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Corona ST, Ali OI, Yu HJ, Schefler AC. Morphological Biomarkers Related to Visual Acuity in Patients With Radiation Retinopathy Treated With Intravitreal Ranibizumab. Ophthalmic Surg Lasers Imaging Retina 2024; 55:255-262. [PMID: 38408221 DOI: 10.3928/23258160-20240129-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to monitor variables via spectral-domain optical coherence tomography (SD-OCT) and identify the most relevant biomarkers related to best-corrected visual acuity (BCVA) in radiation retinopathy (RR). PATIENTS AND METHODS A post-hoc analysis of the two-year Ranibizumab for Radiation Retinopathy (RRR) trial analyzed vision and OCT parameters including intraretinal fluid, ellipsoid zone (EZ) disruption, retinal pigment epithelium atrophy, hard exudates, retinal hemorrhage, retinal neovascularization, and subfoveal fluid. BCVA and SD-OCT parameters were evaluated by univariate analysis and a mixed-effects model. RESULTS Forty eyes from the RRR trial were included. Intraretinal cyst vertical size (week 24: P = 0.032; week 48: P = 0.021), neovascularization (week 48: P = 0.028; week 72: P = 0.025), and EZ disruption (week 72: P = 0.029; week 104: P = 0.019) were the clinical parameters most relevant to BCVA by univariate analysis in at least two time points. The mixed-effects model confirmed the relevance of intraretinal cyst vertical size (P = 0.001) and neovascularization (P = 0.001) but not EZ disruption (P = 0.119) over the course of the study. CONCLUSIONS This study characterizes the course of visual loss in RR by identifying intraretinal cyst vertical size, neovascularization, and EZ disruption as biomarkers of poor BCVA over a span of two years. Larger multicenter studies are needed to confirm these findings. [Ophthalmic Surg Lasers Imaging Retina 2024;55:255-262.].
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Park D, Kim KL, Park SP, Kim YK. Comparison of quantification of intraretinal hard exudates between optical coherence tomography en face image versus fundus photography. Indian J Ophthalmol 2024; 72:S280-S296. [PMID: 38271424 DOI: 10.4103/ijo.ijo_1986_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To compare the quantification of intraretinal hard exudate (HE) using en face optical coherence tomography (OCT) and fundus photography. METHODS Consecutive en face images and corresponding fundus photographs from 13 eyes of 10 patients with macular edema associated with diabetic retinopathy or Coats' disease were analyzed using the machine-learning-based image analysis tool, "ilastik." RESULTS The overall measured HE area was greater with en face images than with fundus photos (en face: 0.49 ± 0.35 mm2 vs. fundus photo: 0.34 ± 0.34 mm2, P < 0.001). However, there was an excellent correlation between the two measurements (intraclass correlation coefficient [ICC] = 0.844). There was a negative correlation between HE area and central macular thickness (CMT) (r = -0.292, P = 0.001). However, HE area showed a positive correlation with CMT in the previous several months, especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy (CMT 3 months before: r = 0.349, P = 0.001; CMT 4 months before: r = 0.287, P = 0.012). CONCLUSION Intraretinal HE can be reliably quantified from either en face OCT images or fundus photography with the aid of an interactive machine learning-based image analysis tool. HE area changes lagged several months behind CMT changes, especially in eyes treated with anti-VEGF injections.
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Affiliation(s)
- Donghee Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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García-Sánchez A, Villalaín-Rodes I, Jaureguizar A, Zamarrón E, Martínez-Cerón E, Casitas R, Galera R, Cubillos-Zapata C, García J, Asencio M, García-Río F. Continuous Positive Airway Pressure Effect on Progression of Retinal Disease in Patients with Sleep Apnea and Nonproliferative Diabetic Retinopathy: A Randomized Clinical Trial. Ann Am Thorac Soc 2024; 21:102-113. [PMID: 37793101 DOI: 10.1513/annalsats.202304-296oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic retinopathy. However, the effect of apnea-hypopnea suppression on retinal disease progression is unclear. Objectives: To evaluate the efficacy and safety of continuous positive airway pressure (CPAP) for the reduction of retinal lesions in patients with non-proliferative diabetic retinopathy (NPDR) and OSA. Methods: This open-label, parallel-group, randomized controlled trial was conducted between October 2016 and February 2020 at a university hospital in Spain. The date of final follow-up was March 2, 2021. Eighty-three patients with OSA and mild to moderate NPDR receiving stable treatment were randomized to receive CPAP and usual care (43 patients with 79 available eyes) or usual care alone (40 patients with 67 available eyes) for 52 weeks. The primary outcomes were the change in the percentage of eyes with retinal exudates and the number of retinal microhemorrhages from baseline to week 52. We also assessed the effects of both interventions on retinal thickness by means of optical coherence tomography, serum concentrations of glycated hemoglobin, blood pressure, lipid concentrations, sleepiness, and quality of life. Results: Fifty-two weeks of CPAP treatment was associated with reductions from baseline in the percentage of eyes with hard exudates (overall difference, -21.7%; P = 0.035) and in optical coherence tomography indices of retinal edema, including central subfield thickness and cube volume. However, in patients who met prespecified criteria for CPAP adherence, treatment was also associated with a higher number of retinal microhemorrhages at 52 weeks (intergroup adjusted difference, 6.0 [95% confidence interval, 0.6-11.5]; P = 0.029), which was directly related to prescribed pressure levels. CPAP treatment also improved glycemic control, sleepiness, and general health-related quality of life. Conclusions: In patients with OSA and NPDR, long-term CPAP treatment in addition to usual care may result in slower progression of retinal disease, although it could also induce an increase in retinal microhemorrhages. Clinical trial registered with www.clinicaltrials.gov (NCT02874313).
