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Li J, Li X, Lei M, Li W, Chen W, Ma T, Gao Y, Ye Z, Li Z. A prediction model for worsening diabetic retinopathy after panretinal photocoagulation. Diabetol Metab Syndr 2022; 14:124. [PMID: 36028852 PMCID: PMC9419399 DOI: 10.1186/s13098-022-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As one of the severe complications of diabetes mellitus, diabetic retinopathy (DR) is the leading cause of blindness in the working age worldwide. Although panretinal photocoagulation (PRP) was standard treatment, PRP-treated DR still has a high risk of progression. Hence, this study aimed to assess the risk factors and establish a model for predicting worsening diabetic retinopathy (DR-worsening) within five years after PRP. METHODS Patients who were diagnosed with severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy and treated with PRP were included, and those patients were randomly assigned to either a training or validation cohort. The multivariate logistic regression analysis was used to screen potential risk factors for DR-worsening in the training cohort. Then the model was established after including significant independent risk factors and further validated using discrimination and calibration. RESULTS A total of 271 patients were included, and 56.46% of patients had an outcome of DR-worsening. In the training cohort (n = 135), age (odds ratio [OR] = 0.94, 95% confidence interval [CI] 0.90-0.98), baseline best corrected visual acuity (logMAR) (OR = 10.74, 95% CI 1.84-62.52), diabetic nephropathy (OR = 9.32, 95% CI 1.49-58.46), and hyperlipidemia (OR = 3.34, 95% CI 1.05-10.66) were screened out as the independent risk factors, which were incorporated into the predictive model. The area under the receiver operating characteristic curve and calibration slope in the training and validation cohort were 0.79, 0.96 (95% CI 0.60-1.31), and 0.79, 1.00 (95% CI 0.66-1.34), respectively. Two risk groups were developed depending on the best cut-off value of the predicted probability, and the actual probability was 34.90% and 82.79% in the low-risk and high-risk groups, respectively (P < 0.001). CONCLUSIONS This study developed and internally validated a new model to predict the probability of DR-worsening after PRP treatment within five years. The model can be used as a rapid risk assessment system for clinical prediction of DR-worsening and identify individuals at a high risk of DR-worsening at an early stage and prescribe additional treatment.
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Affiliation(s)
- Jinglan Li
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Xuanlong Li
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | | | - Wanyue Li
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Wenqian Chen
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Tianju Ma
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Yi Gao
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Zi Ye
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Zhaohui Li
- Department of Ophthalmology, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
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Yen CY, Yen JC, Chen CC, Hu HY, Cheng FS, Tseng PC. Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study. Medicine (Baltimore) 2022; 101:e30115. [PMID: 35984152 PMCID: PMC9387960 DOI: 10.1097/md.0000000000030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to investigate the therapeutic effect of cataract surgery along with simultaneous intravitreal injection (IVI) of aflibercept on diabetic macular edema (DME). This cohort study enrolled 106 patients aged >40 years with type 2 diabetes mellitus and DME who received cataract surgery from January 1, 2016, to October 31, 2020. The baseline and mean data of the following parameters were collected: age, sex, glycated hemoglobin level, diabetic retinopathy (DR) grading, previous DR treatments including IVI of anti-vascular endothelial growth factor and pan-retinal photocoagulation, intraocular pressure, use of intraocular pressure-lowering medication, central subfield thickness (CST), and log MAR visual acuity (VA). Patients were categorized into 2 groups based on whether they received aflibercept IVI or not during cataract surgery and were compared using the t test and Fisher exact test for continuous and discrete variables, respectively. Beta coefficient and standard error were calculated using multiple linear regression analysis to identify the explanatory variables predictive of the net change of CST and log MAR VA. There was no difference in the net change in CST (15.24 ± 45.07 μm vs 18.62 ± 33.84 μm, P = .772) and log MAR VA (-0.27 ± 0.29 vs -0.37 ± 0.31, P = .215). Gender, glycated hemoglobin level, aflibercept IVI during cataract surgery, and baseline CST did not interfere with the morphological and functional outcomes of DME in cataract surgery. Older age was significantly and independently associated with a greater net change in log MAR VA. Proliferative DR was significantly and independently associated with a greater net change in CST and log MAR VA. A greater baseline log MAR VA was significantly and independently associated with lower net change in log MAR VA. Simultaneous aflibercept IVI for treating DME may not interfere with the functional and tomographic parameters of cataract surgery relative to cataract surgery alone. Factors influencing the outcomes of patients with DME undergoing cataract surgery are as follows: age, baseline DR staging, and baseline VA. Identifying these factors of DME preoperatively may be an important consideration in preventing it from progressing and for improving the overall visual prognosis.
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Affiliation(s)
- Chu-Yu Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Ju-Chuan Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Chen Tseng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- *Correspondence: Po-Chen Tseng, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City 10629, Taiwan (e-mail: )
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Kim MK, Yoon JA, Yoon SY, Park M, Lee WS, Lyu SW, Song H. Human Platelet-Rich Plasma Facilitates Angiogenesis to Restore Impaired Uterine Environments with Asherman’s Syndrome for Embryo Implantation and Following Pregnancy in Mice. Cells 2022; 11:cells11091549. [PMID: 35563855 PMCID: PMC9101537 DOI: 10.3390/cells11091549] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
Asherman’s syndrome (AS) is caused by intrauterine adhesions and inactive endometrium from repeated curettage of the uterine endometrium. AS is a major cause of recurrent implantation failure and miscarriage and is very difficult to treat because of the poor recovery of endometrial basal cells. Platelet-rich plasma (PRP) has abundant growth factors that may induce angiogenesis and cell proliferation. Here, we demonstrate that human PRP (hPRP) significantly enhances angiogenesis to restore embryo implantation, leading to successful pregnancy in mice with AS. In mice with AS, hPRP treatment considerably reduced the expression of fibrosis markers and alleviated oligo/amenorrhea phenotypes. Mice with AS did not produce any pups, but the hPRP therapy restored their infertility. AS-induced abnormalities, such as aberrantly delayed embryo implantation and intrauterine growth retardation, were considerably eliminated by hPRP. Furthermore, hPRP significantly promoted not only the elevation of various angiogenic factors, but also the migration of endometrial stromal cells. It also increased the phosphorylation of STAT3, a critical mediator of wound healing, and the expression of tissue remodeling genes in a fibrotic uterus. PRP could be a promising therapeutic strategy to promote angiogenesis and reduce fibrosis in impaired uterine environments, leading to successful embryo implantation for better clinical outcomes in patients with AS.
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Affiliation(s)
- Min Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Jung Ah Yoon
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Sook Young Yoon
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Mira Park
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Korea;
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Haengseok Song
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Korea;
- Correspondence: ; Tel.: +82-031-881-7150
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