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Yuan Y, Ji S, Song Y, Che Z, Xiao L, Tang S, Xiao J. Global trends in diabetic eye disease research from 2012 to 2021. Neural Regen Res 2024; 19:2310-2320. [PMID: 38488565 PMCID: PMC11034595 DOI: 10.4103/1673-5374.391303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/22/2023] [Accepted: 10/07/2023] [Indexed: 04/24/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202410000-00032/figure1/v/2024-02-06T055622Z/r/image-tiff Diabetic eye disease refers to a group of eye complications that occur in diabetic patients and include diabetic retinopathy, diabetic macular edema, diabetic cataracts, and diabetic glaucoma. However, the global epidemiology of these conditions has not been well characterized. In this study, we collected information on diabetic eye disease-related research grants from seven representative countries--the United States, China, Japan, the United Kingdom, Spain, Germany, and France--by searching for all global diabetic eye disease journal articles in the Web of Science and PubMed databases, all global registered clinical trials in the ClinicalTrials database, and new drugs approved by the United States, China, Japan, and EU agencies from 2012 to 2021. During this time period, diabetic retinopathy accounted for the vast majority (89.53%) of the 2288 government research grants that were funded to investigate diabetic eye disease, followed by diabetic macular edema (9.27%). The United States granted the most research funding for diabetic eye disease out of the seven countries assessed. The research objectives of grants focusing on diabetic retinopathy and diabetic macular edema differed by country. Additionally, the United States was dominant in terms of research output, publishing 17.53% of global papers about diabetic eye disease and receiving 22.58% of total citations. The United States and the United Kingdom led international collaborations in research into diabetic eye disease. Of the 415 clinical trials that we identified, diabetic macular edema was the major disease that was targeted for drug development (58.19%). Approximately half of the trials (49.13%) pertained to angiogenesis. However, few drugs were approved for ophthalmic (40 out of 1830; 2.19%) and diabetic eye disease (3 out of 1830; 0.02%) applications. Our findings show that basic and translational research related to diabetic eye disease in the past decade has not been highly active, and has yielded few new treatment methods and newly approved drugs.
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Affiliation(s)
- Yuan Yuan
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Shangli Ji
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Yali Song
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Zhaodi Che
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Lu Xiao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Shibo Tang
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Jia Xiao
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
- Aier Eye Institute, Changsha, Hunan Province, China
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
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Ren Y, Liang H, Xie M, Zhang M. Natural plant medications for the treatment of retinal diseases: The blood-retinal barrier as a clue. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155568. [PMID: 38795692 DOI: 10.1016/j.phymed.2024.155568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Retinal diseases significantly contribute to the global burden of visual impairment and blindness. The occurrence of retinal diseases is often accompanied by destruction of the blood‒retinal barrier, a vital physiological structure responsible for maintaining the stability of the retinal microenvironment. However, detailed summaries of the factors damage the blood‒retinal barrier and treatment methods involving natural plant medications are lacking. PURPOSE To comprehensively summarize and analyze the protective effects of active substances in natural plant medications on damage to the blood-retina barrier that occurs when retinal illnesses, particularly diabetic retinopathy, and examine their medicinal value and future development prospects. METHODS In this study, we searched for studies published in the ScienceDirect, PubMed, and Web of Science databases. The keywords used included natural plant medications, plants, natural herbs, blood retinal barrier, retinal diseases, diabetic retinopathy, age-related macular degeneration, and uveitis. Chinese herbal compound articles, non-English articles, warning journals, and duplicates were excluded from the analysis. RESULTS The blood‒retinal barrier is susceptible to high glucose, aging, immune responses, and other factors that destroy retinal homeostasis, resulting in pathological changes such as apoptosis and increased vascular permeability. Existing studies have shown that the active compounds or extracts of many natural plants have the effect of repairing blood-retinal barrier dysfunction. Notably, berberine, puerarin, and Lycium barbarum polysaccharides exhibited remarkable therapeutic effects. Additionally, curcumin, astragaloside IV, hesperidin, resveratrol, ginsenoside Rb1, luteolin, and Panax notoginseng saponins can effectively protect the blood‒retinal barrier by interfering with distinct pathways. The active ingredients found in natural plant medications primarily repair the blood‒retinal barrier by modulating pathological factors such as oxidative stress, inflammation, pyroptosis, and autophagy, thereby alleviating retinal diseases. CONCLUSION This review summarizes a series of plant extracts and plant active compounds that can treat retinal diseases by preventing and treating blood‒retinal barrier damage and provides reference for the research of new drugs for treating retinal diseases.
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Affiliation(s)
- Yuan Ren
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Huan Liang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Mengjun Xie
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
| | - Mei Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
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Ammari W, Chaabene H, Messaoud R. [Anatomical and functional outcomes of the "3+PRN" therapeutic protocol in the treatment of diabetic macular edema]. J Fr Ophtalmol 2024; 47:104234. [PMID: 38875945 DOI: 10.1016/j.jfo.2024.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/04/2024] [Accepted: 03/12/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To evaluate the anatomical and functional results of the "3+PRN" protocol in the treatment of diabetic macular edema (DME), determine the predictive factors for good final visual acuity, and compare it to other protocols. MATERIALS AND METHODS We conducted a retrospective, descriptive, comparative, cross-sectional study of patients with DME, which we dubbed HTSM. All patients were treated with three monthly initial intravitreal injections (IVT) of 1.25mg bevacizumab and followed according to the pro re nata (PRN) protocol for a period of 3years. The protocol was based on a monthly monitoring schedule for the first 3months, then increasingly spaced out over time. "On-demand" treatment was indicated with resumption of bevacizumab IVT in the event of worsening of DME. RESULTS A total of 52 patients were included. The mean age was 65years. Type 2 was the most frequently observed type of diabetes. The mean duration of the PRN protocol was 6months, and the mean number of injections was 6. The mean visual acuity (VA), initially 1/10, improved to 3/10 by the conclusion of the 3+PRN protocol, with an improvement of more than 5 letters in 77.6% of cases. The mean initial central macular thickness (CMT) was 451.5μm. The final mean EMC decreased to 298.5μm, which corresponds to a reduction of 153μm compared to the initial value. The mean subfoveal choroidal thickness, initially 304.2μm, decreased to a mean of 284.5μm at completion. Comparative analysis of the results before and after the PRN protocol confirmed the existence of a statistically significant correlation between VA and CMT (P<0.05). No correlation was observed between age and visual acuity or between initial and final VA. The analysis of the various tomographic parameters and VA revealed a significantly better visual improvement in the group in whom the external limiting membrane (MLE) and ellipsoid zone (ZE) were intact (P=0.04), as well as in the group in whom serous retinal detachment (SRD) was absent (P<0.001). Posterior vitreous detachment (PVD) was the most frequently observed vitreomacular anomaly. The final VA was similar in the groups with and without PVD (P=0.04). CONCLUSION The 3+PRN protocol is effective both functionally and tomographically in the treatment of DME. Various tomographic parameters might influence therapeutic efficacy. However, further in-depth studies are needed to better investigate these parameters.
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Affiliation(s)
- W Ammari
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie.
| | - H Chaabene
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
| | - R Messaoud
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
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Zhang Q, Yan X, Han H, Wang Y, Sun J. Pericyte in retinal vascular diseases: A multifunctional regulator and potential therapeutic target. FASEB J 2024; 38:e23679. [PMID: 38780117 DOI: 10.1096/fj.202302624r] [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: 12/19/2023] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Retinal vascular diseases (RVDs), in particular diabetic retinopathy, retinal vein occlusion, and retinopathy of prematurity, are leading contributors to blindness. The pathogenesis of RVD involves vessel dilatation, leakage, and occlusion; however, the specific underlying mechanisms remain unclear. Recent findings have indicated that pericytes (PCs), as critical members of the vascular mural cells, significantly contribute to the progression of RVDs, including detachment from microvessels, alteration of contractile and secretory properties, and excessive production of the extracellular matrix. Moreover, PCs are believed to have mesenchymal stem properties and, therefore, might contribute to regenerative therapy. Here, we review novel ideas concerning PC characteristics and functions in RVDs and discuss potential therapeutic strategies based on PCs, including the targeting of pathological signals and cell-based regenerative treatments.
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Affiliation(s)
- Quan Zhang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
| | - Xianchun Yan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
| | - Hua Han
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
| | - Yusheng Wang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jiaxing Sun
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Air Force Medical University, Xi'an, China
- Department of Neurobiology, Air Force Medical University, Xi'an, China
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Abu Arif J, Knecht VA, Rübsam A, Lussac V, Jami Z, Pohlmann D, Müller B, Pleyer U. Fluocinolone Acetonide Implant for Uveitis: Dissecting Responder and Non-Responder Outcomes at a Tertiary Center. Biomedicines 2024; 12:1106. [PMID: 38791073 PMCID: PMC11117563 DOI: 10.3390/biomedicines12051106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Macular edema (ME) remains a primary cause of visual deterioration in uveitis. Visual acuity (VA) can often be maintained using corticosteroid depot systems. This study evaluated the efficacy of a fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN®) in treating non-infectious uveitis using real-world data. This retrospective analysis included 135 eyes subdivided into responders and non-responders. Central retinal thickness (CRT), VA, and intraocular pressure (IOP) were followed over time. A significant decrease in CRT and an increase in VA were observed in all eyes throughout the follow-up period (p < 0.01). An IOP increase (p = 0.028) necessitated treatment in 43% of eyes by Month 6. Non-responders were older (p = 0.004) and had been treated with more dexamethasone (DEX) implants (p = 0.04); 89.3% had a defect in the external limiting membrane (ELM) and inner/outer segment (IS/OS) zone (p < 0.001). Immunomodulatory therapy had no impact on treatment response. Pars plana vitrectomy (PPV) patients had a mean CRT reduction of 47.55 µm and a reduced effect by Month 24 (p = 0.046) versus non-PPV patients. We conclude that the FAc implant achieves long-term control of CRT and improves VA. Increases in IOP were manageable. Eyes with a previous PPV showed milder results. Data showed a correlation between older age, a damaged ELM and IS/OS zone, frequent DEX inserts, and poorer outcome measures.
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Affiliation(s)
- Jasmin Abu Arif
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Vitus André Knecht
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Anne Rübsam
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Vanessa Lussac
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Zohreh Jami
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Dominika Pohlmann
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
| | - Bert Müller
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
| | - Uwe Pleyer
- Department of Ophthalmology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.A.A.); (V.A.K.); (A.R.); (Z.J.); (D.P.); (B.M.)
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charité Platz 1, 10117 Berlin, Germany
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Fu W, Ye Y, Hu F. LncRNA XIST promotes neovascularization in diabetic retinopathy by regulating miR-101-3p/VEGFA. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230097. [PMID: 38739522 PMCID: PMC11156180 DOI: 10.20945/2359-4292-2023-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/04/2023] [Indexed: 05/16/2024]
Abstract
Objective This study sought to investigate the regulation of long noncoding RNA (lncRNA) XIST on the microRNA (miR)-101-3p/vascular endothelial growth factor A (VEGFA) axis in neovascularization in diabetic retinopathy (DR). Materials and methods Serum of patients with DR was extracted for the analysis of XIST, miR-101-3p, and VEGFA expression levels. High glucose (HG)-insulted HRMECs and DR model rats were treated with lentiviral vectors. MTT, transwell, and tube formation assays were performed to evaluate cell viability, migration, and angiogenesis, and ELISA was conducted to detect the levels of inflammatory cytokines. Dual-luciferase reporter, RIP, and RNA pull-down experiments were used to validate the relationships among XIST, miR-101-3p, and VEGFA. Results XIST and VEGFA were upregulated and miR-101-3p was downregulated in serum from patients with DR. XIST knockdown inhibited proliferation, migration, vessel tube formation, and inflammatory responsein HG-treated HRMECs, whereas the above effects were nullified by miR-101-3p inhibition or VEGFA overexpression. miR-101-3p could bind to XIST and VEGFA. XIST promoted DR development in rats by regulating the miR-101-3p/VEGFA axis. Conclusion LncRNA XIST promotes VEGFA expression by downregulating miR-101-3p, thereby stimulating angiogenesis and inflammatory response in DR.