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Affiliation(s)
| | | | - Ana Jaureguizar
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ester Zamarrón
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain; and
| | - Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain; and
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain; and
| | - Carolina Cubillos-Zapata
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain; and
| | - Jesús García
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - Mónica Asencio
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain; and
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Wang X, Zhang Y, Ma Y, Kwapong WR, Ying J, Lu J, Ma S, Yan Q, Yi Q, Zhao Y. Automated evaluation of retinal hyperreflective foci changes in diabetic macular edema patients before and after intravitreal injection. Front Med (Lausanne) 2023; 10:1280714. [PMID: 37869163 PMCID: PMC10587607 DOI: 10.3389/fmed.2023.1280714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Fast and automated reconstruction of retinal hyperreflective foci (HRF) is of great importance for many eye-related disease understanding. In this paper, we introduced a new automated framework, driven by recent advances in deep learning to automatically extract 12 three-dimensional parameters from the segmented hyperreflective foci in optical coherence tomography (OCT). Methods Unlike traditional convolutional neural networks, which struggle with long-range feature correlations, we introduce a spatial and channel attention module within the bottleneck layer, integrated into the nnU-Net architecture. Spatial Attention Block aggregates features across spatial locations to capture related features, while Channel Attention Block heightens channel feature contrasts. The proposed model was trained and tested on 162 retinal OCT volumes of patients with diabetic macular edema (DME), yielding robust segmentation outcomes. We further investigate HRF's potential as a biomarker of DME. Results Results unveil notable discrepancies in the amount and volume of HRF subtypes. In the whole retinal layer (WR), the mean distance from HRF to the retinal pigmented epithelium was significantly reduced after treatment. In WR, the improvement in central macular thickness resulting from intravitreal injection treatment was positively correlated with the mean distance from HRF subtypes to the fovea. Conclusion Our study demonstrates the applicability of OCT for automated quantification of retinal HRF in DME patients, offering an objective, quantitative approach for clinical and research applications.
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Affiliation(s)
- Xingguo Wang
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Yanyan Zhang
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Yuhui Ma
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | | | - Jianing Ying
- Health Science Center, Ningbo University, Ningbo, China
| | - Jiayi Lu
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Shaodong Ma
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Qifeng Yan
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Quanyong Yi
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Yitian Zhao
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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Shen Y, Wang H, Fang J, Liu K, Xu X. Novel insights into the mechanisms of hard exudate in diabetic retinopathy: Findings of serum lipidomic and metabolomics profiling. Heliyon 2023; 9:e15123. [PMID: 37089301 PMCID: PMC10119565 DOI: 10.1016/j.heliyon.2023.e15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Objective Retinal hard exudates (HEs) result from lipoproteins leaking from capillaries into extracellular retinal space, and are related to decreased visual acuity in diabetic retinopathy (DR). This study aims to identify differential serum lipids and metabolites associated with HEs. Materials and methods A cross-sectional study was conducted Jul 2017 ∼ Mar 2021. We assessed the amount of HEs using standard ETDRS photographs for comparison. HEs severity was rated as "no or questionable", "moderate" or "severe". Serum samples were processed via high coverage pseudotargeted lipidomics analysis, and untargeted liquid chromatography coupled with time-of-flight mass spectrometry for metabolomics study, respectively. Weighted gene co-expression network analyses, partial least squares-discriminant analysis, and multi-receiver operating characteristic analysis were applied. Results A total of 167 patients were included. Discovery group: 116 eyes (116 patients). Validation group: 51 eyes (51 patients). 888 lipids were detected and divided into 18 modules (MEs), ME1 ∼ ME18. Lipids in ME1 significantly increased in patients with HEs in DR (NPDR and PDR combined), NPDR, and PDR, respectively. ME1 enriched to triglycerides (29%), ceramides (17%), and N-acylethanolamines (15%). A combined model of 20 lipids was the best to discriminate HEs, area under curve = 0.804, 95% confidence interval = 0.674-0.916. For metabolomics analysis, 19 metabolites and 13 pathways associated with HEs were identified. Taurine and hypotaurine metabolism, cysteine and methionine metabolism were closely related to HEs (P < 0.01). Conclusions The lipids and metabolites identified may serve as prediction biomarkers in the early stage of HEs in DR.
