Retmarker saved costs compared with manual grading both as a replacement for initial human grading and as a filter prior to primary human grading, although the latter approach was less cost-effective. Retmarker and EyeArt systems achieved acceptable sensitivity for referable retinopathy when compared

Polymorphisms in the CTSH gene may influence the progression of diabetic retinopathy

DEFF Research Database (Denmark)

Thorsen, Steffen U; Sandahl, Kristian; Nielsen, Lotte B

2015-01-01

BACKGROUND: The incidence of type 1 diabetes mellitus (T1DM) is increasing globally, and as a consequence, more patients are affected by microvascular complications such as diabetic retinopathy (DR). The aim of this study was to elucidate possible associations between diabetes-related single...... DR level between baseline and follow-up in the worst eye at baseline. Patients were graded on a modified version of the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and 20 SNPs were genotyped in 130 of the 185 patients. RESULTS: We found the CTSH/rs3825932 variant (C > T) was associated...... with reduced risk of progression to proliferative diabetic retinopathy (PDR) (OR [95 % CI] = 0.20 [0.07-0.56], p = 2.4 × 10(-3), padjust = 0.048) and ERBB3/rs2292239 variant (G > T) associated with increased risk of two-step progression (OR [95 % CI] = 2.76 [1.31-5.80], p = 7.5 × 10(-3), padjust = 0...

Grading and disease management in national screening for diabetic retinopathy in England and Wales.

Science.gov (United States)

Harding, S; Greenwood, R; Aldington, S; Gibson, J; Owens, D; Taylor, R; Kohner, E; Scanlon, P; Leese, G

2003-12-01

A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service. Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications. Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no 'questionable' lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1). The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes.

Relationship between diabetic retinopathy and diabetic nephropathy%糖尿病视网膜病变与糖尿病肾病关系的研究

Institute of Scientific and Technical Information of China (English)

贾育梅; 徐援; 杨金奎

2011-01-01

Objective Currently mechanisms of diabetic nephropathy ( DN) and diabetic retinopathy ( DR) remains unclear, but the hypothesis that persistent hyperglycemia and its abnormal metabolites play a vital role has been controversial. It is necessary to analyze the relationship of type 2 diabetic retinopathy and diabetic nephropathy in the aspect of onset and development of them, and whether we can use fundus examination to predict the renal injury level. This study aimed to find the relationship of diabetic retinopathy and diabetic nephropathy. Methods Patients with non-diabetic retinopathy(NDR) or proliferative diabetic retinopathy (PDR) were enrolled. Based on 8-hour urinary albumin excretion rate( UAER), the patients were divided into 3 groups; group A; UAER 200 μg/min. Group A had 169 patients, including 53 NDR patients, PDR 116 patients; group B had a total of 76 patients, including 37 patients with NDR, 39 with PDR; group C had a total of 66 patients, including 40 patients with NDR, 26 with PDR. The glomerular filtration rate was compared between the subgroups. Results Glomerular filtration rate( GFR) was calculated according to the currently recommended MDRD simplified formula; eGFR = 186 x (SCr) -1154 × ( Age) -0.203 × (0.742 women). We found that among the three groups, PDR subgroup eGFR was lower than those in NDR. Significant difference in eGFR was found in groups B and C in PDR sub-group compared with the NDR sub-group(P<0.01). Conclusion Proliferative diabetic retinopathy appears to predict the degree of renal injury, but urinary albumin excretion rate had poor correlation with renal injury. The cause may be poor specificity of microalbuminuria as a biomarker of DN in diagnosis.%目的 本研究探讨了2型糖尿病患者糖尿病肾脏病变( diabetic nephropathy,DN)与视网膜病变(diabetic retinopathy,DR)之间的相关性.方法 本研究的患者为无糖尿病视网膜病变(non-diabetic retinopathy,NDR)或增殖期视网膜病变(proliferative

An automated image processing method for classification of diabetic retinopathy stages from conjunctival microvasculature images

Science.gov (United States)

Khansari, Maziyar M.; O'Neill, William; Penn, Richard; Blair, Norman P.; Chau, Felix; Shahidi, Mahnaz

2017-03-01

The conjunctiva is a densely vascularized tissue of the eye that provides an opportunity for imaging of human microcirculation. In the current study, automated fine structure analysis of conjunctival microvasculature images was performed to discriminate stages of diabetic retinopathy (DR). The study population consisted of one group of nondiabetic control subjects (NC) and 3 groups of diabetic subjects, with no clinical DR (NDR), non-proliferative DR (NPDR), or proliferative DR (PDR). Ordinary least square regression and Fisher linear discriminant analyses were performed to automatically discriminate images between group pairs of subjects. Human observers who were masked to the grouping of subjects performed image discrimination between group pairs. Over 80% and 70% of images of subjects with clinical and non-clinical DR were correctly discriminated by the automated method, respectively. The discrimination rates of the automated method were higher than human observers. The fine structure analysis of conjunctival microvasculature images provided discrimination of DR stages and can be potentially useful for DR screening and monitoring.

Microvascular retinopathy in subjects without diabetes

DEFF Research Database (Denmark)

Munch, Inger Christine; Kessel, Line; Borch-Johnsen, Knut

2012-01-01

Purpose:  Retinal vascular lesions such as microaneurysms and haemorrhages, while typical of diabetic retinopathy, are also seen in subjects without diabetes where they are associated with elevated cardiovascular mortality. In theory, these lesions could be a consequence of past hyperglycaemia. We...... examined the prevalence and risk factors for retinopathy, including lens fluorescence, a biomarker of cumulative life-time glycaemia in adults without diabetes. Methods:  Cross-sectional population-based study of 711 subjects without diabetes (WHO 1999 criteria) aged 30-60 years, including oral glucose...... tolerance testing, clinical and laboratory examinations, non-invasive ocular lens fluorometry and seven-field fundus photography. Results:  Retinopathy was present in 8.3% (CI(95) 6.3-10.3%) of subjects. Higher systolic blood pressure (SBP) (p = 0.032), increasing body mass index (BMI) (p = 0.014) and wider...

Diabetes induces changes in neuroretina before retinal vessels: a spectral-domain optical coherence tomography study

OpenAIRE

Rodrigues, Eduardo B?chele; Urias, M?ller Gon?alves; Penha, Fernando Marcondes; Badar?, Emmerson; Novais, Eduardo; Meirelles, Rodrigo; Farah, Michel Eid

2015-01-01

Purpose To investigate retinal changes prior to vascular signs in patients with type 2 diabetes without diabetic retinopathy or with mild non proliferative diabetic retinopathy. Methods A cross-sectional study was performed in three groups: patients without diabetes, patients with type 2 diabetes without diabetic retinopathy, and patients with diabetes with mild diabetic retinopathy. Analysis of retinal layers was performed objectively with the Cirrus Review Software 6.0 (Carl Zeiss Meditec, ...

Retinopathy is associated with impaired myocardial function assessed by advanced echocardiography in type 1 diabetes patients – The Thousand & 1 Study

DEFF Research Database (Denmark)

Nouhravesh, Nina; Andersen, Henrik U; Jensen, Jan S

2016-01-01

AIMS: Retinopathy and heart disease in Type 1 Diabetes Mellitus (Type 1 DM) may be associated; however previous results have been conflicting. Tissue Doppler Imaging (TDI) and speckle-tracking echocardiography (STE) quantify myocardial function not assessable by conventional echocardiography. We...... investigated the association between severity of retinopathy and early myocardial dysfunction using conventional echocardiography, TDI and STE in Type 1 DM patients. METHODS: Type 1 Diabetes Mellitus patients without known heart disease were included from the Steno Diabetes Center. The cross sectional...... association between retinopathy and myocardial function was analyzed in uni-and multivariable models. Retinopathy was categorized as nil-, simplex- or proliferative retinopathy. RESULTS: A total of 1090 Type 1 Diabetes Mellitus patients were included, mean age was 49.6years and 53% were males. Left...

Awareness of diabetic retinopathy among patients with diabetes ...

African Journals Online (AJOL)

Background: Diabetic retinopathy is a major cause of blindness worldwide. The associated loss of productivity and quality of life of the patients with diabetic retinopathy will lead to additional socioeconomic burden. This study aims to determine the level of awareness of diabetic retinopathy among diabetic patients. Materials ...

Elevated serum fetuin-A levels are associated with grades of retinopathy in type 2 diabetic patients.

Science.gov (United States)

Yilmaz, Ahu; Yilmaz, Tolga; Gunay, Murat

2017-10-25

Fetuin-A is a physiological inhibitor of insulin receptor tyrosine kinase and thus associated with insulin resistance, metabolic syndrome, and an increased risk for type 2 diabetes mellitus (T2DM). This study aims to investigate the possible relation between the serum fetuin-A levels and the stages of diabetic retinopathy (DR) in patients with T2DM. This prospective study included 82 patients with T2DM and 19 age- and gender-matched healthy controls (HCs) (group 1). Diabetic patients were subclassified into three groups according to ocular findings: without DR (group 2; n = 26); non-proliferative DR (group 3; n = 29), and proliferative DR (group 4; n = 27). Serum fetuin-A levels were determined by a spectrophotometric technique using an immulite chemiluminescent immunometric assay. The data were analyzed using a Mann-Whitney U test, and the results were expressed as mean ± standard deviation. Mean fetuin-A values were 256.4 ± 21.3 μg/ml in group 1, 263.5 ± 24.2 μg/ml in group 2, 282.2 ± 31.1 μg/ml in group 3, and 296.3 ± 26.2 μg/ml in group 4. Group 2 had higher mean fetuin-A level compared with group 1, but the difference was not statistically significant (p > 0.05). Serum fetuin-A levels were significantly higher in groups 3 and 4 compared with HCs (both p < 0.05). Compared with group 2, both DR groups had higher fetuin-A levels with a significant difference (both p < 0.05); and patients with proliferative DR had significantly higher serum fetuin-A levels compared with non-proliferative DR (p < 0.05). The mean serum fetuin-A levels increased with the stage of DR, and the highest levels were found in patients with proliferative DR. Our findings suggest an association between fetuin-A levels and DR stage. In diabetic patients, the risk of retinopathy development increases with higher fetuin-A values. Fetuin-A may play an important role in the pathophysiology and progression of DR.

Characteristics of patients with diabetic retinopathy in Gaborone ...

African Journals Online (AJOL)

(GLLAMMs) to account for the non-independence of the eye diabetic retinopathy outcome at the patient level (Rabe-Hesketh et al., 2000). This model allowed for analysis of a polytomous ordinal response on a set of predictors and computed the odds ratios (OR) of having a more severe diabetic retinopathy grade compared ...

Clinical observation of one time short-pulse pattern scan laser pan-retinal photocoagulation for proliferative diabetic retinopathy

Directory of Open Access Journals (Sweden)

Xin Liu

2016-04-01

Full Text Available AIM: To investigate the clinical efficacy and benefit of short-pulse pattern scan laser(PASCALphotocoagulation for proliferative diabetic retinopathy(PDR.METHODS:Twenty-eight PDR patients(42 eyesunderwent short-pulse PASCAL pan-retinal photocoagulation(PRPwere analyzed.The best corrected visual acuity was ≥0.1 in 36 eyes, RESULTS: All the cases had no pain during the short-pulse PASCAL treatment.One year after treatments,the final visual acuity was improved in 6 eyes,kept stable in 28 eyes and decreased in 8 eyes; neovascularization were regressed in 18 eyes(43%, stable in 12 eyes(29%, uncontrolled in 12 eyes(29%. Five eyes(12%received vitrectomy due to vitreous hemorrhage.Compared with before operation, retina thickness in central fovea of macula and visual field had no obvious change after one-time PASCAL PRP(P>0.05. CONCLUSION:The one-time short-pulse PASCAL PRP could stabilize the progress of PDR safely, effectively and simply.

Relação entre retinopatia diabética e dermopatia diabética em pacientes portadores de diabetes mellitus tipo 2 Relation between diabetic retinopathy and diabetic dermopathy in type 2 diabetes mellitus patients

Directory of Open Access Journals (Sweden)

Hugo Roberto Kurtz Lisboa

2008-12-01

both considered as manifestations of diabetic microangiopathy, there are only few reports in the literature regarding their possible association. The purpose of this study was to investigate the association between diabetic dermopathy and diabetic retinopathy and to determine the prevalence and the associated risk factors for diabetic retinopathy in type 2 diabetes patients from the Outpatient Diabetic Clinic of the Faculty of Medicine of the University of Passo Fundo and Teaching Hospital Sao Vicente de Paulo. METHODS: Cross sectional study was performed in 90 type 2 diabetes mellitus patients who attend to the outpatient diabetic clinic, consecutively. Physical, dermatological and ophthalmologic evaluations were performed in all the patients. RESULTS: The prevalence of diabetic dermopathy was 16,6% (n = 15 and diabetic retinopathy was 34,4% (n = 31; 67,8% of those (n = 21 consisted of non-proliferative diabetic retinopathy and 32,2% (n = 10 of proliferative diabetic retinopathy. The duration of the disease greater than 10 years (p = 0,001 and age over 50 years (p = 0,014 were associated to retinopathy, but no association was found with elevated levels of HbA1c (p = 0,5 and fasting plasma glucose of 126 or higher (p = 0,8. The frequency of diabetic retinopathy in patients with diabetic dermopathy was not higher than in patients without dermopathy (7,7%, 7 cases, p = 0,586. There was no statistically significant association between diabetic retinopathy and diabetic dermopathy. CONCLUSION: No association between diabetic dermopathy and diabetic retinopathy in this group of type 2 diabetes patients was found. The presence of diabetic retinopathy was associated to the duration of the disease and the advanced age of the patients.

The Thai DMS Diabetes Complications (DD.Comp.) project: prevalence and risk factors of diabetic retinopathy in Thai patients with type 2 diabetes mellitus.

Science.gov (United States)

Jongsareejit, Amporn; Potisat, Somkiat; Krairittichai, Udom; Sattaputh, Charnvate; Arunratanachote, Woranut

2013-11-01

To determine the prevalence of diabetic retinopathy (DR) among patients with type 2 diabetes mellitus (T2DM) in Thailand and their associated risk factors. A cross-sectional, multi-sites, hospital-based study was carried out between June and December 2006. Diabetic patients from the outpatient department of seven public hospitals (3 tertiary, 2 secondary and 2 community hospital) in Thailand were performed by retinal specialist. One thousand seven of 1,120 diabetic patients received retinal examination using indirect ophthalmoscope. Patients were divided into two groups (absent and present DR). Most patients in both groups were female (72.7 and 68.0%). The prevalence of DR was 24.0% (n = 242), mild NPDR 9.4% (n = 95), moderate NPDR 10.5% (n = 106), severe NPDR 1.3% (n = 13), and proliferative (PDR) 2.8% (n = 28). Age at onset, duration of DM, systolic blood pressure, body mass index (BMI), fasting plasma glucose (FPG), HbA1c, Triglyceride (TG), alcohol consumption, foot ulcer, and proteinuria were recorded. Metformin and insulin taking were statistically, significantly different among these groups. There is more prevalent NPDR and PDR in insulin-taking than non-insulin-taking groups. The grading of diabetic retinopathy is associated with the duration of diabetes. In multivariate regression analysis, associated risk factors of DR patients were the duration of DM, HbA1c levels, and proteinuria. Diabetic retinopathy was present in about one fourth of type 2 diabetic patients in this study. Associated risk factors of DR were the duration of DM, HbA1c levels, and proteinuria. Regular screening for DR especially in T2DM with associated risk factor should be done for early treatment.

Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB prospective complications study

NARCIS (Netherlands)

van Hecke, M.V.; Dekker, J.M.; Stehouwer, C.D.A.; Polak, B.C.P.; Fuller, J.H.; Sjolie, A.K.; Kofinis, A.; Rottiers, R.; Porta, M.; Chaturvedi, N.

2005-01-01

OBJECTIVE - To study the relationship of nonproliferative and proliferative retinopathy with all-cause mortality and cardiovascular disease (CVD) incidence in type 1 diabetic patients and, additionally, the role of cardiovascular risk factors in these associations. RESEARCH DESIGN AND METHODS - This

Macular Edema Formation and Deterioration of Retinal Function after Intravitreal Bevacizumab Injection for Proliferative Diabetic Retinopathy

Directory of Open Access Journals (Sweden)

Hisanori Imai

2011-09-01

Full Text Available Purpose: To report a case of proliferative diabetic retinopathy (PDR showing transient macular edema (ME and deteriorated retinal function after intravitreal bevacizumab injection (IVB. Methods and Results: A 53-year-old man received IVB (1.25 mg/0.05 ml in both eyes for the treatment of PDR. There was no treatment-related complication. However, he complained of photopsia in both eyes 6 h after the injection. Slit-lamp examination revealed mild cellular infiltrations (1+ in the anterior chamber in both eyes. Optical coherence tomography showed ME formation in the left eye. Both full-field and multifocal electroretinography (ERG revealed the deterioration of all parameters in both eyes compared with pretreatment. The inflammation in the anterior segment and ME disappeared 1 day after the injection. ERG parameters were improved 9 days after the injection, except for the N1 and P1 amplitude of multifocal ERG in the left eye. Conclusion: We propose that patients who undergo IVB should be carefully informed and followed up for possible complications including temporal ME formation and retinal function deterioration.

[Diabetic retinopathy during pregnancy.

DEFF Research Database (Denmark)

Mathiesen, E.R.; Rasmussen, K.L.; Laugesen, C.S.

2008-01-01

INTRODUCTION: The aim was to evaluate the prevalence and progression of diabetic retinopathy during pregnancy in women with type 1 or type 2 diabetes. MATERIAL AND METHODS: Dilated fundal photography was performed at approximately 10 and 28 gestational weeks in 58 and 18 women with type 1 and type...... 2 diabetes, respectively. Retinopathy was classified as five stages +/- macular oedema. Progression was defined as deterioration corresponding to at least one stage between the two examinations. Clinical parameters were obtained from the medical records. RESULTS: Diabetic retinopathy was found in 36...... (62%) women with type 1 and three (17%) with type 2 diabetes at the first examination. In 26 (34%) retinopathy progressed; four women developed proliferations, three macular oedema and three reduction of visual acuity >/=0.2 on Snellen's chart in at least one eye. HbA1c in early pregnancy was the only...

Automated diabetic retinopathy detection in smartphone-based fundus photography using artificial intelligence.

Science.gov (United States)

Rajalakshmi, Ramachandran; Subashini, Radhakrishnan; Anjana, Ranjit Mohan; Mohan, Viswanathan

2018-06-01

To assess the role of artificial intelligence (AI)-based automated software for detection of diabetic retinopathy (DR) and sight-threatening DR (STDR) by fundus photography taken using a smartphone-based device and validate it against ophthalmologist's grading. Three hundred and one patients with type 2 diabetes underwent retinal photography with Remidio 'Fundus on phone' (FOP), a smartphone-based device, at a tertiary care diabetes centre in India. Grading of DR was performed by the ophthalmologists using International Clinical DR (ICDR) classification scale. STDR was defined by the presence of severe non-proliferative DR, proliferative DR or diabetic macular oedema (DME). The retinal photographs were graded using a validated AI DR screening software (EyeArt TM ) designed to identify DR, referable DR (moderate non-proliferative DR or worse and/or DME) or STDR. The sensitivity and specificity of automated grading were assessed and validated against the ophthalmologists' grading. Retinal images of 296 patients were graded. DR was detected by the ophthalmologists in 191 (64.5%) and by the AI software in 203 (68.6%) patients while STDR was detected in 112 (37.8%) and 146 (49.3%) patients, respectively. The AI software showed 95.8% (95% CI 92.9-98.7) sensitivity and 80.2% (95% CI 72.6-87.8) specificity for detecting any DR and 99.1% (95% CI 95.1-99.9) sensitivity and 80.4% (95% CI 73.9-85.9) specificity in detecting STDR with a kappa agreement of k = 0.78 (p < 0.001) and k = 0.75 (p < 0.001), respectively. Automated AI analysis of FOP smartphone retinal imaging has very high sensitivity for detecting DR and STDR and thus can be an initial tool for mass retinal screening in people with diabetes.

Investigation of relationship between serum C-peptide and diabetic retinopathy in type 2 diabetes mellitusF%探究血清C肽与2型糖尿病视网膜病变的关系

Institute of Scientific and Technical Information of China (English)

范进绵; 高俊泽

2015-01-01

目的：对血清C肽与2型糖尿病视网膜病变(DR)的关系进行分析与探讨。方法120例2型糖尿病患者，根据患者病情将其分为三组，即：无糖尿病视网膜病变(NDR)组40例，非增殖性糖尿病视网膜病变(NPDR)组42例，增殖性糖尿病视网膜病变(PDR)组38例。以电化学发光法对所有患者空腹血清C肽进行测定。结果三组患者空腹血清C肽水平均呈现下降趋势，三组比较，差异具有统计学意义(P<0.05)。血清C肽与2型糖尿病视网膜病变程度呈负相关。结论研究表明，在2型糖尿病视网膜病变中，血清C肽含量会由于病变程度的加深而逐渐降低，血清C肽水平是2型糖尿病视网膜病变进展的重要标志。%ObjectiveTo analyze and investigate the relationship between serum C-peptide and diabetic retinopathy (DR) in type 2 diabetes mellitus.MethodsA total of 120 type 2 diabetes mellitus patients were divided by their illness condition into three groups, as non diabetic retinopathy (NDR) group with 40 cases, non proliferative diabetic retinopathy (NPDR) group with 42 cases, and proliferative diabetic retinopathy (PDR) group with 38 cases. Electrochemiluminescence method was applied for detection of serum C-peptide in all patients.ResultsAll the three groups had decreased levels of fasting serum C-peptide, and the difference had statistical significance across the three groups (P<0.05). There was a negative correlation between serum C-peptide and diabetic retinopathy in type 2 diabetes mellitus.ConclusionThis study shows the content of serum C-peptide will decrease along with the development of diabetic retinopathy in type 2 diabetes mellitus, therefore, serum C-peptide acts as an important indicator for progression of diabetic retinopathy in type 2 diabetes mellitus.