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Affiliation(s)
- Weina Fu
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, P.R. China,
| | - Yunyan Ye
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, P.R. China
| | - Feng Hu
- Department of Ophthalmology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, P.R. China
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Soares RM, Ferreira CC, Fernandes JDS, Madeira C, Silva LMA, Saraiva E, Ribeiro L, Fonseca S. Real-World Evidence of the Long-Term Effectiveness of 0.2 μg/Day Fluocinolone Acetonide Implant in Persistent and Recurrent Diabetic Macular Edema - A Single Center Study. Clin Ophthalmol 2024; 18:1057-1066. [PMID: 38646183 PMCID: PMC11032137 DOI: 10.2147/opth.s382920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/15/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To report the long-term functional, anatomical and safety outcomes of 0.2 μg/day fluocinolone acetonide 0.19mg in patients with persistent or recurrent diabetic macular edema (DME). Methods Retrospective, observational, single-center study of patients with recurrent or persistent DME. All patients received 0.2 μg/day of fluocinolone acetonide 0.19mg, and data were collected at baseline and months 1, 3, 6, 12, 24 and 36 after implantation. Outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and safety outcomes. Results A total of 28 eyes from 28 patients were included. The mean age was 66.5 years (95% CI 62.8-70.2) with a mean duration of DME of 8.8 years (95% CI 7.7-10.0). Only two eyes were phakic. Mean follow-up was 25.4 months (95% CI 21.2-29.6). Mean BCVA at baseline was 48.6 ETDRS letters (95% CI 41.3-55.8) and improved as early as month 1 of follow-up with a mean gain in BCVA of 7.8 (95% CI 4.3-11.3) ETDRS letters (p<0.001). Statistically significant improvements in BCVA were also observed at months 6, 12 and 24. At baseline, patients had a mean CMT of 530.5µm (95% CI 463.0-598.0), and a decrease in CMT was observed, starting at the first month of follow-up (mean CMT reduction of -170.5µm, 95% CI -223.8- -117.1; p<0.001). Statistically significant decreases in CMT were also observed at months 6, 12, 24, and 36, with the maximum decrease observed at month 12 (p<0.001). Mean IOP at baseline was 16.4mmHg (95% CI 15.3-17.5) and nine eyes (32.1%) had an IOP ≥21mmHg during follow-up. Conclusion Our results support the effectiveness and safety profile of fluocinolone acetonide. Although additional long-term real-world evidence is required, fluocinolone acetonide may represent a safe strategy for daily, low-dose, sustained and localized release to the posterior segment of the eye, providing both functional and anatomical benefits in DME.
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Affiliation(s)
- Ricardo Machado Soares
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Catarina Cunha Ferreira
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | | | - Carolina Madeira
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Luís M A Silva
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Eduardo Saraiva
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Lígia Ribeiro
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Sofia Fonseca
- Department of Ophthalmology - Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal
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Moreno-Martínez A, Blanco-Marchite C, Andres-Pretel F, López-Martínez F, Donate-Tercero A, González-Aquino E, Cava-Valenciano C, Panozzo G, Copete S. ESASO classification relevance in the diagnosis and evolution in diabetic macular edema patients after dexamethasone implant treatment. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06473-2. [PMID: 38573350 DOI: 10.1007/s00417-024-06473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE To assess the clinical relevance of The European School for Advanced Studies in Ophthalmology (ESASO) classification in patients with diabetic macular edema (DME) after their first dexamethasone implant (DEXI) treatment. METHODS Retrospective real-world study conducted on consecutive DME patients who underwent DEXI treatment and were controlled at month-2. Subjects were initially classified according to the ESASO classification stages. The outcomes were anatomical biomarkers with spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA). RESULTS A total of 128 patients were classified according to ESASO classification stages as early (7; 5.5%), advanced (100; 78.1%), and severe (21; 16.4%). At baseline, there were significant differences between stages in BCVA, central macular thickness (CMT), and tomography anatomical biomarkers (p < 0.05). Initial BCVA (logMAR) was 0.33 ± 0.10, 0.58 ± 0.34, and 0.71 ± 0.35 in the early, advanced, and severe stages, respectively (p < 0.05). At month-2, BCVA was 0.17 ± 0.15, 0.46 ± 0.29, and 0.69 ± 0.27 in those classified as early, advanced, and severe stages, respectively. At month-2, DME was resolved or improved in 6 (85.7%), 60 (60%), and 12 (60%) patients classified as early, advanced, and severe stages, respectively. CONCLUSIONS There was a good correlation between BCVA and ESASO classification stages. Patients in the severe stage did not achieve visual acuity improvement over the study period.
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Affiliation(s)
- Almudena Moreno-Martínez
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain.
| | - Cristina Blanco-Marchite
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | - Fernando Andres-Pretel
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | - Francisco López-Martínez
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | - Antonio Donate-Tercero
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | - Eva González-Aquino
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | - Carlos Cava-Valenciano
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
| | | | - Sergio Copete
- Department of Ophthalmology, Albacete University Hospital Complex, C/ Seminario, 4, E-02006, Albacete, Spain
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Boscia F, Veritti D, Iaculli C, Lattanzio R, Freda S, Piergentili B, Varano M. Management of treatment-naïve diabetic macular edema patients: Review of real-world clinical data. Eur J Ophthalmol 2024:11206721241237069. [PMID: 38462923 DOI: 10.1177/11206721241237069] [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: 03/12/2024]
Abstract
The high prevalence of Diabetic macular edema (DME) is a real global health problem. Its complex pathophysiology involves different pathways. Over the last decade, the introduction of intravitreal treatments has dramatically changed the management and prognosis of DME. Among the different treatment options, inhibitors of vascular endothelial growth factor (anti-VEGF) and intravitreal steroids implants represent the first-line therapy of DME. We conducted a review of electronic databases to compile the available evidence about the clinical management of DME in a clinical setting, with a special focus on treatment-naïve patients. Anti-VEGF therapies represent a valuable option for treating DME patients. However, many patients do not respond properly to this treatment and, due to its administration regimen, many patients receive suboptimal treatment in real life. Current evidence demonstrated that in patients with DME, DEX-i improved significantly both anatomic and visual outcomes. Besides eyes with insufficient anti-VEGF respond or recalcitrant DME cases, DEX-i can be effectively and safely used in treatment-naïve DME patients as first line therapy. DEX-i may be considered first line therapy in different clinical scenarios, such as DME eyes with a greater inflammatory component, patients with cardiovascular events, vitrectomized eyes, or those requiring cataract surgery. In conclusion, there are still many points for improvement pending in the clinical management of the patient with DME. Since DME treatment must follow a patient-tailored approach, selecting the best therapeutic approach for each patient requires a good understanding of the pathophysiology of DME.
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Affiliation(s)
- Francesco Boscia
- Department of Translational Medicine and Neurosciences (DiBraiN), University of Bari, Bari, Italy
| | - Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Freda
- AbbVie S.r.l., SR 148 Pontina, 04011, Campoverde, LT
| | | | - Monica Varano
- Ophthalmology Department, IRCCS - Fondazione Bietti, Rome, Italy
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10
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Mahmoudzadeh R, Salabati M, Israilevich R, Hinkle JW, Obeid A, Khan MA, Hsu J, Chaudhary V, Garg SJ. Outcomes of Eyes Lost to Follow-up After Treatment With Intraocular or Periocular Steroid Injections. JOURNAL OF VITREORETINAL DISEASES 2024; 8:144-151. [PMID: 38465363 PMCID: PMC10924586 DOI: 10.1177/24741264231218044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To evaluate the visual, intraocular pressure (IOP), and anatomic outcomes of eyes with loss to follow-up (LTFU) after intravitreal or periocular steroid injections. Methods: Patients receiving intraocular or periocular steroid injections and with LTFU for at least 180 days were included in this retrospective cohort study. Charts were reviewed for the visual acuity (VA), IOP, and central foveal thickness at the visit before LTFU, the first return visit, and 3, 6, and 12 months after return. Results: Fifty-three eyes of 47 patients were identified. The mean (±SD) age was 62.3 ± 14.9 years, the mean LTFU time was 295 ± 181.2 days (range, 182-1101), and the mean follow-up after return was 354 ± 339.3 days (range, 32-1141). The overall mean number of steroid injections was 5.2 ± 3.9 (range, 1-18). Compared with the mean logMAR VA at the visit before LTFU (0.59 [Snellen 20/77]), the mean VA remained stable at all timepoints after return as follows: return visit (0.62 [20/83]; P = .6), month 3 (0.55 [20/70]; P = .6), month 6 (0.55 [20/70]; P = .5), month 12 (0.64 [20/87]; P = .6), and final visit (0.69 [20/97]; P = .2). At the first return visit, 8 (15%) of 53 patients had an IOP of 21 mm Hg or higher (range, 21-31); 2 required treatment with a new antihypertensive medication (latanoprost and timolol, respectively). Conclusions: Patients with LTFU after receiving steroid injections maintained their VA. No patient required incisional glaucoma surgery. Compared with other etiologies, eyes with diabetic macular edema had a greater increase in IOP.
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Affiliation(s)
- Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel Israilevich
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Hinkle
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony Obeid
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Ali Khan
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Varun Chaudhary
- Hamilton Regional Eye Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sunir J Garg
- Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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11
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Anderson A, Alfahad N, Wimalachandra D, Bouzinab K, Rudzinska P, Wood H, Fazey I, Xu H, Lyons TJ, Barnes NM, Narendran P, Lord JM, Rauz S, Ganley IG, Curtis TM, Wallace GR, Hombrebueno JR. Relaxation of mitochondrial hyperfusion in the diabetic retina via N6-furfuryladenosine confers neuroprotection regardless of glycaemic status. Nat Commun 2024; 15:1124. [PMID: 38321058 PMCID: PMC10847490 DOI: 10.1038/s41467-024-45387-9] [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: 07/18/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
The recovery of mitochondrial quality control (MQC) may bring innovative solutions for neuroprotection, while imposing a significant challenge given the need of holistic approaches to restore mitochondrial dynamics (fusion/fission) and turnover (mitophagy and biogenesis). In diabetic retinopathy, this is compounded by our lack of understanding of human retinal neurodegeneration, but also how MQC processes interact during disease progression. Here, we show that mitochondria hyperfusion is characteristic of retinal neurodegeneration in human and murine diabetes, blunting the homeostatic turnover of mitochondria and causing metabolic and neuro-inflammatory stress. By mimicking this mitochondrial remodelling in vitro, we ascertain that N6-furfuryladenosine enhances mitochondrial turnover and bioenergetics by relaxing hyperfusion in a controlled fashion. Oral administration of N6-furfuryladenosine enhances mitochondrial turnover in the diabetic mouse retina (Ins2Akita males), improving clinical correlates and conferring neuroprotection regardless of glycaemic status. Our findings provide translational insights for neuroprotection in the diabetic retina through the holistic recovery of MQC.
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Affiliation(s)
- Aidan Anderson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nada Alfahad
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Kaouthar Bouzinab
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Paula Rudzinska
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Heather Wood
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Isabel Fazey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Heping Xu
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Timothy J Lyons
- Division of Endocrinology and Diabetes, Medical University of South Carolina, Charleston, SC, USA
- Diabetes Free South Carolina, Columbia, SC, USA
| | - Nicholas M Barnes
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham & Midland Eye Centre, Birmingham, UK
| | - Ian G Ganley
- MRC Protein Phosphorylation and Ubiquitylation Unit, University of Dundee, Dundee, UK
| | - Tim M Curtis
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Graham R Wallace
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Jose R Hombrebueno
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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12
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Mei JH, Lin Z. Subthreshold micropulse diode laser treatment in diabetic macular edema: biological impact, therapeutic effects, and safety. Int Ophthalmol 2024; 44:3. [PMID: 38315299 DOI: 10.1007/s10792-024-02973-6] [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: 03/25/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To introduce the treatment of diabetic macular edema (DME) with subthreshold micropulse diode laser (SMPL), to summarize the biological impact, therapeutic effects, and safety of this treatment, and to discuss the response to DME when SMPL is combined with anti-vascular endothelial growth factor (anti-VEGF) or steroid. METHODS The literature search was performed on the PubMed database, with a selection of English-language articles published from 2000 to 2023 with the following combinations of search terms: diabetes macular (o) edema, micropulse laser or subthreshold micropulse laser, anti-vascular endothelial growth factor, and steroid. RESULTS SMPL is a popular, invisible retinal laser phototherapy that is inexpensive, safe, and effective in the treatment of DME. It can selectively target the retinal pigment epithelium, reduce the expression of pro-inflammatory factors, promote the absorption of macular edema, and exert a similar and lasting clinical effect to traditional lasers. No significant difference was found in the therapeutic effects of SMPL between different wavelengths. However, HbA1c level and pretreatment central macular thickness (CMT) may affect the therapeutic outcomes of SMPL. CONCLUSION SMPL has a slow onset and produces lasting clinical effects similar to conventional photocoagulation. It has been reported that SMPL combined with the intravitreal anti-VEGF injection can significantly reduce the number of injections without influencing the therapeutic effect, which is essential for clinical applications and research. Although 577 nm SMPL is widely used clinically, there are no standardized protocols for SMPL. Additionally, some important problems regarding the treatment of SMPL require further discussion and exploration.