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Morel JB, Fajnkuchen F, Amari F, Sritharan N, Bloch-Queyrat C, Giocanti-Aurégan A. Ultra-Wide-Field Fluorescein Angiography Assessment of Non-Perfusion in Patients with Diabetic Retinopathy Treated with Anti-Vascular Endothelial Growth Factor Therapy. J Clin Med 2023; 12:jcm12041365. [PMID: 36835902 PMCID: PMC9963628 DOI: 10.3390/jcm12041365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose: To follow the evolution of peripheral ischemia by fluorescein angiography (FA) on ultra-wide-field (UWF) images in diabetic patients treated with anti-vascular endothelial growth factor (anti-VEGF) for macular edema. Methods: Prospective, non-interventional cohort study analyzing UWF-FA images of 48 patients with diabetic retinopathy (48 eyes) treated for diabetic macular edema. UWF-FA was performed at baseline and after one year of anti-VEGF therapy (M12). The primary endpoint was the change in the non-perfusion index. Results: Of the 48 patients included in this study, 25 completed the one-year follow-up, and 20 had FA images of sufficient quality to be interpreted. The non-perfusion index did not significantly change from baseline after one year of anti-VEGF treatment (0.7% of the non-perfused area at baseline versus 0.5% at M12; p = 0.29). In contrast, the diabetic retinopathy severity score improved significantly between baseline and M12. Conclusions: Anti-VEGF treatment with aflibercept for diabetic macular edema had no impact on the retinal perfusion assessed by FA, but it allowed for artificially improving diabetic retinopathy severity scores.
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Affiliation(s)
- Jean-Baptiste Morel
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Franck Fajnkuchen
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Fatima Amari
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Nanthara Sritharan
- Department of Clinical Research, Paris Seine Saint Denis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, Paris Seine Saint Denis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Audrey Giocanti-Aurégan
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
- Correspondence:
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Chou HD, Wu CH, Chiang WY, Chen NN, Hwang YS, Chen KJ, Lai CH, Wu PC, Chen YH, Yeung L, Shao SC, Lai CC, Wu WC. Optical coherence tomography and imaging biomarkers as outcome predictors in diabetic macular edema treated with dexamethasone implant. Sci Rep 2022; 12:3872. [PMID: 35264625 PMCID: PMC8907275 DOI: 10.1038/s41598-022-07604-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
In this retrospective, multicenter study, we determined the predictive value of imaging biomarkers in diabetic macular edema (DME) outcomes following dexamethasone (DEX) implant(s). Sixty-seven eyes of 47 patients' best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography (OCT) before and after intravitreal DEX implants were evaluated. Baseline imaging biomarkers were graded using fundus photography and OCT, and the predictive value of biomarkers for significant treatment effects at six months was analyzed. Six months after 2.0 ± 0.8 (mean ± SD) DEX implants, 35 (52%) and 16 (24%) eyes had CFT reduction ≥ 10% from baseline and decreased to < 300 µm, respectively. BCVA improved ≥ 3 lines in 15 (22%) and remained stable in 38 (57%) eyes. At six months, eyes with severe intraretinal cyst (IRC), abundant hyperreflective dots (HRD), and moderate or severe hard exudate had a significantly higher chance of CFT reduction ≥ 10%. Eyes with abundant HRD at baseline and those underwent three DEX implants were more likely to achieve CFT < 300 µm. Eyes with DME and severe IRC, abundant HRD, or moderate-to-severe hard exudate at baseline were more likely to show a significant reduction in CFT six months after DEX implant.
