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Haliyur R, Parkinson DH, Ma F, Xu J, Li Q, Huang Y, Tsoi LC, Bogle R, Liu J, Gudjonsson JE, Rao RC. Liquid Biopsy for Proliferative Diabetic Retinopathy: Single-Cell Transcriptomics of Human Vitreous Reveals Inflammatory T-Cell Signature. OPHTHALMOLOGY SCIENCE 2024; 4:100539. [PMID: 39220810 PMCID: PMC11365369 DOI: 10.1016/j.xops.2024.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 09/04/2024]
Abstract
Purpose Current therapies for proliferative diabetic retinopathy (PDR) do not specifically target VEGF-independent, cell-type-specific processes that lead to vision loss, such as inflammatory pathways. This study aimed to identify targetable cell types and corresponding signaling pathways by elucidating the single-cell landscape of the vitreous of patients with PDR. Design Case series. Subjects Vitreous and peripheral blood obtained from 5 adult patients (6 eyes) undergoing pars plana vitrectomy for vision-threatening PDR. Methods Single-cell RNA sequencing (scRNA-seq) was performed on vitreous cells obtained from diluted cassette washings during vitrectomy from 6 eyes and peripheral blood mononuclear cells (PBMCs, n = 5). Droplet-based scRNA-seq was performed using the Chromium 10x platform to obtain single-cell transcriptomes. Differences in tissue compartments were analyzed with gene ontology enrichment of differentially expressed genes and an unbiased ligand-receptor interaction analysis. Main Outcome Measures Single-cell transcriptomic profiles of vitreous and peripheral blood. Results Transcriptomes from 13 675 surgically harvested vitreous cells and 22 636 PBMCs were included. Clustering revealed 4 cell states consistently across all eyes with representative transcripts for T cells (CD2, CD3D, CD3E, and GZMA), B cells (CD79A, IGHM, MS4A1 (CD20), and HLA-DRA), myeloid cells (LYZ, CST3, AIF1, and IFI30), and neutrophils (BASP1, CXCR2, S100A8, and S100A9). Most vitreous cells were T cells (91.6%), unlike the peripheral blood (46.2%), whereas neutrophils in the vitreous were essentially absent. The full repertoire of adaptive T cells including CD4+, CD8+ and T regulatory cells (Treg) and innate immune system effectors (i.e., natural killer T cells) was present in the vitreous. Pathway analysis also demonstrated activation of CD4+ and CD8+ memory T cells and ligand-receptor interactions unique to the vitreous. Conclusions In the first single-cell transcriptomic characterization of human vitreous in a disease state, we show PDR vitreous is primarily composed of T cells, a critical component of adaptive immunity, with activity and proportions distinct from T cells within the peripheral blood, and neutrophils are essentially absent. These results demonstrate the feasibility of liquid vitreous biopsies via collection of otherwise discarded, diluted cassette washings during vitrectomy to gain mechanistic and therapeutic insights into human vitreoretinal disease. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Rachana Haliyur
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - David H. Parkinson
- Medical Scientist Training Program, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Feiyang Ma
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jing Xu
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Qiang Li
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Yuanhao Huang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Lam C. Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rachael Bogle
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jie Liu
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Johann E. Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rajesh C. Rao
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Center for RNA Biomedicine, University of Michigan, Ann Arbor, Michigan
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, Michigan
- Section of Ophthalmology, Surgery Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
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Bozkurt E, Kaplan FB, Önder Tokuç E, Aykut A, Özsoy Saygın I, Kanar HS, Kutlutürk I, Sevik MO, Yayla U, Çelik E, Demirciler Sönmez A, Aydogan Gezginaslan T, Limon U, Türkseven Kumral E, Erçalık NY, Aydın Öncü Ö, Başaran Emengen E, Özkaya A, Açıkalın Öncel B, Yenerel NM, Şahin Ö, Karabaş VL. Evaluation of the effect of vitreomacular interface disorders on anti-VEGF treatment in patients with diabetic macular edema in real life: MARMASIA study group report No. 10. Int Ophthalmol 2024; 44:391. [PMID: 39317810 DOI: 10.1007/s10792-024-03251-1] [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: 03/24/2024] [Accepted: 07/14/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE The aim of this study is to investigate the effect of vitreomacular interface disorders (VMID) on treatment response in patients treated with anti-vascular endothelial growth factor (anti-VEGF) due to diabetic macular edema (DME). METHODS Three hundred seventy-seven eyes of 239 patients in the MARMASIA Study Group who received intravitreal anti-VEGF treatment (IVT) due to DME were included in the study. The group 1 consisted of 44 eyes of the patients who had not received any treatment before, were followed up regularly for 24 months after at least a 3-month loading dose, and suffered from VMID such as epiretinal membrane, vitreomacular adhesion or traction, and lamellar hole. The group 2 consisted of 333 eyes of the patients without VMID. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients at baseline, 3rd month, 6th month, 1st year and 2nd year follow-ups were measured. RESULTS The mean age of the Groups 1 and 2 was 67.1 ± 11.3 and 61.9 ± 10.2 years, respectively. 61.3% of the group 1 and 58.8% of the group 2 were female (p > 0.05). The duration of diabetes was 19.2 ± 3.7 and 15.8 ± 3.2 years, respectively, and the number of follow-ups was 16.09 ± 4.68 and 12.06 ± 4.58, respectively in the groups (p < 0.001, 0.001, respectively). The number of IVT was 7.13 ± 2.71 and 7.20 ± 2.22, respectively in the groups 1 and 2 and no statistically significant difference was observed between them (p = 0.860). According to logMAR, BCVA values at baseline were 0.63 ± 0.24 and 0.59 ± 0.26 (p = 0.29), respectively, in the groups and the amount of change in BCVA at the end of the 2nd year was - 0.02 ± 0.48 in the group 1 and - 0.12 ± 0.48 in the group 2. It was observed as 0.48 (p = 0.13). Although the increase in BCVA was greater at all follow-ups in the group 2 compared to their initial examination, no significant difference was observed between the groups in terms of BCVA change. The CMT values of the groups at baseline were 442.5 ± 131.3 µm and 590.9 ± 170.6 µm, respectively (p = 0.03) The decrease in CMT after IVT was significantly greater in the group 2 at all follow-ups when compared to the first group (p < 0.05). CONCLUSION While the presence of VMID in DME patients receiving IVT did not affect visual results, it negatively affected the anatomical response and macular edema morphology. The presence of VMID at baseline affected the success of IVT. It should be taken into consideration that VMID may resolve spontaneously or with IVT, and new cases of VMID may occur in patients during the treatment process.
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Affiliation(s)
- Erdinç Bozkurt
- Umraniye Education and Research Hospital, Department of Ophthalmology, FEBO, The University of Health Sciences, Istanbul, Turkey.
| | - Fatih Bilgehan Kaplan
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ecem Önder Tokuç
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Işılay Özsoy Saygın
- Umraniye Education and Research Hospital, Department of Ophthalmology, FEBO, The University of Health Sciences, Istanbul, Turkey
| | - Hatice Selen Kanar
- Kartal Dr. Lütfi Kırdar City Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Işıl Kutlutürk
- Kartal Dr. Lütfi Kırdar City Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Uğur Yayla
- Department of Ophthalmology, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey
| | - Erkan Çelik
- Department of Ophthalmology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ayşe Demirciler Sönmez
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Tugba Aydogan Gezginaslan
- Umraniye Education and Research Hospital, Department of Ophthalmology, FEBO, The University of Health Sciences, Istanbul, Turkey
| | - Utku Limon
- Umraniye Education and Research Hospital, Department of Ophthalmology, FEBO, The University of Health Sciences, Istanbul, Turkey
| | - Esra Türkseven Kumral
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Nimet Yeşim Erçalık
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Özlem Aydın Öncü
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ece Başaran Emengen
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Abdullah Özkaya
- Ophthalmology Clinic, Memorial Şişli Hospital, Istanbul, Turkey
| | - Banu Açıkalın Öncel
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Nursal Melda Yenerel
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Veysel Levent Karabaş
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Ivanescu A, Popescu S, Ivanescu R, Potra M, Timar R. Predictors of Diabetic Retinopathy in Type 2 Diabetes: A Cross-Sectional Study. Biomedicines 2024; 12:1889. [PMID: 39200353 PMCID: PMC11352174 DOI: 10.3390/biomedicines12081889] [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: 07/09/2024] [Revised: 08/04/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) represents one of the most impacting health issues of the modern era, as it is associated with an extensive range of comorbidities. Diabetic retinopathy (DR) is one the utmost severe diabetes complications as it is one of the major causes of vision loss among these patients. Our present research aims to evaluate the most frequent risk factors related to the occurrence of DR in T2DM patients. METHOD This study consisted of a research group of 302 participants, priorly diagnosed with T2DM, that were evaluated for the most important risk factors related to the occurrence of DR. RESULTS Patients had a median age of 64 years, 48% of them being women, with a 12-year median duration of DM and presenting a deficient glycaemic control echoed by a median HbA1C value of 7.5%. From the total number of participants, the total prevalence of DR in different stages of severity was 34.8% with a 95% CI. Statistically significant values were found regarding DM duration (p = 0.007), HbA1c > 7.2% (p = 0.001) and patients aged over 67 years (p = 0.0035), all these parameters being directly linked to DR. CONCLUSIONS Older patients with T2DM that have a longer disease duration and simultaneous comorbidities present a higher risk of DR development, consequently a stringent management of these pathologies is needed.