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Affiliation(s)
- Jing Hao Mei
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
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13
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Sharma S, Daigavane S, Shinde P. Innovations in Diabetic Macular Edema Management: A Comprehensive Review of Automated Quantification and Anti-vascular Endothelial Growth Factor Intervention. Cureus 2024; 16:e54752. [PMID: 38523956 PMCID: PMC10961153 DOI: 10.7759/cureus.54752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Diabetic macular edema (DME) poses a significant threat to the vision and quality of life of individuals with diabetes. This comprehensive review explores recent advancements in DME management, focusing on integrating automated quantification techniques and anti-vascular endothelial growth factor (anti-VEGF) interventions. The review begins with an overview of DME, emphasizing its prevalence, impact on diabetic patients, and current challenges in management. It then delves into the potential of automated quantification, leveraging machine learning and artificial intelligence to improve early detection and monitoring. Concurrently, the role of anti-VEGF therapies in addressing the underlying vascular abnormalities in DME is scrutinized. The review synthesizes vital findings, highlighting the implications for the future of DME management. Promising outcomes from recent clinical trials and case studies are discussed, providing insights into the evolving landscape of personalized medicine approaches. The conclusion underscores the transformative potential of these innovations, calling for continued research, collaboration, and integration of these advancements into clinical practice. This review aims to serve as a roadmap for researchers, clinicians, and industry stakeholders, fostering a collective effort to enhance the precision and efficacy of DME management.
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Affiliation(s)
- Soumya Sharma
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranaykumar Shinde
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Choi J, Kim SJ, Kang SW, Hwang S, Son KY. Biomarkers determining treatment interval of diabetic macular edema after initial resolution by anti-vascular endothelial growth factor. Graefes Arch Clin Exp Ophthalmol 2024; 262:421-429. [PMID: 37843565 DOI: 10.1007/s00417-023-06269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To identify predictive factors that help determine the interval of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection after the initial resolution of diabetic macular edema (DME). METHODS This retrospective case-control study enrolled treatment-naïve DME patients who had achieved DME resolution after intravitreal anti-VEGF injections. Patients were classified into the recurrence and no-recurrence groups, depending on the development of recurrent DME after deferring intravitreal anti-VEGF injection. The demographics and clinical features, including optical coherence tomography findings, were compared between the two groups. RESULTS We enrolled 105 eyes. Sixty eyes (57.1%) belonged to the no-recurrence group, and 45 (42.9%), belonged to the recurrence group. The severity of diabetic retinopathy at baseline was related to early DME recurrence (P = 0.009). At the treatment deferring point, the non-recurrence group had both thinner central subfield thickness (289.5 ± 27.2 μm vs. 307.0 ± 38.2 μm, P = 0.011) and thinner central retinal thickness (214.9 ± 41.4 μm vs. 231.8 ± 41.2 μm, P = 0.043) compared to the recurrence group. Intraretinal cyst was observed in 34 eyes (56.7%) in the no-recurrence group and 42 eyes (93.3%) in the recurrence group at the deferring point (P < 0.001). CONCLUSION A low risk of early DME recurrence is anticipated in the eyes with foveal thinning and no intraretinal cyst when anti-VEGF injection is deferred. These predictive biomarkers can be useful for patient monitoring and determining treatment strategies for DME patients.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, South Korea
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15
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Lawali DJAM, Wu G, Adam ND, Lin Z, Kong H, Yi L, Fang Y, Niu Y, Tang C, Amza A, Zhang H, Yu H, Yuan L, Hu Y. Difference of central foveal thickness measurement in patients with macular edema using optical coherence tomography in different display modes. Front Endocrinol (Lausanne) 2024; 15:1295745. [PMID: 38344662 PMCID: PMC10853465 DOI: 10.3389/fendo.2024.1295745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose To assess the differences in the measurement of central foveal thickness (CFT) in patients with macular edema (ME) between two display modes (1:1 pixel and 1:1 micron) on optical coherence tomography (OCT). Design This is a retrospective, cross-sectional study. Methods Group A consisted of participants with well-horizontal OCT B-scan images and group B consisted of participants with tilted OCT B-scan. We manually measured the CFT under the two display modes, and the values were compared statistically using the paired t-test. Spearman's test was used to assess the correlations between the OCT image tilting angle (OCT ITA) and the differences in CFT measurement. The area under the curve (AUC) was calculated to define the OCT ITA cutoff for a defined CFT difference. Results In group A, the mean CFT in the 1:1 pixel display mode was 420.21 ± 130.61 µm, similar to the mean CFT of 415.27 ± 129.85 µm in the 1:1 micron display mode. In group B, the median CFT in the 1:1 pixel display mode is 409.00 μm (IQR: 171.75 μm) and 368.00 μm (IQR: 149.00 μm) in the 1:1 micron display mode. There were significant differences between the two display modes with the median (IQR) absolute difference and median (IQR) relative difference of 38.00 μm (75.00 μm) and 10.19% (21.91%) (all p = 0.01). The differences in CFT measurement between the two display modes were correlated with the OCT ITA (absolute differences, r = 0.88, p < 0.01; relative differences, r = 0.87, p < 0.01). The AUC for a predefined CFT difference was 0.878 (10 μm), 0.933 (20 μm), 0.938 (30 μm), 0.961 (40 μm), 0.962 (50 μm), and 0.970 (60 μm). Conclusion In patients with DM, when the OCT B-scan images were well-horizontal, manual CFT measurements under the two display modes were similar, but when the B-scan images were tilted, the CFT measurements were different under the two display modes, and the differences were correlated to the OCT ITA.
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Affiliation(s)
- Dan Jouma Amadou Maman Lawali
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guanrong Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Nouhou Diori Adam
- Department of Ophthalmology, Amirou Boubacar Diallo National Hospital, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Zhangjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Huiqian Kong
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Liaohui Yi
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yongyi Niu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Changting Tang
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Abdou Amza
- Department of Ophthalmology, Amirou Boubacar Diallo National Hospital, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Hongyang Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Ling Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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16
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Li G, Gao J, Ding P, Gao Y. The role of endothelial cell-pericyte interactions in vascularization and diseases. J Adv Res 2024:S2090-1232(24)00029-8. [PMID: 38246244 DOI: 10.1016/j.jare.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Endothelial cells (ECs) and pericytes (PCs) are crucial components of the vascular system, with ECs lining the inner layer of blood vessels and PCs surrounding capillaries to regulate blood flow and angiogenesis. Intercellular communication between ECs and PCs is vital for the formation, stability, and function of blood vessels. Various signaling pathways, such as the vascular endothelial growth factor/vascular endothelial growth factor receptor pathway and the platelet-derived growth factor-B/platelet-derived growth factor receptor-β pathway, play roles in communication between ECs and PCs. Dysfunctional communication between these cells is associated with various diseases, including vascular diseases, central nervous system disorders, and certain types of cancers. AIM OF REVIEW This review aimed to explore the diverse roles of ECs and PCs in the formation and reshaping of blood vessels. This review focused on the essential signaling pathways that facilitate communication between these cells and investigated how disruptions in these pathways may contribute to disease. Additionally, the review explored potential therapeutic targets, future research directions, and innovative approaches, such as investigating the impact of EC-PCs in novel systemic diseases, addressing resistance to antiangiogenic drugs, and developing novel antiangiogenic medications to enhance therapeutic efficacy. KEY SCIENTIFIC CONCEPTS OF REVIEW Disordered EC-PC intercellular signaling plays a role in abnormal blood vessel formation, thus contributing to the progression of various diseases and the development of resistance to antiangiogenic drugs. Therefore, studies on EC-PC intercellular interactions have high clinical relevance.
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Affiliation(s)
- Gan Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Junjie Gao
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Shanghai Sixth People's Hospital Fujian, No. 16, Luoshan Section, Jinguang Road, Luoshan Street, Jinjiang City, Quanzhou, Fujian, China
| | - Peng Ding
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China.
| | - Youshui Gao
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China.
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17
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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18
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Wei J, Shu Y, Wang Y, Liu H. Bibliometric and visualized analysis of diabetic macular edema. Indian J Ophthalmol 2024; 72:S66-S74. [PMID: 38131545 PMCID: PMC10833150 DOI: 10.4103/ijo.ijo_399_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/10/2023] [Accepted: 07/31/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors. METHODS We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends. RESULTS A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. "Diabetic macular edema," "retinopathy," "ranibizumab," and "optical coherence tomography angiography" were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, "deep learning" (AAY:2020.83), "optical coherence tomography angiography" (AAY:2019.59), "intravitreal Aflibercept" (AAY:2019.29), and "dexamethasone implant" (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run. CONCLUSION In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots.
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Affiliation(s)
- Jin Wei
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yiyang Shu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yimin Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
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Rana V, Agarwal A, Arora A, Bansal R, Dogra M, Bhadada SK, Singh N, Gupta V. Predicting visual outcomes following anti-vascular endothelial growth factor treatment for diabetic macular edema. Indian J Ophthalmol 2024; 72:S16-S21. [PMID: 38131536 PMCID: PMC10833155 DOI: 10.4103/ijo.ijo_893_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To assess the utility of pre-defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME) following anti-vascular endothelial growth factor (anti-VEGF) therapy in determining visual and anatomical outcomes. METHODS In this prospective, non-randomized, and interventional study, 17 patients with treatment-naive DME were included. OCT biomarkers [size/reflectivity of cysts, disorganization of retinal inner layers, integrity of ellipsoid zone or external limiting membrane, subfoveal serous retinal detachment, hyper-reflective foci (HRF)] and OCTA [vascular density (VD), foveal avascular zone (FAZ), and total micro-aneurysms in superficial capillary plexus and deep capillary plexus (DCP)] were analyzed at baseline and after three monthly intravitreal anti-VEGF injections. Response was defined as a decrease of 10% or more in central macular thickness from the baseline after three injections. RESULTS 13/17 (76.47%) patients were categorized as responders to anti-VEGF therapy. Non-responders had significantly greater hyper-reflectivity of cysts (P = 0.015), larger cystic spaces (P = 0.023), and an increased number of HRF (P = 0.04) at baseline. On OCTA, non-responders showed larger FAZ in DCP (1.35 ± 0.21 versus 1.14 ± 0.28 mm2) (P = 0.042) and lower VD (61.17 ± 0.45 versus 62.73 ± 3.32) in DCP at baseline. At 3 months, the VD increased in responders (63.10 ± 3.42) compared to a decrease in non-responders (60.82 ± 1.13) (P = 0.032). CONCLUSIONS Non-responders show a higher number of micro-aneurysms, larger FAZ, and lower VD in the DCP on OCTA and higher cyst hyper-reflectivity and HRF and larger cystic spaces on OCT imaging.
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Affiliation(s)
- Vipin Rana
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Ophthalmology, University of Maastricht Medical Center+, Maastricht, The Netherlands
| | - Atul Arora
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mohit Dogra
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirbhai Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cheema AA, Cheema HR. Diabetic Macular Edema Management: A Review of Anti-Vascular Endothelial Growth Factor (VEGF) Therapies. Cureus 2024; 16:e52676. [PMID: 38264181 PMCID: PMC10804209 DOI: 10.7759/cureus.52676] [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] [Accepted: 01/21/2024] [Indexed: 01/25/2024] Open
Abstract
Diabetic macular edema (DME) is a major cause of vision impairment in diabetic individuals, characterized by fluid accumulation in the macula due to a breakdown of the blood-retinal barrier (BRB). This review article explores the role of anti-vascular endothelial growth factor (anti-VEGF) therapies in the management of DME. Anti-VEGF treatments, including ranibizumab, bevacizumab, and aflibercept, have revolutionized DME management by targeting VEGF, a key mediator in DME pathogenesis. We critically examined the efficacy of these therapies in reducing macular edema and improving visual acuity, assessed their safety and tolerability, and explored the variability in treatment response. The review highlights the latest advancements and future directions in anti-VEGF therapy, including novel drug delivery systems and emerging treatment paradigms. By providing a comprehensive overview of current anti-VEGF therapies, this review seeks to inform clinical practice, guide future research, and contribute to improved patient outcomes in DME management.
