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Lee D, Kim SJ, Lee J. Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration. Vision (Basel) 2025; 9:35. [PMID: 40265403 PMCID: PMC12015909 DOI: 10.3390/vision9020035] [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: 03/19/2025] [Revised: 04/11/2025] [Accepted: 04/15/2025] [Indexed: 04/24/2025] Open
Abstract
Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). To date, anti-vascular endothelial growth factor (VEGF) treatment has been widely used to manage neovascular diseases associated with retinal ischemia. Nonetheless, a substantial number of patients with DR or AMD still suffer from incomplete response and adverse effects related to its therapy with limitations. Therefore, research scientists have been developing and finding novel treatments to protect against or prevent vision loss in those diseases. In this review article, we summarize the recent novel therapeutic approaches for the treatment of ischemic retinopathy (e.g., cell therapy, advanced molecular targeting, or drug delivery). This summary enables further research to obtain more solid evidence of novel effective drug development in retinal ischemic diseases.
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Affiliation(s)
| | | | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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2
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Singh RP, Welch L, Longo NL, Frese M. Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol 2023; 23:285. [PMID: 37349689 DOI: 10.1186/s12886-023-03034-9] [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: 02/08/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps. METHODS This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. RESULTS Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners' incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001). CONCLUSIONS This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
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Affiliation(s)
- Rishi P Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Lauren Welch
- Med Learning Group, 17th St #4, New York, NY, 10011, USA.
| | - Nicole L Longo
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
| | - Matt Frese
- Med Learning Group, 17th St #4, New York, NY, 10011, USA
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Hisamuddin ASDB, Naomi R, Manan KAB, Bahari H, Othman F, Embong H, Ismail A, Ahmed QU, Jumidil SH, Hussain MK, Zakaria ZA. The role of lutein-rich purple sweet potato leaf extract on the amelioration of diabetic retinopathy in streptozotocin-induced Sprague-Dawley rats. Front Pharmacol 2023; 14:1175907. [PMID: 37274105 PMCID: PMC10232805 DOI: 10.3389/fphar.2023.1175907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023] Open
Abstract
The objective of this study is to access the effect of purple sweet potato leaf (PSPL) extract on diabetic retinopathy (DR) of streptozotocin (STZ)-induced male Sprague-Dawley (SD) rats. In this study, rats were injected intraperitoneally with a single dose of 60 mg/kg STZ, and diabetes was confirmed on day 7. Rats were further divided into a few groups, which were then orally administered with one of the following treatments: 25 mg/kg of gliclazide (D25G), 200 mg/kg of PSPL extract (DT 200), and 400 mg/kg of PSPL extract (DT 400). However, the normal control (NS) and control group for diabetic (DNS) were given normal saline (NS) for 12 weeks. The results show that the treated group demonstrated a reduction in serum oral glucose tolerance test (OGTT) levels of DT 200 and DT 400, and an increase in the serum and retinal insulin levels, and restored oxidative stress markers in serum and retina on week 12. The PSPL extract exhibited protective effects in maintaining the kidney, liver, retina, and pancreas architecture in 400 mg/kg compared to the 200 mg/kg treated group and D25G, thereby restoring fully transparent lenses in diabetes-induced rats. In conclusion, 400 mg/kg PSPL is the most effective dose for the amelioration of STZ-induced DR pathology in male SD rats.
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Affiliation(s)
- Ahmad Safiyyu'd-din Bin Hisamuddin
- Borneo Research on Algesia, Inflammation and Neurodegeneration (BRAIN) Group, Faculty of Medicine and Health Sciences, Sabah Universiti Malaysia, Kota Kinabalu, Sabah, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ruth Naomi
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Khairul Aiman Bin Manan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hasnah Bahari
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Fezah Othman
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hashim Embong
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amin Ismail
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Qamar Uddin Ahmed
- Department of Pharmaceutical Chemistry, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Siti Hadizah Jumidil
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohd Khairi Hussain
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zainul Amiruddin Zakaria
- Borneo Research on Algesia, Inflammation and Neurodegeneration (BRAIN) Group, Faculty of Medicine and Health Sciences, Sabah Universiti Malaysia, Kota Kinabalu, Sabah, Malaysia
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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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Saha B, Roy A, Beltramo E, Sahoo OS. Stem cells and diabetic retinopathy: From models to treatment. Mol Biol Rep 2023; 50:4517-4526. [PMID: 36842153 DOI: 10.1007/s11033-023-08337-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/15/2023] [Indexed: 02/27/2023]
Abstract
Diabetic retinopathy is a common yet complex microvascular disease, caused as a complication of diabetes mellitus. Associated with hyperglycemia and subsequent metabolic abnormalities, advanced stages of the disease lead to fibrosis, subsequent visual impairment and blindness. Though clinical postmortems, animal and cell models provide information about the progression and prognosis of diabetic retinopathy, its underlying pathophysiology still needs a better understanding. In addition to it, the loss of pericytes, immature retinal angiogenesis and neuronal apoptosis portray the disease treatment to be challenging. Indulged with cell loss of both vascular and neuronal type cells, novel therapies like cell replacement strategies by various types of stem cells have been sightseen as a possible treatment of the disease. This review provides insight into the pathophysiology of diabetic retinopathy, current models used in modelling the disease, as well as the varied aspects of stem cells in generating three-dimensional retinal models. Further outlook on stem cell therapy and the future directions of stem cell treatment in diabetic retinopathy have also been contemplated.
