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Pradhana D, Priya NS, Manayath GJ, Kulkarni S, Behera UC, Agarwal T, Agarwal M, Shah S, Giridhar A, Surya J, Ramasamy K, Vignesh TP, Shoba S, Bhende M, Raman R. Natural course of non-center-involving diabetic macular edema progression in patients under initial observation. Indian J Ophthalmol 2024; 72:236-239. [PMID: 38153973 PMCID: PMC10941951 DOI: 10.4103/ijo.ijo_2182_22] [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: 09/05/2022] [Revised: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE We aim to report the natural course of non-center involving diabetic macular edema (NCIDME) progression to center involving diabetic macular edema (CIDME) and associated risk factors. METHODS This is a multicenter retrospective comparative study. Data was collected from electronic medical records from 8 centers in India covering. We included patients with type 2 diabetes above 18 years of age with treatment-naïve NCIDME on OCT and best-corrected visual acuity at baseline of 6/12 or better who were under observation for NCIDME and had 2 years follow-up data. RESULTS Out of 72 patients with NCIDME, 26.38% patients progressed to CI DME by 2 years, and the visit wise proportion was 11.11% at 6 months, 7% at 1st year and 8.3% at 2 years. The change in CST was statistically significant at 2 years in patients who developed CIDME, the mean difference was 137.73 ± 48.56 microns p = 0.045. Duration of diabetes mellitus > 10 years was the only risk factor for conversion to CIDME. CONCLUSION A quarter of eyes with NCIDME developed CIDME and 15% progressed from NPDR to PDR by 2 years, highlighting the disease burden in these patients with NCIDME.
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Affiliation(s)
- Divya Pradhana
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - N Swathi Priya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - George J Manayath
- Department of Vitreo Retina, Aravind Eye Hospital and Post Graduate Institute, Coimbatore, Tamil Nadu, India
| | - Sucheta Kulkarni
- Department of Vitreo Retina, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Umesh C Behera
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Tushar Agarwal
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Manisha Agarwal
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - Shalin Shah
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - A Giridhar
- Department of Vitreo Retina, Giridhar Eye Institute, Kerala, India
| | - Janani Surya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - TP Vignesh
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sivaprasad Shoba
- Department of Vitreo Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Ikegami Y, Shiraya T, Araki F, Ueta T, Toyama T, Yanagita T, Numaga J, Shoji N, Kato S. Navigated direct photocoagulation with a 30-ms short-pulse laser for treating microaneurysms in diabetic macular edema exhibits a high closure rate. Sci Rep 2023; 13:6092. [PMID: 37055549 PMCID: PMC10102157 DOI: 10.1038/s41598-023-33260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
This study carried out direct photocoagulation for treating microaneurysms (MAs) in diabetic macular edema (DME) using a navigation laser system with a 30-ms pulse duration. The MA closure rate after 3 months was investigated using pre and postoperative fluorescein angiography images. MAs primarily inside the edematous area based on optical coherence tomography (OCT) maps were selected for treatment, and leaking MAs (n = 1151) were analyzed in 11 eyes (eight patients). The total MA closure rate was 90.1% (1034/1151), and the mean MA closure rate in each eye was 86.5 ± 8.4%. Mean central retinal thickness (CRT) decreased from 471.9 ± 73.0 μm to 420.0 ± 87.5 μm (P = 0.049), and there was a correlation between the MA closure rate and the CRT reduction rate (r = 0.63, P = 0.037). There was no difference in the MA closure rate depending on the degree of edema thickness based on a false-color topographic OCT map image. Direct photocoagulation for DME with a short pulse using the navigated photocoagulator resulted in a high MA closure rate in just 3 months and a corresponding improvement in retinal thickness. These findings encourage the use of a new therapeutic approach for DME.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
- Department of Ophthalmology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Taku Toyama
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Tomohiko Yanagita
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Jiro Numaga
- Department of Ophthalmology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Satoshi Kato
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
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Ikegami Y, Shiraya T, Araki F, Ueta T, Toyama T, Yanagita T, Numaga J, Shoji N, Kato S. Microperimetric analysis of diabetic macular edema after navigated direct photocoagulation with short-pulse laser for microaneurysms. Int J Retina Vitreous 2023; 9:12. [PMID: 36864536 PMCID: PMC9979500 DOI: 10.1186/s40942-023-00447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Focal laser photocoagulation is an important treatment option for diabetic macular edema (DME). This study aimed to examine the retinal sensitivity (RS) and morphological changes at the coagulated site after direct photocoagulation of microaneurysms (MAs) in patients with DME using a navigated laser photocoagulator with a short-pulse duration of 30 ms. METHODS Images of early-phase fluorescein angiography were merged with images from the optical coherence tomography (OCT) map with 9 Early Treatment Diabetic Retinopathy Study grid circles, and MAs inside the edema area were selected for direct photocoagulation. The best-corrected visual acuity (BCVA), parameters of the OCT map including central retinal thickness and retinal thickness in edema range, central RS, and RS in the edema area were assessed at 1 and 3 months after the laser treatment. The RS points that overlapped with the laser spots were identified by merging the Navilas' digital treatment reports and the microperimetry images. RESULTS Seventeen eyes from 14 patients were studied. The mean retinal thickness in the edema range decreased at 3 months compared with pretreatment (P = 0.042), but the BCVA, central retinal thickness, central RS, and RS in the edema area remained unchanged. Overall, 32 of 400 sensitivity points overlapped with the laser-coagulated spots. The mean RS at these spots were 22.4 ± 5.3 dB at 1 month and 22.5 ± 4.8 dB at 3 months, with no significant change from the baseline of 22.7 ± 3.5 dB. CONCLUSIONS Retinal thickness improved in the coagulated edema area without a decrease in RS after direct photocoagulation of MAs with a short 30-ms pulse using Navilas. This promising therapeutic strategy for DME is effective and minimally invasive.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. .,Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
| | - Tomoyasu Shiraya
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Fumiyuki Araki
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takashi Ueta
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Toyama
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomohiko Yanagita
- grid.410786.c0000 0000 9206 2938Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa Japan
| | - Jiro Numaga
- grid.417092.9Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Nobuyuki Shoji
- grid.410786.c0000 0000 9206 2938Department of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa Japan
| | - Satoshi Kato
- grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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