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Leite J, Ferreira A, Castro C, Coelho J, Borges T, Correia N, Pessoa B. Retinal changes after fluocinolone acetonide implant (ILUVIEN®) for DME: SD-OCT imaging assessment using ESASO classification. Eur J Ophthalmol 2024; 34:233-244. [PMID: 37475207 DOI: 10.1177/11206721231183471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
INTRODUCTION A detailed understanding of the anatomical and structural changes occurring in the retina following intravitreal fluocinolone acetonide implantation may help improve the management and prognosis of persistent or recurrent diabetic macular edema (DME). METHODS Overall, 45 eyes (from 35 patients) with refractory center-involved DME received an intravitreal fluocinolone acetonide implant. They were monitored at baseline and at 6, 12, 24, and 36 months for best-corrected visual acuity (BCVA), central foveal thickness (CFT), and the seven retinal parameters used in the classification of diabetic maculopathy recently developed at the European School for Advanced Studies in Ophthalmology (ESASO). RESULTS Within 6 months of implantation, significant improvements were evident in BCVA, CFT, maculopathy stage, and the percentage of eyes with: intraretinal cysts; CFT > 30% above the upper normal value; and disrupted or absent ellipsoid zone (EZ) and/or external limiting membrane (ELM). Significant improvements were still maintained at 36 months post-implantation. At month 36, early treatment with the implant (i.e., after < 6 previous intravitreal injections for DME) trended toward being more effective than later treatment in improving BCVA, CFT, maculopathy stage, and the percentage of eyes with CFT > 30% above the upper normal value. However, statistical significance was not achieved. CONCLUSION In persistent or recurrent DME, fluocinolone acetonide implantation can be effective in improving maculopathy stage and reducing the percentage of eyes with: intraretinal cysts; CFT > 30% above the upper normal value; and disrupted or absent EZ and/or ELM. It can also increase BCVA and reduce CFT.
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Affiliation(s)
- João Leite
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Ferreira
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
- CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Catarina Castro
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Coelho
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Tânia Borges
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Nuno Correia
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Bernardete Pessoa
- Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Investigations in Biomedicine/Instituto de Ciências Biomédicas Abel Salazar/Universidade do Porto, (UMIB/ICBAS/UP), Porto, Portugal
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22
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Rennie C, Lotery A, Payne J, Singh M, Ghanchi F. Suboptimal outcomes and treatment burden of anti-vascular endothelial growth factor treatment for diabetic macular oedema in phakic patients. Eye (Lond) 2024; 38:215-223. [PMID: 37542174 PMCID: PMC10764926 DOI: 10.1038/s41433-023-02667-w] [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: 11/25/2022] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES In England and Wales, treatment options were limited for patients with diabetic macular oedema (DMO) with phakic eyes that failed anti-vascular endothelial growth factor (anti-VEGF) treatment pre-2022. This study aimed to quantify the response to, and treatment burden of, anti-VEGF treatment in phakic eyes. METHODS Retrospective, cohort study using electronic patient record data from two UK centres between 2015 and 2020. Primary objective was proportion of phakic eyes with a suboptimal response after initial 6 months of anti-VEGF treatment. Data were available for 500 eyes from 399 patients. RESULTS At 6 months significantly more eyes had a suboptimal response to anti-VEGF treatment: 65.8% (95% CI 61.5-70.0%) vs 34.2% (95% CI 30.0-38.5%), p < 0.0001. Baseline visual acuity (VA) predicted VA outcome, however, despite greater gains in eyes with poorer VA, such eyes did not achieve the same VA levels as those who started treatment with better VA. Only 53.6% of eyes had more than three injections in the first 6 months indicating difficulties in delivering high volume/high frequency treatment. Treatment and review burden were similar over the following years regardless of response to anti-VEGF treatment. CONCLUSIONS Data confirm previous real world evidence around response to anti-VEGF treatment, importance of baseline VA and frequency of injections in predicting outcomes in a UK setting. Continuing treatment beyond 6 months in suboptimal responders imposes unnecessary treatment burden without significant change in VA. In suboptimal responders, consideration of early switch to longer acting steroid treatments may help to reduce treatment burden, whilst maintaining or improving vision.
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Affiliation(s)
- Christina Rennie
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jo Payne
- AbbVie Ltd, AbbVie House, Vanwall Business Park, Maidenhead, UK
| | - Moushmi Singh
- AbbVie Ltd, AbbVie House, Vanwall Business Park, Maidenhead, UK
| | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Roth DB, Eichenbaum D, Malik D, Radcliffe NM, Cutino A, Small KW. The 0.19-mg Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema: Intraocular Pressure-Related Effects over 36 Months. Ophthalmol Retina 2024; 8:49-54. [PMID: 37586482 DOI: 10.1016/j.oret.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/27/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate effects of the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN) on intraocular pressure (IOP) in patients with diabetic macular edema (DME). DESIGN Secondary analysis of a 36-month, phase IV, nonrandomized, open-label, observational study. PARTICIPANTS The study included 202 eyes from 159 patients who received the 0.19-mg FAc implant after a successful prior steroid challenge per the United States label indication. METHODS Study eyes were assessed for IOP values, incidence of IOP elevations, and best-corrected visual acuity (BCVA) for up to 36 months post-FAc implant. RESULTS Mean IOP was stable over 36 months post-FAc; IOP change from baseline peaked at 2.12 mmHg at 9 months, then declined to baseline levels. At 36 months, eyes had a 32.5% cumulative probability of an IOP event > 25 mmHg and a 15.6% probability of an IOP event > 30 mmHg (Kaplan-Meier). The probability of requiring IOP-lowering medication at any time by month 36 was 38.3%. A total of 78% of eyes did not have IOP elevations > 25 mmHg if similar values were seen with the previous steroid challenge. Although 7.4% of eyes had an IOP > 30 mmHg during a scheduled study visit, most exceeded this threshold only once (60%). Regardless of IOP status, mean BCVA remained stable. CONCLUSIONS Over 36 months, the 0.19-mg FAc implant was associated with relatively stable IOPs in patients with DME, and there was no significant impact of IOP elevations identified regarding their effects on long-term visual outcomes. The probability that a prior corticosteroid challenge will not predict an IOP elevation > 25 mmHg over 36 months post-FAc is 22%; therefore, routine IOP monitoring should be scheduled. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel B Roth
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | | | - Deepika Malik
- Ophthalmic Consultants of Long Island, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Kent W Small
- Macula and Retina Institute, Glendale, California and Molecular Insight Research Foundation, Los Angeles and Glendale, California
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Ruiz-Moreno JM, Adán A, Lafuente M, Asencio Durán M, Arias Barquet L, García Layana A, Araiz Iribarren J. Effectiveness and safety of fluocinolone acetonide intravitreal implant in diabetic macular edema patients considered insufficiently responsive to available therapies (REACT): a prospective, non-randomized, and multicenter study. Int Ophthalmol 2023; 43:4639-4649. [PMID: 37697082 PMCID: PMC10724319 DOI: 10.1007/s10792-023-02864-2] [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: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess the effectiveness and safety of the intravitreal fluocinolone-acetonide implant (FAc-i) in patients with chronic diabetic macular edema who did not sufficiently respond to other available therapies. METHODS This was a multicenter, prospective, non-randomized, and phase-IV observational study conducted on patients with recurrent-DME who were insufficient responders to currently available therapies (REACT-Study). The primary end-point was the mean change in best-corrected-visual-acuity from baseline to month-24 values. RESULTS Thirty-one eyes from 31 patients were included in the study. Mean age was 68.0 ± 7.7 years, and 10 (32.3%) were women. Study patients had received 5.3 ± 7.3 previous DME treatments before starting the study. In the overall study sample, BCVA improved from 56.1 ± 12.3 letters at baseline to 62.4 ± 17.0 letters at month-24 (p = 0.0510). The eyes with a baseline BCVA < 70 ETDRS letters had a significant improvement in BCVA from 53.2 ± 10.2 letters at baseline to 61.5 ± 17.9 letters at month-24 (p = 0.0165). In the overall study population, central-subfoveal-thickness (CST) was significantly reduced from 474.0 ± 135.1 µm at baseline to 333.4 ± 135.6 at month-24 (p < 0.0001). Similarly, macular-volume (MV) was significantly reduced from 10.7 ± 2.7 mm3 at baseline to 9.6 ± 2.9 mm3 (p = 0.0027) at month-24. Among the 31 study eyes, 19 (61.3%) required an additional treatment for DME. Throughout the study, 9 (29.0%) eyes required ocular hypotensive medication for controlling their intraocular-pressure and 5 (16.1%) eyes underwent cataract surgery. CONCLUSIONS In DME eyes who did not sufficiently respond to previous therapies, the FAc-i was associated with an improvement in visual and anatomic outcomes. There were no unexpected adverse-events. TRIAL REGISTRATION NUMBER EudraCT identifier: 2016-001680-37.
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Affiliation(s)
- José María Ruiz-Moreno
- Puerta de Hierro-Majadahonda University Hospital, Joaquín Rodrigo, 2, 28222, Majadahonda, Madrid, Spain.
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
- , Miranza, Spain.
| | | | - María Lafuente
- Virgen de la Arraixaca University Hospital, Murcia, Spain
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Thng ZX, Bromeo AJ, Mohammadi SS, Khatri A, Tran ANT, Akhavanrezayat A, T T Than N, Nguyen KS, Yoo WS, Mobasserian A, Or CCM, Nguyen QD. Recent advances in uveitis therapy: focus on selected phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023; 28:297-309. [PMID: 38129984 DOI: 10.1080/14728214.2023.2293049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract. It is a leading cause of blindness in developed countries and exerts significant psychological, social, and economic impact on both patients and the larger society. While there are numerous pharmacotherapy options, posterior segment noninfectious uveitis remains a significant challenge to treat due to its severity, chronicity, and high recurrence rates. AREAS COVERED The index review highlights the unmet needs of uveitis pharmacotherapy and its research and the shortcomings of existing ocular and systemic therapeutic options for noninfectious uveitis. The more promising novel ocular drug delivery methods and therapeutic targets/drugs are discussed, and evidence from the clinical trials is evaluated. EXPERT OPINION There has been incredible growth in the number of treatment options available to uveitis patients today, especially with the new generation of biologic drugs. Available evidence suggests that these newer options may be superior to conventional immunosuppressive therapies in terms of efficacy and side effect profiles. Further high-quality research and additional clinical trials will be needed to clarify their roles in the stepladder treatment approach of noninfectious uveitis.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Asian Eye Institute, Makati, Philippines
| | - S Saeed Mohammadi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Khiem S Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Woong-Sun Yoo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Fang YC, Lai IP, Lai TT, Chen TC, Yang CH, Ho TC, Yang CM, Hsieh YT. Long-Term Change in Renal Function After Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema: A 2-Year Retrospective Cohort Study. Ophthalmol Ther 2023; 12:2977-2988. [PMID: 37589931 PMCID: PMC10640545 DOI: 10.1007/s40123-023-00771-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION To investigate the longitudinal changes in renal function and associated factors after intravitreal anti-vascular endothelial growth factor (VEGF) administration in diabetic macular edema (DME). METHODS A total of 108 patients who had received intravitreal ranibizumab or aflibercept for DME and had follow-up visits for at least 2 years in one hospital were retrospectively enrolled. The estimated glomerular filtration rate (eGFR) at baseline and during the follow-up period and receipt of any renal replacement therapy were recorded. Linear regression and Cox regression models were used to evaluate factors associated with eGFR decline and renal replacement therapy. RESULTS After intravitreal anti-VEGF treatment, eGFR showed a mean decline of -10.4 ± 23.2% and -16.5 ± 26.4% at months 12 and 24, respectively. Patients in the eGFR > 120 mL/min and 15-30 mL/min groups had the greatest decline (-32.0 ± 20.6% and -37.4 ± 30.9%, respectively) while those in the 61-90 mL/min group had the smallest decline (-4.3 ± 19.7%) in eGFR after the 2-year treatment. One out of 52 patients (1.9%) receiving ranibizumab and five out of 56 patients (8.9%) receiving aflibercept started hemodialysis or peritoneal dialysis within the 2-year follow-up period (P = 0.21). Baseline eGFR correlated with renal replacement therapy after intravitreal anti-VEGF treatment (hazard ratio = 0.879 per increase of 1 in eGFR, P = 0.018). CONCLUSIONS In DME patients receiving intravitreal anti-VEGF treatment, a persistent decline in eGFR was observed during the 2-year treatment course. Patients with extremely high or low eGFR had greater eGFR decline, and those with poor baseline eGFR tended to require dialysis after intravitreal anti-VEGF treatment.