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Affiliation(s)
- Bihan Saha
- National Institute of Technology Durgapur, Durgapur, 713209, West Bengal, India
| | - Akshita Roy
- Autonomous State Medical College, Fatehpur, 212601, Uttar Pradesh, India
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, 10124, Turin, Italy
| | - Om Saswat Sahoo
- National Institute of Technology Durgapur, Durgapur, 713209, West Bengal, India.
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7
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Lee AJ, Moon CH, Lee YJ, Jeon HY, Park WS, Ha KS. Systemic C-peptide supplementation ameliorates retinal neurodegeneration by inhibiting VEGF-induced pathological events in diabetes. FASEB J 2023; 37:e22763. [PMID: 36625326 DOI: 10.1096/fj.202201390rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/18/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
Diabetic retinopathy (DR) is caused by retinal vascular dysfunction and neurodegeneration. Intraocular delivery of C-peptide has been shown to be beneficial against hyperglycemia-induced microvascular leakage in the retina of diabetes; however, the effect of C-peptide on diabetes-induced retinal neurodegeneration remains unknown. Moreover, extraocular C-peptide replacement therapy against DR to avoid various adverse effects caused by intravitreal injections has not been studied. Here, we demonstrate that systemic C-peptide supplementation using osmotic pumps or biopolymer-conjugated C-peptide hydrogels ameliorates neurodegeneration by inhibiting vascular endothelial growth factor-induced pathological events, but not hyperglycemia-induced vascular endothelial growth factor expression, in the retinas of diabetic mice. C-peptide inhibited hyperglycemia-induced activation of macroglial and microglial cells, downregulation of glutamate aspartate transporter 1 expression, neuronal apoptosis, and histopathological changes by a mechanism involving reactive oxygen species generation in the retinas of diabetic mice, but transglutaminase 2, which is involved in retinal vascular leakage, is not associated with these pathological events. Overall, our findings suggest that systemic C-peptide supplementation alleviates hyperglycemia-induced retinal neurodegeneration by inhibiting a pathological mechanism, involving reactive oxygen species, but not transglutaminase 2, in diabetes.
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Affiliation(s)
- Ah-Jun Lee
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Chan-Hee Moon
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Yeon-Ju Lee
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hye-Yoon Jeon
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Kwon-Soo Ha
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, South Korea
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Bhambra N, Sayal AP, Popovic MM, Muni RH, Kertes PJ. Combination intravitreal anti-vascular endothelial growth factor inhibitors and macular laser photocoagulation relative to intravitreal injection monotherapy in macular oedema secondary to retinal vein occlusion: a meta-analysis of randomized controlled trials. Eye (Lond) 2022; 36:2271-2278. [PMID: 34819660 PMCID: PMC9674600 DOI: 10.1038/s41433-021-01833-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES This meta-analysis investigates the efficacy and safety of intravitreal anti-VEGF injections (IVI) compared to combination laser photocoagulation and IVI (LPC-IVI) in treating macular oedema secondary to retinal vein occlusion (RVO). SUBJECTS/METHODS A literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted from inception until March 2021. Randomized controlled trials that reported relevant efficacy and/or safety parameters following LPC-IVI relative to IVI were included. Meta-analysis was conducted with a random effects model. The primary outcome was best-corrected visual acuity (BCVA), while secondary outcomes were central macular thickness (CMT), central retinal thickness (CRT), central subfield thickness (CST), number of IVIs received, and incidence of adverse events. RESULTS A total of 10 studies were included, for which 362 eyes were randomized to LPC-IVI and 365 to IVI. In comparing macular laser photocoagulation with IVI (MLP-IVI) in BRVO patients, no significant differences were seen in final BCVA (p = 0.78) or change in BCVA (p = 0.09) after treatment. Similarly, no significant differences were seen in final CMT (p = 0.54), change in CMT (p = 0.33), final CRT (p = 0.90), change in CRT (p = 0.97), or number of injections required (p = 0.78). The same results were seen in subgroup analyses for macular laser without peripheral laser in BRVO and CRVO patients. Consistent results were observed when considering peripheral LPC-IVI to IVI in BRVO and CRVO. CONCLUSIONS No significant differences were seen between combination MLP-IVI or peripheral LPC-IVI relative to IVI monotherapy for final BCVA or OCT parameters in macular oedema secondary to RVO.