A proposed new classification for diabetic retinopathy: The concept of primary and secondary vitreopathy

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Dubey Arvind

2008-01-01

Full Text Available Background: Many eyes with proliferative diabetic retinopathy (PDR require vitreous surgery despite complete regression of new vessels with pan retinal laser photocoagulation (PRP. Changes in the vitreous caused by diabetes mellitus and diabetic retinopathy may continue to progress independent of laser regressed status of retinopathy. Diabetic vitreopathy can be an independent manifestation of the disease process. Aim: To examine this concept by studying the long-term behavior of the vitreous in cases of PDR regressed with PRP. Materials and Methods: Seventy-four eyes with pure PDR (without clinically evident vitreous traction showing fundus fluorescein angiography (FFA proven regression of new vessels following PRP were retrospectively studied out of a total of 1380 eyes photocoagulated between March 2001 and September 2006 for PDR of varying severity. Follow-up was available from one to four years. Results: Twenty-three percent of eyes showing FFA-proven regression of new vessels with laser required to undergo surgery for indications produced by vitreous traction such as recurrent vitreous hemorrhage, tractional retinal detachment, secondary rhegmatogenous retinal detachment and tractional macular edema within one to four years. Conclusion: Vitreous changes continued to progress despite regression of PDR in many diabetics. We identifies this as "clinical diabetic vitreopathy" and propose an expanded classification for diabetic retinopathy to signify these changes and to redefine the indications for surgery.

Frequency of retinopathy in newly diagnosed patients of type 2 diabetes mellitus (dm)

International Nuclear Information System (INIS)

Khan, K.A.; Kamran, S.M.; Qureshi, M.N.

2015-01-01

This study was to determine the frequency of retinopathy in newly diagnosed type-II Diabetics. Study Design: Cross sectional descriptive study. Place and Duration of Study: It was conducted at Department of medicine, Military Hospital (MH), Rawalpindi from 1st Jan 2012 to 30 Jun 2012. Material and Methods: We included 200 patients of type-II DM from both genders diagnosed in last 03 months from both outdoor and indoor departments in the age range of 40 to 70 years by consecutive sampling. All patients having co morbidities affecting retina were excluded. Informed written consent was taken before enrollment. Formal approval of the study was taken from hospital ethical committee. Ocular Fundoscopy was performed with WelchAllyn Ophthalmoscope (REF 11470) as per standard protocols and both eyes were examined. The grade of DR (diabetic retinopathy) awarded as per highest changes in any of the two eyes. All tests were carried by a single person to avoid inter-observer variations. Findings of ocular fundoscopy were confirmed by ophthalmologist. All data was analyzed by using SPSS version 11. Results: Out of 200 subjects 63.5% were male and 36.5% were female. Age ranged from 40 to 70 years with mean age of 51.05+ 6.910 years. 29 (14.5%) subjects had Diabetic retinopathy. Out of 29 patients, 24 (82.8%) had preproliferative and 5 (17.2%) had proliferative diabetic retinopathy. Conclusion: A significant proportion of diabetic patients have retinopathy at the time of diagnosis of their disease which is more common in males and with increasing age. It is recommended to thoroughly screen the newly diagnosed diabetics for early detection of diabetic retinopathy and its management involving early referral to eye specialist. (author)

Frequency of different grades of retinopathy in type-2 diabetes mellitus patients at Military Hospital Rawalpindi

International Nuclear Information System (INIS)

Khan, A.U.; Yasmeen, R.; Habib, M.

2012-01-01

To analyse the various types of retinopathy in individuals with type 2 DM. Design: Descriptive study. Place and duration of study: Military Hospital Rawalpindi from January 2010 to July 2010 Methods: One hundred and fifty patients with type 2 DM were studied into for different types of retinopathy, based on history, clinical examination (ophthalmological) and laboratory investigations. Results: Out of 150 patients who fulfilled the criteria for study, 93(62%) were male and 57(38%) were female patients, frequency of retinopathy was 28.67%. The duration of diabetes ranged from 5 to 30 years. The frequency of retinopathy was higher in males as compared to females. The mean age of the patients was 51.10 +- 8.33 years with range 36-77 years. Proliferative retinopathy was seen more in those diabetic patients whose duration of disease was more than 10 years. They also showed poor glycaemic control in the form of raised blood glucose and HbA1C levels. Conclusion: About twenty eight percent of our diabetic patients are suffering from diabetic retinopathy. This can be controlled by early detection and effective treatment both in terms of strict glycemic control and laser photocoagulation, thus decreasing the morbidity and mortality due to this chronic disease. (author)

Factors predicting visual improvement post pars plana vitrectomy for proliferative diabetic retinopathy

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Evelyn Tai Li Min

2017-08-01

Full Text Available AIM: To identify factors predicting visual improvement post vitrectomy for sequelae of proliferative diabetic retinopathy(PDR.METHODS: This was a retrospective analysis of pars plana vitrectomy indicated for sequelae of PDR from Jan. to Dec. 2014 in Hospital Sultanah Bahiyah, Alor Star, Kedah, Malaysia. Data collected included patient demographics, baseline visual acuity(VAand post-operative logMAR best corrected VA at 1y. Data analysis was performed with IBM SPSS Statistics Version 22.0. RESULTS: A total of 103 patients were included. The mean age was 51.2y. On multivariable analysis, each pre-operative positive deviation of 1 logMAR from a baseline VA of 0 logMAR was associated with a post-operative improvement of 0.859 logMAR(P0.001. Likewise, an attached macula pre-operatively was associated with a 0.374(P=0.003logMAR improvement post vitrectomy. Absence of iris neovascularisation and absence of post-operative complications were associated with a post vitrectomy improvement in logMAR by 1.126(P=0.001and 0.377(P=0.005respectively. Absence of long-acting intraocular tamponade was associated with a 0.302(P=0.010improvement of logMAR post vitrectomy.CONCLUSION: Factors associated with visual improvement after vitrectomy are poor pre-operative VA, an attached macula, absence of iris neovascularisation, absence of post-operative complications and abstaining from use of long-acting intraocular tamponade. A thorough understanding of the factors predicting visual improvement will facilitate decision-making in vitreoretinal surgery.

Association of statin use and hypertriglyceridemia with diabetic macular edema in patients with type 2 diabetes and diabetic retinopathy.

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Chung, Yoo-Ri; Park, Sung Wook; Choi, Shin-Young; Kim, Seung Woo; Moon, Ka Young; Kim, Jeong Hun; Lee, Kihwang

2017-01-07

To investigate the effects of dyslipidemia and statin therapy on progression of diabetic retinopathy and diabetic macular edema in patients with type 2 diabetes. The medical records of 110 patients with type 2 diabetes (70 statin users and 40 non-users) were retrospectively reviewed. The two outcome measures were progression of diabetic retinopathy by two or more steps on the early treatment diabetic retinopathy study scale and diabetic macular edema based on optical coherence tomography. Serum lipid profiles were analyzed from 6 months prior to diagnosis of diabetic macular edema. Diabetic retinopathy progressed in 23% of statin users and 18% of non-users (p = 0.506), but diabetic macular edema was present in 23% of statin users and 48% of non-users (p = 0.008). Statins reduced low-density lipoprotein cholesterol levels in patients with and without diabetic macular edema (p = 0.043 and p = 0.031, respectively). Among statin users, patients with diabetic macular edema had higher levels of triglycerides (p = 0.004) and lower levels of high-density lipoprotein cholesterol (p = 0.033) than those without diabetic macular edema. Logistic regression analysis showed that statin use significantly lowered the risk of diabetic macular edema [odds ratio (OR): 0.33, 95% confidence interval (CI) 0.12-0.91, p = 0.032]. Hypertriglyceridemia at 6 months prior to development of macular edema was significantly associated with central retinal thickness (OR: 1.52; 95% CI 1.14-2.02, p = 0.005). Lipid lowering therapy with statins protected against the development of diabetic macular edema and progression of diabetic retinopathy in patients with type 2 diabetes. Hypertriglyceridemia could be used as a surrogate marker for diabetic macular edema.

The impact of diabetic retinopathy: perspectives from patient focus groups.

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Coyne, Karin S; Margolis, Mary Kay; Kennedy-Martin, Tessa; Baker, Timothy M; Klein, Ronald; Paul, Matthew D; Revicki, Dennis A

2004-08-01

Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in visual impairment or blindness. This exploratory qualitative research was conducted to evaluate the symptom experience of DR, its impact on daily activities and health-related quality of life (HRQL), and the applicability of two vision-specific questionnaires. Four focus groups (n = 15) were conducted with people with DR to explore their symptom experience and the impact on functioning and HRQL. Adults with type I or II diabetes and mild, moderate or severe non-proliferative DR (NPDR) or proliferative DR (PDR) were recruited. Content analysis and descriptive statistics were used to analyse the data. Participants described a range of symptoms and impact. Difficulty driving, especially at night, and trouble reading were noted with all levels of severity. Participants with PDR and decreased visual acuity have foregone many other important life aspects such as work, reading and sports. For the severely affected, diabetic care activities (e.g. exercising, reading nutritional labels, preparing insulin injections and glucose testing) were difficult to accomplish. Loss of independence, especially mobility and increased fear of accidents, had a profound impact on social activities. For those patients who had not experienced other complications of diabetes, the threat of vision loss was the most devastating. The loss of independence and mobility associated with decreased visual functioning and visual loss were major concerns. Moderate, severe NPDR and PDR associated with visual impairment have a significant impact on HRQL, particularly in the areas of independence, mobility, leisure and self-care activities.

Screening in Primary Care for Diabetic Retinopathy, Maculopathy and Visual Loss in South Africa.

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Webb, Elizabeth M; Rheeder, Paul; Roux, Polla

2016-01-01

The aim of the study was to determine the prevalence of diabetic retinopathy, maculopathy and visual loss in primary care patients and to identify associated risk factors. We conducted a cluster randomised trial at primary care clinics in the Tshwane district in South Africa. Grades of retinopathy and maculopathy (with fundus camera) and visual acuity (Snellen chart) were assessed and, using mobile screening and teleophthalmology, clinical and biochemical testing was conducted to obtain information about glycaemic control and microvascular complications. The prevalence rates for any retinopathy, preproliferative retinopathy and proliferative retinopathy were 24.9, 19.5 and 5.5%, respectively. The prevalence rates of diabetic maculopathy, observable maculopathy and referable maculopathy were 20.8, 11.8 and 9.0%, respectively. The presence of retinopathy was associated with high body mass index, systolic blood pressure, being on insulin treatment, high HbA1c and the presence of neuropathy. High systolic blood pressure, being on insulin treatment, high HbA1c level and high low-density lipoprotein cholesterol level as well as the presence of albuminuria were significant in predicting any diabetic maculopathy. Laser photocoagulation was given to 8.3% of patients from the mobile unit and 12% of patients were referred to the nearest hospital with an outpatient eye clinic for follow-up treatment of various other eye conditions. Using the WHO categories, the study found that 78.1% of diabetes patients had normal vision, 19.3% were visually impaired and 2.2% were severely impaired or blind. High prevalence rates for diabetic retinopathy, maculopathy and visual loss were found and associations were identified. © 2016 S. Karger AG, Basel.

Patient Self-Report of Prior Laser Treatment Reliably Indicates Presence of Severe Diabetic Retinopathy

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GRASSI, MICHAEL A.; MAZZULLA, D. ANTHONY; KNUDTSON, MICHAEL D.; HUANG, WENDY W.; LEE, KRISTINE E.; KLEIN, BARBARA E.; NICOLAE, DAN L.; KLEIN, RONALD

2009-01-01

PURPOSE To determine whether patient self-report of prior laser treatment can be used as a reliable tool for assessing the presence of severe diabetic retinopathy. DESIGN This was a retrospective study on two groups of diabetic subjects. METHODS One hundred patients with diabetes were recruited from the general eye and retina clinics at the University of Chicago Hospitals. The patients were asked, “Have you ever received laser treatment for your diabetic eye disease (DED)?” A chart review was then conducted noting if the patient had received either focal laser treatment for diabetic macular edema or panretinal photocoagulation for proliferative diabetic retinopathy. Data from the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) were also analyzed. Participant responses to the question “Have you had laser photocoagulation treatment for your eyes?” were analyzed with documentation of photocoagulation scars determined by grading seven-standard field color fundus photographs. RESULTS In the University of Chicago group, 96 of 100 (96%) of patients were accurate in reporting whether they had received previous laser treatment for DED (sensitivity 95.8%, specificity 96.1%, and positive predictive value 88.5%). In the WESDR analysis, 2,329 of 2,348 (99%) of participants were accurate in reporting whether they had prior laser treatment for DED (sensitivity 96.0%, specificity 99.5%, and positive predictive value 95.6%). CONCLUSIONS The high sensitivity and specificity of our results validate the use of patient self-report as a useful tool in assessing past laser treatment for severe diabetic retinopathy. Patient self-report may be a useful surrogate to clinical examination or medical record review to determine the presence of severe diabetic retinopathy. PMID:19054495

Body Mass Index: A Risk Factor for Retinopathy in Type 2 Diabetic Patients

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Snježana Kaštelan

2013-01-01

Full Text Available The aim of the study was to investigate whether body mass index (BMI independently or in correlation with other risk factors is associated with diabetic retinopathy (DR progression. The study included 545 patients with type 2 diabetes. According to DR status, they were divided into three groups: group 1 (no retinopathy; n=296, group 2 (mild/moderate nonproliferative DR; n=118, and group 3 (severe/very severe NPDR or proliferative DR; n=131. Patients without DR were younger than those with signs of retinopathy at time of diabetes onset whilst diabetes duration was longer in groups with severe NPDR and PDR. DR progression was correlated with diabetes duration, BMI, HbA1c, hypertension, and cholesterol. Statistical analyses showed that the progression of retinopathy increased significantly with higher BMI (gr. 1: 26.50 ± 2.70, gr. 2: 28.11 ± 3.00, gr. 3: 28.69 ± 2.50; P<0.01. We observed a significant deterioration of HbA1c and a significant increase in cholesterol and hypertension with an increase in BMI. Correlation between BMI and triglycerides was not significant. Thus, BMI in correlation with HbA1c cholesterol and hypertension appears to be associated with the progression of DR in type 2 diabetes and may serve as a predictive factor for the development of this important cause of visual loss in developed countries.

Early diagnosis of sub-clinical stage of diabetic retinopathy

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Xing-Hui Xu

2014-12-01

Full Text Available AIM: To evaluate the early diagnosis of sub-clinic stage of diabetic retinopathy.METHODS: This was cross sectional study,multifocal retina electroretinogram(mf-ERG, contrast sensitivity(CSand central retinal artery color Doppler examination were recorded from 30 cases(30 eyesmatched control subjects, 35 cases(35 eyeswith type 2 diabetes mellitus(DMwithout diabetic retinopathy(NDRand 38 cases(38 eyeswith non-prolifera tive diabetic retinopathy(NPDR. One-way ANOVA and SNK-q test were used for data analysis.RESULTS: P1 response density of NDR patients were found decrease, N1 implicit time were delayed. Which were related with the degree of retinopathy(PPPP>0.05, The differences between normal group, NDR group and NPDR group were found statistically significant(PCONCLUSION: mf-ERG and CS are sensitive indexes for early evaluation of visual function in patients with diabetes mellitus, with development of the disease, CRA blood flow also appears to decline.

Associations Between Diabetic Retinopathy and Plasma Levels of High-sensitive C-reactive Protein or Von Willebrand Factor in Long-term Type 1 Diabetic Patients

DEFF Research Database (Denmark)

Laursen, Jonas Vejvad Nørskov; Hoffmann, Stine Skovbo; Green, Anders

2013-01-01

.27 IU/ml (0.79-2.07 IU/ml), respectively. No or minimal DR (ETDRS-levels 10-20) was found in 16.4%, mild DR (ETDRS-level 35) in 19.4%, moderate DR (ETDRS-levels 43-47) in 11.0%, and 53.2% had proliferative diabetic retinopathy (PDR) corresponding to ETDRS-level 60 or more. In an age- and sex......Purpose: To evaluate high-sensitive C-reactive protein (hs-CRP) and von Willebrand factor as possible plasma markers of diabetic retinopathy in a population-based cohort of type 1 diabetic patients. Materials and Methods: This was a cross-sectional study of 201 type 1 diabetic patients from...... a population-based cohort from Fyn County, Denmark. Plasma levels of hs-CRP and von Willebrand factor antigen were measured and related to the level of diabetic retinopathy (DR) as evaluated by dilated nine-field 45 degree monoscopic fundus photos captured by Topcon TRC-NWS6 and graded according to the Early...

The relationship between diabetic retinopathy and cognitive impairment.

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Crosby-Nwaobi, Roxanne R; Sivaprasad, Sobha; Amiel, Stephanie; Forbes, Angus

2013-10-01

Recent studies have shown an increased risk for cognitive impairment and dementia in patients with diabetes. An association between diabetic retinopathy (DR) and retinal microvasculature disease and cognitive impairment has been reported as potential evidence for a microvascular component to the cognitive impairment. It was hypothesized that severity of DR would be associated with cognitive impairment in individuals with type 2 diabetes. Three hundred eighty patients with type 2 diabetes were recruited from a population-based eye screening program and grouped by severity of DR as follows: no/mild DR (n=252) and proliferative diabetic retinopathy (PDR) (n=128). Each participant underwent psychosocial assessment; depression screening; ophthalmic and physical examination, including blood assays; and cognitive assessment with the Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), and the Mini-Cog. General linear modeling was used to examine severity of DR and cognitive impairment, adjusting for confounders. Severity of DR demonstrated an inverse relationship with cognitive impairment (fully adjusted R2=0.415, Pcognitive impairment scores on ACE-R (adjusted mean±SE 77.0±1.9) compared with the PDR group (82.5±2.2, Pcognitive impairment compared with 5% in the PDR group (n=6). Patients with minimal DR demonstrated more cognitive impairment than those with advanced DR. Therefore, the increased prevalence of cognitive impairment in diabetes may be associated with factors other than evident retinal microvascular disease.

Retinal oxygen extraction in individuals with type 1 diabetes with no or mild diabetic retinopathy.

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Fondi, Klemens; Wozniak, Piotr A; Howorka, Kinga; Bata, Ahmed M; Aschinger, Gerold C; Popa-Cherecheanu, Alina; Witkowska, Katarzyna J; Hommer, Anton; Schmidl, Doreen; Werkmeister, René M; Garhöfer, Gerhard; Schmetterer, Leopold

2017-08-01

The aim of this study was to compare retinal oxygen extraction in individuals with diabetes with no or mild non-proliferative diabetic retinopathy and healthy age- and sex-matched volunteers. A total of 24 participants with type 1 diabetes and 24 healthy age- and sex-matched volunteers were included in this cross-sectional study. Retinal oxygen extraction was measured by combining total retinal blood flow measurements using a custom-built bi-directional Doppler optical coherence tomography system with measurements of oxygen saturation using spectroscopic reflectometry. Based on previously published mathematical modelling, the oxygen content in retinal vessels and total retinal oxygen extraction were calculated. Total retinal blood flow was higher in diabetic participants (46.4 ± 7.4 μl/min) than in healthy volunteers (40.4 ± 5.3 μl/min, p = 0.002 between groups). Oxygen content in retinal arteries was comparable between the two groups, but oxygen content in retinal veins was higher in participants with diabetes (0.15 ± 0.02 ml O 2 /ml) compared with healthy control participants (0.13 ± 0.02 ml O 2 /ml, p diabetes compared with healthy volunteers (total retinal oxygen extraction 1.40 ± 0.44 vs 1.70 ± 0.47 μl O 2 /min, respectively, p = 0.03). Our data indicate early retinal hypoxia in individuals with type 1 diabetes with no or mild diabetic retinopathy as compared with healthy control individuals. Further studies are required to fully understand the potential of the technique in risk stratification and treatment monitoring. ClinicalTrials.gov NCT01843114.

To report a case of unilateral proliferative retinopathy following noncerebral malaria with Plasmodium falciparum in Southern India

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Aditya Verma

2015-01-01

Full Text Available The retinopathy in association with malaria fever described so far includes retinal hemorrhages, vessel changes, retinal discoloration/whitening and papilledema. Malaria retinopathy has been mostly described in severe cases, associated with Plasmodium falciparum, correlating the patho-physiology of retinal and cerebral manifestations. We report an unusual case of proliferative retinopathy as a manifestation of malaria fever, caused by P. falciparum with no cerebral involvement. The patient had features of unilateral retinal vascular occlusion with proliferative changes and vitreous hemorrhage. To the best of our knowledge, such a case has never been reported so far in the literature. This report highlights the possible occurrence of severe proliferative changes associated with malaria fever, which if diagnosed early can prevent possible blindness.