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Affiliation(s)
- Yi-Chung Fang
- National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ivan Pochou Lai
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Yu Y, Wang J, Liu Q, Wei F, Xie X, Zhang M. Integrated serum pharmacochemistry and serum pharmacology to investigate the active components and mechanism of Bushen Huoxue Prescription in the treatment of diabetic retinopathy. J Pharm Biomed Anal 2023; 235:115586. [PMID: 37494766 DOI: 10.1016/j.jpba.2023.115586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
This study aimed to investigate the active components of Bushen Huoxue Prescriptions (BHP), and further clarify the mechanism by the integration of serum pharmacochemistry and serum pharmacology based on spectrum-effect relationship in vivo. In this paper, the components absorbed into serum were analyzed by ultra-high performance liquid chromatography-quadrupole-Exactive Orbitrap-high resolution mass spectrometry (UPLC-Q-Exactive Orbitrap-HRMS). And Müller cells were chosen as target cells to further investigate the mechanism. After cell purification, the well-grown cells were identified by Hematoxylin-eosin staining (HE) staining and immunofluorescence assay, such as glial fibrillary acidic protein (GFAP) and glutamine synthetase (GS). The logarithmic phase cells were divided into normal group, model group and 12 BHP groups. The hyperglycemic and hypoxic model was induced by 50 mmol/L glucose and 1 mmol/L sodium disulfite. Enzyme-linked immunesorbnent assay (ELISA) was used to detect the expressions of five factors closely related to DR, named vascular endothelial growth factor (VEGF), hypoxia-inducible factor1-alpha (HIF-1α), protein kinase C-β (PKC-β), angiopoietin-2 (ANG-2) and transforming growth factor-β (TGF-β). Finally, the spectrum-effect relationship was investigated to screen the active components of BHP by partial least squares regression (PLSR). The results showed that 83 metabolic components, containing 30 prototypes and 53 metabolites were found in BHP serum. 12 characteristic common peaks were chosen to establish spectrum-effect relationship. Significantly, all the 12 BHP serum exhibited stronger inhibition on the expression of VEGF, PKC-β, and ANG-2, and the expression of VEGF, PKC-β, ANG-2 was chosen to establish the spectrum-effect relationship in vivo. The results of PLSR revealed that the content of methylation and sulfuration of caffeic acid, dehydroxylation and sulfation of Danshensu, daidzein, O-demethylangolanolin, cryptotanshinone, tanshinone IIA and protopanaxatriol were inversely correlated with VEGF expression of Müller cells; the areas of dihydrocaffeic acid, methylation and sulfuration of caffeic acid, dehydroxylation and sulfation of Danshensu, daidzein, cryptotanshinone, tanshinone IIA were negative correlation with the expression of PKC-β; while the coefficient of hydroxytyrosol sulfation, R-equol, O-demethylangolanolin, dihydrotanshinone IIA, hydrated cryptotanshinone, protopanaxatriol showed negative correlation with the expression of ANG-2. The above results indicated that cryptotanshinone, tanshinone IIA, daidzein and protopanaxatriol need be focused in our future research. In addition, this research idea provides feasible ways to investigate and determine pharmacodyamic material basis and screen the Q-markers of TCM and its formulas.
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Affiliation(s)
- Yueting Yu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Institute of TianJiang, TianJiang Pharmaceutical Co., Ltd, Jiangyin 214400, China
| | - Jia Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Qingze Liu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Fangyong Wei
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xuejun Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China.
| | - Mei Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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Guo H, Li W, Nie Z, Zhang X, Jiao M, Bai S, Duan N, Li X, Hu B. Microinvasive pars plana vitrectomy combined with internal limiting membrane peeling versus anti-VEGF intravitreal injection for treatment-naïve diabetic macular edema (VVV-DME study): study protocol for a randomized controlled trial. Trials 2023; 24:685. [PMID: 37875997 PMCID: PMC10594908 DOI: 10.1186/s13063-023-07735-w] [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: 08/10/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Diabetic macular edema (DME) is the main cause of vision loss in diabetic patients. Currently, anti-vascular endothelial growth factor (VEGF) intravitreal injection stands as the first-line therapy for DME. However, some patients exhibit insufficient response to anti-VEGF agents and often require multiple injections, imposing psychological and economic burdens. While microinvasive pars plana vitrectomy (PPV) has been shown to be safe and effective in treating refractory DME, scant research has explored its application to treatment-naïve DME. The purpose of this study is to determine whether early PPV combined with internal limiting membrane (ILM) peeling can lessen the therapeutic burden of DME patients, prevent vision loss, and maintain long-term stabilization of diabetic retinopathy. METHODS This is a single-center, prospective, parallel-group, non-inferiority randomized controlled trial involving 102 DME participants. Participants will be randomly assigned to either the study group (PPV combined with ILM peeling) or the control group (conbercept intravitreal injection (IVC)) at a 1:1 ratio, with a scheduled follow-up at 12 months post-operation. Comparative analysis of results between the two groups will be conducted at months 1, 3, 6, and 12 after the intervention. The primary outcomes involve evaluating the changes in central subfield thickness (CST) and best corrected visual acuity (BCVA). The secondary outcomes include assessment of optical coherence tomography (OCT) and OCT angiography (OCTA) biomarkers, re-treatment and adverse events rates, diabetic retinopathy (DR) development, cost-effectiveness analysis, and vision-related quality of life (VRQL). DISCUSSION Some patients do not respond well to anti-VEGF drugs and repeated intravitreal injections increase the treatment burden for patients. The VVV study aims to explore whether PPV combined with ILM peeling could become an initial treatment option for treatment-naïve DME patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05728476. Registered on 15 February 2023.
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Affiliation(s)
- Haoxin Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Wenbo Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Zetong Nie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xiang Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Mingfei Jiao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Siqiong Bai
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Naxin Duan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Bojie Hu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
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Loukovaara S, Korhonen A, Niskanen L, Haukka J. Development of diabetic macular oedema shows associations with systemic medication - An epidemiological study. Acta Ophthalmol 2023. [PMID: 37789702 DOI: 10.1111/aos.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To identify associations between systemic drugs and the incidence of diabetic macular oedema (DME). Of interest was to find beneficial and/or deleterious associations of used drugs. METHODS A historic cohort design based on administrative data. Study population consisted of 150 353 individuals with diabetes. Endpoint event was the development of DME (ICD-10 H36.01), censoring events were death or study end December 2017. The follow-up started between 1997 and 2010. The systemic medication consisted of 95 substances. We constructed a nested case-control study design comparing 2630 cases with DME to 13 144 age- and sex-matched controls without DME. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs) based on conditional logistic regression models. RESULTS Incidence rate for DME was 1.80 per 1000 person-years (95% CI 1.73-1.87). In all, we observed a lower incidence rate of DME in females (IRR 0.57; 95% CI 0.52-0.62) compared to males. Exposure to hormone replacement therapy estradiol (OR 0.42; 0.25-0.68), temazepam (0.23; 0.08-0.62) and allopurinol (0.61; 0.43-0.86) were associated with lower risk of DME, while use of insulin or insulin analogue (3.30; 2.99-3.64), sulfonylureas (1.21; 1.05-1.40), diuretic furosemide (1.90; 1.61-2.24), calcium channel blocker amlodipine (1.53; 1.34-1.75), ACE inhibitors ramipril (1.66; 1.46-1.89) and enalapril (1.38; 1.16-1.64) were associated with an increased risk of DME. CONCLUSIONS Large-scale studies examining the incidence of DME are lacking. Our findings suggest that associations of systemic medications with the incidence of DME may shed light on the pathogenesis of complex DME, encouraging further studies.
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Affiliation(s)
- Sirpa Loukovaara
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ani Korhonen
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
| | - Leo Niskanen
- Päijät-Häme Central Hospital, Lahti and Eira Hospital, Helsinki Finland and University of Eastern Finland, Kuopio, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Bai Y, Li J, Shi L, Jiang Q, Yan B, Wang Z. DME-DeepLabV3+: a lightweight model for diabetic macular edema extraction based on DeepLabV3+ architecture. Front Med (Lausanne) 2023; 10:1150295. [PMID: 37746086 PMCID: PMC10515718 DOI: 10.3389/fmed.2023.1150295] [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: 01/24/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Diabetic macular edema (DME) is a major cause of vision impairment in the patients with diabetes. Optical Coherence Tomography (OCT) is an important ophthalmic imaging method, which can enable early detection of DME. However, it is difficult to achieve high-efficiency and high-precision extraction of DME in OCT images because the sources of OCT images are diverse and the quality of OCT images is not stable. Thus, it is still required to design a model to improve the accuracy of DME extraction in OCT images. Methods A lightweight model (DME-DeepLabV3+) was proposed for DME extraction using a DeepLabV3+ architecture. In this model, MobileNetV2 model was used as the backbone for extracting low-level features of DME. The improved ASPP with sawtooth wave-like dilation rate was used for extracting high-level features of DME. Then, the decoder was used to fuse and refine low-level and high-level features of DME. Finally, 1711 OCT images were collected from the Kermany dataset and the Affiliated Eye Hospital. 1369, 171, and 171 OCT images were randomly selected for training, validation, and testing, respectively. Conclusion In ablation experiment, the proposed DME-DeepLabV3+ model was compared against DeepLabV3+ model with different setting to evaluate the effects of MobileNetV2 and improved ASPP on DME extraction. DME-DeepLabV3+ had better extraction performance, especially in small-scale macular edema regions. The extraction results of DME-DeepLabV3+ were close to ground truth. In comparative experiment, the proposed DME-DeepLabV3+ model was compared against other models, including FCN, UNet, PSPNet, ICNet, and DANet, to evaluate DME extraction performance. DME-DeepLabV3+ model had better DME extraction performance than other models as shown by greater pixel accuracy (PA), mean pixel accuracy (MPA), precision (Pre), recall (Re), F1-score (F1), and mean Intersection over Union (MIoU), which were 98.71%, 95.23%, 91.19%, 91.12%, 91.15%, and 91.18%, respectively. Discussion DME-DeepLabV3+ model is suitable for DME extraction in OCT images and can assist the ophthalmologists in the management of ocular diseases.
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Affiliation(s)
- Yun Bai
- College of Information Science, Shanghai Ocean University, Shanghai, China
| | - Jing Li
- College of Information Science, Shanghai Ocean University, Shanghai, China
| | - Lianjun Shi
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
| | - Qin Jiang
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
| | - Biao Yan
- Eye Institute, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenhua Wang
- College of Information Science, Shanghai Ocean University, Shanghai, China
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Choi J, Kim SJ, Kang SW, Son KY, Hwang S. Local ocular factors associated with the development of diabetic macular edema: an inter-eye study. Sci Rep 2023; 13:14868. [PMID: 37684395 PMCID: PMC10491578 DOI: 10.1038/s41598-023-42038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023] Open
Abstract
To investigate local ocular factors associated with the development of diabetic macular edema (DME), we classified each eye of patients with unilateral DME as the DME eyes or the fellow eyes (without DME). We compared the clinical characteristics, optical coherence tomography (OCT), and OCT angiography (OCTA), ultra-wide field fundus photography, and angiography features of each eye. As a result, fifty-five patients with unilateral DME were enrolled. Although the diabetic retinopathy stage was not different between each group of eyes, DME eyes showed a higher prevalence of venous beading and a larger area of nonperfusion region than did fellow eyes (all P < 0.05). OCTA features of DME eyes also showed a larger foveal avascular zone in the deep capillary plexus and a lower vascular density in both the superficial and deep capillary plexuses (all P < 0.05). This study highlighted ocular features reflecting retinal ischemia, such as venous beading, area of nonperfusion region, and vascular density in the central retinal area, are associated with the development of DME. OCTA and ultra-wide field fluorescein angiography may be useful for evaluating the parameters of retinal ischemia and the risk of DME development.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Xu Y, Xiang Z, E W, Lang Y, Huang S, Qin W, Yang J, Chen Z, Liu Z. Single-cell transcriptomes reveal a molecular link between diabetic kidney and retinal lesions. Commun Biol 2023; 6:912. [PMID: 37670124 PMCID: PMC10480496 DOI: 10.1038/s42003-023-05300-4] [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: 11/18/2022] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
The occurrence of diabetic nephropathy (DN) and diabetic retinopathy (DR) are closely associated in patients with diabetes. However, the cellular and molecular linkage of DN and DR has not been elucidated, and further revelations are needed to improve mutual prognostic decisions and management. Here, we generate and integrate single-cell RNA sequencing profiles of kidney and retina to explore the cellular and molecular association of kidney and retina in both physiological and pathological conditions. We find renal mesangial cells and retinal pericytes share molecular features and undergo similar molecular transitions under diabetes. Furthermore, we uncover that chemokine regulation shared by the two cell types is critical for the co-occurrence of DN and DR, and the chemokine score can be used for the prognosis of DN complicated with DR. These findings shed light on the mechanism of the co-occurrence of DN and DR and could improve the prevention and treatments of diabetic microvascular complications.