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Affiliation(s)
- Adriana Ivanescu
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.I.); (M.P.); (R.T.)
- Opticlass Ophtalmology Clinic, 300012 Timisoara, Romania
| | - Simona Popescu
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.I.); (M.P.); (R.T.)
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
| | - Radu Ivanescu
- Opticlass Ophtalmology Clinic, 300012 Timisoara, Romania
| | - Monica Potra
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.I.); (M.P.); (R.T.)
| | - Romulus Timar
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.I.); (M.P.); (R.T.)
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
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İnam O, El-Baz A, Kaplan HJ, Tezel TH. Colorimetric Analyses of the Optic Nerve Head and Retina Indicate Increased Blood Flow After Vitrectomy. Transl Vis Sci Technol 2024; 13:12. [PMID: 39007833 PMCID: PMC467108 DOI: 10.1167/tvst.13.7.12] [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: 01/22/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of vitrectomy and posterior hyaloid (PH) peeling on color alteration of optic nerve head (ONH) and retina as a surrogate biomarker of induced perfusion changes. Methods Masked morphometric and colorimetric analyses were conducted on preoperative (<1 month) and postoperative (<18 months) color fundus photographs of 54 patients undergoing vitrectomy, either with (44) or without (10) PH peeling and 31 years of age and gender-matched control eyes. Images were calibrated according to the hue and saturation values of the parapapillary venous blood column. Chromatic spectra of the retinal pigment epithelium and choroid were subtracted to avoid color aberrations. Red, green, and blue (RGB) bit values over the ONH and retina were plotted within the constructed RGB color space to analyze vitrectomy-induced color shift. Vitrectomy-induced parapapillary vein caliber changes were also computed morphometrically. Results A significant post-vitrectomy red hue shift was noted on the ONH (37.1 degrees ± 10.9 degrees vs. 4.1 degrees ± 17.7 degrees, P < 0.001), which indicates a 2.8-fold increase in blood perfusion compared to control (2.6 ± 1.9 vs. 0.9 ± 1.8, P < 0.001). A significant post-vitrectomy increase in the retinal vein diameter was also noticed (6.8 ± 6.4% vs. 0.1 ± 0.3%, P < 0.001), which was more pronounced with PH peeling (7.9 ± 6.6% vs. 3.1 ± 4.2%, P = 0.002). Conclusions Vitrectomy and PH peeling increase ONH and retinal blood flow. Colorimetric and morphometric analyses offer valuable insights for future artificial intelligence and deep learning applications in this field. Translational Relevance The methodology described herein can easily be applied in different clinical settings and may enlighten the beneficial effects of vitrectomy in several retinal vascular diseases.