Telemedicine for diabetic retinopathy screening using an ultra-widefield fundus camera

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Hussain N

2017-08-01

Full Text Available Nazimul Hussain,1 Maryam Edraki,2 Rima Tahhan,2 Nishanth Sanalkumar,2 Sami Kenz,2 Nagwa Khalil Akasha,2 Brian Mtemererwa,2 Nahed Mohammed2 1Department of Ophthalmology, Al Zahra Hospital, Sharjah, United Arab Emirates; 2Department of Endocrinology, Al Zahra Hospital, Sharjah, United Arab Emirates Objective: Telemedicine reporting of diabetic retinopathy (DR screening using ultra-widefield (UWF fundus camera. Materials and methods: Cross-sectional study of diabetic patients who visited the endocrinology department of a private multi-specialty hospital in United Arab Emirates between April 2015 and January 2017 who underwent UWF fundus imaging. Fundus pictures are then accessed at the Retina Clinic in the Department of Ophthalmology. Primary outcome measure was incidence of any form of DR detected. The secondary outcome measure was failure to take good image and inability to grade. Results: A total of 1,024 diabetic individuals were screened for DR from April 2015 to January 2017 in the department of Endocrinology. Rate of DR was 9.27%; 165 eyes of 95 individuals were diagnosed to have some form of DR. Mild non-proliferative DR (NPDR was seen in 114 of 165 eyes (69.09%, moderate NPDR in 32 eyes (19.39%, severe NPDR in six eyes (3.64%, and proliferative DR (PDR in 13 eyes (7.88%. The secondary outcome measure of poor image acquisition was seen in one individual who had an image acquired in one eye that could not be graded due to bad picture quality. Conclusions: The present study has shown the effectiveness of DR screening using UWF fundus camera. It has shown the effectiveness of trained nursing personnel taking fundus images. This model can be replicated in any private multi-specialty hospital and reduce the burden of DR screening in the retina clinic and enhance early detection of treatable DR. Keywords: telemedicine, ultra-widefield camera, diabetic retinopathy screening

Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture

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Arevalo, J. Fernando; Sanchez, Juan G.; Lasave, Andres F.; Wu, Lihteh; Maia, Mauricio; Bonafonte, Sergio; Brito, Miguel; Alezzandrini, Arturo A.; Restrepo, Natalia; Berrocal, Maria H.; Saravia, Mario; Farah, Michel Eid; Fromow-Guerra, Jans; Morales-Canton, Virgilio

2011-01-01

This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy. PMID:21584260

Endocrinological disturbances in diabetic retinopathy

International Nuclear Information System (INIS)

Hafiez, A.A.; Shalaby, E.; Atia, H.; Abdel-Hafez, M.A.; Hammad, A.B.

1985-01-01

Microvascular complications of diabetes mellitus were extensively studied from various points of view. The aim was to elucidate the possible interaction of insulin, glucagon, prolactin, growth hormone, T 3 , and T 4 in the pathogenesis of diabetic retinopathy. Forty patients with diabetic retinopathy (group II) and twenty age-matched controls (group I) were investigated. Plasma levels of both insulin and glucagon were significantly elevated in group II versus group I, whereas other hormones were insignificantly changed. This shows the role that might be played by T 3 , T 4 , growth hormone, and prolactin in the established cases of diabetic retinopathy. (author)

Correlation between Common Carotid Artery Intima-media Thickness and Degree of Retinopathy in Type 2 Diabetes Mellitus%2型糖尿病视网膜病变程度与颈总动脉内-中膜厚度的相关性研究

Institute of Scientific and Technical Information of China (English)

李晶晶; 邓又斌; 杨顺实

2011-01-01

目的 评估2型糖尿病患者(diabetes mellitus,DM)视网膜病变程度与颈总动脉内-中膜厚度(common carotid artery inti-ma-media thickness,CCA IMT)的相关性,以期早期发现糖尿病视网膜病变(diabetic retinopathy,DR)并评估其病变程度.方法 筛选2型糖尿病患者84例.根据眼底荧光造影的结果分为糖尿病无视网膜病变(non-diabetic retinopathy,NDR)组、非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组及增殖期糖尿病视网膜病变(proliferative di-abetic retinopathy,PDR)组三组.记录各组病例的性别、年龄、糖尿病病程,测量其CCA IMT、空腹血糖(fasting blood glu-cose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血清甘油三脂(serum triglycerides,TG)、总胆固醇(totalcholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholestero,LDL-C)及高密度脂蛋白胆固醇(high-density lipo-protein cholesterol,HDL-C).结果 CCA IMT、FBG、HbA1c及糖尿病病程均同DR的程度具有正相关性(P<0.05);且排除了FBG、HbA1c及糖尿病病程的影响后,CCA IMT仍与DR程度相关(P<0.01).结论 2型糖尿病患者DR的程度同CCA IMT具有正相关性.%Objective To estimate the correlation between the degree of the diabetic retinopathy(DR)and the common carotid artery intima-media thickness (CCA IMT)in type 2 diabetes mellitus(DM)for early detection of DR and the the extent of their lesions. Methods A total of 84 patients with type 2 diabetes mellitus,according to the result of fundus fluorescein angiography,were divided into three groups:non-diabetic retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)group and proliferative diabetic retinopathy(PDR)group. In each group, gender, age and duration of diabetes were recorded, and common carotid artery intima-media thickness(CCA IMT), fasting blood glucose (FBG) ,glycosylated hemoglobin( HbAlc), serum triglycerides(TG), total cholesterol(TC), low

Low Vision Rehabilitation and Diabetic Retinopathy

International Nuclear Information System (INIS)

Khan, Sarfaraz A.

2007-01-01

Diabetic retinopathy is emerging as a major cause of blindness. Diabetic retinopathy calls for a multidisciplinary to the patients. Management of the patient requires a team work by the internist, diabetologist, dietician, ophthalmologist and low vision therapist. Diabetic retinopathy very often results in vision loss. It is important for ophthalmologist to recognize the importance of low vision rehabilitation in formulating appropriate treatment strategies. People with low vision loss due to diabetic retinopathy usually experience difficulty in daily life. Most people with diabetic retinopathy (who have remaining useful vision) can be helped with low vision devices. However, often one low vision device may not be suitable for all purposes. A comprehensive low vision evaluation is required to assess the person's current visual status, identify the goals and the visual needs, and then design an individualized vision rehabilitation program to meet these needs. (author)

Predictors of Diabetic Retinopathy in Patients with Type 2 Diabetes ...

African Journals Online (AJOL)

Predictors of Diabetic Retinopathy in Patients with Type 2 Diabetes Who Have Normoalbuminuria. R Karoli, J Fatima, V Shukla, P Garg, A Ali. Abstract. Background: Microalbuminuria is an independent predictor of retinopathy, so absence of microalbuminuria may tend clinician not to screen for diabetic retinopathy (DR).

TO STUDY THE EFFECT OF ANGIOTENSIN RECEPTOR BLOCKERS ON DIABETIC RETINOPATHY

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Chakravarthy K

2017-05-01

Full Text Available BACKGROUND Diabetic Retinopathy (DR is the most common microvascular complication of Diabetes Mellitus (DM and is the leading cause of blindness in working age adults of patients with type 1 and 2 DM. Large observational and randomised studies shown that optimal blood glucose and blood pressure control halt or regress the disease and limit the risk of progression to the proliferative stage and visual loss. Recently, evidence has also emerged that Renin-Angiotensin System (RAS inhibitors may electively prevent or delay progression of retinopathy by acting on local RAS. Thus, metabolic and blood pressure control by RAS inhibition is to prevent or limit the onset of retinopathy and its progression towards visual-threatening stages. The aim of the study is to categorise and analyse grading of DR who are on currently ACE and ARBs unchanged for at least 2 years. MATERIALS AND METHODS 178 patients with type 1 and 2 DM of both genders on ARBs and ACEI unchanged for at least 2 years are divided into two groups as follows- 1. ARB group, which includesa 28 patients on losartan (50 mg. b 32 patients on losartan (50 mg + hydrochlorothiazide (12.5 mg. c 28 patients on telmisartan (40 mg. d 32 patients on telmisartan (40 mg + hydrochlorothiazide (12.5 mg. 2. ACE inhibitor group includesa 30 patients on enalapril (5 mg. b 28 patients on ramipril (2.5 mg + hydrochlorothiazide (12.5 mg. Retinopathy grading assessed by indirect ophthalmoscope and comparison of retinopathy grading between ARBs and ACEI groups have done. Two-tailed Chi-square test, GraphPad Prism Software used for statistical calculations. RESULTS Losartan and telmisartan (ARB group showed significant protection from diabetic retinopathy than enalapril and ramipril (ACEI group (p<0.05. CONCLUSION ARBs help in preventing the progression of DR and vision loss in those belonging to mild and moderate nonproliferative diabetic retinopathy patients.

Pain score of patients undergoing single spot, short pulse laser versus conventional laser for diabetic retinopathy.

Science.gov (United States)

Mirshahi, Ahmad; Lashay, Alireza; Roozbahani, Mehdi; Fard, Masoud Aghsaei; Molaie, Saber; Mireshghi, Meysam; Zaferani, Mohamad Mehdi

2013-04-01

To compare pain score of single spot short duration time (20 milliseconds) panretinal photocoagulation (PRP) with conventional (100 milliseconds) PRP in diabetic retinopathy. Sixty-six eyes from 33 patients with symmetrical severe non-proliferative diabetic retinopathy (non-PDR) or proliferative diabetic retinopathy (PDR) were enrolled in this prospective randomized controlled trial. One eye of each patient was randomized to undergo conventional and the other eye to undergo short time PRP. Spot size of 200 μm was used in both laser types, and energy was adjusted to achieve moderate burn on the retina. Patients were asked to mark the level of pain felt during the PRP session for each eye on the visual analog scale (VAS) and were examined at 1 week, and at 1, 2, 4 and 6 months. Sixteen women and 17 men with mean age 58.9 ± 7.8 years were evaluated. The conventional method required a mean power of 273 ± 107 mW, whereas the short duration method needed 721 ± 406 mW (P = 0.001). An average of 1,218 ± 441 spots were delivered with the conventional method and an average of 2,125 ± 503 spots were required with the short duration method (P = 0.001). Average pain score was 7.5 ± 1.14 in conventional group and 1.75 ± 0.87 in the short duration group (P = 0.001). At 1 week, 1 month, and 4 months following PRP, the mean changes of central macular thickness (CMT) from baseline in the conventional group remained 29.2 μm (P = 0.008), 40.0 μm (P = 0.001), and 40.2 μm (P = 0.007) greater than the changes in CMT for short time group. Patient acceptance of short time single spot PRP was high, and well-tolerated in a single session by all patients. Moreover, this method is significantly less painful than but just as effective as conventional laser during 6 months of follow-up. The CMT change was more following conventional laser than short time laser.

Radiation retinopathy in diabetes mellitus

International Nuclear Information System (INIS)

Dhir, S.P.; Joshi, A.V.; Banerjee, A.K.

1982-01-01

A case of radiation retinopathy in a diabetic individual who received a total dose of 45 Gy for lymphoblastic lymphoma of the orbit is reported. The relationship between radiation retinopathy and diabetes mellitus is discussed. (Auth.)

Endoplasmic reticulum stress and diabetic retinopathy

Directory of Open Access Journals (Sweden)

Toshiyuki Oshitari

2008-02-01

Full Text Available Toshiyuki Oshitari1,2, Natsuyo Hata1, Shuichi Yamamoto11Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan; 2Department of Ophthalmology, Kimitsu Central Hospital, Kisarazu City, Chiba, JapanAbstract: Endoplasmic reticulum (ER stress is involved in the pathogenesis of several diseases including Alzheimer disease and Parkinson disease. Many recent studies have shown that ER stress is related to the pathogenesis of diabetes mellitus, and with the death of pancreatic β-cells, insulin resistance, and the death of the vascular cells in the retina. Diabetic retinopathy is a major complication of diabetes and results in death of both neural and vascular cells. Because the death of the neurons directly affects visual function, the precise mechanism causing the death of neurons in early diabetic retinopathy must be determined. The ideal therapy for preventing the onset and the progression of diabetic retinopathy would be to treat the factors involved with both the vascular and neuronal abnormalities in diabetic retinopathy. In this review, we present evidence that ER stress is involved in the death of both retinal neurons and vascular cells in diabetic eyes, and thus reducing or blocking ER stress may be a potential therapy for preventing the onset and the progression of diabetic retinopathy.Keywords: endoplasmic reticulum stress, diabetic retinopathy, vascular cell death, neuronal cell death

Lipasin, a biomarker of diabetic retinopathy.

Science.gov (United States)

Fang, Chen; Huang, Yun; Guo, Heming; Gao, Yan; Ji, Xiaoyan; Hu, Ji

2016-05-01

The present study recruited 74 participants with type 2 diabetes, among which 23 had retinopathy. Those with retinopathy had a longer duration of diabetes and higher levels of lipasin compared with those without retinopathy. Logistic regression revealed that lipasin was independently and significantly associated with retinopathy even after adjustments for confounders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

激光治疗糖尿病视网膜病变的疗效观察%Laser treatment for diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

张未来; 陈蕾

2008-01-01

目的 探讨激光治疗糖尿病视网膜病变的效果.方法 根据DRPSG(Diabetic Retinopathy Photocoagulation Study Group)制定的治疗技术规定,对280例365只眼分别为增殖前期糖尿病视网膜病变(Preproliferative diabetic retinopathy,PPDR)、增殖期糖尿病视网膜病变(Proliferative diabetic retinopathy,PDR)及糖尿病性黄斑水肿(Diabetic macular edema,DME)患者,分别行标准全视网膜光凝(S-PRP)、超全视网膜光凝(E-PRP)、局限或格栅光凝.术后3、6、12个月行FFA及彩色眼底像,新生血管未消退者和无灌注区尚存者追加光凝,随访3～36个月.结果 355只眼行全视网膜光凝,新生血管或无灌注区全部或部分消退256只眼,有效率为72.1%:视力不变和增进292只眼,占82.3%;35只黄斑水肿眼局限或格栅光凝后,26只眼水肿减轻或消失,有效率74.3%.结论 激光治疗糖尿病性视网膜病变安全有效.%Objective To evaluate the technique of laser treatment for diabetic retinopathy.Methods According to the treatment technique stipulations formulated by DRPSG (Diabetic Retinopathy photo coagulation Study Group),365 eyes of 280 patients suffering from preprcliferative diabetic retinopathy(PPDR), proliferative diabetic retinopathy (POR) and diabetic macular edema (DME) repectively were treated with laser treatment.These patients received the treatment of standard panretinal photocoagulation(S-PRP) and extra panretinal photocoagulation (E-PRP).Those with macular edema received the focal and grid photocoagulation.The fundus fluorescein angio graphy (FFA)and color photograph were taken 3,6 and12 months after the treatment.For those cases with remaining new vessels and non-perfusion areas, the treatment was complemented with further photocoagulation. The follow-up period was 3～36 months. Results Retinal new vessels partly or entirely regressed in 256 eyes (about 72.1%)of the 355 eyes subjected to PRP. Visual acuity were improved or maintained in 292 eyes

Impairment of Colour Vision in Diabetes with No Retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SNDREAMS- II, Report 3.

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Laxmi Gella

Full Text Available To assess impairment of colour vision in type 2 diabetics with no diabetic retinopathy and elucidate associated risk factors in a population-based cross-sectional study.This is part of Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular-genetics Study (SN-DREAMS II which was conducted between 2007-2010. FM 100 hue-test was performed in 253 subjects with no clinical evidence of diabetic retinopathy. All subjects underwent detailed ophthalmic evaluation including cataract grading using LOCS III and 45° 4-field stereoscopic fundus photography. Various ocular and systemic risk factors for impairment of colour vision (ICV were assessed in subjects with diabetes but no retinopathy. P value of < 0.05 was considered statistically significant.The mean age of the study sample was 57.08 ± 9.21 (range: 44-86 years. Gender adjusted prevalence of ICV among subjects with diabetes with no retinopathy was 39.5% (CI: 33.5-45.5. The mean total error score in the study sample was 197.77 ± 100 (range: 19-583. The risk factors for ICV in the study were women OR: 1.79 (1.00-3.18, increased resting heart rate OR: 1.04 (1.01-1.07 and increased intraocular pressure OR: 1.12 (1.00-1.24. Significant protective factor was serum high-density lipoprotein OR: 0.96 (0.93-0.99.Acquired ICV is an early indicator of neurodegenerative changes in the retina. ICV found in diabetic subjects without retinopathy may be of non-vascular etiology.

AMA0428, A Potent Rock Inhibitor, Attenuates Early and Late Experimental Diabetic Retinopathy.

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Hollanders, Karolien; Hove, Inge Van; Sergeys, Jurgen; Bergen, Tine Van; Lefevere, Evy; Kindt, Nele; Castermans, Karolien; Vandewalle, Evelien; van Pelt, Jos; Moons, Lieve; Stalmans, Ingeborg

2017-02-01

Diabetic retinopathy (DR) is characterized by an early stage of inflammation and vessel leakage, and an advanced vasoproliferative stage. Also, neurodegeneration might play an important role in disease pathogenesis. The aim of this study was to investigate the effect of the Rho kinase (ROCK) inhibitor, AMA0428, on these processes. The response to ROCK inhibition by AMA0428 (1 µg) was studied in vivo using the murine model for streptozotocin (STZ)-induced diabetes, focusing on early non-proliferative DR features and the oxygen-induced retinopathy (OIR) model to investigate proliferative DR. Intravitreal (IVT) administration of AMA0428 was compared with murine anti-VEGF-R2 antibody (DC101, 6.2 µg) and placebo (H 2 O/PEG; 1C8). Outcome was assessed by analyzing leukostasis using fluorescein isothiocyanate coupled concanavalin A (FITC-ConA) and vessel leakage (bovine serum albumin conjugated with fluorescein isothiocyanate; FITC-BSA)/neovascularization and neurodegeneration by immunohistological approaches (hematoxylin and eosin (H&E), terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling (TUNEL), Brn3a). ELISA and Western blotting were employed to unravel the consequences of ROCK inhibition (1 µM AMA0428) on myosin phosphatase target protein (MYPT)-1 phosphorylation, endothelial nitric oxide synthase (eNOS) phosphorylation, and vascular endothelial growth factor (VEGF) levels in retinas of diabetic mice, on NF-κβ activity and ICAM-1 expression in endothelial cells (ECs). In vivo, AMA0428 significantly reduced vessel leakage and neovascularization, respectively, in the STZ and OIR model, comparable to DC101 therapy. Additionally, the ROCK inhibitor decreased neurodegeneration in both models and inhibited leukostasis by 30% (p diabetic retina and AMA0428 administration resulted in decreased phospho-MYPT-1, enhanced phospho-eNOS, and reduced VEGF levels. In vitro, AMA0428 interfered with NF-κβ activity, thereby inhibiting ICAM-1

Global prevalence and major risk factors of diabetic retinopathy

DEFF Research Database (Denmark)

Yau, Joanne W Y; Rogers, Sophie L; Kawasaki, Ryo

2012-01-01

To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.......To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes....

A study of whether automated Diabetic Retinopathy Image Assessment could replace manual grading steps in the English National Screening Programme.

Science.gov (United States)

Kapetanakis, Venediktos V; Rudnicka, Alicja R; Liew, Gerald; Owen, Christopher G; Lee, Aaron; Louw, Vern; Bolter, Louis; Anderson, John; Egan, Catherine; Salas-Vega, Sebastian; Rudisill, Caroline; Taylor, Paul; Tufail, Adnan

2015-09-01

Diabetic retinopathy screening in England involves labour intensive manual grading of digital retinal images. We present the plan for an observational retrospective study of whether automated systems could replace one or more steps of human grading. Patients aged 12 or older who attended the Diabetes Eye Screening programme, Homerton University Hospital (London) between 1 June 2012 and 4 November 2013 had macular and disc-centred retinal images taken. All screening episodes were manually graded and will additionally be graded by three automated systems. Each system will process all screening episodes, and screening performance (sensitivity, false positive rate, likelihood ratios) and diagnostic accuracy (95% confidence intervals of screening performance measures) will be quantified. A sub-set of gradings will be validated by an approved Reading Centre. Additional analyses will explore the effect of altering thresholds for disease detection within each automated system on screening performance. 2,782/20,258 diabetes patients were referred to ophthalmologists for further examination. Prevalence of maculopathy (M1), pre-proliferative retinopathy (R2), and proliferative retinopathy (R3) were 7.9%, 3.1% and 1.2%, respectively; 4749 (23%) patients were diagnosed with background retinopathy (R1); 1.5% were considered ungradable by human graders. Retinopathy prevalence was similar to other English diabetic screening programmes, so findings should be generalizable. The study population size will allow the detection of differences in screening performance between the human and automated grading systems as small as 2%. The project will compare performance and economic costs of manual versus automated systems. © The Author(s) 2015.

Retcam fluorescein gonioangiography: a new modality for early detection of angle neovascularization in diabetic retinopathy.

Science.gov (United States)

Azad, Rajvardhan; Arora, Tarun; Sihota, Ramanjit; Chandra, Parijat; Mahajan, Deepankur; Sain, Siddarth; Sharma, Yograj

2013-10-01

To evaluate the role of Retcam fluorescein gonioangiography in detecting neovascularization of the angle and correlate the same with gonioscopy in diabetic retinopathy. One hundred and fifty eyes of 150 patients (25 each of mild, moderate, severe, very severe nonproliferative diabetic retinopathy (NPDR) proliferative diabetic retinopathy (PDR); and PDR with high-risk characteristics) were recruited. They underwent complete ocular examination including applanation tonometry, gonioscopy, Retcam fluorescein gonioangiography, and fundus fluorescein angiography. Using Retcam fluorescein gonioangiography, of 150 eyes neovascularization of the angle was detected in 37 eyes (24.66%) compared with 22 eyes (14.66%) on gonioscopy (P = 0.04). Small newly formed vessels were evident only with Retcam fluorescein gonioangiography. In 10 of 50 patients (20%) with severe/very severe NPDR, angle neovascularization was appreciable on Retcam fluorescein angiography compared with 5 patients (10%) on gonioscopy. Similarly, 25 of 50 patients (50%) with PDR/PDR with high-risk characteristics had neovascularization of the angle on Retcam gonioangiography compared with 17 (34%) on gonioscopy. Retcam fluorescein gonioangiography is a novel technique for early detection of angle neovascularization in diabetic retinopathy and hence preventing progression to neovascular glaucoma. The objective nature of this test helps in precise decision making compared with gonioscopy for early intervention especially in cases of pre-PDR.