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Affiliation(s)
- Ying Xu
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhidan Xiang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weigao E
- Center for Stem Cell and Regenerative Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Lang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sijia Huang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Weisong Qin
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingping Yang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
- Medical School of Nanjing University, Nanjing, China.
| | - Zhaohong Chen
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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Seyyar SA, Tıskaoğlu NS, Onder Tokuc E, Mercanlı M, Doğan L. Is serum vitamin D associated with diabetic retinopathy and its severity or with diabetes itself ? Clin Exp Optom 2023; 106:612-618. [PMID: 35786311 DOI: 10.1080/08164622.2022.2090232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022] Open
Abstract
CLINICAL RELEVANCE Vitamin D (VitD) deficiency, which is found in approximately one-third of the population of the world, may play a role in the pathogenesis of diabetic retinopathy. Physicians following diabetes patients should be aware of this relationship and should refer patients to for ophthalmic care for control in a timely manner. BACKGROUND Diabetic retinopathy is one of the most common complications of diabetic microvascular disease. VitD deficiency has been implicated in the pathogenesis and progression of diabetes and may have a role in development and severity of diabetic retinopathy. The aim of this study was to examine the relationship of serum VitD and some laboratory parameters with the presence of diabetes and retinopathy. METHODS In this study, which has a retrospective epidemiological study design, comprehensive ophthalmologic examination data from the eye clinic, laboratory data from fasting blood tests, and internal medicine outpatient clinic examination data were reviewed. All participants were divided into four groups: 109 healthy controls, and 165 patients with type 2 diabetes of whom 54 did not have retinopathy, 64 had proliferative diabetic retinopathy, and 47 had non-proliferative diabetic retinopathy. Participants were also divided into four groups according to their serum VitD levels. Serum 25(OH)D, HbA1C, creatine, calcium, phosphate, triglyceride, low-density lipoprotein, and high-density lipoprotein levels were evaluated. RESULTS In the whole study cohort, 152 (55.5%) were female and 122 (44.5%) were male. A statistically significant difference was observed in VitD between the healthy group and the diabetic and proliferative diabetic retinopathy groups (p ≤ 0.001). However, no significant correlation was observed between the presence of diabetes and retinopathy and serum VitD in logistic regression analyses (p > 0.05). CONCLUSION Diabetic patients have lower 25(OH)D than non-diabetic patients and there is no direct relationship between 25(OH)D and the development of diabetic retinopathy.
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Affiliation(s)
- Sevim Ayça Seyyar
- Kocaeli Derince Education and Research Hospital Ophthalmology Department, Kocaeli, Turkey
| | - Nesime Setge Tıskaoğlu
- Ersin Arslan Education and Research Hospital Ophthalmology Department, Gaziantep, Turkey
| | - Ecem Onder Tokuc
- Kocaeli Derince Education and Research Hospital Ophthalmology Department, Kocaeli, Turkey
| | - Murat Mercanlı
- Gaziantep University Hospital Ophthalmology Department, Gaziantep, Turkey
| | - Levent Doğan
- Ophthalmology Department, Tatvan State Hospital, Bitlis, Turkey
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Tsai MJ, Cheng CK. Morphological changes of foveal cysts as a predictor for visual response to anti-vascular endothelial growth factor treatments in diabetic macular edema : Degenerative cyst in DME. Int Ophthalmol 2023; 43:2751-2762. [PMID: 36939978 DOI: 10.1007/s10792-023-02674-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/22/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To investigate morphological changes of intraretinal cyst in association with visual acuity following treatment for diabetic macular edema. METHODS This retrospective study enrolled 105 eyes from 105 treatment naïve patients with diabetic macular edema following anti-vascular endothelial growth factor injections. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline, 1, 3, 6, and 12 months. The width and height of the largest intraretinal cyst (IRC) at all different visits were measured and were correlated to final visual acuity by receiver operating characteristic curve. The exudative feature was defined by the presence of hard exudates. Multivariate logistic regression was used to select the independent predictor for visual outcomes. RESULTS Intraretinal cyst width but not the cyst height after treatment at 1 month independently predicted final visual loss of ten letters or more (multivariate P = 0.009). The optimal cutoff value was 196 um with a sensitivity of 0.889 and a specificity of 0.656. Eyes with large IRC width using this cutoff were consistently larger than those with small IRC width through 12 months (P = 0.008, Mann-Whitney U test). Small IRC width < 196 um at 1 month was more likely to coexist with exudative feature (P = 0.011, Fisher's exact test). Among baseline factors, large IRC width predicted IRC width ≥ 196 um at 1 month (multivariate P < 0.001). CONCLUSION Cyst morphology following intravitreal injection predicts visual outcomes. Eyes with IRC width ≥ 196 um after treatment at 1 month tends to be more degenerative, and less likely to coexist with exudative feature.
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Affiliation(s)
- Meng-Ju Tsai
- Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, No 95, Wen-chang Road, Shih-lin District, Taipei, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, No 95, Wen-chang Road, Shih-lin District, Taipei, Taiwan.
- Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
- School of Medicine, National Taiwan University, Taipei, Taiwan.
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Felfeli T, Katsnelson G, Kiss A, Plumptre L, Paterson JM, Ballios BG, Mandelcorn ED, Glazier RH, Brent MH, Wong DT. Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:278-286. [PMID: 35577027 DOI: 10.1016/j.jcjo.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country. DESIGN A retrospective population-based repeated-cross-sectional study. PARTICIPANTS All individuals with diabetes (types 1 and 2) aged ≥20 years in the universal health care system in Ontario were identified in the 2011-2013 and 2017-2019 time periods. METHODS The Mantel-Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods. RESULTS A total of 1 145 645 and 1 346 578 individuals with diabetes were identified in 2011-2013 and 2017-2019, respectively. The proportion of patients unscreened for DR declined very slightly from 35% (n = 405 967) in 2011-2013 to 34% (n = 455 027) in 2017-2019 of the population with diabetes (RR = 0.967; 95% CI, 0.964-0.9693; p < 0.0001). Young adults aged 20-39 years of age had the highest proportion of unscreened patients (62% and 58% in 2011-2013 and 2017-2019, respectively). Additionally, those who had a lower income quintile (RR = 1.039; 95% CI, 1.036-1.044; p < 0.0001), were recent immigrants (RR = 1.286; 95% CI, 1.280-1.293; p < 0.0001), lived in urban areas (RR = 1.149; 95% CI, 1.145-1.154; p < 0.0001), had a mental health history (RR = 1.117; 95% CI, 1.112-1.122; p < 0.0001), or lacked a connection to a primary care provider (RR = 1.656; 95% CI, 1.644-1.668; p < 0.0001) had a higher risk of being unscreened. CONCLUSIONS This population-based study suggests that over 1 decade, 33% of individuals with diabetes are unscreened for DR, and young age, low income, immigration, residing in a large city, mental health illness, and no primary care access are the main predictors.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON.
| | | | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | - J Michael Paterson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON
| | - Brian G Ballios
- Department of Ophthalmology, Toronto Western Hospital, Toronto, ON; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Han YE, Jo J, Kim YJ, Lee J. Factors Affecting Intensive Aflibercept Treatment Response in Diabetic Macular Edema: A Real-World Study. J Diabetes Res 2023; 2023:1485059. [PMID: 37497120 PMCID: PMC10368507 DOI: 10.1155/2023/1485059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Objective To investigate the systemic and ocular factors that affect the response to intensive aflibercept treatment in diabetic macular edema (DME) in a real-world setting. Methods This retrospective cohort study evaluated 30 eyes of 23 patients with DME who underwent intensive intravitreal aflibercept injections (five monthly loading doses). Treatment response was assessed by central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at each monthly visit. The patients were categorized as good (<300 μm) and suboptimal (≥300 μm) responders based on CRT after the loading phase. Baseline systemic and ocular factors associated with treatment response were investigated. Results The mean CRT and BCVA significantly improved after five loading injections (486.87 ± 95.46 to 334.90 ± 69.47 μm and 0.51 ± 0.30 to 0.35 ± 0.25 LogMAR, respectively, all p < 0.05). During 12 months of follow-up, 16 eyes (53.33%) maintained CRT without additional treatment. Eyes with diabetes mellitus (DM) for ≥15 years, estimated glomerular filtration rate (eGFR) < 80 mL/min/1.73 m2, serum creatinine ≥ 0.95 mg/dL and potassium ≥ 4.7 mmol/L, and presence of epiretinal membrane (ERM) were more likely to have a suboptimal response to the treatment. Conclusions Five monthly loading doses of intravitreal aflibercept injection provided significant anatomical and visual improvements in patients with DME. Patients with longer DM duration, lower eGFR, higher serum creatinine or potassium levels, or ERM were predisposed to a suboptimal treatment response. Individual response to intensive aflibercept treatment for DME can be predicted by these systemic and ocular risk factors.
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Affiliation(s)
- Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
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Sapowadia A, Ghanbariamin D, Zhou L, Zhou Q, Schmidt T, Tamayol A, Chen Y. Biomaterial Drug Delivery Systems for Prominent Ocular Diseases. Pharmaceutics 2023; 15:1959. [PMID: 37514145 PMCID: PMC10383518 DOI: 10.3390/pharmaceutics15071959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular diseases, such as age-related macular degeneration (AMD) and glaucoma, have had a profound impact on millions of patients. In the past couple of decades, these diseases have been treated using conventional techniques but have also presented certain challenges and limitations that affect patient experience and outcomes. To address this, biomaterials have been used for ocular drug delivery, and a wide range of systems have been developed. This review will discuss some of the major classes and examples of biomaterials used for the treatment of prominent ocular diseases, including ocular implants (biodegradable and non-biodegradable), nanocarriers (hydrogels, liposomes, nanomicelles, DNA-inspired nanoparticles, and dendrimers), microneedles, and drug-loaded contact lenses. We will also discuss the advantages of these biomaterials over conventional approaches with support from the results of clinical trials that demonstrate their efficacy.
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Affiliation(s)
- Avin Sapowadia
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Delaram Ghanbariamin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Libo Zhou
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Ophthalmology, University of Southern California, Los Angeles, CA 90089, USA
| | - Tannin Schmidt
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Ali Tamayol
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Yupeng Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
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Shughoury A, Bhatwadekar A, Jusufbegovic D, Hajrasouliha A, Ciulla TA. The evolving therapeutic landscape of diabetic retinopathy. Expert Opin Biol Ther 2023; 23:969-985. [PMID: 37578843 PMCID: PMC10592121 DOI: 10.1080/14712598.2023.2247987] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Recent decades have seen rapid progress in the management of diabetic eye disease, evolving from pituitary ablation to photocoagulation and intravitreal pharmacotherapy. The advent of effective intravitreal drugs inhibiting vascular endothelial growth factor (VEGF) marked a new era in DR therapy. Sustained innovation has since produced several promising biologics targeting angiogenesis, inflammation, oxidative stress, and neurodegeneration. AREAS COVERED This review surveys traditional, contemporary, and emerging therapeutics for DR, with an emphasis on anti-VEGF therapies, receptor tyrosine kinase inhibitors, angiopoietin-Tie2 pathway inhibitors, integrin pathway inhibitors, gene therapy 'biofactory' approaches, and novel systemic therapies. Some of these investigational therapies are being delivered intravitreally via sustained release technologies for extended durability. Other investigational agents are being delivered non-invasively via topical and systemic routes. These strategies hold promise for early and long-lasting treatment of DR. EXPERT OPINION The evolving therapeutic landscape of DR is rapidly expanding our toolkit for the effective and durable treatment of blinding eye disease. However, further research is required to validate the efficacy of novel therapeutics and characterize real world outcomes.