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Affiliation(s)
| | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Ashraf M, Wagdy W, Tawfik MA, Ahmed ISH, Souka A. Potential impact of fluorescein angiography as a primary imaging modality in the management of diabetic retinopathy. Indian J Ophthalmol 2022; 70:3579-3583. [PMID: 36190050 PMCID: PMC9789841 DOI: 10.4103/ijo.ijo_641_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management. Methods Cross-sectional survey conducted in Egypt amongst practicing ophthalmologists. Results The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non-proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one-year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045. Conclusion Given that FA detects significantly greater pathology than CI, and that treatment and follow-up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs.
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Affiliation(s)
- Mohamed Ashraf
- Harvard Medical School, 1 Joslin Place, Boston, USA,Correspondence to: Dr. Mohamed Ashraf, Harvard Medical School, 1 Joslin Place, Boston, USA. E-mail:
| | - Walaa Wagdy
- Alexandria Faculty of Medicine, Champilion Street, Azarita, Raml Station, Alexandria, Egypt
| | | | | | - Ahmed Souka
- Alexandria Faculty of Medicine, Champilion Street, Azarita, Raml Station, Alexandria, Egypt
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10
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Li D, Liu Y, Wu N. Application progress of nanotechnology in regenerative medicine of diabetes mellitus. Diabetes Res Clin Pract 2022; 190:109966. [PMID: 35718019 DOI: 10.1016/j.diabres.2022.109966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
In recent years, the development of diabetic regenerative medicine has led to new developments and progress for the clinical treatment of diabetes mellitus and its various complications. Besides, the emergence of nanotechnology has injected new vitality into diabetic regenerative medicine. Nano-stent provides an appropriate direction for the regeneration of islet β cells, retinal tissue, nerve tissue, and wound tissue cells. Conductive nanomaterials promote various tissues' growth. Many nanoparticles also promote wound healing and present other advantages that have solved many potential problems in the practical application of regenerative medicine. In this review, we will summarize the application of nanotechnology in diabetic regenerative medicine.
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Affiliation(s)
- Danyang Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Yuxin Liu
- Student Affairs Department, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang 110004, PR China; Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang 110004, PR China.
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11
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Sharma D, Bisen S, Kaur G, Van Buren EC, Rao GN, Singh NK. IL-33 enhances Jagged1 mediated NOTCH1 intracellular domain (NICD) deubiquitination and pathological angiogenesis in proliferative retinopathy. Commun Biol 2022; 5:479. [PMID: 35589941 PMCID: PMC9120174 DOI: 10.1038/s42003-022-03432-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/29/2022] [Indexed: 01/10/2023] Open
Abstract
Pathological retinal neovascularization (NV) is a clinical manifestation of various proliferative retinopathies, and treatment of NV using anti-VEGF therapies is not selective, as it also impairs normal retinal vascular growth and function. Here, we show that genetic deletion or siRNA-mediated downregulation of IL-33 reduces pathological NV in a murine model of oxygen-induced retinopathy (OIR) with no effect on the normal retinal repair. Furthermore, our fluorescent activated cell sorting (FACS) data reveals that the increase in IL-33 expression is in endothelial cells (ECs) of the hypoxic retina and conditional genetic deletion of IL-33 in retinal ECs reduces pathological NV. In vitro studies using human retinal microvascular endothelial cells (HRMVECs) show that IL-33 induces sprouting angiogenesis and requires NFkappaB-mediated Jagged1 expression and Notch1 activation. Our data also suggest that IL-33 enhances de-ubiquitination and stabilization of Notch1 intracellular domain via its interaction with BRCA1-associated protein 1 (BAP1) and Numb in HRMVECs and a murine model of OIR.
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Affiliation(s)
- Deepti Sharma
- Integrative Biosciences Center, Wayne State University, Detroit, MI, 48202, USA
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, 48202, USA
| | - Shivantika Bisen
- Integrative Biosciences Center, Wayne State University, Detroit, MI, 48202, USA
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, 48202, USA
| | - Geetika Kaur
- Integrative Biosciences Center, Wayne State University, Detroit, MI, 48202, USA
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, 48202, USA
| | - Eric C Van Buren
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Gadiparthi N Rao
- Department of Physiology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Nikhlesh K Singh
- Integrative Biosciences Center, Wayne State University, Detroit, MI, 48202, USA.