Correlation analysis of diabetic retinopathy and diabetic nephropathy%糖尿病视网膜病变与糖尿病肾病相关性分析

Institute of Scientific and Technical Information of China (English)

闫济民

2014-01-01

目的：分析糖尿病视网膜病变与糖尿病肾病的相关性。方法：2013年4月-2014年4月收治糖尿病患者160例，根据患者视网膜病变程度分为3组，NDR组(无视网膜病变)、BDR组(非增殖性视网膜病变)、PDR组(增殖性视网膜病变)，比较3组患者 HbA1C、μ-ALB、SDBG、MAGE 与糖尿病肾病相关性。结果：PDR 组 HbA1C、μ-ALB、SDBG、MAGE 指标均高于 BDR 组和 NDR 组，其中 BDR 组各项指标比 NDR 组高，比较差异均具统计学意义(P＜0.05)，糖尿病视网膜病变与糖尿病肾病呈正相关。结论：糖尿病视网膜病变与糖尿病肾病关系密切，相互以平行关系共同发展。%Objective:To explore the correlation analysis of diabetic retinopathy and diabetic nephropathy.Methods:160 diabetic patients were selected from April 2013 to April 2014.According to the degree of retinopathy patients,they were divided into the NDR group(no retinopathy),the BDR group(non proliferative retinopathy),the PDR group(diabetic retinopathy).We compared the correlation of HbA1C,μ-ALB,SDBG,MAGE with diabetic nephropathy of the three groups.Results:In the PDR group,HbA1C,μ-ALB,SDBG,MAGE were higher than that of BDR group and NDR group,and the indexes of BDR group was higher than that of NDR group.The difference was statistically significant(P<0.05).Diabetic retinopathy was positively associated with diabetic nephropathy.Conclusion:The relationship between diabetic retinopathy and diabetic nephropathy is close.They are the common development in parallel relationship.

Social well-being of young adults with type 1 diabetes since childhood. The Oulu cohort study of diabetic retinopathy.

Science.gov (United States)

Hannula, Virva; Hautala, Nina M; Tossavainen, Päivi; Falck, Aura A K

2015-08-01

To evaluate the social performance of young adults with type 1 diabetes (T1D) since childhood with particular interest in its relation to the severity of diabetic retinopathy (DR). The prevalence of DR was evaluated in a population-based Finnish cohort of children with T1D during 1989-1990. The subjects were contacted 18 years later for evaluation of DR, education, employment, and family relations. 136 of 216 subjects participated in the study in 2007 (mean age 30 ± 3 years, mean diabetes duration 23 ± 4 years, 78 men). There were 42 subjects (31%) with proliferative diabetic retinopathy (PDR). A university degree was held by 9%, a degree from a university of applied sciences by 33%, and 45% had a vocational school education; 7% were full-time students while 4% had received no education after comprehensive school. PDR was associated with lower education. Sixty percent of the subjects with PDR and 68% of those with non-PDR held full-time jobs. Four percent of the non-PDR group were unemployed while 26% of subjects with PDR were outside working life because of either unemployment or retirement. Seventy-one percent of the subjects had a spouse, and 60 subjects had a total of 119 children. PDR did not compromise the likelihood of having a spouse and children. The majority of young adults with T1D take active roles in society by working and raising families. However, patients with PDR lacked secondary education significantly more often and were less likely to work than those with non-PDR. © 2015 the Nordic Societies of Public Health.

Study of retrobulbar hemodynamics in diabetes via color doppler ultrasound

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Wei Chen

2014-09-01

Full Text Available AIM: To explore the changes of retrobulbar hemodynamics in diabetes via color doppler ultrasound. METHODS: Totally 80 patients(160 eyeswith eye diseases in type 2 diabetes from June 2010 to May 2013 in our hospital were enrolled as research group. By fundus photography and direct ophthalmoscopy, patients were assigned to diabetes without retinopathy group(DNR subgroup, non-proliferative diabetic retinopathy group(NPDR subgroupand proliferative diabetic retinopathy group(PDR subgroup. Of 60 healthy patients(120 eyesover the same period were chosen as control group. The doppler parameters of central retinal artery(CRA, posterior ciliary artery(PCAand ophthalmic artery(OAwere measured.RESULTS: There were significant differences on circulatory parameters of CRA, PCA and OA between both groups(PPPCONCLUSION: The monitoring of retinal blood flow and analysis of blood spectrum morphology via color doppler ultrasound can effectively evaluate the degree of diabetic retinopathy lesions, especially before DR vascular disease. Early detection can reveal the hemodynamic change pattern of DR, facilitating the prevention of diabetic eye complications and improvement of the quality of life.

Noninvasive Retinal Markers in Diabetic Retinopathy

DEFF Research Database (Denmark)

Blindbæk, Søren Leer; Torp, Thomas Lee; Lundberg, Kristian

2017-01-01

The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber...... and fractals with micro- and macrovascular dysfunction in diabetes. Likewise, the retinal metabolism can be evaluated by retinal oximetry, and higher retinal venular oxygen saturation has been demonstrated in patients with diabetic retinopathy. So far, most studies have been cross-sectional, but these can only...... retinopathy and diabetic macular edema. The Department of Ophthalmology at Odense University Hospital, Denmark, has a strong tradition of studying the retinal microvasculature in diabetic retinopathy. In the present paper, we demonstrate the importance of the retinal vasculature not only as predictors of long...

Diabetic Retinopathy Awareness among Diabetic Patients Attending COMS-TH.

Science.gov (United States)

Dahal, P; Adhikari, H

Background Diabetic retinopathy (DR) is one of the leading causes of blindness in Nepal. Objective The main objective of the study is to know the awareness of diabetic retinopathy among new cases of diabetes mellitus (DM) attending the college of medical science- teaching hospital, Bharatpur, Nepal. Method All the diabetic cases referred for ophthalmic consultation and also referred outpatient department cases from other departments to ophthalmic outpatient department was carried out. Detailed demographics of the subjects and their awareness of potential ocular problems from diabetes mellitus were noted. Result Total one hundred and thirty-one patients were enrolled during the study period from 15 November 2016 to 15 May 2017. Brahmin 39.69% and 19.08% Mongolian were the most predominant ethnical group. The predominant group of patients were housewives (41.22%) then followed by service (19.85%), business (13.74%), agriculture (12.21%), others (12.98%). Among 36.64% of the literate patients, 19.85% had passed school level, 9.92% had passed intermediate level, 88.55% were aware of Diabetic retinopathy. Among them majority 88.55% were referred by physician. Family history were present in 35.68% and fundus evaluation was done for the first time in almost half of diabetic cases (64.12%) and diabetic retinopathy was found in 32.06% of total cases in right eye and 30.53% of total cases in left eye. Conclusion Along with the awareness, routine dilated fundoscopy is mandatory for slight threating stage of retinopathy and to reduce the burden of blindness from diabetic retinopathy in Nepal.

Association between aqueous humor and vitreous fluid levels of Th17 cell-related cytokines in patients with proliferative diabetic retinopathy.

Science.gov (United States)

Takeuchi, Masaru; Sato, Tomohito; Sakurai, Yutaka; Taguchi, Manzo; Harimoto, Kozo; Karasawa, Yoko; Ito, Masataka

2017-01-01

Inflammation is known to be involved in the progression of diabetic retinopathy. We have recently reported that vitreous levels of IL-4, IL-17A, IL-22, IL-31, and TNFα are higher than the respective serum levels in proliferative diabetic retinopathy (PDR) patients, and that vitreous levels of these cytokines are higher in PDR than in other non-inflammatory vitreoretinal diseases or uveitis associated with sarcoidosis. In the present study, we investigated inflammatory cytokines including Th17 cell-related cytokines in aqueous humor samples obtained from eyes with PDR, and analyzed the association between the aqueous humor and vitreous fluid levels of individual cytokines. The study group consisted of 31 consecutive type 2 diabetic patients with PDR who underwent cataract surgery and vitrectomy for vitreous hemorrhage and/or tractional retinal detachment. Undiluted aqueous humor was collected during cataract surgery, and then vitreous fluid was obtained using a 25G vitreous cutter inserted into the mid-vitreous cavity at the beginning of vitrectomy. IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, soluble CD40 ligand (sCD40L), and TNFα levels in the aqueous humor and vitreous fluid were measured using a beads-array system. Although IL-17A was detected in the aqueous humor of eyes with PDR and the level correlated with IL-17A level in the vitreous fluid, both percent detectable and level of IL-17A in the aqueous humor were significantly lower than those in the vitreous fluid. Vitreous IL-17A level was related significantly to IL-10, IL-22, and TNFα levels in aqueous humor as well as in vitreous fluid, On the other hand, aqueous IL-17A level was not related significantly to aqueous or vitreous levels of IL-10, IL-22 or TNFα level. The present study demonstrated that IL-17A level and detectable rate in the aqueous humor of patients with PDR are markedly lower than those in the vitreous fluid and aqueous IL-17A does not

Role of Inflammation in Diabetic Retinopathy

Science.gov (United States)

Rübsam, Anne; Parikh, Sonia; Fort, Patrice E.

2018-01-01

Diabetic retinopathy is a common complication of diabetes and remains the leading cause of blindness among the working-age population. For decades, diabetic retinopathy was considered only a microvascular complication, but the retinal microvasculature is intimately associated with and governed by neurons and glia, which are affected even prior to clinically detectable vascular lesions. While progress has been made to improve the vascular alterations, there is still no treatment to counteract the early neuro-glial perturbations in diabetic retinopathy. Diabetes is a complex metabolic disorder, characterized by chronic hyperglycemia along with dyslipidemia, hypoinsulinemia and hypertension. Increasing evidence points to inflammation as one key player in diabetes-associated retinal perturbations, however, the exact underlying molecular mechanisms are not yet fully understood. Interlinked molecular pathways, such as oxidative stress, formation of advanced glycation end-products and increased expression of vascular endothelial growth factor have received a lot of attention as they all contribute to the inflammatory response. In the current review, we focus on the involvement of inflammation in the pathophysiology of diabetic retinopathy with special emphasis on the functional relationships between glial cells and neurons. Finally, we summarize recent advances using novel targets to inhibit inflammation in diabetic retinopathy. PMID:29565290

Role of Inflammation in Diabetic Retinopathy

Directory of Open Access Journals (Sweden)

Anne Rübsam

2018-03-01

Full Text Available Diabetic retinopathy is a common complication of diabetes and remains the leading cause of blindness among the working-age population. For decades, diabetic retinopathy was considered only a microvascular complication, but the retinal microvasculature is intimately associated with and governed by neurons and glia, which are affected even prior to clinically detectable vascular lesions. While progress has been made to improve the vascular alterations, there is still no treatment to counteract the early neuro-glial perturbations in diabetic retinopathy. Diabetes is a complex metabolic disorder, characterized by chronic hyperglycemia along with dyslipidemia, hypoinsulinemia and hypertension. Increasing evidence points to inflammation as one key player in diabetes-associated retinal perturbations, however, the exact underlying molecular mechanisms are not yet fully understood. Interlinked molecular pathways, such as oxidative stress, formation of advanced glycation end-products and increased expression of vascular endothelial growth factor have received a lot of attention as they all contribute to the inflammatory response. In the current review, we focus on the involvement of inflammation in the pathophysiology of diabetic retinopathy with special emphasis on the functional relationships between glial cells and neurons. Finally, we summarize recent advances using novel targets to inhibit inflammation in diabetic retinopathy.

Comparison of Optomap ultrawide-field imaging versus slit-lamp biomicroscopy for assessment of diabetic retinopathy in a real-life clinic

Directory of Open Access Journals (Sweden)

Purbrick RMJ

2014-07-01

Full Text Available Robert M J Purbrick, Shahrnaz Izadi, Ankur Gupta, N Victor Chong Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK Purpose: We aimed to assess the agreement between clinical assessment of diabetic retinopathy and Optomap ultrawide-field imaging (UWFI in a real-life clinic setting. Methods: Structured examination findings, from diabetic patients attending routine medical retina clinics in July 2011, were retrospectively compared with the grade obtained from Optomap UWFI images, graded independently by two ophthalmologists, taken at the same visit. Results: A total of 84 eyes (42 patients were examined, and 74 eyes (37 patients were suitable for analysis. The hospital Eye Service slit-lamp biomicroscopy grades for retinopathy were: no diabetic retinopathy in zero eyes; background retinopathy in 21 eyes; preproliferative retinopathy in 34 eyes; and proliferative retinopathy in 19 eyes. For retinopathy, the agreement between the Optomap UWFI and clinical grading was moderate for both graders (κ=0.57 and κ=0.63, and there was almost perfect agreement between the two graders (κ=0.92. The clinical grades for the presence of photocoagulation scars were: no photocoagulation scars in 46 eyes and photocoagulation scars visible in 28 eyes, indicating substantial agreement between the Optomap UWFI and clinical grading for both graders (κ=0.73 and κ=0.64. There were two instances where proliferative retinopathy was documented clinically but graded as preproliferative by both graders of Optomap UWFI. These were investigated, and neither patient required treatment, ie, the difference in retinopathy grade would not have affected the patient outcomes. Conclusion: This study demonstrated moderate agreement between Optomap UWFI and hospital slit-lamp biomicroscopy grading of patients’ retinopathy in a real-life medical retina clinic setting. The authors believe that Optomap UWFI is, not only a very useful adjunct to clinical examination in terms of

Prevalence of Diabetic retinopathy in Kashmir, India - A hospital based study

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Tariq Qureshi

2013-03-01

Full Text Available Objective To assess the prevalence of diabetic retinopathy among Kashmiri population. Material and Method In a cross-sectional hospital based study, 500 patients with established diabetes who attended eye OPD at Govt Medical College Srinagar were evaluated for the presence or absence of retinopathy. Relevant clinical examination was done and the findings were recorded at one point of time. No follow-up findings of the patients were included in this study. Direct Ophthalmoscope (Heinzand slit lamp bio-microscope (Zeiss were used for examination. Statistical package for Social Sciences (SPSS was used for statistical analysis. p60 yrs of age and 49 patients (36.2% were between 40-68 yrs of age. 33 (24.5% were males and 102 (75.5% were females. 30 patients (12.8% with diabetes of = 15 yr. Mild DR was present in 67 (37.4% patients, moderate to severe DR in 46 (9.2% patients, proliferative DR in 5(1% patients and diabetic maculopathy in 17(3.4%patients. Patients who were managed with insulin, either alone or with oral hypoglycemic drugs, had more prevalence of DR. Conclusion The present study concluded that DR is highly prevalent in this part

Genetic algorithm based feature selection combined with dual classification for the automated detection of proliferative diabetic retinopathy.

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Welikala, R A; Fraz, M M; Dehmeshki, J; Hoppe, A; Tah, V; Mann, S; Williamson, T H; Barman, S A

2015-07-01

Proliferative diabetic retinopathy (PDR) is a condition that carries a high risk of severe visual impairment. The hallmark of PDR is the growth of abnormal new vessels. In this paper, an automated method for the detection of new vessels from retinal images is presented. This method is based on a dual classification approach. Two vessel segmentation approaches are applied to create two separate binary vessel map which each hold vital information. Local morphology features are measured from each binary vessel map to produce two separate 4-D feature vectors. Independent classification is performed for each feature vector using a support vector machine (SVM) classifier. The system then combines these individual outcomes to produce a final decision. This is followed by the creation of additional features to generate 21-D feature vectors, which feed into a genetic algorithm based feature selection approach with the objective of finding feature subsets that improve the performance of the classification. Sensitivity and specificity results using a dataset of 60 images are 0.9138 and 0.9600, respectively, on a per patch basis and 1.000 and 0.975, respectively, on a per image basis. Copyright © 2015 Elsevier Ltd. All rights reserved.

C-reactive protein and chitinase 3-like protein 1 as biomarkers of spatial redistribution of retinal blood vessels on digital retinal photography in patients with diabetic retinopathy.

Science.gov (United States)

Cekić, Sonja; Cvetković, Tatjana; Jovanović, Ivan; Jovanović, Predrag; Pesić, Milica; Stanković Babić, Gordana; Milenković, Svetislav; Risimić, Dijana

2014-08-20

The aim of the study was to investigate the correlation between the levels of C-reactive protein (CRP) and chitinase 3-like protein 1 (YKL-40) in blood samples with morpohometric parameters of retinal blood vessels in patients with diabetic retinopathy. Blood laboratory examination of 90 patients included the measurement of glycemia, HbA1C, total cholesterol, LDL-C, HDL-C, triglycerides and CRP. Levels of YKL-40 were detected and measured in serum by ELISA (Micro VueYKL-40 EIA Kit, Quidel Corporation, San Diego, USA). YKL-40 correlated positively with diameter and negatively with number of retinal blood vessels. The average number of the blood vessels per retinal zone was significantly higher in the group of patients with mild non-proliferative diabetic retinopathy than in the group with severe form in the optic disc and all five retinal zones. The average outer diameter of the evaluated retinal zones and optic disc vessels was significantly higher in the group with severe compared to the group with mild diabetic retinopathy. Morphological analysis of the retinal vessels on digital fundus photography and correlation with YKL-40 may be valuable for the follow-up of diabetic retinopathy.

Retinopathy screening in patients with type 1 diabetes diagnosed in young age using a non-mydriatic digital stereoscopic retinal imaging.

Science.gov (United States)

Minuto, N; Emmanuele, V; Vannati, M; Russo, C; Rebora, C; Panarello, S; Pistorio, A; Lorini, R; d'Annunzio, G

2012-04-01

Diabetic retinopathy seriously impairs patients' quality of life, since it represents the first cause of blindness in industrialized countries. To estimate prevalence of retinopathy in young Type 1 diabetes patients using a non-mydriatic digital stereoscopic retinal imaging (NMDSRI), and to evaluate the impact of socio-demographic, clinical, and metabolic variables. In 247 young patients glycated hemoglobin (HbA1c), gender, age, pubertal stage, presence of diabetic ketoacidosis (DKA), HLA-DQ heterodimers of susceptibility for Type 1 diabetes, and β-cell autoimmunity at clinical onset were considered. At retinopathy screening, we evaluated age, disease duration, pubertal stage, body mass index (BMI-SDS), insulin requirement, HbA1c levels, other autoimmune diseases, diabetes-related complications, serum concentrations of cholesterol and triglycerides, systolic and diastolic blood pressure. Retinopathy was found in 26/247 patients: 25 showed background retinopathy, and 1 had a sight-threatening retinopathy. A significant relationship between retinopathy and female gender (p=0.01), duration of disease ≥15 yr (p65 mg/dl (p=0.012) and mean HbA1c ≥7.5% or >9% (p=0.0014) were found at the multivariate logistic analysis. Metabolic control is the most important modifiable factor and promotion of continuous educational process to reach a good metabolic control is a cornerstone to prevent microangiopathic complications. Symptoms appear when the complication is already established; a screening program with an early diagnosis is mandatory to prevent an irreversible damage.

Retinal changes in diabetic patients without diabetic retinopathy.

Science.gov (United States)

Dumitrescu, Alina Gabriela; Istrate, Sinziana Luminita; Iancu, Raluca Claudia; Guta, Oana Maria; Ciuluvica, Radu; Voinea, Liliana

2017-01-01

The purpose of this study was to measure retinal vessel caliber and to examine early changes in macular thickness using optical coherence tomography (OCT). We evaluated to what extend vascular caliber and macular thickness differed between patients with type 2 diabetes mellitus without diabetic retinopathy compared with healthy individuals. 26 diabetic patients without diabetic retinopathy and 26 normal participants without any retinal and optic nerve diseases underwent ophthalmic examination, fundus photography, and OCT imaging. Temporal inferior retinal vessel diameters were measured using OCT. Also, we measured macular thickness in nine ETDRS subfields using Cirrus OCT. The mean age in the diabetic group was 61.5 years and in the control group, 55.5 years. Wider retinal arterioles and venules were found in patients with diabetes compared with healthy subjects (120 µm versus 96 µm, pdiabetes mellitus, central macular thickness was significantly thinner than that of control eyes (243.5 µm versus 269.9 µm, p value diabetes without diabetic retinopathy.

Simple hybrid method for fine microaneurysm detection from non-dilated diabetic retinopathy retinal images.

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Sopharak, Akara; Uyyanonvara, Bunyarit; Barman, Sarah

2013-01-01

Microaneurysms detection is an important task in computer aided diagnosis of diabetic retinopathy. Microaneurysms are the first clinical sign of diabetic retinopathy, a major cause of vision loss in diabetic patients. Early microaneurysm detection can help reduce the incidence of blindness. Automatic detection of microaneurysms is still an open problem due to their tiny sizes, low contrast and also similarity with blood vessels. It is particularly very difficult to detect fine microaneurysms, especially from non-dilated pupils and that is the goal of this paper. Simple yet effective methods are used. They are coarse segmentation using mathematic morphology and fine segmentation using naive Bayes classifier. A total of 18 microaneurysms features are proposed in this paper and they are extracted for naive Bayes classifier. The detected microaneurysms are validated by comparing at pixel level with ophthalmologists' hand-drawn ground-truth. The sensitivity, specificity, precision and accuracy are 85.68, 99.99, 83.34 and 99.99%, respectively. Copyright © 2013 Elsevier Ltd. All rights reserved.

Diabetic retinopathy screening: global and local perspective.