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Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hsiu Wu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Wei-Yu Chiang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Nan-Ni Chen
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi City, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China.,Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Hsiung Lai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi City, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Pei-Chang Wu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yi-Hao Chen
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Ebrahimi M, Balibegloo M, Rezaei N. Monoclonal antibodies in diabetic retinopathy. Expert Rev Clin Immunol 2022; 18:163-178. [PMID: 35105268 DOI: 10.1080/1744666x.2022.2037420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Diabetic retinopathy (DR), as one of the main complications of diabetes, is among the leading causes of blindness and visual impairment worldwide. AREAS COVERED Current clinical therapies include photocoagulation, vitrectomy, and anti-vascular endothelial growth factor (VEGF) therapies. Bevacizumab and ranibizumab are two monoclonal antibodies (mAbs) inhibiting angiogenesis. Intravitreal ranibizumab and bevacizumab can decrease the rate of blindness and retinal thickness, and improve visual acuity whether as monotherapy or combined with other treatments. They can increase the efficacy of other treatments and decrease their adverse events. Although administered intravitreally, they also might enter the circulation and cause systemic effects. This study is aimed to review our current knowledge about mAbs, bevacizumab and ranibizumab, in DR including superiorities, challenges, and limitations. Meanwhile, we tried to shed light on new ideas to overcome these limitations. Our latest search was done in April 2021 mainly through PubMed and Google Scholar. Relevant clinical studies were imported. EXPERT OPINION Future direction includes detection of more therapeutic targets considering other components of DR pathophysiology and shared pathogenesis of DR and neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, the treat-and-extend regimen, and new ways of drug delivery and other routes of ocular drug administration.
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Affiliation(s)
- Moein Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Balibegloo
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Giridhar S, Verma L, Rajendran A, Bhende M, Goyal M, Ramasamy K, Rajalakshmi, Padmaja R, Natarajan S, Palanivelu MS, Raman R, Sivaprasad S. Diabetic macular edema treatment guidelines in India: All India Ophthalmological Society Diabetic Retinopathy Task Force and Vitreoretinal Society of India consensus statement. Indian J Ophthalmol 2021; 69:3076-3086. [PMID: 34708746 PMCID: PMC8725123 DOI: 10.4103/ijo.ijo_1469_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetic macular edema (DME) is a common cause of moderate visual impairment among people with diabetes. Due to the rising number of people with diabetes in India, the absolute numbers of people with DME are significant. There are several treatment options for DME, and the choice of treatment is based on the availability of retinal specialists and infrastructure for the delivery of treatment. A major challenge is the out-of-pocket expenditure incurred by patients as most treatment options are costly. Treatment also varies based on the associated ocular and systemic conditions. The All India Ophthalmology Society (AIOS) and the Vitreo-Retinal Society of India (VRSI) have developed this consensus statement of the AIOS DR task force and VRSI on practice points of DME management in India. The objective is to describe the preferred practice patterns for the management of DME considering the different presentations of DME in different clinical scenarios.
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Affiliation(s)
- Sneha Giridhar
- Shri Bhagwan Mahavir Vitreoretinal Services Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Anand Rajendran
- Retina-Vitreous Services, Aravind Eye Hospital Chennai, Tamil Nadu, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Mallika Goyal
- Retina-Vitreous and Uveitis Service, Apollo Health City, Jubilee Hills, Hyderabad, Telangana, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - R Padmaja
- Smt Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hosp NHS Foundation Trust, London, UK
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10
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Gong R, Han R, Guo J, Liu W, Xu G. Quantitative evaluation of hard exudates in diabetic macular edema by multicolor imaging and their associations with serum lipid levels. Acta Diabetol 2021; 58:1161-1167. [PMID: 33811294 DOI: 10.1007/s00592-021-01697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
AIMS To quantify hard exudates (HEs) by multicolor imaging (MCI) and traditional color fundus photography (CFP) in diabetic macular edema (DME), and study their associations with serum lipid levels. METHODS Observational study. DME patients with HEs were recruited. The HE area and location both by MCI and CFP were measured by ImageJ software. Multivariate regression models were used to analyze the associations of serum lipid levels with the total HE area and HE location. RESULTS Sixty-two patients (74 eyes) were enrolled to quantify HEs in DME. The total HE area by MCI was larger than that by CFP (P = 0.004), and the distance between the fovea and the nearest HE by MCI was shorter than that by CFP (P = 0.003). The percentage of patients with HEs involving the central macula by MCI was significantly higher than that by CFP (P < 0.001). Furthermore, 62 eyes of 62 patients were included to analyze the associations of HE parameters with serum lipid levels. In both MCI and CFP, the HE areas were positively associated with triglyceride level (P = 0.016, P = 0.022, respectively). HEs involving the central macula were positively associated with triglyceride and low-density cholesterol levels in MCI (P = 0.028, P = 0.046, respectively), while no significant association was found between serum lipid levels and HE location in CFP. CONCLUSIONS MCI is superior to traditional CFP for the detection of HEs and the analysis of associations between HEs and serum lipid levels in DME.