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Affiliation(s)
- Onur İnam
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Biophysics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - Henry J. Kaplan
- Department of Ophthalmology & Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, KY, USA
- Department of Ophthalmology, Saint Louis University, School of Medicine, St. Louis, MO, USA
| | - Tongalp H. Tezel
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Ophthalmology & Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, KY, USA
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Karimi S, Karrabi N, Hassanpour K, Amirabadi A, Daneshvar K, Nouri H, Abtahi SH. The additive effect of intravitreal dexamethasone combined with bevacizumab in refractory diabetic macular edema. J Fr Ophtalmol 2023; 46:1019-1029. [PMID: 37481454 DOI: 10.1016/j.jfo.2023.04.001] [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: 08/31/2022] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To evaluate the short-term structural and visual outcomes and side effects associated with intravitreal dexamethasone (IVD) combined with bevacizumab (IVB) in treating patients with diabetic macular edema (DME) and an inadequate response to anti-vascular endothelial growth factor (anti-VEGF) agents. METHODS In this prospective interventional case series, a total of 81 eyes of 81 patients with type 2 diabetes mellitus (T2DM) and refractory DME were included and assigned to one of two groups: I) those receiving three monthly intravitreal injections of combined bevacizumab and dexamethasone (IVB+IVD) and II) those receiving three monthly intravitreal injections of bevacizumab alone (IVB). The primary outcome was the inter-group difference in central macular thickness (CMT); secondary outcomes included best-corrected visual acuity (BCVA), baseline optical coherence tomography (OCT) biomarkers, and intraocular pressure (IOP) one month after the last injection. RESULTS Reduction in CMT and improvement in BCVA were significantly greater in the IVB+IVD group than the IVB group (109.88±156.25 vs. 43±113.67, respectively, P=0.03; and -0.13±0.23 vs. -0.01±0.17, respectively, P=0.008). Presence of neurosensory retinal detachment (NSD) (P<0.001) and complete inner segment/outer segment junction (IS-OS) disruption (P=0.049) on baseline OCT scans were associated with further CMT reductions in response to IVD. Conversely, identifiable epiretinal membrane (ERM) (P=0.002) and multiple hyperreflective foci (>20) (P=0.049) were associated with smaller reductions in CMT. Vitreomacular traction correlated with worse visual outcomes in the IVB+IVD group (P=0.003). The intergroup IOP difference was not clinically significant. CONCLUSION In patients with refractory DME, addition of IVD to the standard IVB regimen can improve visual and structural outcomes without increasing the risk of endophthalmitis, IOP rise, or intraocular inflammation. Patients with NSD are more likely to respond well to IVD. The presence of ERM may predict poor treatment response.
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Affiliation(s)
- S Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Karrabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - K Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Amirabadi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - K Daneshvar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jones CH, Gui W, Schumann RG, Boneva S, Lange CAK, van Overdam K, Chui TYP, Rosen RB, Engelbert M, Sebag J. Hyalocytes in proliferative vitreo-retinal diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:263-280. [PMID: 36466118 PMCID: PMC9718005 DOI: 10.1080/17469899.2022.2100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
Abstract
Introduction Hyalocytes are sentinel macrophages residing within the posterior vitreous cortex anterior to the retinal inner limiting membrane (ILM). Following anomalous PVD and vitreoschisis, hyalocytes contribute to paucicellular (vitreo-macular traction syndrome, macular holes) and hypercellular (macular pucker, proliferative vitreo-retinopathy, proliferative diabetic vitreo-retinopathy) diseases. Areas covered Studies of human tissues employing dark-field, phase, and electron microscopy; immunohistochemistry; and in vivo imaging of human hyalocytes. Expert opinion Hyalocytes are important in early pathophysiology, stimulating cell migration and proliferation, as well as subsequent membrane contraction and vitreo-retinal traction. Targeting hyalocytes early could mitigate advanced disease. Ultimately, eliminating the role of vitreous and hyalocytes may prevent proliferative vitreo-retinal diseases entirely.
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Affiliation(s)
| | - Wei Gui
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | | | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens AK Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | | | - Toco YP Chui
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York; NYU School of Medicine, New York, USA
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
- Doheny Eye Institute, UCLA, Pasadena, California, USA
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Garip R, Çınar AK, Çınar AC, Gürlü V. NATURAL COURSE OF VITREOMACULAR TRACTION IN EYES WITH DIABETIC RETINOPATHY AND FACTORS ASSOCIATED WITH SPONTANEOUS RELEASE. Retina 2021; 41:1668-1674. [PMID: 33394961 DOI: 10.1097/iae.0000000000003093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy and to evaluate the factors associated with VMT relief. METHODS Seventy-four eyes of 65 patients with VMT accompanying diabetic retinopathy were evaluated retrospectively. The presence of intravitreal injection and the presence of panretinal photocoagulation were obtained from the medical records of the patients. Spontaneous release of VMT, the horizontal length of vitreomacular traction, the presence of hyperreflective retinal spots, the presence of the epiretinal membrane, and the grade of VMT were evaluated from the spectral-domain optical coherence tomography images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis. RESULTS Spontaneous release was observed in 28 eyes (37.8%). The horizontal length of VMT was lower in the release of the VMT group compared with the persistent VMT group (P = 0.03). The persistent VMT group had a higher rate of hyperreflective retinal spots and epiretinal membrane compared with the release of the VMT group (respectively; P = 0.003 and P = 0.031). No statistically significant difference was observed between the release of VMT and persistent VMT groups in terms of intravitreal injection and panretinal photocoagulation treatment (respectively; P = 0.938 and P = 0.36). The absence of hyperreflective retinal spots was the most important prognostic factor for the spontaneous release of VMT (P = 0.029). CONCLUSION Spontaneous release of VMT observed higher rates of patients without hyperreflective retinal spots, epiretinal membrane, and patients with lower horizontal length of VMT.