Science.gov (United States)

Gangwani, R A; Lian, J X; McGhee, S M; Wong, D; Li, K Kw

2016-10-01

Diabetes mellitus has become a global epidemic. It causes significant macrovascular complications such as coronary artery disease, peripheral artery disease, and stroke; as well as microvascular complications such as retinopathy, nephropathy, and neuropathy. Diabetic retinopathy is known to be the leading cause of blindness in the working-age population and may be asymptomatic until vision loss occurs. Screening for diabetic retinopathy has been shown to reduce blindness by timely detection and effective laser treatment. Diabetic retinopathy screening is being done worldwide either as a national screening programme or hospital-based project or as a community-based screening programme. In this article, we review different methods of screening including grading used to detect the severity of sight-threatening retinopathy and the newer screening methods. This review also includes the method of systematic screening being carried out in Hong Kong, a system that has helped to identify diabetic retinopathy among all attendees in public primary care clinics using a Hong Kong-wide public patients' database.

Intravitreal Bevacizumab (Avastin for Diabetic Retinopathy: The 2010 GLADAOF Lecture

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J. Fernando Arevalo

2011-01-01

Full Text Available This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB on diabetic retinopathy (DR including diabetic macular edema (DME and proliferative diabetic retinopathy (PDR at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD, and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.

A case of early-onset radiation retinopathy

International Nuclear Information System (INIS)

Sato, Yoko; Den, Seika; Shimizu, Kazuhiro; Ikeda, Tsunehiko

2001-01-01

We encountered a 27-year-old male early caused by radiation retinopathy five months after radiotherapy (51 Gy) for astrocytoma. The retinopathy was the proliferative retinopathy, with several dot and blot hemorrhages, hard and soft exudate, increased capillary permeability, macula edema and avasucular areas. So it was treated with panretial photocoagulation like diabetic retinopathy. Now hemorrhage, exudate, edema and avascular areas were improved. Photocoagulation treatment is effective to stop the progression of radiation retinopathy. Radiation retinopathy is sometimes early caused, therefore long-term follow up is recommended on starting radiotherapy. (author)

A case of early-onset radiation retinopathy

Energy Technology Data Exchange (ETDEWEB)

Sato, Yoko; Den, Seika; Shimizu, Kazuhiro; Ikeda, Tsunehiko [Osaka Medical Coll., Takatsuki (Japan)

2001-12-01

We encountered a 27-year-old male early caused by radiation retinopathy five months after radiotherapy (51 Gy) for astrocytoma. The retinopathy was the proliferative retinopathy, with several dot and blot hemorrhages, hard and soft exudate, increased capillary permeability, macula edema and avasucular areas. So it was treated with panretial photocoagulation like diabetic retinopathy. Now hemorrhage, exudate, edema and avascular areas were improved. Photocoagulation treatment is effective to stop the progression of radiation retinopathy. Radiation retinopathy is sometimes early caused, therefore long-term follow up is recommended on starting radiotherapy. (author)

Relationship between retinopathy in type 2 diabetics and glycated hemoglobin%糖尿病视网膜病变与糖化血红蛋白的关系

Institute of Scientific and Technical Information of China (English)

马金力; 朱成义

2011-01-01

探讨糖化血红蛋白（glycated hemoglobin,HbA1c）与2型糖尿病性视网膜病变（diabetic retinopathy,DR）的关系.方法300例2型糖尿病患者,根据其有无糖尿病视网膜病变及病变程度分为3组:正常视网膜组(non-diabetic retinopathy group,NDR)、非增殖型视网膜病变组(nonproliferative diabetic retinopathy group,NPDR)和增殖型视网膜病变组(proliferative diabetic retinopathy group,PDR),同时测定患者HbA1c浓度,并对相关因素如年龄、性别、病程、血压、糖尿病家族史等进行统计分析.结果NDR组、NPDR组和PDR组的HbAlc浓度差异有统计学意义(P＜0.05).结论HbA1c可作为监测DR发生和发展的重要指标之一.

The Danish Registry of Diabetic Retinopathy

DEFF Research Database (Denmark)

Andersen, Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina

2016-01-01

. Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease in hospital eye departments...... and in private ophthalmological practice. In 2014-2015, DiaBase included data collected from 77,968 diabetes patients. Main variables: The main variables provide data for calculation of performance indicators to monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data...... with respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopathy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of blindness were obtained. Data analysis from DiaBase’s latest annual report (2014-2015) indicates...

The Danish Registry of Diabetic Retinopathy

DEFF Research Database (Denmark)

Andersen, Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina

2016-01-01

. Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease in hospital eye departments...... and in private ophthalmological practice. In 2014-2015, DiaBase included data collected from 77,968 diabetes patients. MAIN VARIABLES: The main variables provide data for calculation of performance indicators to monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data...... with respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopathy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of blindness were obtained. Data analysis from DiaBase's latest annual report (2014-2015) indicates...

糖尿病视网膜病变患者血清转化生长因子β水平研究%Serum transforming growth factor-β levels in patients with diabetic retinopathy

Institute of Scientific and Technical Information of China (English)

罗大卫; 郑志; 刘堃; 朱弼珺; 夏欣; 许迅; 邹海东

2013-01-01

Objective To investigate the serum transforming growth factor-β(TGF-β) levels in patients with diabetic retinopathy (DR).Methods Seventy-two patients with diabetes were selected,including 15 patients with proliferative diabetic retinopathy (PDR group),32 patients with non-proliferative diabetic retinopathy (NPDR group) and 25 patients with non-diabetic retinopathy group (NDR group).Besides,45 healthy people were served as normal control group.The serum TGF-β levels were detected by ELISA.Results Serum TGF-β levels in groups with diabetes were significantly higher than that in normal control group (P ＜ 0.01).Serum TGF-β level in PDR group was significantly higher than those in NPDR group and NDR group (P ＜ 0.05).Conclusion Serum TGF-β level is associated with the severity of diabetic retinopathy.%目的 探讨糖尿病视网膜病变患者血清转化生长因子β(TGF-β)水平变化.方法 72例糖尿病患者分为增生性糖尿病视网膜病变组(PDR组,n=15)、非增生性糖尿病视网膜病变组(NPDR组,n=32)和无糖尿病视网膜病变组(NDR组,n=25)；以45名体检健康者作为正常对照组.采用酶联免疫吸附法测定各组血清TGF-β水平.结果 糖尿病患者TGF-β水平显著高于正常对照组(P＜0.01),PDR组血清TGF-β水平显著高于NPDR组和NDR组(P＜0.05).结论 TGF-β水平与糖尿病视网膜病变的病变程度密切相关.

Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia

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Al-Sisi A

2012-02-01

, being of moderate grade in 8% and of severe grade in 8.1%. A further 6.4% had proliferative diabetic retinopathy.Conclusion: Regular screening to detect diabetic retinopathy is strongly recommended because early detection has the best chance of preventing retinal complications.Keywords: diabetic retinopathy, diabetes complications, risk factors

Epigenetic Modifications and Diabetic Retinopathy

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Renu A. Kowluru

2013-01-01

Full Text Available Diabetic retinopathy remains one of the most debilitating chronic complications, but despite extensive research in the field, the exact mechanism(s responsible for how retina is damaged in diabetes remains ambiguous. Many metabolic pathways have been implicated in its development, and genes associated with these pathways are altered. Diabetic environment also facilitates epigenetics modifications, which can alter the gene expression without permanent changes in DNA sequence. The role of epigenetics in diabetic retinopathy is now an emerging area, and recent work has shown that genes encoding mitochondrial superoxide dismutase (Sod2 and matrix metalloproteinase-9 (MMP-9 are epigenetically modified, activates of epigenetic modification enzymes, histone lysine demethylase 1 (LSD1, and DNA methyltransferase are increased, and the micro RNAs responsible for regulating nuclear transcriptional factor and VEGF are upregulated. With the growing evidence of epigenetic modifications in diabetic retinopathy, better understanding of these modifications has potential to identify novel targets to inhibit this devastating disease. Fortunately, the inhibitors and mimics targeted towards histone modification, DNA methylation, and miRNAs are now being tried for cancer and other chronic diseases, and better understanding of the role of epigenetics in diabetic retinopathy will open the door for their possible use in combating this blinding disease.

Diabetic retinopathy screening using deep neural network.

Science.gov (United States)

Ramachandran, Nishanthan; Hong, Sheng Chiong; Sime, Mary J; Wilson, Graham A

2017-09-07

There is a burgeoning interest in the use of deep neural network in diabetic retinal screening. To determine whether a deep neural network could satisfactorily detect diabetic retinopathy that requires referral to an ophthalmologist from a local diabetic retinal screening programme and an international database. Retrospective audit. Diabetic retinal photos from Otago database photographed during October 2016 (485 photos), and 1200 photos from Messidor international database. Receiver operating characteristic curve to illustrate the ability of a deep neural network to identify referable diabetic retinopathy (moderate or worse diabetic retinopathy or exudates within one disc diameter of the fovea). Area under the receiver operating characteristic curve, sensitivity and specificity. For detecting referable diabetic retinopathy, the deep neural network had an area under receiver operating characteristic curve of 0.901 (95% confidence interval 0.807-0.995), with 84.6% sensitivity and 79.7% specificity for Otago and 0.980 (95% confidence interval 0.973-0.986), with 96.0% sensitivity and 90.0% specificity for Messidor. This study has shown that a deep neural network can detect referable diabetic retinopathy with sensitivities and specificities close to or better than 80% from both an international and a domestic (New Zealand) database. We believe that deep neural networks can be integrated into community screening once they can successfully detect both diabetic retinopathy and diabetic macular oedema. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Association of choroidal thickness with early stages of diabetic retinopathy in type 2 diabetes

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Zhi-Jun; Shen; Xiu-Fen; Yang; Jun; Xu; Chong-Yang; She; Wen-Wen; Wei; Wan-Lu; Zhu; Ning-Pu; Liu

2017-01-01

AIM:To assess the correlation between choroidal thickness(CT) and the early stages of diabetic retinopathy(DR) in type 2 diabetic patients.METHODS:We divided 83 diabetic patients(51-80 years of age;50 females) into non diabetic retinopathy group(NDR) and mild/moderate nonproliferative diabetic retinopathy(NPDR) group,and compared them with 26 non-diabetic control subjects(51-78 years of age;16 females).Subfoveal choroidal thickness(SFCT) and parafoveal choroidal thickness(PFCT) were measured using enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT).Ocular health status,disease duration,body mass index,and hemoglobin A1c(Hb A1c) were recorded.RESULTS:The mean ages of the NDR,NPDR,and control groups were 68.0±6.9y,67.8±6.4y,and 65.1±6.3y,respectively(P=0.17).Pearson correlation of the right and left eyes for the control subjects was 0.95 and for the NDR subjects was 0.93.SFCT for the right eyes of the controls was 252.77± 41.10 μm,which was significantly thicker than that of the right eyes in NDR group(221.51±46.56 μm) and the worse eyes of the NPDR group(207.18±61.87 μm;ANOVA,P<0.01).In the diabetic patients pooled together,age was the only variable significantly associated with SFCT(multiple linear regression analysis,P=0.01).CONCLUSION:CT decreased significantly in the NDR and mild/moderate NPDR eyes compared with the control eyes.Age is significantly associated with SFCT in the diabetic patients.Diabetic choroidopathy may be present before clinical retinopathy.

Erythropoietin Receptor Positive Circulating Progenitor Cells and Endothelial Progenitor Cells in Patients with Different Stages of Diabetic Retinopathy

Institute of Scientific and Technical Information of China (English)

Liu-mei Hu; Guo-xu Xu; Guo-tong XU; Wei-ye Li; Xia Lei; Bo Ma; Yu Zhang; Yan Yan; Ya-lan Wu; Ge-zhi Xu; Wen Ye; Ling Wang

2011-01-01

Objective To investigate the possible involvement of erythropoietin (EPO)/erythropoietin receptor(EPOR) system in neovascularization and vascular regeneration in diabetic retinopathy (DR).Methods EPOR positive circulating progenitor cells (CPCs: CD34+) and endothelial progenitor cells (EPCs: CD34+KDR+) were assessed by flow cytometry in type 2 diabetic patients with different stages of DR. The cohort consisted of age- and sex-matched control patients without diabetes (n=7), non-prolif-erative DR (NPDR, n=7), proliferative DR (PDR, n=8), and PDR complicated with diabetic nephropathy (PDR-DN, n=7). Results The numbers of EPOR+ CPCs and EPOR+ EPCs were reduced remarkably in NPDR compared with the control group (both P<0.01), whereas rebounded in PDR and PDR-DN groups in varying degrees. Similar changes were observed in respect of the proportion of EPOR+ CPCs in CPCs (NPDR vs.control, P< 0.01) and that of EPOR+ EPCs in EPCs (NPDR vs. control, P< 0.05). Conclusion Exogenous EPO, mediated via the EPO/EPOR system of EPCs, may alleviate the im-paired vascular regeneration in NPDR, whereas it might aggravate retinal neovascularization in PDR due to a rebound of EPOR+ EPCs associated with ischemia.

Study on the relationship between E-selectin and proliferative diabetic retinopathy%增殖型糖尿病视网膜病变与血清 E-选择素的相关性

Institute of Scientific and Technical Information of China (English)

张志红; 张海芳; 曹江欣; 尹世跃

2014-01-01

目的：探讨糖尿病视网膜病变（DR）患者血清可溶性E-选择素（sE-sel）及糖化血红蛋白（HbA1c）的水平与糖尿病视网膜病变严重程度的相关性。方法将92例糖尿病视网膜病变患者分为背景型糖尿病视网膜病变组（ BDR组）47例，增生糖尿病视网膜病变组（ PDR组）45例，同期正常健康体检者55例为对照组。比较各组体质量指数（ BMI ）、空腹血糖（FBG）、HbA1c、总胆固醇（TC）、甘油三酯（TG），收缩压（SBP）、舒张压（DBP）、sE-sel水平。结果⑴BDR组和PDR组sE-sel、FBG、HbA1c水平明显高于对照组，差异有统计学意义（ P ＜0.05）。⑵BDR组SBP、DBP、BMI、TC、TG水平与对照组差异无统计学意义（ P ＞0.05）。⑶PDR组患者血清E-选择素与HbA1c、FBG呈正相关（ r ＝0.352， P ＜0.05；r ＝0.634， P ＜0.05）。结论血浆高sE-sel、HbA1c、FBG水平是糖尿病视网膜病变的重要危险因素，与PDR严重程度密切相关。测定血浆sE-sel、HbA1c将有助于预测糖尿病视网膜病变的发生及其预后。%Objective To investigate the relationship between proliferative diabetic retinopathy and E-selectin level .Meth-ods Ninty-two patients with diabetic retinopathy were divided into two groups based on the results of fundus fluorescence angiography :basic diabetic retinopathy (BDR) group, and proliferative diabetic retinopathy (PDR) group.Body mass index (BMI), fasting blood-glucose (FPG), total cholesterol (TC), triglycerides (TG), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure ( DBP) , and E-selectin levels of two groups were determined and compared .Results Compared with normal control group, the BDR and PDR group soluble E-selectin (sE-sel), FPG, HbA1c levels were increased significantly ( P 0.05).The level of E-sel was positively correlated with HbA 1c and FBG in diabetic retinopathy patients .Conclusions High levels of sE-sel, HbA1c

Plasma coenzyme Q10 levels in type 2 diabetic patients with retinopathy

Science.gov (United States)

Ates, Orhan; Bilen, Habip; Keles, Sadullah; Alp, H. Hakan; Keleş, Mevlüt Sait; Yıldırım, Kenan; Öndaş, Osman; Pınar, L. Can; Civelekler, Mustafa; Baykal, Orhan

2013-01-01

AIM To determine the relationship between proliferative diabetic retinopathy (PDRP) and plasma coenzyme Q10(CoQ10) concentration. METHODS Patients with type 2 diabetes and PDRP were determined to be the case group (n=50). The control group was consist of healthy individuals (n=50). Plasma CoQ10 and malondialdehyde (MDA) levels were measured in both groups. RESULTS Ubiquinone-10 (Coenzyme Q10) levels in PDRP and control subjects are 3.81±1.19µmol/L and 1.91±0.62µmol/L, respectively. Plasma MDA levels in PDRP and control subjects were 8.16±2µmol/L and 3.44±2.08µmol/L, respectively. Ratio of Ubiquinol-10/ubiquinone-10 in PDRP and control subjects were 0.26±0.16 and 1.41±0.68, respectively. CONCLUSION The ratio of ubiquinol-10/ubiquinone-10 is found lower in patients with PDRP. High levels of plasma ubiquinol-10/ubiquinone-10 ratio indicate the protective effect on diabetic retinopathy. PMID:24195048

Plasma coenzyme Q10 levels in type 2 diabetic patients with retinopathy

Directory of Open Access Journals (Sweden)

Orhan Ates

2013-10-01

Full Text Available AIM: To determine the relationship between proliferative diabetic retinopathy (PDRP and plasma coenzyme Q10(CoQ10 concentration.METHODS: Patients with type 2 diabetes and PDRP were determined to be the case group (n=50. The control group was consist of healthy individuals (n=50. Plasma CoQ10 and malondialdehyde (MDA levels were measured in both groups.RESULTS: Ubiquinone-10 (Coenzyme Q10 levels in PDRP and control subjects are 3.81±1.19µmol/L and 1.91±0.62µmol/L, respectively. Plasma MDA levels in PDRP and control subjects were 8.16±2µmol/L and 3.44±2.08µmol/L, respectively. Ratio of Ubiquinol-10/ubiquinone-10 in PDRP and control subjects were 0.26±0.16 and 1.41±0.68, respectively.CONCLUSION:The ratio of ubiquinol-10/ubiquinone-10 is found lower in patients with PDRP. High levels of plasma ubiquinol-10/ubiquinone-10 ratio indicate the protective effect on diabetic retinopathy.

Association between diabetic retinopathy and subclinical atherosclerosis in China: Results from a community-based study.

Science.gov (United States)

Liu, Yu; Teng, Xiangyu; Zhang, Wei; Zhang, Ruifeng; Liu, Wei

2015-09-01

To evaluate the association of diabetic retinopathy with subclinical atherosclerosis in middle-aged and elderly Chinese with type 2 diabetes. A cross-sectional community-based study was performed among 1607 patients aged 40 years or older in Shanghai. Non-mydriatic digital fundus photography examination was used in diabetic retinopathy detection. Presence of elevated carotid intima-media thickness or carotid plaque was defined as subclinical atherosclerosis. The prevalence of diabetic retinopathy was 15.1% in total patients. Patients with diabetic retinopathy were more likely to have elevated carotid intima-media thickness, carotid plaque and subclinical atherosclerosis than those without diabetic retinopathy (37.9% vs 30.7%, 57.6% vs 49.6% and 64.6% vs 57.1%, respectively). The presence of diabetic retinopathy was significantly associated with increased odds of subclinical atherosclerosis (odds ratio = 1.93, 95% confidence interval = 1.03-3.60) after full adjustments. The presence of diabetic retinopathy was significantly associated with subclinical atherosclerosis in middle-aged and elderly patients with type 2 diabetics in China. © The Author(s) 2015.

Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in Jordan.

Science.gov (United States)

Bakkar, May M; Haddad, Mera F; Gammoh, Yazan S

2017-01-01

Increasing the level of awareness of diabetic retinopathy among individuals with type 2 diabetes mellitus is considered an important factor for early diagnosis and management of diabetic retinopathy. The aim of this study was to evaluate awareness of diabetic retinopathy among a sample of type 2 diabetes mellitus patients in Jordan. The study period was from August to December 2015. The sample was selected randomly from patients with type 2 diabetes mellitus from the general population in three main cities of Jordan (Amman, Irbid, and Zarqa). A questionnaire was distributed to 237 participants with diabetes to assess their awareness and knowledge of diabetes and diabetic retinopathy. The questionnaire included questions to assess awareness about diabetic retinopathy, sources of knowledge about the disease, and patients' knowledge and compliance with available treatments and routine eye examinations. Patients were also questioned about the barriers that may interfere with early eye examination. A total of 237 participants (107 [45.1%] females and 130 [54.9%] males) with type 2 diabetes were interviewed. Mean age±SD for the study population was 54.51±10.28 years. Of the study population, 88.2% were aware that diabetes can affect the eyes and 81% reported that diabetic retinopathy can lead to blindness. Higher level of patients' awareness of diabetic retinopathy was related to higher level of formal education ( p diabetic retinopathy as reported by 47.3% patients was general practitioners. Patients' compliance with diabetes management was relatively high; however, their compliance with routine retinal assessment was poor, with only a total of 29.5% of participants having had an eye examination in the previous year. Awareness of the nature and consequences of diabetic retinopathy among patients with diabetes in Jordan is relatively high. However, patients' motivation to undergo retinal assessment was poor in the sample, thus hindering early diagnosis and management.

Diabetes Care and Treatment Project: A Diabetes Institute of Walter Reed Health Care System and Joslin Telemedicine Initiative

Science.gov (United States)

2008-09-01

teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651...a telemedicine system for comprehensive diabetes management andassessment of diabetic retinopathy that provides increased access for diabetic ...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy

Diabetes Care and Treatment Project: A Diabetes Institute of the Walter Reed Health Care System and Joslin Telemedicine Initiative

Science.gov (United States)

2009-04-09

detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651. MILESTONES AND DELIVERABLES: Completion of data...telemedicine system for comprehensive diabetes management and assessment of diabetic retinopathy that provides increased access for diabetic patients to...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy

Importance of Considering the Middle Capillary Plexus on OCT Angiography in Diabetic Retinopathy.