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, 48202, USA.
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12
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Vithalani NM, Belenje A, Narayanan R. Bilateral serous choroidal detachment post panretinal photocoagulation as a clue in diagnosis of early diabetic nephropathy. BMJ Case Rep 2022; 15:e248272. [PMID: 35039385 PMCID: PMC8768933 DOI: 10.1136/bcr-2021-248272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nidhi Mahendra Vithalani
- Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Akash Belenje
- Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Retina, LV Prasad Eye Institute, Hyderabad, Telangana, India
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13
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Abstract
Laser photocoagulation of the retina is a highly effective technique for preventing visual loss in patients with a wide range of eye fundus diseases. The procedure involves creating thermal burns in the eye fundus accompanied by tissue coagulation, but unfortunately it can lead to possible side-effects and potential complications in the future. Some of the rare complications following retinal laser photocoagulation discussed in this article are accommodative weakness and pupil dilation with eventual transitory myopia and corneal sensitivity impairment. This literature review aims to provide an objective summary of global scientific literature on the issue of internal ophthalmoplegia developing after retinal laser photocoagulation, and describes in detail the current state of the problem including reported occurrences, inciting factors and underlying pathophysiology.
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Affiliation(s)
- I A Veliyeva
- Research Institute of Eye Diseases, Moscow, Russia
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14
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Silva M, Peng T, Zhao X, Li S, Farhan M, Zheng W. Recent trends in drug-delivery systems for the treatment of diabetic retinopathy and associated fibrosis. Adv Drug Deliv Rev 2021; 173:439-460. [PMID: 33857553 DOI: 10.1016/j.addr.2021.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/05/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Diabetic retinopathy is a frequent microvascular complication of diabetes and a major cause of visual impairment. In advanced stages, the abnormal neovascularization can lead to fibrosis and subsequent tractional retinal detachment and blindness. The low bioavailability of the drugs at the target site imposed by the anatomic and physiologic barriers within the eye, requires long term treatments with frequent injections that often compromise patient's compliance and increase the risk of developing more complications. In recent years, much effort has been put towards the development of new drug delivery platforms aiming to enhance their permeation, to prolong their retention time at the target site and to provide a sustained release with reduced toxicity and improved efficacy. This review provides an overview of the etiology and pathophysiology of diabetic retinopathy and current treatments. It addresses the specific challenges associated to the different ocular delivery routes and provides a critical review of the most recent developments made in the drug delivery field.
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Affiliation(s)
- Marta Silva
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Tangming Peng
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Xia Zhao
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Shuai Li
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Mohd Farhan
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Wenhua Zheng
- Centre of Reproduction, Development and Aging, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau.
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15
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Boyer DS, Rippmann JF, Ehrlich MS, Bakker RA, Chong V, Nguyen QD. Amine oxidase copper-containing 3 (AOC3) inhibition: a potential novel target for the management of diabetic retinopathy. Int J Retina Vitreous 2021; 7:30. [PMID: 33845913 PMCID: PMC8042903 DOI: 10.1186/s40942-021-00288-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Diabetic retinopathy (DR), a microvascular complication of diabetes, is the leading cause of visual impairment in people aged 20–65 years and can go undetected until vision is irreversibly lost. There is a need for treatments for non-proliferative diabetic retinopathy (NPDR) which, in comparison with current intravitreal (IVT) injections, offer an improved risk–benefit ratio and are suitable for the treatment of early stages of disease, during which there is no major visual impairment. Efficacious systemic therapy for NPDR, including oral treatment, would be an important and convenient therapeutic approach for patients and physicians and would reduce treatment burden. In this article, we review the rationale for the investigation of amine oxidase copper-containing 3 (AOC3), also known as semicarbazide-sensitive amine oxidase and vascular adhesion protein 1 (VAP1), as a novel target for the early treatment of moderate to severe NPDR. AOC3 is a membrane-bound adhesion protein that facilitates the binding of leukocytes to the retinal endothelium. Adherent leukocytes reduce blood flow and in turn rupture blood vessels, leading to ischemia and edema. AOC3 inhibition reduces leukocyte recruitment and is predicted to decrease the production of reactive oxygen species, thereby correcting the underlying hypoxia, ischemia, and edema seen in DR, as well as improving vascular function. Conclusion There is substantial unmet need for convenient, non-invasive treatments targeting moderately severe and severe NPDR to reduce progression and preserve vision. The existing pharmacotherapies (IVT corticosteroids and IVT anti-vascular endothelial growth factor-A) target inflammation and angiogenesis, respectively. Unlike these treatments, AOC3 inhibition is predicted to address the underlying hypoxia and ischemia seen in DR. AOC3 inhibitors represent a promising therapeutic strategy for treating patients with DR and could offer greater choice and reduce treatment burden, with the potential to improve patient compliance.