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Affiliation(s)
- Rüveyde Garip
- Department of Ophthalmology, Trakya University School of Medicine, Edirne, Turkey
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Mastropasqua L, Perilli R, D'Aloisio R, Toto L, Mastropasqua A, Donato S, Taraborrelli M, Ginestra F, Porta M, Consoli A. Why Miss the Chance? Incidental Findings while Telescreening for Diabetic Retinopathy. Ophthalmic Epidemiol 2020; 27:237-245. [PMID: 31958252 DOI: 10.1080/09286586.2020.1715450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To report on incidental pathological findings met while screening for Diabetic Retinopathy (DR) in Diabetes Clinics (DC) by ophthalmologist-graded digital fundus imaging. METHODS At the DC of Pescara (central Italy), for 3,859 eyes of 1,930 consecutive patients having not undergone fundus examination in the last year, two mydriatic fundus digital images, taken with a CenterVue DRS Digital Retinal Camera, were sent along with Best Corrected Visual Acuity, on a "store-and-forward" basis, to an ophthalmologist trained in DR screening, and graded according to the UK Diabetic Eye Screening Programme. Incidental fundus abnormalities other than DR were reported. RESULTS No adverse event to mydriasis was reported. One hundred and eighty eyes (4.66%) were ungradable. Among the 3,679 gradable ones, 1,105 (30.04%) showed different degrees of DR (R1 to R3), and 126 (3.42%) maculopathy (M1). Any Age-Related Macular Degeneration was present in 387 eyes (10.52%), any optic disc and parapapillary area features suspect for glaucoma in 562 eyes (15.27%), any hypertensive retinopathy in 1,263 eyes (34.33%), vitreoretinal interface disease in 252 eyes (6.84%), myopic choroidopathy in 92 eyes (2.50%), disc pallor in 31 eyes (0.84%). Mean time was 5 min for screening, 2 min for grading. CONCLUSION Teleretinography is a well-established, cost-effective procedure in DR screening. Along with increased attendance, locating a digital camera in a DC with a retina-specialist grader results in finding fundus pathologies also beyond DR, very similarly to fundus examination in an outpatient ophthalmic setting.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Roberto Perilli
- Territorial Ophthalmology Unit, Local Health Authority , Pescara, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Alessandra Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Simone Donato
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Merilda Taraborrelli
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Federica Ginestra
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Massimo Porta
- Chair of Internal Medicine, Department Of Medical Sciences, University of Turin , Turin, Italy
| | - Agostino Consoli
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
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Anderson W, Piggott K, Bao YK, Pham H, Kavali S, Rajagopal R. Complete Posterior Vitreous Detachment Reduces the Need for Treatment of Diabetic Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e266-e273. [PMID: 31755977 PMCID: PMC7941753 DOI: 10.3928/23258160-20191031-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the vitreomacular interface and its relation to treatment burden for diabetic macular edema (DME) in patients without overt vitreomacular traction (VMT). PATIENTS AND METHODS A retrospective cohort study of 494 eyes from 274 patients who had macular spectral-domain optical coherence tomography (SD-OCT) and did not have proliferative diabetic retinopathy, DME, or VMT at the initial visit. Posterior vitreous detachment (PVD) was categorized at the initial visit into five stages (0-4) using SD-OCT parameters alone. RESULTS Two of 34 eyes (6.9%) presenting with a complete PVD required DME treatment during follow-up, whereas 144 of 460 eyes (31.3%) without a complete PVD at baseline required treatment (P = .001, Chi-squared). After adjusting for age, ethnicity, gender, and HbA1c, complete PVD at baseline was associated with a significant reduction in risk of DME therapy (hazard ratio: 0.18; 95% confidence interval, 0.05-0.73; P = .02). CONCLUSION Complete PVD is independently associated with a reduced need for DME treatment. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e266-e273.].