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Onishi, Alex C; Nesper, Peter L; Roberts, Philipp K; Moharram, Ganna A; Chai, Haitao; Liu, Lei; Jampol, Lee M; Fawzi, Amani A

2018-04-01

To quantify microvasculature changes in the superficial (SCP), middle (MCP), and deep capillary plexuses (DCP) in diabetic retinopathy (DR). Retrospective cross-sectional study at a tertiary academic referral center, in which 26 controls (44 eyes), 27 diabetic subjects without retinopathy (44 eyes), 32 subjects with nonproliferative retinopathy (52 eyes), and 27 subjects with proliferative retinopathy (40 eyes) were imaged with optical coherence tomography angiography (OCTA). Outcome measures included parafoveal vessel density (VD), percentage area of nonperfusion (PAN), and adjusted flow index (AFI) at the different plexuses. MCP VD and MCP AFI decreased with worsening DR, while PAN increased, mirroring changes within the DCP. The fitted regression line for MCP and DCP AFI were significantly different than the SCP, while DCP PAN differed from SCP PAN with disease progression. Higher SCP AFI and PAN were different in eyes with diabetes without retinopathy compared with controls. Unexpectedly, sex was found to independently influence MCP VD and AFI with worsening disease. OCTA parameters in the MCP and DCP displayed parallel changes with DR progression, different from the SCP, emphasizing the importance of physiologic considerations in the retinal capillaries. Thus, segmentation protocols that include the MCP within the SCP may be confounded. A difference in DCP PAN with worsening DR was unmasked relative to a prior study that included the MCP with SCP. We confirm that SCP AFI and PAN may serve as early indicators of microvascular changes in DR and identify an interaction between sex and the MCP deserving further study.

Vision-Related Functional Burden of Diabetic Retinopathy Across Severity Levels in the United States.

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Willis, Jeffrey R; Doan, Quan V; Gleeson, Michelle; Haskova, Zdenka; Ramulu, Pradeep; Morse, Lawrence; Cantrell, Ronald A

2017-09-01

Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. To assess the functional burden of DR across severity levels in the United States. This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95

Heritability of the severity of diabetic retinopathy: the FIND-Eye study.

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Arar, Nedal H; Freedman, Barry I; Adler, Sharon G; Iyengar, Sudha K; Chew, Emily Y; Davis, Mathew D; Satko, Scott G; Bowden, Donald W; Duggirala, Ravi; Elston, Robert C; Guo, Xiuxing; Hanson, Robert L; Igo, Robert P; Ipp, Eli; Kimmel, Paul L; Knowler, William C; Molineros, Julio; Nelson, Robert G; Pahl, Madeleine V; Quade, Shannon R E; Rasooly, Rebekah S; Rotter, Jerome I; Saad, Mohammed F; Scavini, Marina; Schelling, Jeffrey R; Sedor, John R; Shah, Vallabh O; Zager, Philip G; Abboud, Hanna E

2008-09-01

Diabetic retinopathy (DR) and diabetic nephropathy (DN) are serious microvascular complications of diabetes mellitus. Correlations between severity of DR and DN and computed heritability estimates for DR were determined in a large, multiethnic sample of diabetic families. The hypothesis was that (1) the severity of DR correlates with the presence and severity of nephropathy in individuals with diabetes mellitus, and (2) the severity of DR is under significant familial influence in members of multiplex diabetic families. The Family Investigation of Nephropathy and Diabetes (FIND) was designed to evaluate the genetic basis of DN in American Indians, European Americans, African Americans, and Mexican Americans. FIND enrolled probands with advanced DN, along with their diabetic siblings who were concordant and discordant for nephropathy. These diabetic family members were invited to participate in the FIND-Eye study to determine whether inherited factors underlie susceptibility to DR and its severity. FIND-Eye participants underwent eye examinations and had fundus photographs taken. The severity of DR was graded by using the Early Treatment Diabetic Retinopathy Study Classification (ETDRS). Sib-sib correlations were calculated with the SAGE 5.0 program FCOR, to estimate heritability of retinopathy severity. This report summarizes the results for the first 2368 diabetic subjects from 767 families enrolled in FIND-Eye; nearly 50% were Mexican American, the largest single ethnicity within FIND. The overall prevalence of DR was high; 33.4% had proliferative DR; 7.5%, 22.8%, and 9.5% had severe, moderate, and mild nonproliferative DR, respectively; 26.6% had no DR. The severity of DR was significantly associated with severity of DN, both by phenotypic category and by increasing serum creatinine concentration (chi(2) = 658.14, df = 20; P FIND-Eye sample. These data confirm that the severity of DR parallels the presence and severity of nephropathy in individuals with diabetes

Ultra-wide-field imaging in diabetic retinopathy.

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Ghasemi Falavarjani, Khalil; Tsui, Irena; Sadda, Srinivas R

2017-10-01

Since 1991, 7-field images captured with 30-50 degree cameras in the Early Treatment Diabetic Retinopathy Study were the gold standard for fundus imaging to study diabetic retinopathy. Ultra-wide-field images cover significantly more area (up to 82%) of the fundus and with ocular steering can in many cases image 100% of the fundus ("panretinal"). Recent advances in image analysis of ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. There is a growing consensus in the literature that ultra-wide-field imaging improves detection of peripheral lesions in diabetic retinopathy and leads to more accurate classification of the disease. There is discordance among studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema and optimal management strategies to treat diabetic retinopathy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Advanced glycation endproducts link inflammatory cues to upregulation of galectin-1 in diabetic retinopathy.

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Kanda, Atsuhiro; Dong, Yoko; Noda, Kousuke; Saito, Wataru; Ishida, Susumu

2017-11-23

Diabetic retinopathy (DR) is an inflammatory and progressive vaso-occlusive disease resulting in angiogenesis. Galectin-1 is a hypoxia-induced angiogenic factor associated with cancer and proliferative DR. Here we reveal a significant upregulation of galectin-1 in eyes of DR patients along with progression of clinical stages beginning from the pre-ischemic, inflammatory stage with diabetic macular edema, but not in eyes with non-diabetic retinal vascular occlusions. As for its regulatory mechanism unrelated to hypoxia but selective to DR, in vitro galectin-1/LGALS1 expression was shown to increase after application to Müller glial cells with interleukin (IL)-1β, which was induced in monocyte-derived macrophages and microglial cells via toll-like receptor (TLR) 4 signaling stimulated by advanced glycation endproducts (AGE). In vivo inhibition of AGE generation with aminoguanidine, macrophage depletion with clodronate liposomes, and antibody-based blockade of Il-1β and Tlr4 attenuated diabetes-induced retinal Lgals1 expression in mice. Fibrovascular tissues from proliferative DR eyes were immunoreactive for AGE, TRL4 and IL-1β in macrophages, and IL-1β receptor-positive glial cells expressed galectin-1. Therefore, diabetes-induced retinal AGE accumulation was suggested to activate IL-1β-related inflammatory cues in macrophages followed by Müller cells, linking to galectin-1 upregulation in human DR with time. Our data highlight AGE-triggered inflammation as the DR-selective inducer of galectin-1.

Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

DEFF Research Database (Denmark)

Rasmussen, K.L.; Laugesen, C.S.; Nielsen, Lene Ringholm

2010-01-01

We studied the progression of diabetic retinopathy during pregnancy in women with type 2 diabetes.......We studied the progression of diabetic retinopathy during pregnancy in women with type 2 diabetes....

Proliferative diabetic retinopathy characterization based on fractal features: Evaluation on a publicly available dataset.

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Orlando, José Ignacio; van Keer, Karel; Barbosa Breda, João; Manterola, Hugo Luis; Blaschko, Matthew B; Clausse, Alejandro

2017-12-01

Diabetic retinopathy (DR) is one of the most widespread causes of preventable blindness in the world. The most dangerous stage of this condition is proliferative DR (PDR), in which the risk of vision loss is high and treatments are less effective. Fractal features of the retinal vasculature have been previously explored as potential biomarkers of DR, yet the current literature is inconclusive with respect to their correlation with PDR. In this study, we experimentally assess their discrimination ability to recognize PDR cases. A statistical analysis of the viability of using three reference fractal characterization schemes - namely box, information, and correlation dimensions - to identify patients with PDR is presented. These descriptors are also evaluated as input features for training ℓ1 and ℓ2 regularized logistic regression classifiers, to estimate their performance. Our results on MESSIDOR, a public dataset of 1200 fundus photographs, indicate that patients with PDR are more likely to exhibit a higher fractal dimension than healthy subjects or patients with mild levels of DR (P≤1.3×10-2). Moreover, a supervised classifier trained with both fractal measurements and red lesion-based features reports an area under the ROC curve of 0.93 for PDR screening and 0.96 for detecting patients with optic disc neovascularizations. The fractal dimension of the vasculature increases with the level of DR. Furthermore, PDR screening using multiscale fractal measurements is more feasible than using their derived fractal dimensions. Code and further resources are provided at https://github.com/ignaciorlando/fundus-fractal-analysis. © 2017 American Association of Physicists in Medicine.

Increased Retinal Thinning after Combination of Internal Limiting Membrane Peeling and Silicone Oil Endotamponade in Proliferative Diabetic Retinopathy.

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Kaneko, Hiroki; Matsuura, Toshiyuki; Takayama, Kei; Ito, Yasuki; Iwase, Takeshi; Ueno, Shinji; Nonobe, Norie; Yasuda, Shunsuke; Kataoka, Keiko; Terasaki, Hiroko

2017-01-01

The aim of this study was to examine the change in retinal thickness after vitrectomy with internal limiting membrane (ILM) peeling and/or silicone oil (SO) endotamponade in proliferative diabetic retinopathy (PDR). The actual amount and ratio of changes in the retinal thickness were calculated. Compared to control eyes in the ILM peeling (-)/SO (-) group, the central, superior inner, and temporal inner retina in the ILM peeling (+)/SO (-) group, the central and superior inner retina in the ILM peeling (-)/SO (+) group, and the central, inferior inner, temporal inner, and nasal inner retina in the ILM peeling (+)/SO (+) group showed a significant reduction of the retinal thickness. The central, superior inner, and temporal inner retina in the ILM peeling (+)/SO (-) group, the central and superior inner retina in the ILM peeling (-)/SO (+) group, and the central, superior inner, inferior inner, and temporal inner retina in the ILM peeling (+)/SO (+) group showed a significantly increased reduction rate of the retinal thickness compared to the control group. Macular retinal thinning in PDR was observed after ILM peeling and SO endotamponade, and it was increased by the combination of these 2 factors. © 2017 S. Karger AG, Basel.

Prevalence of Diabetic retinopathy in Kashmir, India -A hospital based study

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Tariq Qureshi

2013-01-01

Full Text Available Objective To assess the prevalence of diabetic retinopathy among Kashmiri population. MaterialandMethod Inacross-sectionalhospitalbasedstudy,500patientswith established diabetes who attended eye OPD at Govt Medical College Srinagar were evaluated for the presence or absence of retinopathy. Relevant clinical examination was done and the findings were recorded at one point of time. No follow-up findings of the patients were included in this study. Direct Ophthalmoscope (Heinzand slit lamp bio-microscope (Zeiss were used for examination. Statistical package for Social Sciences (SPSS was used for statistical analysis. p60 yrs of age and 49 patients (36.2% were between 40-68 yrs of age. 33 (24.5% were males and 102 (75.5% were females. 30 patients (12.8% with diabetes of = 15 yr. Mild DR was present in 67 (37.4% patients, moderate to severe DR in 46 (9.2% patients, proliferative DR in 5(1% patients and diabetic maculopathy in 17(3.4%patients. Patients who were managed with insulin, either alone or with oral hypoglycemic drugs, had more prevalence of DR. Conclusion The present study concluded that DR is highly prevalent in this part of the world and needs early detection and appropriate treatment to prevent blindness due to this condition.

Detection of retinal lesions in diabetic retinopathy: comparative evaluation of 7-field digital color photography versus red-free photography.

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Venkatesh, Pradeep; Sharma, Reetika; Vashist, Nagender; Vohra, Rajpal; Garg, Satpal

2015-10-01

Red-free light allows better detection of vascular lesions as this wavelength is absorbed by hemoglobin; however, the current gold standard for the detection and grading of diabetic retinopathy remains 7-field color fundus photography. The goal of this study was to compare the ability of 7-field fundus photography using red-free light to detect retinopathy lesions with corresponding images captured using standard 7-field color photography. Non-stereoscopic standard 7-field 30° digital color fundus photography and 7-field 30° digital red-free fundus photography were performed in 200 eyes of 103 patients with various grades of diabetic retinopathy ranging from mild to moderate non-proliferative diabetic retinopathy to proliferative diabetic retinopathy. The color images (n = 1,400) were studied with corresponding red-free images (n = 1,400) by one retina consultant (PV) and two senior residents training in retina. The various retinal lesions [microaneurysms, hemorrhages, hard exudates, soft exudates, intra-retinal microvascular anomalies (IRMA), neovascularization of the retina elsewhere (NVE), and neovascularization of the disc (NVD)] detected by all three observers in each of the photographs were noted followed by determination of agreement scores using κ values (range 0-1). Kappa coefficient was categorized as poor (≤0), slight (0.01-0.20), fair (0.2 -0.40), moderate (0.41-0.60), substantial (0.61-0.80), and almost perfect (0.81-1). The number of lesions detected by red-free images alone was higher for all observers and all abnormalities except hard exudates. Detection of IRMA was especially higher for all observers with red-free images. Between image pairs, there was substantial agreement for detection of hard exudates (average κ = 0.62, range 0.60-0.65) and moderate agreement for detection of hemorrhages (average κ = 0.52, range 0.45-0.58), soft exudates (average κ = 0.51, range 0.42-0.61), NVE (average κ = 0.47, range 0.39-0.53), and NVD

CASE REPORT OF SEVERE PROLIFERATIVE RETINOPATHY IN A PATIENT WITH CONGENITAL LIPODYSTROPHY.

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Rosin, Boris; Jaouni, Tareq

2017-08-21

A case report of a patient with severe proliferative retinopathy due to congenital lipodystrophy. We reviewed the medical history, imaging, and surgical procedures of a 25-year-old woman with a history of congenital lipodystrophy, presenting with bilateral combined tractional and exudative retinal detachment, poorly controlled diabetes mellitus, and extreme dislipidemia. The patient underwent retinal detachment repair surgery both eyes. On the last follow-up, both retinae were flat, and visual acuity had improved in the right eye to J3 for near and finger counting 3 m for distance. Surgery combining pars plana vitrectomy and scleral bucking successfully flattened both retinae and significantly improved visual acuity in one eye in this case of bilateral retinal detachment with combined tractional and exudative components in a patient with congenital lipodystrophy. Surgical control of retinal complications is thus possible, provided there is adequate control of the underlying risk factors.

Lipoprotein(a Serum Levels in Diabetic Patients with Retinopathy

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Giulia Malaguarnera

2013-01-01

Full Text Available Background. Atherogenic lipoproteins, such as total cholesterol, LDL cholesterol, oxidized low density lipoprotein, and triglycerides, are associated with progression of retinopathy. Aim. To evaluate the relationship between lipoprotein(a and retinopathy in patients with type 2 diabetes mellitus. Materials and Methods. We enrolled 145 diabetic consecutive patients (82 females, 63 males; mean age 66.8±12 years, mean duration of diabetes 9.4±6.8 years. Presence and severity of retinopathy were evaluated. Serum lipid profile, including Lp(a level, was assessed. Results. High Lp(a levels have been observed in 54 (78.3% subjects and normal levels in 13 (18.85% subjects as regards diabetic patients with retinopathy. Lp(a levels were high in 15 subjects (21.75% and normal in 63 subjects (91.35% as regards patients without retinopathy. Conclusions. Lp(a levels are increased in a significant percentage of patients with retinopathy compared to diabetic patients without retinopathy. The impact of Lp(a levels on diabetic retinopathy needs to be further investigated.

Treatment of diabetic retinopathy: Recent advances and unresolved challenges

Institute of Scientific and Technical Information of China (English)

Michael W Stewart

2016-01-01

Diabetic retinopathy(DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered. The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor(VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema(DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation(PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era. Aggressive treatment improves vision in most patients, but many still do not achieve reading and driving vision. New drugs are needed to add to gains achieved with available therapies.

Treatment of diabetic retinopathy: Recent advances and unresolved challenges

Institute of Scientific and Technical Information of China (English)

Michael; W; Stewart[1

2016-01-01

Diabetic retinopathy (DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered.The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor (VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema (DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era.Aggressive treatment improves vision in most patients,but many still do not achieve reading and driving vision.New drugs are needed to add to gains achieved with available therapies.

SERUM MAGNESIUM, LIPID PROFILE AND GLYCATED HAEMOGLOBIN IN DIABETIC RETINOPATHY

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Sunanda Vusikala

2016-07-01

Full Text Available BACKGROUND Diabetic retinopathy is one of the important microvascular complications of diabetes mellitus of long duration. Alterations in trace metals like magnesium and lipid profile was observed in diabetic retinopathy with hyperglycaemic status. AIM The study was taken up to assess the role of magnesium, lipid profile and glycated haemoglobin in diabetic retinopathy. MATERIALS AND METHODS A total of 80 subjects between 40-65 years were included in the study. Group 1 includes 20 age and sex matched healthy controls. Group 2 includes 30 cases of Diabetes mellitus without retinopathy. Group 3 includes 30 cases of Diabetes mellitus with retinopathy. RESULTS Magnesium was found to be significantly low in the diabetic group with retinopathy. Serum cholesterol and triglycerides were significantly elevated in the diabetic group with retinopathy. Fasting and Postprandial plasma glucose and glycated haemoglobin (HbA1c levels confirmed the glycaemic status of each of the groups. CONCLUSIONS Hypomagnesemia, hypercholesterolaemia, hypertriglyceridemia was observed in diabetic retinopathy along with increased levels of glycated haemoglobin in our study.

Thickness of the retinal photoreceptor outer segment layer in healthy volunteers and in patients with diabetes mellitus without retinopathy, diabetic retinopathy, or diabetic macular edema

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Abdullah Ozkaya

2017-04-01

Conclusion: The PROS layer at the foveal center was thinner in patients who had diabetic retinopathy or diabetic macular edema than both the healthy volunteers and diabetic patients without retinopathy.

Screening for diabetic retinopathy | Rice | Continuing Medical ...

African Journals Online (AJOL)

Good glucose control and the treatment of hypertension and hyperlipidaemia remain the key strategies in preventing diabetic retinopathy and its progression. Unfortunately, some degree of retinopathy will eventually develop in almost all type 1 diabetics and over 60% of type 2 diabetics over a 20-year period.

PPAR Agonists: Potential as Therapeutics for Neovascular Retinopathies

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Harrihar A. Pershadsingh

2008-01-01

Full Text Available The angiogenic, neovascular proliferative retinopathies, proliferative diabetic retinopathy (PDR, and age-dependent macular degeneration (AMD complicated by choroidal neovascularization (CNV, also termed exudative or “wet” AMD, are common causes of blindness. The antidiabetic thiazolidinediones (TZDs, rosiglitazone, and troglitazone are PPAR agonists with demonstrable antiproliferative, and anti-inflammatory effects, in vivo, were shown to ameliorate PDR and CNV in rodent models, implying the potential efficacy of TZDs for treating proliferative retinopathies in humans. Activation of the angiotensin II type 1 receptor (AT1-R propagates proinflammatory and proliferative pathogenic determinants underlying PDR and CNV. The antihypertensive dual AT1-R blocker (ARB, telmisartan, recently was shown to activate PPAR and improve glucose and lipid metabolism and to clinically improve PDR and CNV in rodent models. Therefore, the TZDs and telmisartan, clinically approved antidiabetic and antihypertensive drugs, respectively, may be efficacious for treating and attenuating PDR and CNV humans. Clinical trials are needed to test these possibilities.

Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes

DEFF Research Database (Denmark)

Vestgaard, Marianne; Nielsen, Lene Ringholm; Laugesen, C.S.

2010-01-01

To determine the progression of diabetic retinopathy in pregnant women with diabetes offered tight glycaemic and blood pressure control.......To determine the progression of diabetic retinopathy in pregnant women with diabetes offered tight glycaemic and blood pressure control....

Fruit intake and incident diabetic retinopathy with type 2 diabetes.

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Tanaka, Shiro; Yoshimura, Yukio; Kawasaki, Ryo; Kamada, Chiemi; Tanaka, Sachiko; Horikawa, Chika; Ohashi, Yasuo; Araki, Atsushi; Ito, Hideki; Akanuma, Yasuo; Yamada, Nobuhiro; Yamashita, Hidetoshi; Sone, Hirohito

2013-03-01

Antioxidants and dietary fiber are postulated to have preventive effects on diabetic retinopathy, but evidence is lacking. We investigated this association in a cohort with type 2 diabetes 40-70 years of age with hemoglobin (Hb)A1C ≥6.5%, originally part of the Japan Diabetes Complications Study. After excluding people who did not respond to a dietary survey and patients with diabetic retinopathy or a major ocular disease at baseline, we analyzed 978 patients. Baseline dietary intake was assessed by a food frequency questionnaire based on food groups and 24-hour dietary records. Primary outcome was incident diabetic retinopathy determined using international severity scales. Mean fruit intake in quartiles ranged from 23 to 253 g/day, with increasing trends across quartiles of fruit intake for vitamin C, vitamin E, carotene, retinol equivalent, dietary fiber, potassium, and sodium. Mean energy intake ranged from 1644 to 1863 kcal/day, and fat intake was approximately 25%. HbA1C, body mass index, triglycerides, and systolic blood pressure were well controlled. During the 8-year follow-up, the numbers of incident cases of diabetic retinopathy from the first through the fourth quartiles of fruit intake were 83, 74, 69, and 59. Multivariate-adjusted hazard ratios for the second, third, and fourth quartiles of fruit intake compared with the first quartile were 0.66 (95% confidence interval = 0.46-0.92), 0.59 (0.41-0.85), and 0.48 (0.32-0.71) (test for trend, P diabetes duration, overweight, smoking, and hypertension. Risk for diabetic retinopathy declined with increased intake of fruits and vegetables, vitamin C, and carotene. Increased fruit intake in ranges commonly consumed was associated with reduced incident diabetic retinopathy among patients adhering to a low-fat energy-restricted diet.