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Affiliation(s)
- Ruowen Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Ruyi Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Jingli Guo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China.
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China.
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Yoon CK, Sagong M, Shin JP, Lee SJ, Lee JE, Lee JE, Chung I, Jeong WJ, Pak KY, Kim HW. Title: efficacy of intravitreal dexamethasone implant on hard exudate in diabetic macular edema. BMC Ophthalmol 2021; 21:41. [PMID: 33451297 PMCID: PMC7811249 DOI: 10.1186/s12886-020-01786-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
Background To investigate the effect of intravitreal dexamethasone implant (DEX implant) on hard exudate (HE) accompanying diabetic macular edema (DME). Methods This study was a non-comparative non-randomized 1-year prospective interventional study. Patients with DME and HE were treated using DEX implant two or three times. Color fundus photography and optical coherence tomography (OCT) were performed at every visit. HE area was measured semi-automatically from the fundus photographs. Results Thirty-five patients completed the study. Eleven patients (31.4%) received two injections, while the remaining received three times. HE area (primary outcome) significantly decreased from 1.404±2.094 mm2 (baseline) to 0.212±0.592 mm2 (last visit), which was 24% of the baseline HE area (P<0.001). HE1500 (HE within 1500 μm from the fovea) area also decreased significantly from 0.382±0.467 mm2 to 0.066±0.126 mm2 (P<0.001). Furthermore, anaverage best corrected visual acuity (BCVA) improvement of 4.4 Early Treatment Diabetic Retinopathy Study (ETDRS) letters was observed (from 49.9±18.3 to 54.3±20.4 letters) (P= 0.008). Central macular thickness (CMT) decreased from 455.8±23.6 μm to 366.8±31.1 μm (P=0.009). Repetitive measurements for entire study duration was analyzed using generalized estimating equations (GEE), where BCVA was related to age, CMT, and HE1500 area in multivariate analyses. Conclusion DEX implant could reduce and suppress HE in DME for one year with two or three injections. And centrally located HE area (HE1500 area) is related to vision. Trial registration ClinicalTrials.gov, NCT02399657, Registered 26 March 2015.
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Affiliation(s)
- Chang Ki Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Kosin University college of medicine, Gospel Hospital, Busan, Korea
| | | | - Ji Eun Lee
- College of Medicine, Pusan National University, Yangsan, Korea
| | - Inyoung Chung
- Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Korea
| | | | - Kang Yeun Pak
- Inje Univertisy, Haeundae Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea
| | - Hyun Woong Kim
- Inje Univertisy, Haeundae Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea. .,Inje University Pusan Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea.
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Algorithms for Diagnosis of Diabetic Retinopathy and Diabetic Macula Edema- A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:357-373. [PMID: 32166636 DOI: 10.1007/5584_2020_499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human eye is one of the important organs in human body, with iris, pupil, sclera, cornea, lens, retina and optic nerve. Many important eye diseases as well as systemic diseases manifest themselves in the retina. The most widespread causes of blindness in the industrialized world are glaucoma, Age Related Macular Degeneration (ARMD), Diabetic Retinopathy (DR) and Diabetic Macula Edema (DME). The development of a retinal image analysis system is a demanding research topic for early detection, progression analysis and diagnosis of eye diseases. Early diagnosis and treatment of retinal diseases are essential to prevent vision loss. The huge and growing number of retinal disease affected patients, cost of current hospital-based detection methods (by eye care specialists) and scarcity in the number of ophthalmologists are the barriers to achieve the recommended screening compliance in the patient who is at the risk of retinal diseases. Developing an automated system which uses pattern recognition, computer vision and machine learning to diagnose retinal diseases is a potential solution to this problem. Damage to the tiny blood vessels in the retina in the posterior part of the eye due to diabetes is named as DR. Diabetes is a disease which occurs when the pancreas does not secrete enough insulin or the body does not utilize it properly. This disease slowly affects the circulatory system including that of the retina. As diabetes intensifies, the vision of a patient may start deteriorating and leading to DR. The retinal landmarks like OD and blood vessels, white lesions and red lesions are segmented to develop automated screening system for DR. DME is an advanced symptom of DR that can lead to irreversible vision loss. DME is a general term defined as retinal thickening or exudates present within 2 disk diameter of the fovea center; it can either focal or diffuse DME in distribution. In this paper, review the algorithms used in diagnosis of DR and DME.
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