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Affiliation(s)
- Aumer Shughoury
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Ashay Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Denis Jusufbegovic
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Amir Hajrasouliha
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
- Midwest Eye Institute, Indianapolis, IN, USA 46290
- Clearside Biomedical, Inc., Alpharetta, GA, USA 30005
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Colé N, Thoele J, Ullmer C, Foxton RH. Real-time measurements of vascular permeability in the mouse eye using vitreous fluorophotometry. Sci Rep 2023; 13:9226. [PMID: 37286795 DOI: 10.1038/s41598-023-36202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
Breakdown of blood-retinal barrier integrity underpins pathological changes in numerous ocular diseases, including neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Whilst anti-vascular endothelial growth factor (VEGF) therapies have revolutionised disease treatment, novel therapies are still required to meet patients' unmet needs. To help develop new treatments, robust methods are needed to measure changes in vascular permeability in ocular tissues in animal models. We present here a method for detecting vascular permeability using fluorophotometry, which enables real-time measurements of fluorescent dye accumulation in different compartments of the mouse eye. We applied this method in several mouse models with different increased vascular leakage, including models of uveitis, diabetic retinopathy and choroidal neovascularization (CNV). Furthermore, in the JR5558 mouse model of CNV, we observed with anti-VEGF post-treatment a longitudinal reduction in permeability, in the same animal eyes. We conclude fluorophotometry is a useful method for measuring vascular permeability in the mouse eye, and can be used over multiple time points, without the need to sacrifice the animal. This method has the potential to be used in both basic research for studying the progression and factors underlying disease, but also for drug discovery and development of novel therapeutics.
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Affiliation(s)
- Nadine Colé
- Ophthalmology Discovery, Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Janina Thoele
- Ophthalmology Discovery, Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Christoph Ullmer
- Ophthalmology Discovery, Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Richard H Foxton
- Ophthalmology Discovery, Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland.
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Jiang F, Zhou L, Zhang C, Jiang H, Xu Z. Malondialdehyde levels in diabetic retinopathy patients: a systematic review and meta-analysis. Chin Med J (Engl) 2023; 136:1311-1321. [PMID: 37101358 PMCID: PMC10309507 DOI: 10.1097/cm9.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND It remains unclear whether circulating malondialdehyde (MDA) levels change in people with diabetic retinopathy (DR). This systematic review compared circulating MDA levels in diabetic people with and without DR. METHODS PubMed, Medline (Ovid), Embase (Ovid), and Web of Science were searched for case-control studies conducted before May 2022 in English that compared circulating MDA levels in people with and without DR. The following MeSH search terms were used: ("malondialdehyde" or "thiobarbituric acid reactive substances [TBARS]" or "lipid peroxidation" or "oxidative stress") and "diabetic retinopathy." Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of the included studies. Random-effects pairwise meta-analysis pooled the effect size with standardized mean difference (SMD) and 95% confidence intervals (CIs). RESULTS This meta-analysis included 29 case-control studies with 1680 people with DR and 1799 people with diabetes but not DR. Compared to people without DR, the circulating MDA levels were higher in those with DR (SMD, 0.897; 95% CI, 0.631 to 1.162; P < 0.001). The study did not identify credible subgroup effects or publication bias and the sensitivity analysis confirmed the robustness of the study. CONCLUSIONS Circulating MDA levels are higher in people with DR compared to those without. Future comparative studies that use more specific methods are required to draw firm conclusions. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022352640.
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Affiliation(s)
- Fanwen Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Midena E, Torresin T, Schiavon S, Danieli L, Polo C, Pilotto E, Midena G, Frizziero L. The Disorganization of Retinal Inner Layers Is Correlated to Müller Cells Impairment in Diabetic Macular Edema: An Imaging and Omics Study. Int J Mol Sci 2023; 24:ijms24119607. [PMID: 37298558 DOI: 10.3390/ijms24119607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The disorganization of retinal inner layers (DRIL) is an optical coherence tomography (OCT) biomarker strictly associated with visual outcomes in patients with diabetic macular edema (DME) whose pathophysiology is still unclear. The aim of this study was to characterize in vivo, using retinal imaging and liquid biopsy, DRIL in eyes with DME. This was an observational cross-sectional study. Patients affected by center-involved DME were enrolled. All patients underwent spectral domain optical coherence tomography (SD-OCT) and proteomic analysis of aqueous humor (AH). The presence of DRIL at OCT was analyzed by two masked retinal experts. Fifty-seven biochemical biomarkers were analyzed from AH samples. Nineteen eyes of nineteen DME patients were enrolled. DRIL was present in 10 patients (52.63%). No statistically significant difference was found between DME eyes with and without DRIL, considering the AH concentration of all the analyzed biomarkers except for glial fibrillary acidic protein (GFAP), a biomarker of Müller cells dysfunction (p = 0.02). In conclusion, DRIL, in DME eyes, seems to strictly depend on a major dysfunction of Müller cells, explaining its role not only as imaging biomarker, but also as visual function Müller cells-related parameter.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
- IRCCS-Fondazione Bietti, 00198 Rome, Italy
| | - Tommaso Torresin
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | - Stefano Schiavon
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | | | - Chiara Polo
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | | | | | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
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Monickaraj F, Acosta G, Cabrera AP, Das A. Transcriptomic Profiling Reveals Chemokine CXCL1 as a Mediator for Neutrophil Recruitment Associated With Blood-Retinal Barrier Alteration in Diabetic Retinopathy. Diabetes 2023; 72:781-794. [PMID: 36930735 PMCID: PMC10202768 DOI: 10.2337/db22-0619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/12/2023] [Indexed: 03/19/2023]
Abstract
Inflammation plays an important role in the pathogenesis of diabetic retinopathy (DR). To precisely define the inflammatory mediators, we examined the transcriptomic profile of human retinal endothelial cells exposed to advanced glycation end products, which revealed the neutrophil chemoattractant chemokine CXCL1 as one of the top genes upregulated. The effect of neutrophils in the alteration of the blood-retinal barrier (BRB) was further assessed in wild-type C57BL/6J mice intravitreally injected with recombinant CXCL1 as well as in streptozotocin-induced diabetic mice. Both intravitreally CXCL1-injected and diabetic animals showed significantly increased retinal vascular permeability, with significant increase in infiltration of neutrophils and monocytes in retinas and increased expression of chemokines and their receptors, proteases, and adhesion molecules. Treatment with Ly6G antibody for neutrophil depletion in both diabetic mice as well as CXCL1-injected animals showed significantly decreased retinal vascular permeability accompanied by decreased infiltration of neutrophils and monocytes and decreased expression of cytokines and proteases. CXCL1 level was significantly increased in the serum samples of patients with DR compared with samples of those without diabetes. These data reveal a novel mechanism by which the chemokine CXCL1, through neutrophil recruitment, alters the BRB in DR and, thus, serves as a potential novel therapeutic target. ARTICLE HIGHLIGHTS Intravitreal CXCL1 injection and diabetes result in increased retinal vascular permeability with neutrophil and monocyte recruitment. Ly6G antibody treatment for neutrophil depletion in both animal models showed decreased retinal permeability and decreased cytokine expression. CXCL1 is produced by retinal endothelial cells, pericytes, and astrocytes. CXCL1 level is significantly increased in serum samples of patients with diabetic retinopathy. CXCL1, through neutrophil recruitment, alters the blood-retinal barrier in diabetic retinopathy and, thus, may be used as a therapeutic target.
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Affiliation(s)
- Finny Monickaraj
- Ophthalmology and Visual Sciences, University of New Mexico, Albuquerque, NM
- New Mexico VA Health Care System, Albuquerque, NM
| | - Gabriella Acosta
- Ophthalmology and Visual Sciences, University of New Mexico, Albuquerque, NM
| | - Andrea P. Cabrera
- Ophthalmology and Visual Sciences, University of New Mexico, Albuquerque, NM
| | - Arup Das
- Ophthalmology and Visual Sciences, University of New Mexico, Albuquerque, NM
- New Mexico VA Health Care System, Albuquerque, NM
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Petrovic N, Todorovic D, Sarenac Vulovic T, Sreckovic S, Zivic F, Risimic D. Combined Treatment of Persistent Diabetic Macular Edema with Aflibercept and Triamcinolone Acetonide in Pseudophakic Eyes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050982. [PMID: 37241214 DOI: 10.3390/medicina59050982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular endothelial growth factor therapy could improve therapeutic outcomes for pseudophakic eyes with persistent diabetic macular edema. Materials and Methods: twenty-four pseudophakic eyes with refractory diabetic macular edema, that had appeared despite three previously administered intravitreal injections of aflibercept, were divided into two groups (twelve eyes in each group). The first group continued to have aflibercept administered according to a fixed dosing regimen (once in two months). Triamcinolone acetonide 10 mg/0.1 mL (administered once per four months) was included for the second group, i.e., their treatment continued with a combination of aflibercept + triamcinolone acetonide. Results: The reduction in central macular thickness was higher in the eyes treated with combined therapy (aflibercept + triamcinolone acetonide) compared with the use of aflibercept alone during the entire 12-month follow-up period (3rd month p = 0.019; 6th month p = 0.023; 9th month p = 0.027; 12th month p = 0.031). As was evident from the p-values, the differences were statistically significant. No statistically significant difference was recorded for visual acuity: 3rd month p = 0.423; 6th month p = 0.392; 9th month p = 0.413; 12th month p = 0.418. Conclusions: Combined anti-vascular endothelial growth factor and steroid therapy leads to a better anatomical outcome of persistent diabetic macular edema in pseudophakic eyes, but does not lead to a more significant improvement in visual acuity than continuous anti-VEGF therapy alone.
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Affiliation(s)
- Nenad Petrovic
- Clinic of Ophthalmology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Faculty of Medical Sciences, Department of Ophthalmology, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dusan Todorovic
- Clinic of Ophthalmology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Faculty of Medical Sciences, Department of Ophthalmology, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tatjana Sarenac Vulovic
- Clinic of Ophthalmology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Faculty of Medical Sciences, Department of Ophthalmology, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Suncica Sreckovic
- Clinic of Ophthalmology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Faculty of Medical Sciences, Department of Ophthalmology, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Fatima Zivic
- Faculty of Engineering, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dijana Risimic
- Clinic for Eye Diseases, University Clinical Center of Serbia, 34000 Kragujevac, Serbia
- Medical Faculty, University of Belgrade, 11000 Beograd, Serbia
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Hsieh TC, Deng GH, Chang YC, Chang FL, He MS. A real-world study for timely assessing the diabetic macular edema refractory to intravitreal anti-VEGF treatment. Front Endocrinol (Lausanne) 2023; 14:1108097. [PMID: 37265702 PMCID: PMC10230025 DOI: 10.3389/fendo.2023.1108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
Background Early Identifying and characterizing patients with diabetic macular edema (DME) is essential for individualized treatment and outcome optimization. This study aimed to timely investigate optical coherence tomography (OCT) biomarkers of DME refractory to intravitreal anti-vascular endothelial growth factor (VEGF) therapy. Methods We retrospective reviewed 72 eyes from 44 treatment-naïve patients who were treated with intravitreal anti-VEGF for DME. OCT scans prior to anti-VEGF were evaluated for serous retinal detachment (SRD), size of outer nuclear layer cystoid changes, diffuse retinal thickening, integrity of the inner segment-outer segment (IS-OS) junction, quantity and location of hyperreflective foci, vitreomacular interface abnormalities, and epiretinal membrane (ERM). The Baseline best-corrected visual acuity (BCVA) and central macular thickness was recorded at baseline and 4 months after treatment with anti-VEGF. The main outcome measure was the correlation between spectral-domain OCT measurements and BCVA response at baseline and after anti-VEGF treatment (mean change from baseline; ≥ 10 Early Treatment Diabetic Retinopathy Study letters in BCVA). Results Partially continuous IS-OS layers (partially vs. completely continuous: β, -0.138; Wald chi-square, 16.392; P<0.001) was predictor of better response to anti-VEGF treatment. In contrast, ERM (present vs. absent ERM: β, 0.215; Wald chi-square, 5.921; P=0.015) and vitreomacular traction (vitreomacular traction vs. posterior vitreous detachment: β=0.259; Wald chi-square=5.938; P=0.015) were the predictors of poor response. The improvement of BCVA trended toward the OCT predictive value of central macular thickness reduction; however, this was not significant. Conclusion Partially continuous IS-OS layers is predictive of better response to anti-VEGF therapy in DME. Meanwhile, ERM is a significant predictor of poor response.