Diabetic retinopathy: A predictor of coronary artery disease

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Fawzia El Demerdash

2012-06-01

Conclusion: Diabetic retinopathy is a good predictor of coronary artery disease that exceeds the conventional risk factors. Diabetics with retinopathy would benefit from early coronary angiography and diabetic retinocoronary clinics are warranted.

EPIDEMIOLOGICAL STUDY OF DIABETIC RETINOPATHY IN DIABETES MELLITUS PATIENTS IN TERTIARY CARE CENTRE

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Bhaskar

2016-02-01

Full Text Available OBJECTIVE The study objective was to examine the effect of glycaemic control and variations on the incidence and progression of diabetic retinopathy (DR among the diabetes mellitus patients visiting Medicine and Ophthalmology OPD Sapthagiri Medical college, Bangalore. MATERIALS AND METHODS 10 patients with type 1 diabetes mellitus, and 70 persons with type 2 diabetes mellitus, visiting the Medicine OPD of Sapthagiri Medical College and referred to Ophthalmology department of the above to detect the Diabetic Retinopathy changes in a diabetes mellitus management programme conducted for 3 months in Bangalore, participated in the study. Patients who were followed up for 6 months the same above were also included in the study. Analyses were conducted to assess the relationship between the risk factors, incidence and progression of Diabetic Retinopathy among Diabetes Mellitus patients and management. MAIN OUTCOME MEASURES To determine the risk factors associated with it, stage of retinopathy diagnosed at presentation, management of it, and final visual outcome. The prevention is by strict glycaemic control, prompt use of anti-diabetic drugs and regular exercises. These included age and gender-adjusted prevalence of diabetes and diabetic retinopathy, 1 and correlation of prevalence with history-based risk factors. RESULTS The three months cumulative incidence of DR was 58 %in type I diabetes mellitus and 42 % among type II Diabetes mellitus. After controlling for known risk factors for DR,1 a high baseline haemoglobin A1c (HbA1c, ethnicity, age, type of diabetes mellitus, duration were associated with the incidence of referable DR in patients with type 1 and type 2 diabetes mellitus. The age- and gender-adjusted prevalence rate of diabetes in urban Bangalore 28.2% (95% confidence interval [CI], and the prevalence of diabetic retinopathy in general population was 3.5% (95% CI. The prevalence of diabetic retinopathy in the population with diabetes

Animal Models of Diabetic Retinopathy: Summary and Comparison

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Lo, Amy C. Y.

2013-01-01

Diabetic retinopathy (DR) is a microvascular complication associated with chronic exposure to hyperglycemia and is a major cause of blindness worldwide. Although clinical assessment and retinal autopsy of diabetic patients provide information on the features and progression of DR, its underlying pathophysiological mechanism cannot be deduced. In order to have a better understanding of the development of DR at the molecular and cellular levels, a variety of animal models have been developed. They include pharmacological induction of hyperglycemia and spontaneous diabetic rodents as well as models of angiogenesis without diabetes (to compensate for the absence of proliferative DR symptoms). In this review, we summarize the existing protocols to induce diabetes using STZ. We also describe and compare the pathological presentations, in both morphological and functional aspects, of the currently available DR animal models. The advantages and disadvantages of using different animals, ranging from zebrafish, rodents to other higher-order mammals, are also discussed. Until now, there is no single model that displays all the clinical features of DR as seen in human. Yet, with the understanding of the pathological findings in these animal models, researchers can select the most suitable models for mechanistic studies or drug screening. PMID:24286086

Clinical Course and Risk Factors of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea

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Jae-Seung Yun

2016-10-01

Full Text Available BackgroundWe investigated clinical course and risk factors for diabetic retinopathy (DR in patients with type 2 diabetes mellitus (T2DM.MethodsA total of 759 patients with T2DM without DR were included from January 2001 to December 2004. Retinopathy evaluation was performed at least annually by ophthalmologists. The severity of the DR was classified into five categories according to the International Clinical Diabetic Retinopathy Severity Scales.ResultsOf the 759 patients, 523 patients (68.9% completed the follow-up evaluation. During the follow-up period, 235 patients (44.9% developed DR, and 32 patients (13.6% progressed to severe nonproliferative DR (NPDR or proliferative DR (PDR. The mean duration of diabetes at the first diagnosis of mild NPDR, moderate NPDR, and severe NPDR or PDR were 14.8, 16.7, and 17.3 years, respectively. After adjusting multiple confounding factors, the significant risk factors for the incidence of DR risk in patients with T2DM were old age, longer duration of diabetes, higher mean glycosylated hemoglobin (HbA1c, and albuminuria. Even in the patients who had been diagnosed with diabetes for longer than 10 years at baseline, a decrease in HbA1c led to a significant reduction in the risk of developing DR (hazard ratio, 0.73 per 1% HbA1c decrement; 95% confidence interval, 0.58 to 0.91; P=0.005.ConclusionThis prospective cohort study demonstrates that glycemic control, diabetes duration, age, and albuminuria are important risk factors for the development of DR. More aggressive retinal screening for T2DM patients diagnosed with DR should be required in order to not miss rapid progression of DR.

The Adenosinergic System in Diabetic Retinopathy

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J. Vindeirinho

2016-01-01

Full Text Available The neurodegenerative and inflammatory environment that is prevalent in the diabetic eye is a key player in the development and progression of diabetic retinopathy. The adenosinergic system is widely regarded as a significant modulator of neurotransmission and the inflammatory response, through the actions of the four types of adenosine receptors (A1R, A2AR, A2BR, and A3R, and thus could be revealed as a potential player in the events unfolding in the early stages of diabetic retinopathy. Herein, we review the studies that explore the impact of diabetic conditions on the retinal adenosinergic system, as well as the role of the said system in ameliorating or exacerbating those conditions. The experimental results described suggest that this system is heavily affected by diabetic conditions and that the modulation of its components could reveal potential therapeutic targets for the treatment of diabetic retinopathy, particularly in the early stages of the disease.

Micronutrients and Diabetic Retinopathy A Systematic Review

NARCIS (Netherlands)

Lee, Chee-Tin Christine; Gayton, Emma L.; Beulens, Joline W. J.; Flanagan, Declan W.; Adler, Amanda I.

Background: We have evaluated the evidence for the association between intake and blood levels of micronutrients and diabetic retinopathy. Treatment for diabetic retinopathy requires significant clinical input and specialist ophthalmologic care. Micronutrients, including vitamin C, vitamin E, and

The Diabetic Retinopathy Screening Workflow

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Bolster, Nigel M.; Giardini, Mario E.; Bastawrous, Andrew

2015-01-01

Complications of diabetes mellitus, namely diabetic retinopathy and diabetic maculopathy, are the leading cause of blindness in working aged people. Sufferers can avoid blindness if identified early via retinal imaging. Systematic screening of the diabetic population has been shown to greatly reduce the prevalence and incidence of blindness within the population. Many national screening programs have digital fundus photography as their basis. In the past 5 years several techniques and adapters have been developed that allow digital fundus photography to be performed using smartphones. We review recent progress in smartphone-based fundus imaging and discuss its potential for integration into national systematic diabetic retinopathy screening programs. Some systems have produced promising initial results with respect to their agreement with reference standards. However further multisite trialling of such systems’ use within implementable screening workflows is required if an evidence base strong enough to affect policy change is to be established. If this were to occur national diabetic retinopathy screening would, for the first time, become possible in low- and middle-income settings where cost and availability of trained eye care personnel are currently key barriers to implementation. As diabetes prevalence and incidence is increasing sharply in these settings, the impact on global blindness could be profound. PMID:26596630

Diabetes Care and Treatment Project: A Diabetes Institute of the Walter Reed Health Care System and Joslin (and University of Hawaii) Telemedicine Initiative

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2010-04-01

digital teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy . Telemedicine and e...Research Group. Detection of diabetic macular edema: ophthalmoscopy versus photography—Early Treatment Diabetic Retinopathy Study report number 5...project are the establishment of a telemedicine system for comprehensive diabetes management and the assessment of diabetic retinopathy that

Non-Traditional Systemic Treatments for Diabetic Retinopathy: An
Evidence-Based Review

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Simó, Rafael; Ballarini, Stefania; Cunha-Vaz, José; Ji, Linong; Haller, Hermann; Zimmet, Paul; Wong, Tien Y.

2015-01-01

The rapid escalation in the global prevalence diabetes, with more than 30% being afflicted with diabetic retinopathy (DR), means it is likely that associated vision-threatening conditions will also rise substantially. This means that new therapeutic approaches need to be found that go beyond the current standards of diabetic care, and which are effective in the early stages of the disease. In recent decades several new pharmacological agents have been investigated for their effectiveness in preventing the appearance and progression of DR or in reversing DR; some with limited success while others appear promising. This up-to-date critical review of non-traditional systemic treatments for DR is based on the published evidence in MEDLINE spanning 1980-December 2014. It discusses a number of therapeutic options, paying particular attention to the mechanisms of action and the clinical evidence for the use of renin-angiotensin system blockade, fenofibrate and calcium dobesilate monohydrate in DR. PMID:25989912

Impact of The Protective Renin-Angiotensin System (RAS) on The Vasoreparative Function of CD34+ CACs in Diabetic Retinopathy

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Duan, Yaqian; Moldovan, Leni; Miller, Rehae C.; Beli, Eleni; Salazar, Tatiana; Hazra, Sugata; Al-Sabah, Jude; Chalam, KV; Raghunandan, Sneha; Vyas, Ruchi;

Assessment of automated disease detection in diabetic retinopathy screening using two-field photography.

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Goatman, Keith; Charnley, Amanda; Webster, Laura; Nussey, Stephen

2011-01-01

To assess the performance of automated disease detection in diabetic retinopathy screening using two field mydriatic photography. Images from 8,271 sequential patient screening episodes from a South London diabetic retinopathy screening service were processed by the Medalytix iGrading™ automated grading system. For each screening episode macular-centred and disc-centred images of both eyes were acquired and independently graded according to the English national grading scheme. Where discrepancies were found between the automated result and original manual grade, internal and external arbitration was used to determine the final study grades. Two versions of the software were used: one that detected microaneurysms alone, and one that detected blot haemorrhages and exudates in addition to microaneurysms. Results for each version were calculated once using both fields and once using the macula-centred field alone. Of the 8,271 episodes, 346 (4.2%) were considered unassessable. Referable disease was detected in 587 episodes (7.1%). The sensitivity of the automated system for detecting unassessable images ranged from 97.4% to 99.1% depending on configuration. The sensitivity of the automated system for referable episodes ranged from 98.3% to 99.3%. All the episodes that included proliferative or pre-proliferative retinopathy were detected by the automated system regardless of configuration (192/192, 95% confidence interval 98.0% to 100%). If implemented as the first step in grading, the automated system would have reduced the manual grading effort by between 2,183 and 3,147 patient episodes (26.4% to 38.1%). Automated grading can safely reduce the workload of manual grading using two field, mydriatic photography in a routine screening service.

High-Resolution Imaging of Parafoveal Cones in Different Stages of Diabetic Retinopathy Using Adaptive Optics Fundus Camera.

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Mohamed Kamel Soliman

Full Text Available To assess cone density as a marker of early signs of retinopathy in patients with type II diabetes mellitus.An adaptive optics (AO retinal camera (rtx1™; Imagine Eyes, Orsay, France was used to acquire images of parafoveal cones from patients with type II diabetes mellitus with or without retinopathy and from healthy controls with no known systemic or ocular disease. Cone mosaic was captured at 0° and 2°eccentricities along the horizontal and vertical meridians. The density of the parafoveal cones was calculated within 100×100-μm squares located at 500-μm from the foveal center along the orthogonal meridians. Manual corrections of the automated counting were then performed by 2 masked graders. Cone density measurements were evaluated with ANOVA that consisted of one between-subjects factor, stage of retinopathy and the within-subject factors. The ANOVA model included a complex covariance structure to account for correlations between the levels of the within-subject factors.Ten healthy participants (20 eyes and 25 patients (29 eyes with type II diabetes mellitus were recruited in the study. The mean (± standard deviation [SD] age of the healthy participants (Control group, patients with diabetes without retinopathy (No DR group, and patients with diabetic retinopathy (DR group was 55 ± 8, 53 ± 8, and 52 ± 9 years, respectively. The cone density was significantly lower in the moderate nonproliferative diabetic retinopathy (NPDR and severe NPDR/proliferative DR groups compared to the Control, No DR, and mild NPDR groups (P < 0.05. No correlation was found between cone density and the level of hemoglobin A1c (HbA1c or the duration of diabetes.The extent of photoreceptor loss on AO imaging may correlate positively with severity of DR in patients with type II diabetes mellitus. Photoreceptor loss may be more pronounced among patients with advanced stages of DR due to higher risk of macular edema and its sequelae.

[Diabetic retinopathy: pathogenesis and therapeutic implications].

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Pelikánová, Terezie

Diabetic retinopathy (DR) develops in patients with both type 1 and type 2 diabetes and is the major cause of vision loss and blindness in the working population. The main risk factor of DR is hyperglycemia accompanied by enhanced mitochondrial production of reactive oxygen species and oxidative stress, formation of advanced glycation end products (AGE) and hexosamines, increase in polyol metabolism of glucose. The severity of vascular injury depends on the individual genetic background and is modified by other epigenetic, metabolic and haemodynamic factors, including hypertension, dyslipidemia and oxidative stress. In diabetes, damage to the retina occurs in the vasculature (endothelial cells and pericytes), neurons and glia, pigment epithelial cells and infiltrating immunocompetent cells: monocytes, granulocytes, lymfocytes. These activated cells change the production pattern of a number of mediators such as growth factors, proinflammatory cytokines, vasoactive molecules, coagulation factors and adhesion molecules resulting in increased blood flow, increased capillary permeability, proliferation of extracellular matrix and thickening of basal membranes, altered cell turnover (apoptosis, proliferation, hypertrophy), procoagulant and proaggregant pattern, and finally in angiogenesis and tissue remodelling. Brain, liver, adipose tissue, GUT, skeletal muscle and other tissues could be another source of mediators. Therapeutic approaches used for patients with or at risk for diabetic retinopathy include drug therapy to reduce modifiable risk factors, laser photocoagulation, intravitreous administration of anti-VEGF agents/steroids and intraocular surgery. Screening plays an important role in early detection and intervention to prevent the progression of diabetic retinopathy. Described insights into pathophysiological mechanisms responsible for DR, could help in the development of more targeted approach for prevention and treatment of diabetic retinopathy. anti

Inflammation in Diabetic Retinopathy

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Tang, Johnny; Kern, Timothy S.

2012-01-01

Diabetes causes a number of metabolic and physiologic abnormalities in the retina, but which of these abnormalities contribute to recognized features of diabetic retinopathy (DR) is less clear. Many of the molecular and physiologic abnormalities that have been found to develop in the retina in diabetes are consistent with inflammation. Moreover, a number of anti-inflammatory therapies have been found to significantly inhibit development of different aspects of DR in animal models. Herein, we review the inflammatory mediators and their relationship to early and late DR, and discuss the potential of anti-inflammatory approaches to inhibit development of different stages of the retinopathy. We focus primarily on information derived from in vivo studies, supplementing with information from in vitro studies were important. PMID:21635964

Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective.

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Sivaprasad, Sobha; Gupta, Bhaskar; Crosby-Nwaobi, Roxanne; Evans, Jennifer

2012-01-01

The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy. Copyright © 2012 Elsevier Inc. All rights

Serum Lipids and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetic Subjects

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Shahana Shermin

2011-07-01

Full Text Available Background: Diabetic retinopathy is the commonest and usually the first observable vascular complication of diabetes mellitus. Along with hyperglycaemia, dyslipidaemia is a contributing factor for the occurrence of diabetic retinopathy. It is postulated that dyslipidaemia results in formation of hard exudate by increasing blood viscosity and altering the fibrinolytic system. A case control study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of January 2006 to December 2007 to evaluate the serum lipid profile in newly diagnosed type 2 diabetic subjects with diabetic retinopathy. Materials and Methods: Total 85 newly diagnosed type 2 diabetic subjects were included in this study, 40 were cases having retinopathy and 45 were age and sex matched controls without retinopathy. Serum triglyceride (TG, total cholesterol (TC, low density lipoprotein cholesterol (LDL-C and high density lipoprotein cholesterol (HDL-C were compared between cases and controls. Unpaired t-test and chi-square test were done between groups as tests of significance. Results: All the parameters of lipid profile showed dyslipidaemic trend both in cases and controls. In the cases TG was significantly higher and HDL-C was significantly lower than that of controls (p < 0.05 whereas no significant difference was found between cases and controls with respect to serum TC and LDL-C. Conclusion: It can be concluded that high TG and low HDL-C are associated with diabetic retinopathy in newly diagnosed type 2 diabetes.

Different lasers and techniques for proliferative diabetic retinopathy.

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Moutray, Tanya; Evans, Jennifer R; Lois, Noemi; Armstrong, David J; Peto, Tunde; Azuara-Blanco, Augusto

2018-03-15

Diabetic retinopathy (DR) is a chronic progressive disease of the retinal microvasculature associated with prolonged hyperglycaemia. Proliferative DR (PDR) is a sight-threatening complication of DR and is characterised by the development of abnormal new vessels in the retina, optic nerve head or anterior segment of the eye. Argon laser photocoagulation has been the gold standard for the treatment of PDR for many years, using regimens evaluated by the Early Treatment of Diabetic Retinopathy Study (ETDRS). Over the years, there have been modifications of the technique and introduction of new laser technologies. To assess the effects of different types of laser, other than argon laser, and different laser protocols, other than those established by the ETDRS, for the treatment of PDR. We compared different wavelengths; power and pulse duration; pattern, number and location of burns versus standard argon laser undertaken as specified by the ETDRS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 8 June 2017. We included randomised controlled trials (RCTs) of pan-retinal photocoagulation (PRP) using standard argon laser for treatment of PDR compared with any other laser modality. We excluded studies of lasers that are not in common use, such as the xenon arc, ruby or Krypton laser. We followed Cochrane guidelines and graded the certainty of evidence using the GRADE approach. We identified 11 studies from Europe (6), the USA (2), the Middle East (1) and Asia (2). Five studies compared different types of laser to argon: Nd:YAG (2 studies) or diode (3 studies). Other studies compared modifications to the standard argon laser PRP technique. The studies were poorly reported and we judged all to be at high risk of bias in at least one domain. The sample size

Association between diabetic nephrology and other diabetic microvascularand macrovascular complications

International Nuclear Information System (INIS)

Chandy, A.; John, M.; Pawar, B.; Isaac, R.

2008-01-01

Diabetic nephropathy is found to be significantly associated withdiabetic retinopathy and coronary artery disease. Few studies have also shownan association between diabetic nephropathy and neuropathy and peripheralvascular disease. A cross sectional study was done among consecutive type 2diabetics presenting to Christian Medical College and Hospital, Ludhiana fromJune 2004 to may 2005. Patients were subjected to the clinical and laboratoryinvestigations 174 patients were studied over a period of one year. Diabeticnephropathy was found to be associated with proliferative diabeticretinopathy, neuropathy and cardiovascular disease by univariate analysis. Inmultivariate analysis, diabetic nephropathy was again sufficiently associatedwith proliferative diabetic retinopathy and coronary artery disease. Weconclude that close association between diabetic nephropathy and other microand macrovascular complications exists in our Indian patients also. (author)

Relation of retinopathy in patients with type 2 diabetes mellitus to other diabetic complications%2型糖尿病视网膜病变与糖尿病其他并发症的相关性

Institute of Scientific and Technical Information of China (English)

陈淑惠; 孟倩丽; 张敏; 郭海科; 刘清洋; 崔颖; 李达桔

2016-01-01

目的：探讨2型糖尿病视网膜病变（ diabetic retinopathy， DR）与糖尿病的全身并发症的相关性。方法：分析2型糖尿病住院患者702例，将其分为NDR组、DR组两组，DR组又分为非增生性糖尿病视网膜病变（non－proliferative diabetic retinopathy，NPDR）组和增生性糖尿病视网膜病变（ proliferative diabetic retinopathy， PDR）组，分析DR与糖尿病大血管并发症、糖尿病肾病（ diabetic nephropathy， DN ）、糖尿病周围神经病变（ diabetic peripheral neuropathy，DPN），糖尿病周围血管性疾病（ peripheral vascular disease of diabetes mellitus， PVD）、糖尿病足（ diabetic foot，DF）、糖尿病酮症酸中毒（ diabetic ketoacidosis，DKA）等糖尿病并发症的相关性。结果：DR的发生、发展与高血压、高血脂、颈部血管硬化、斑块，下肢动脉硬化、斑块， DN、DPN、DF及PVD等并发症有关。 PDR与高血压、DPN关系密切。结论：血管内皮损伤、微循环障碍是DR及糖尿病的全身大、小血管并发症的共同病理基础。糖尿病患者出现全身并发症时，DR的患病率增加，尤其是合并高血压、DPN时，PDR的患病率增加。所以糖尿病患者尤其是出现全身并发症者必需定期行眼底检查，以早期发现、早期治疗DR，降低致盲率。%Abstract•AIM: To investigate the correlation between systemic complications and diabetic retinopathy in the patients with type 2 diabetes mellitus.• METHODS: Seven hundred and two hospitalized patients with type 2 diabetes were included.All patients were divided into two groups according to with or without retinopathy: NDR group and DR group. DR group was divided into group non-proliferative diabetic retinopathy ( NPDR ) and group proliferative diabetic retinopathy (PDR).The relation between DR and other complications of diabetes, including diabetic macrovascular complications, diabetic nephropathy ( DN) , diabetic

Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema

International Nuclear Information System (INIS)

Wahab, S.; Rab, K. F. U.; Hargun, L. D.