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Affiliation(s)
- William Anderson
- Department of Ophthalmology, Saint Louis University School of Medicine, Saint Louis, MO 63104 (WA, HP, SK)
| | - Kisha Piggott
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110 (KP, RR)
| | - Yicheng K. Bao
- Department of Medicine, University of Missouri – Kansas City School of Medicine, Kansas City, MO 64112 (YKB)
| | - Hang Pham
- Department of Ophthalmology, Saint Louis University School of Medicine, Saint Louis, MO 63104 (WA, HP, SK)
| | - Sweta Kavali
- Department of Ophthalmology, Saint Louis University School of Medicine, Saint Louis, MO 63104 (WA, HP, SK)
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110 (KP, RR)
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Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J Clin Med 2019; 8:jcm8050716. [PMID: 31137510 PMCID: PMC6572121 DOI: 10.3390/jcm8050716] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.
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Nawaz IM, Rezzola S, Cancarini A, Russo A, Costagliola C, Semeraro F, Presta M. Human vitreous in proliferative diabetic retinopathy: Characterization and translational implications. Prog Retin Eye Res 2019; 72:100756. [PMID: 30951889 DOI: 10.1016/j.preteyeres.2019.03.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
Diabetic retinopathy (DR) is one of the leading causes of visual impairment in the working-age population. DR is a progressive eye disease caused by long-term accumulation of hyperglycaemia-mediated pathological alterations in the retina of diabetic patients. DR begins with asymptomatic retinal abnormalities and may progress to advanced-stage proliferative diabetic retinopathy (PDR), characterized by neovascularization or preretinal/vitreous haemorrhages. The vitreous, a transparent gel that fills the posterior cavity of the eye, plays a vital role in maintaining ocular function. Structural and molecular alterations of the vitreous, observed during DR progression, are consequences of metabolic and functional modifications of the retinal tissue. Thus, vitreal alterations reflect the pathological events occurring at the vitreoretinal interface. These events are caused by hypoxic, oxidative, inflammatory, neurodegenerative, and leukostatic conditions that occur during diabetes. Conversely, PDR vitreous can exert pathological effects on the diabetic retina, resulting in activation of a vicious cycle that contributes to disease progression. In this review, we recapitulate the major pathological features of DR/PDR, and focus on the structural and molecular changes that characterize the vitreal structure and composition during DR and progression to PDR. In PDR, vitreous represents a reservoir of pathological signalling molecules. Therefore, in this review we discuss how studying the biological activity of the vitreous in different in vitro, ex vivo, and in vivo experimental models can provide insights into the pathogenesis of PDR. In addition, the vitreous from PDR patients can represent a novel tool to obtain preclinical experimental evidences for the development and characterization of new therapeutic drug candidates for PDR therapy.
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Affiliation(s)
- Imtiaz M Nawaz
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Sara Rezzola
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Anna Cancarini
- Department of Ophthalmology, University of Brescia, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Brescia, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Marco Presta
- Department of Molecular and Translational Medicine, University of Brescia, Italy.
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ILM peeling in nontractional diabetic macular edema: review and metanalysis. Int Ophthalmol 2017; 38:2709-2714. [PMID: 29090356 DOI: 10.1007/s10792-017-0761-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 10/23/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate the effect of internal limiting membrane (ILM) peeling during vitrectomy for nontractional diabetic macular edema. METHODS PUBMED, MEDLINE and CENTRAL were reviewed using the following terms (or combination of terms): diabetic macular edema, nontractional diabetic macular edema, internal limiting membrane peeling, vitrectomy, Müller cells. Randomized and nonrandomized studies were included. The eligible studies compared anatomical and functional outcomes of vitrectomy with or without ILM peeling for tractional and nontractional diabetic macular edema. Postoperative best-corrected visual acuity and central macular thickness were considered, respectively, the primary and secondary outcomes. Meta-analysis on mean differences between vitrectomy with and without ILM peeling was performed using inverse variance method in random effects. RESULTS Four studies with 672 patients were eligible for analysis. No significant difference was found between postoperative best-corrected visual acuity or best-corrected visual acuity change of ILM peeling group compared with nonpeeling group. There was no significant difference in postoperative central macular thickness and central macular thickness reduction between the two groups. CONCLUSIONS The visual acuity outcomes in patients affected by nontractional diabetic macular edema using pars plana vitrectomy with ILM peeling versus no ILM peeling were not significantly different. A larger prospective and randomized study would be necessary.
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Moisseiev E, Moisseiev J, Loewenstein A. Surgical treatment for diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1182864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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