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Affiliation(s)
| | - Guang-Hong Deng
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Hualien, Taiwan
| | - Yung-Ching Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Fang-Ling Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ming-Shan He
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
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45
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Xie X, Lian C, Zhang Z, Feng M, Wang W, Yuan X, Shi Y, Liu T. Aflibercept for long-term treatment of diabetic macular edema and proliferative diabetic retinopathy: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1144422. [PMID: 37260449 PMCID: PMC10227619 DOI: 10.3389/fendo.2023.1144422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Purpose This meta-analysis compared the long-term (12 months or 24 months) efficacy and safety of intravitreal aflibercept injection (IAI) for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Methods We selected 16 randomized controlled trials (RCTs) performed after 2015 that had a minimum of 12 months and up to 24 months of treatment and conducted a meta-analysis with Review Manager version 5.3. Visual acuity (VA), central subfield thickness (CST) and adverse events were the outcomes selected for evaluation from the eligible studies. Results Based on 16 RCTs, we evaluated a total of 7125 patients. For PDR and severe DME with poor baseline vision, after a minimum of 12 months and up to 24 months of treatment, the aflibercept treatment group obtained better VA improvement than the focal/grid laser photocoagulation treatment group (MD=13.30; 95%CI: 13.01~13.58; P<0.001) or other treatments (ranibizumab, focal/grid laser photocoagulation, PRP, et al.) group (MD=1.10; 95%CI: 1.05~1.16; P<0.001). In addition, the aflibercept treatment group got higher CST reduction than the focal/grid laser photocoagulation treatment (MD=-33.76; 95%CI: -45.53 ~ -21.99; P<0.001) or other treatments (ranibizumab, focal/grid laser photocoagulation, et al.) group (MD=-33.76; 95%CI: -45.53 ~ -21.99; P<0.001). There was no significant difference in the overall incidence of ocular and non-ocular adverse events in each treatment group. Conclusions This meta-analysis showed that the advantages of IAI are obvious in the management of DME and PDR with poor baseline vision for long-term observation (a minimum of 12 months and up to 24 months) with both VA improvement and CST reduction. Applied IAI separately trended to be more effective than panretinal photocoagulation separately in VA improvement for PDR. More parameters should be required to assess functional and anatomic outcomes.
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Affiliation(s)
- Xiao Xie
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Chao Lian
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Zhiping Zhang
- Chinese Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng Feng
- Laboratory Department, Affiliated Hospital of Shanxi University of Chinese Medicine, Xianyang, China
| | - Wenqi Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaomeng Yuan
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yanmei Shi
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Tingting Liu
- Eye Hospital of Shandong First Medical University, Shandong Eye Hospital, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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Kato F, Nozaki M, Kato A, Yasukawa T. Retinal Microvascular Changes after Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema. J Clin Med 2023; 12:jcm12103475. [PMID: 37240582 DOI: 10.3390/jcm12103475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Intravitreal injection of triamcinolone acetonide (TA) is essential for clinical treatment in patients who insufficiently respond to vascular endothelial factor inhibitors for diabetic macular edema (DME). The aim of this study was to investigate microvascular changes treated with TA using optical coherence tomography angiography (OCTA). After TA in twelve eyes of eleven patients with central retinal thickness (CRT), there was a 20% or more reduction observed. Visual acuity, the number of microaneurysms, vessel density, and the foveal avascular zone (FAZ) area were compared before and at 2 months after TA. At baseline, the number of microaneurysms was 2.1 ± 1.1 in the superficial capillary plexuses (SCP) and 2.0 ± 1.1 in the deep capillary plexuses (DCP), with a significant decrease post-treatment to 1.0 ± 1.0 for SCP and 0.8 ± 0.8 for DCP (SCP; p = 0.018, DCP; p = 0.008). There was significant enlargement of the FAZ area from 0.28 ± 0.11 mm2 to 0.32 ± 0.14 mm2 (p = 0.041). There was no significant difference in the visual acuity and vessel density of SCP and DCP. Results indicated that OCTA was useful for the evaluation of qualitative and morphological retinal microcirculation and that intravitreal TA may decrease microaneurysms.
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Affiliation(s)
- Fusae Kato
- Department of Ophthalmology, Toyota Kosei Hospital, Toyota 470-0396, Japan
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Miho Nozaki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
- Department of Ophthalmology, Nagoya City University East Medical Center, Nagoya 464-8547, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Zolfaghari N, Soheili ZS, Samiei S, Latifi-Navid H, Hafezi-Moghadam A, Ahmadieh H, Rezaei-Kanavi M. microRNA-96 targets the INS/AKT/GLUT4 signaling axis: Association with and effect on diabetic retinopathy. Heliyon 2023; 9:e15539. [PMID: 37180885 PMCID: PMC10172874 DOI: 10.1016/j.heliyon.2023.e15539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Background miR-96-5p is a highly expressed microRNA in the retina of subjects with diabetes. The INS/AKT/GLUT4 signaling axis is the main cell signaling pathway of glucose uptake in cells. Here, we investigated the role of miR-96-5p in this signaling pathway. Methods Expression levels of miR-96-5p and its target genes were measured under high glucose conditions, in the retina of streptozotocin-induced diabetic mice, in the retina of AAV-2-eGFP-miR-96 or GFP intravitreal injected mice and in the retina of human donors with diabetic retinopathy (DR). MTT, wound healing, tube formation, Western blot, TUNEL, angiogenesis assays and hematoxylin-eosin staining of the retinal sections were performed. Results miR-96-5p expression was increased under high glucose conditions in mouse retinal pigment epithelial (mRPE) cells, in the retina of mice receiving AAV-2 carrying miR-96 and STZ-treated mice. Expression of the miR-96-5p target genes related to the INS/AKT/GLUT4 signaling pathway was reduced following miR-96-5p overexpression. mmu-miR-96-5p expression decreased cell proliferation and thicknesses of retinal layers. Cell migration, tube formation, vascular length, angiogenesis, and TUNEL-positive cells were increased. Conclusions In in vitro and in vivo studies and in human retinal tissues, miR-96-5p regulated the expression of the PIK3R1, PRKCE, AKT1, AKT2, and AKT3 genes in the INS/AKT axis and some genes involved in GLUT4 trafficking, such as Pak1, Snap23, RAB2a, and Ehd1. Because disruption of the INS/AKT/GLUT4 signaling axis causes advanced glycation end product accumulation and inflammatory responses, the inhibition of miR-96-5p expression could ameliorate DR.
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Affiliation(s)
- Narges Zolfaghari
- Department of Molecular Medicine, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Zahra-Soheila Soheili
- Department of Molecular Medicine, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
- Corresponding author. Department of Molecular Medicine, National Institute of Genetic Engineering and Biotechnology (NIGEB), Shahrak-e- Pajoohesh, 15th Km, Tehran -Karaj Highway, Tehran. P.O. Box: 14965/161, Iran.
| | - Shahram Samiei
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Hamid Latifi-Navid
- Department of Molecular Medicine, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Ali Hafezi-Moghadam
- Molecular Biomarkers Nano-Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei-Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Merrill PT, Holekamp N, Roth D, Kasper J, Grigorian R. The 0.19-mg Fluocinolone Acetonide Intravitreal Implant Reduces Treatment Burden in Diabetic Macular Edema. Am J Ophthalmol 2023; 248:16-23. [PMID: 36223849 DOI: 10.1016/j.ajo.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/12/2022] [Accepted: 09/17/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess treatment burden in patients with diabetic macular edema (DME) after the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN). DESIGN Prospective and retrospective analyses of a 36-month, phase 4, open-label, observational study. METHODS Setting: Multicenter. PATIENT POPULATION Included patients had DME and previously received corticosteroid treatment without a clinically significant rise in intraocular pressure (IOP) (N = 202 eyes in 159 patients). Patients were not randomized. OBSERVATION PROCEDURES Prospective, observational treatment burden data were analyzed for their relationship to safety and functional efficacy outcomes across 36 months. MAIN OUTCOME MEASURES Outcomes included the mean number of yearly treatments, supplemental-free probability over time, best-corrected visual acuity, and monitoring of IOP-related events. RESULTS Over 36 months, the mean number of yearly treatments decreased from 3.5 before FAc to 1.7 after FAc; at 36 months, 68.3% of patients required 0 to 2 treatments per year. After FAc, the percentage of eyes requiring supplemental therapy decreased vs before FAc (P < .0001 for each). Through 36 months, 25% of FAc-treated eyes did not require supplemental treatment. At 36 months, mean best-corrected visual acuity increased by 4.5 letters vs a decline of 6.4 letters in the 36 months before FAc. IOP elevations >25 mm Hg occurred in 18.2% of eyes that did not receive supplemental treatment after FAc vs 27.2% of eyes that received supplemental treatments, which included additional intraocular steroids. CONCLUSIONS Over 36 months, the FAc implant is associated with improved visual outcomes and better disease control as measured by a significant reduction in yearly treatment burden in patients with DME.
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Affiliation(s)
- Pauline T Merrill
- From the Department of Ophthalmology, Rush University, Chicago, Illinois (P.T.M.).
| | | | - Daniel Roth
- Department of Ophthalmology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey (D.R.)
| | | | - Ruben Grigorian
- Northeast Louisiana Retina Eye Center, West Monroe, Louisiana (R.G.), USA
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49
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Szeto SK, Hui VWK, Tang FY, Yang D, Sun ZH, Mohamed S, Chan CKM, Lai TYY, Cheung C. OCT-based biomarkers for predicting treatment response in eyes with centre-involved diabetic macular oedema treated with anti-VEGF injections: a real-life retina clinic-based study. Br J Ophthalmol 2023; 107:525-533. [PMID: 34750100 DOI: 10.1136/bjophthalmol-2021-319587] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections. METHODS This is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid. RESULTS The presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness. CONCLUSION AND RELEVANCE Baseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong
| | - Vivian W K Hui
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Dawei Yang
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Zi Han Sun
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
| | - Carol Cheung
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Faculty of Medicine, Hong Kong, Hong Kong
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50
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Chitturi SP, Venkatesh R, Mangla R, Parmar Y, Sangoram R, Yadav NK, Chhablani J. REal-world treatment outcomes after delayed intRavitreal therapy in center-involving diabetic macular edema - RETORT study. Int J Retina Vitreous 2023; 9:22. [PMID: 36998064 DOI: 10.1186/s40942-023-00463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To compare real-life data on delayed intravitreal treatment of diabetic macular edema (DME) patients to early treatment. METHODS In this single-centre, retrospective, interventional, comparative study, DME patients were divided into two groups based on when they received treatment: Group 1 - received treatment within 24 weeks and Group 2 - at or after 24 weeks from the time of treatment advice. Visual acuity and central subfield thickness (CSFT) changes were compared at various time points. Reasons for delaying treatment were noted. RESULTS The study included 109 (Group 1-94; Group 2-15) eyes. When treatment was advised, demographic profile, diabetes duration, glucose control and VA between two groups were comparable. At this point, CSFT was higher in Group 1 than in Group 2 (p = 0.036). At injection time, Group 2 had better VA and lower CSFT than Group 1 (p < 0.05). Group 2's VA (53.4 ± 12.67) was significantly lower than Group 1's (57.38 ± 20.01) after 1-year treatment. At 1-year, CSFT decreased in Group 1 and increased in Group 2. Group 1 had mean improvement of + 7.6 letters and Group 2 had a decline of -6.9 letters. Group 2 required more intravitreal anti-VEGF (median - 3; IQR: 2-4), steroid injections (median - 4; IQR: 2-4) and focal laser sessions (median - 4; IQR: 2-4). CONCLUSION Late-treated DME eyes needed more injections and focal laser sessions than early treated eyes. Adherence to early treatment of DME in real-life will help prevent long-term vision loss.
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Affiliation(s)
- Sai Prashanti Chitturi
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
| | - Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Yash Parmar
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Rohini Sangoram
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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