2013-01-01

Objective: To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. Study Design: Interventional study. Place and Duration of Study: Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. Methodology: Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema (CSME), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. Results: The male to female ratio was 1:1.44. Out of 218 patients; 129 (59.2%) were males and 89 (40.8%) were females. CSME was found in 82 patients (37.6%) at first postoperative week which declined to 29 cases (13.3%) at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity (BCVA) gradually improved in each subsequent follow-up visit. Conclusion: Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed. (author)

Serum CD73 and apelin levels in patients with diabetic retinopathy and the clinical significance

Institute of Scientific and Technical Information of China (English)

Wei-Qiang Du

2017-01-01

Objective:To study the serum ecto-5'-nucleotidase (CD73) and apelin levels in patients with diabetic retinopathy (DR) and the clinical significance.Methods:A total of 108 patients with type 2 diabetes treated in our hospital between April 2013 and February 2016 were collected and divided into non-diabetic retinopathy (NDR) group (n=51), background diabetic retinopathy (BDR) group (n=40) and proliferative diabetic retinopathy (PDR) group (n=17) based on the results of fundus fluorescence angiography. Enzyme-linked immunosorbent assay (ELISA) was used to determine CD73 and apelin level immediately after admission; thiobarbituric acid method and xanthine oxidase method were used to determine the serum levels of oxidative stress indicators; ELISA method was used to determine the levels of angiogenesis indexes and inflammatory factors; Pearson test was used to analyze the correlation of serum CD73 and apelin levels with the illness-related indexes in patients with DR.Results:Serum CD73 and apelin levels of BDR group and PDR group were significantly higher than those of NDR group, and serum CD73 and apelin levels of PDR group were significantly higher than those of BDR group; serum malondialdehyde (MDA), advanced oxidation protein products (AOPP), interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), vascular endothelial growth factor (VEGF), angiogenin-2 (Ang-2) and hypoxia-inducible factor 1α (HIF-1α) levels of BDR group and PDR group were significantly higher than those of NDR group while total antioxidant capacity (TAOC), superoxide dismutase (SOD) and interleukin-10 (IL-10) levels were lower than those of NDR group, and the changes in above indexes of PDR group were more significant; Pearson test showed that serum CD73 and apelin levels in patients with DR were directly correlated with the levels of illness-related indexes.Conclusion:CD73 and apelin expression are abnormally high in patients with

Serum CD73 and apelin levels in patients with diabetic retinopathy and the clinical significance

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Wei-Qiang Du

2017-04-01

Full Text Available Objective: To study the serum ecto-5'-nucleotidase (CD73 and apelin levels in patients with diabetic retinopathy (DR and the clinical significance. Methods: A total of 108 patients with type 2 diabetes treated in our hospital between April 2013 and February 2016 were collected and divided into non-diabetic retinopathy (NDR group (n=51, background diabetic retinopathy (BDR group (n=40 and proliferative diabetic retinopathy (PDR group (n=17 based on the results of fundus fluorescence angiography. Enzyme-linked immunosorbent assay (ELISA was used to determine CD73 and apelin level immediately after admission; thiobarbituric acid method and xanthine oxidase method were used to determine the serum levels of oxidative stress indicators; ELISA method was used to determine the levels of angiogenesis indexes and inflammatory factors; Pearson test was used to analyze the correlation of serum CD73 and apelin levels with the illness-related indexes in patients with DR. Results: Serum CD73 and apelin levels of BDR group and PDR group were significantly higher than those of NDR group, and serum CD73 and apelin levels of PDR group were significantly higher than those of BDR group; serum malondialdehyde (MDA, advanced oxidation protein products (AOPP, interleukin-2 (IL-2, interleukin-6 (IL-6, tumor necrosis factor-毩 (TNF- 毩, hypersensitive C-reactive protein (hs-CRP, vascular endothelial growth factor (VEGF, angiogenin-2 (Ang-2 and hypoxia-inducible factor 1毩 (HIF-1毩 levels of BDR group and PDR group were significantly higher than those of NDR group while total antioxidant capacity (TAOC, superoxide dismutase (SOD and interleukin-10 (IL-10 levels were lower than those of NDR group, and the changes in above indexes of PDR group were more significant; Pearson test showed that serum CD73 and apelin levels in patients with DR were directly correlated with the levels of illness-related indexes. Conclusion: CD73 and apelin expression are abnormally high in

Expression of the angiogenic mediator, angiopoietin-like 4, in the eyes of patients with proliferative sickle retinopathy.

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Kathleen Jee

Full Text Available The recent success of therapies directly targeting the angiogenic mediator, vascular endothelial growth factor (VEGF, for the treatment of proliferative diabetic retinopathy has encouraged clinicians to extend the use of anti-VEGF therapies for the treatment of another ischemic retinal vascular disease, proliferative sickle cell retinopathy (PSR, the most common cause of irreversible blindness in patients with sickle cell disease. However, results from case reports evaluating anti-VEGF therapies for PSR have been mixed. This highlights the need to identify alternative therapeutic targets for the treatment of retinal neovascularization in sickle cell patients. In this regard, angiopoietin-like 4 (ANGPTL4 is a novel angiogenic factor regulated by the transcription factor, hypoxia-inducible factor 1, the master regulator of angiogenic mediators (including VEGF in ischemic retinal disease. In an effort to identify alternative targets for the treatment of sickle cell retinopathy, we have explored the expression of ANGPTL4 in the eyes of patients with PSR. To this end, we examined expression and localization of ANGPTL4 by immunohistochemistry in autopsy eyes from patients with known PSR (n = 5 patients. Complementary studies were performed using enzyme-linked immunosorbent assays in aqueous (n = 8; 7 patients, 2 samples from one eye of same patient and vitreous (n = 3 patients samples from a second group of patients with active PSR. We detected expression of ANGPTL4 in neovascular tissue and in the ischemic inner retina in PSR, but not control, eyes. We further observed elevated expression of ANGPTL4 in the aqueous and vitreous of PSR patients compared to controls. These results suggest that ANGPTL4 could contribute to the development of retinal neovascularization in sickle cell patients and could therefore be a therapeutic target for the treatment of PSR.

Neurodegeneration and Neuroprotection in Diabetic Retinopathy

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Abdullah S. Alhomida

2013-01-01

Full Text Available Diabetic retinopathy is widely considered to be a neurovascular disease. This is in contrast to its previous identity as solely a vascular disease. Early in the disease progression of diabetes, the major cells in the neuronal component of the retina consist of retinal ganglion cells and glial cells, both of which have been found to be compromised. A number of retinal function tests also indicated a functional deficit in diabetic retina, which further supports dysfunction of neuronal cells. As an endocrinological disorder, diabetes alters metabolism both systemically and locally in several body organs, including the retina. A growing body of evidences indicates increased levels of excitotoxic metabolites, including glutamate, branched chain amino acids and homocysteine in cases of diabetic retinopathy. Also present, early in the disease, are decreased levels of folic acid and vitamin-B12, which are potential metabolites capable of damaging neurons. These altered levels of metabolites are found to activate several metabolic pathways, leading to increases in oxidative stress and decreases in the level of neurotrophic factors. As a consequence, they may damage retinal neurons in diabetic patients. In this review, we have discussed those potential excitotoxic metabolites and their implications in neuronal damage. Possible therapeutic targets to protect neurons are also discussed. However, further research is needed to understand the exact molecular mechanism of neurodegeneration so that effective neuroprotection strategies can be developed. By protecting retinal neurons early in diabetic retinopathy cases, damage of retinal vessels can be protected, thereby helping to ameliorate the progression of diabetic retinopathy, a leading cause of blindness worldwide.

Correlation between glycemic excursion by CGMS and diabetic retinopathy among Type 2 diabetes mellitus

International Nuclear Information System (INIS)

Pu Li; Ji Ning; Zhu Wei

2011-01-01

Objective: To investigate correlation between glycemic excursion by CGMS and diabetic retinopathy among type 2 diabetes mellitus. Methods: Used continuous glucose monitoring system (CGMS) to monitoring glycemic excursion within a day of twenty four patients with type 2 diabetes mellitus, and inspect fundus photography, correlation was analyzed. Results: Glycemic excursion might reveal the risk for diabetic retinopathy better than HbA1c does. Conclusion: Diabetic retinopathy may correlate with glycemic excursion. (authors)

Glycomic characterization of basal tears and changes with diabetes and diabetic retinopathy.

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Nguyen-Khuong, Terry; Everest-Dass, Arun V; Kautto, Liisa; Zhao, Zhenjun; Willcox, Mark D P; Packer, Nicolle H

2015-03-01

As a secreted fluid, the state of tear glycosylation is particularly important in the role of immunity of the ocular surface. Tears are a valuable source of non-invasive biomarkers for disease and there are continued efforts to characterize their components thoroughly. In this study, a small volume of basal tears (5 μL) was collected from healthy controls, patients with diabetes without retinopathy and patients with diabetes and retinopathy. The detailed N- and O-linked tear protein glycome was characterized and the relative abundance of each structure determined. Of the 50 N-linked glycans found, 89% were complex with 50% containing a bisecting N-acetylglucosamine, 65% containing a core fucose whilst 33% were sialylated. Of the 8 O-linked glycans detected, 3 were of cores 1 and 5 of core 2 type, with a majority of them being sialylated (90%). Additionally, these glycan structures were profiled across the three diabetic disease groups. Whilst the higher abundant structures did not alter across the three groups, only five low abundance N-linked glycans and 1 O-linked glycan did alter with the onset of diabetes mellitus and diabetic retinopathy (DR). These results suggest the conservation of glycan types on basal tear proteins between individuals and point to only small changes in glycan expression on the proteins in tears with the development of diabetes and DR. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

UPP mediated Diabetic Retinopathy via ROS/PARP and NF-κB inflammatory factor pathways.

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Luo, D-W; Zheng, Z; Wang, H; Fan, Y; Chen, F; Sun, Y; Wang, W-J; Sun, T; Xu, X

2015-01-01

Diabetic retinopathy (DR) is a leading cause of blindness in adults at working age. Human diabetic retinopathy is characterized by the basement membrane thick, pericytes loss, microaneurysms formation, retina neovascularization and vitreous hemorrhage. To investigate whether UPP activated ROS/PARP and NF-κB inflammatory factor pathways in Diabetic Retinopathy, human retinal endothelial cells (HRECs) and rats with streptozotocin-induced diabetes were used to determine the effect of UPP on ROS generation, cell apoptosis, mitochondrial membrane potential (ΔΨm) and inflammatory factor protein expression, through flow cytometry assay, immunohistochemistry, Real-time PCR, Western blot analysis and ELISA. The levels of ROS and apoptosis and the expressions of UPP (Ub and E3) and inflammatory factor protein were increased in high glucose-induced HRECs and retina of diabetic rats, while ΔΨm was decreased. The UPP inhibitor and UbshRNA could attenuate these effects through inhibiting the pathway of ROS/PARP and the expression of NF-κB inflammatory factors, and the increased UPP was a result of high glucose-induced increase of ROS generation and NF-κBp65 expression, accompanied with the decrease of ΔΨm. Clinical study showed the overexpression of UPP and detachment of epiretinal membranes in proliferative DR (PDR) patients. It has been indicated that the pathogenic effect of UPP on DR was involved in the increase of ROS generation and NF-κB expression, which associated with the ROS/PARP and NF-κB inflammatory factor pathways. Our study supports a new insight for further application of UPP inhibitor in DR treatment.

Quantitative assessment of early diabetic retinopathy using fractal analysis.

Science.gov (United States)

Cheung, Ning; Donaghue, Kim C; Liew, Gerald; Rogers, Sophie L; Wang, Jie Jin; Lim, Shueh-Wen; Jenkins, Alicia J; Hsu, Wynne; Li Lee, Mong; Wong, Tien Y

2009-01-01

Fractal analysis can quantify the geometric complexity of the retinal vascular branching pattern and may therefore offer a new method to quantify early diabetic microvascular damage. In this study, we examined the relationship between retinal fractal dimension and retinopathy in young individuals with type 1 diabetes. We conducted a cross-sectional study of 729 patients with type 1 diabetes (aged 12-20 years) who had seven-field stereoscopic retinal photographs taken of both eyes. From these photographs, retinopathy was graded according to the modified Airlie House classification, and fractal dimension was quantified using a computer-based program following a standardized protocol. In this study, 137 patients (18.8%) had diabetic retinopathy signs; of these, 105 had mild retinopathy. Median (interquartile range) retinal fractal dimension was 1.46214 (1.45023-1.47217). After adjustment for age, sex, diabetes duration, A1C, blood pressure, and total cholesterol, increasing retinal vascular fractal dimension was significantly associated with increasing odds of retinopathy (odds ratio 3.92 [95% CI 2.02-7.61] for fourth versus first quartile of fractal dimension). In multivariate analysis, each 0.01 increase in retinal vascular fractal dimension was associated with a nearly 40% increased odds of retinopathy (1.37 [1.21-1.56]). This association remained after additional adjustment for retinal vascular caliber. Greater retinal fractal dimension, representing increased geometric complexity of the retinal vasculature, is independently associated with early diabetic retinopathy signs in type 1 diabetes. Fractal analysis of fundus photographs may allow quantitative measurement of early diabetic microvascular damage.

Clinical analysis of patients with diabetic retinopathy and theirs quality of evaluating diabetes control%糖尿病视网膜病变与血糖控制情况临床分析

Institute of Scientific and Technical Information of China (English)

纪丽君; 孙景莹; 梁俊芳; 戎君; 赵俊颖

2014-01-01

ObjectiveTo explore the clinical significance between fasting blood glucose (FBG),2h postprandial blood glucose (2hPBG),Glycated Albumin (GA) and Glycosylated hemoglobin (HbAlc) in the occurrence and development of diabetic retinopathy (DR).Methods The subjects were divided into non diabetic retinopathy (NDR) group,non proliferative diabetic retinopathy (NP-DR) group and proliferative diabetic retinopathy (PDR) group.FBG,2hPBG,GA and HbAlc of 175 patients with type 2 diabetes were detected in which DR was diagnosed and staging by fundus examination and fluorescein fundus angiography (FFA).Results There was no difference in FBG among groups (P ＞0.05) and the 2hPBG of NPDR group was higher than that of NDR and PDR group (P ＜0.05).The GA and HbAlc of NDR group was lower than those of DR group.Conclusions It suggests that DR and its progression might be closely related to the glucose variability.The GA and HbAlc are desirable markers for controlling diabetic retinopathy.%目的 探讨糖尿病视网膜病变患者与其血糖控制指标的关系.方法 选取2型糖尿病患者175例,按眼底变化分为3组.其中糖尿病正常眼底(NDR)组45例,非增生性糖尿病视网膜病变(NPDR)组87例,增生性糖尿病视网膜病变(PDR)组43例.检测其空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血清白蛋白(GA)及糖化血红蛋白(HbA1c),并相应行眼底检查.结果 与NDR组相比较,NPDR、PDR组GA、HbA1c升高差异有统计学意义(P＜0.05),而在NPDR组与PDR组比较差异无统计学意义(P ＞0.05);NPDR组中2hPBG水平较NDR组升高差异有统计学意义(P＜0.05),而FBG水平DR组与NDR组差异无统计学意义(P＞0.05).结论 血糖波动与2型糖尿病视网膜病变的发生发展有一定相关性,中长期血糖监控指标(GA、HbA1c)比点监测血糖指标(FBG及2hPBG)对DR患者的治疗、预后的预测更有临床意义.

Prevalence of blindness and diabetic retinopathy in northern Jordan.

Science.gov (United States)

Rabiu, Mansur M; Al Bdour, Muawyah D; Abu Ameerh, Mohammed A; Jadoon, Muhammed Z

2015-01-01

To estimate the prevalence of blindness, visual impairment, diabetes, and diabetic retinopathy in north Jordan (Irbid) using the rapid assessment of avoidable blindness and diabetic retinopathy methodology. A multistage cluster random sampling technique was used to select participants for this survey. A total of 108 clusters were selected using probability proportional to size method while subjects within the clusters were selected using compact segment method. Survey teams moved from house to house in selected segments examining residents 50 years and older until 35 participants were recruited. All eligible people underwent a standardized examination protocol, which included ophthalmic examination and random blood sugar test using digital glucometers (Accu-Chek) in their homes. Diabetic retinopathy among diabetic patients was assessed through dilated fundus examination. A total of 3638 out of the 3780 eligible participants were examined. Age- and sex-adjusted prevalence of blindness, severe visual impairment, and visual impairment with available correction were 1.33% (95% confidence interval [CI] 0.87-1.73), 1.82% (95% CI 1.35-2.25), and 9.49% (95% CI 8.26-10.74), respectively, all higher in women. Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. Glaucoma was the third major cause, accounting for 8.9% of cases. The prevalence of diabetes mellitus was 28.6% (95% CI 26.9-30.3) among the study population and higher in women. The prevalence of any retinopathy among diabetic patients was 48.4%. Cataract and diabetic retinopathy are the 2 major causes of blindness and visual impairment in northern Jordan. For both conditions, women are primarily affected, suggesting possible limitations to access to services. A diabetic retinopathy screening program needs to proactively create sex-sensitive awareness and provide easily accessible screening services with prompt treatment.

Postnatal weight gain modifies severity and functional outcome of oxygen-induced proliferative retinopathy.

Science.gov (United States)

Stahl, Andreas; Chen, Jing; Sapieha, Przemyslaw; Seaward, Molly R; Krah, Nathan M; Dennison, Roberta J; Favazza, Tara; Bucher, Felicitas; Löfqvist, Chatarina; Ong, Huy; Hellström, Ann; Chemtob, Sylvain; Akula, James D; Smith, Lois E H

2010-12-01

In clinical studies, postnatal weight gain is strongly associated with retinopathy of prematurity (ROP). However, animal studies are needed to investigate the pathophysiological mechanisms of how postnatal weight gain affects the severity of ROP. In the present study, we identify nutritional supply as one potent parameter that affects the extent of retinopathy in mice with identical birth weights and the same genetic background. Wild-type pups with poor postnatal nutrition and poor weight gain (PWG) exhibit a remarkably prolonged phase of retinopathy compared to medium weight gain or extensive weight gain pups. A high (r(2) = 0.83) parabolic association between postnatal weight gain and oxygen-induced retinopathy severity is observed, as is a significantly prolonged phase of proliferative retinopathy in PWG pups (20 days) compared with extensive weight gain pups (6 days). The extended retinopathy is concomitant with prolonged overexpression of retinal vascular endothelial growth factor in PWG pups. Importantly, PWG pups show low serum levels of nonfasting glucose, insulin, and insulin-like growth factor-1 as well as high levels of ghrelin in the early postoxygen-induced retinopathy phase, a combination indicative of poor metabolic supply. These differences translate into visual deficits in adult PWG mice, as demonstrated by impaired bipolar and proximal neuronal function. Together, these results provide evidence for a pathophysiological correlation between poor postnatal nutritional supply, slow weight gain, prolonged retinal vascular endothelial growth factor overexpression, protracted retinopathy, and reduced final visual outcome.

Risk factors associated with diabetic retinopathy among type 2 diabetes patients at teaching hospital in Malaysia.

Science.gov (United States)

Abougalambou, Salwa Selim Ibrahim; Abougalambou, Ayman S

2015-01-01

Diabetic retinopathy (DR) is the leading cause of blindness in the United States and it is the leading cause of new cases of blindness in adults aged 20-74. It is estimated that about 20% of patients with type 2 DM have evidence of diabetic retinopathy at diagnosis with diabetes. To evaluate the prevalence of DR and to determine risk factors related to diabetic retinopathy among type 2 diabetes patients attending endocrinology clinics at Hospital Universiti Sains Malaysia (HUSM). The study design was observational prospective longitudinal follow-up study, the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited via attended the diabetes clinics at HUSM. Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye exams by fundoscopy. Logistic regression analysis was used to assess the independent variables that affect the development of retinopathy. The prevalence of retinopathy was 39.3%. It has been noticed from this study findings, that the progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. DR is highly prevalent among type 2 DM. The progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. DR is a serious diabetic complication and public health strategies are required in order to reduce its risk factors and decrease its prevalence. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Global prevalence and major risk factors of diabetic retinopathy

NARCIS (Netherlands)

J.W.Y. Yau (Joanne W.); S.L. Rogers (Sophie); Y. Kawasaki; E.L. Lamoureux (Ecosse); J.W. Kowalski (Jonathan); T. Bek (Toke); S.-J. Chen (Shih-Jen); J.M. Dekker (Jacqueline); A.E. Fletcher (Astrid E.); J. Grauslund (Jakob); R.C.G. Haffner; U. Hamman (Ute); M.K. Ikram (Kamran); T. Kayama (Takamasa); B.E.K. Klein (Barbara); B.E.K. Klein (Barbara); S. Krishnaiah (Sannapaneni); K. Mayurasakorn (Korapat); J.P. O'Hare (Joseph); T. Orchard; M. Porta; M. Rema (Mohan); M.S. Roy (Monique); T. Sharma (Tarun); S-M. Saw (Seang-Mei); H. Taylor (Hugh); J.M. Tielsch (James); D. Varma (Dhiraj); J.J. Wang (Jie Jin); N. Wang (Ningli); S. West (Sheila); L. Zu (Liang); M. Yasuda (Maya); X. Zhang (Xinzhi); P. Mitchell (Paul); T.Y. Wong (Tien Yin)

2012-01-01

textabstractOBJECTIVE - To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS - A pooled analysis using individual participant data from population-based studies

Outcomes of vitrectomy for advanced diabetic retinopathy at Groote ...

African Journals Online (AJOL)

Background. Present limitations in primary and secondary prevention of diabetic retinopathy mean that many patients with diabetes present with advanced retinal complications, often requiring surgery (vitrectomy). Objectives. To determine the outcomes of vitrectomy for advanced diabetic retinopathy and to examine ...