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Affiliation(s)
- David S Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA
| | - Joerg F Rippmann
- CardioMetabolic Diseases Research, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | | | - Remko A Bakker
- CardioMetabolic Diseases Research, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
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16
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Liu Y, Wu N. Progress of Nanotechnology in Diabetic Retinopathy Treatment. Int J Nanomedicine 2021; 16:1391-1403. [PMID: 33658779 PMCID: PMC7917322 DOI: 10.2147/ijn.s294807] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022] Open
Abstract
Diabetic retinopathy (DR) is a chronic diabetes complication that progressively manifests itself as blurred vision, eye floaters, distorted vision, and even partial or total loss of vision as a result of retinal detachment in severe cases. Clinically, patients who have undergone variations in the microcirculation of the ocular fundus are treated with laser photocoagulation to improve the circulation of retina; but for patients with macular edema, anti-vascular endothelial growth factor (anti-VEGF) drugs are generally injected to eliminate macular edema and improve vision. The worst cases are patients with fundus hemorrhage or proliferative vitreoretinopathy, for whom vitrectomy has been performed. At present, these clinical treatment methods have widely been used, providing satisfactory results. However, considering the low bioavailability and potential side effects of drugs and the inevitable risks in major surgery, DR prevention, and treatment as well as nerve tissue regeneration in the later stage have always been the focus of research. In recent years, nanotechnology has been increasingly applied in the medical field, leading to new ideas for DR treatment. This study aims to systematically review the research progress of nanotechnology in DR treatment.
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Affiliation(s)
- Yuxin Liu
- Student Affairs Department, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
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17
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Koponen S, Kokki E, Kinnunen K, Ylä-Herttuala S. Viral-Vector-Delivered Anti-Angiogenic Therapies to the Eye. Pharmaceutics 2021; 13:pharmaceutics13020219. [PMID: 33562561 PMCID: PMC7915489 DOI: 10.3390/pharmaceutics13020219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Pathological vessel growth harms vision and may finally lead to vision loss. Anti-angiogenic gene therapy with viral vectors for ocular neovascularization has shown great promise in preclinical studies. Most of the studies have been conducted with different adeno-associated serotype vectors. In addition, adeno- and lentivirus vectors have been used. Therapy has been targeted towards blocking vascular endothelial growth factors or other pro-angiogenic factors. Clinical trials of intraocular gene therapy for neovascularization have shown the treatment to be safe without severe adverse events or systemic effects. Nevertheless, clinical studies have not proceeded further than Phase 2 trials.
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Affiliation(s)
- Sanna Koponen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (S.K.); (E.K.)
| | - Emmi Kokki
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (S.K.); (E.K.)
| | - Kati Kinnunen
- Department of Ophthalmology, Kuopio University Hospital, 70211 Kuopio, Finland;
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; (S.K.); (E.K.)
- Gene Therapy Unit, Kuopio University Hospital, 70211 Kuopio, Finland
- Correspondence: ; Tel./Fax: +358-403-552-075
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18
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Park YJ, Ahn J, Kim TW, Park SJ, Joo K, Park KH, Shin JY. Efficacy of bevacizumab for vitreous haemorrhage in proliferative diabetic retinopathy with prior complete panretinal photocoagulation. Eye (Lond) 2021; 35:3056-3063. [DOI: 10.1038/s41433-020-01384-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/27/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022] Open
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19
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Wang J, Jiang PF, Liu M, Kou MR, Lei JY, Yu XT, Zhao Y, Wang H, Zhang LN. Efficacy of intravitreal injection of conbercept on non-proliferative diabetic retinopathy: a retrospective study. J Int Med Res 2021; 48:300060519893176. [PMID: 32241206 PMCID: PMC7132809 DOI: 10.1177/0300060519893176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study assessed the efficacy of conbercept for patients with non-proliferative diabetic retinopathy (NPDR). Methods In this retrospective clinical study, 54 patients with NPDR (54 eyes) were treated with intravitreal injection of conbercept using a 3+ pro re nata regimen and followed up for 12 months. Best corrected visual acuity (BCVA), central foveal thickness (CFT), area of hard exudate (HE), and number of microaneurysms (MAs) were used as indicators of therapeutic effects. Systemic adverse reactions were recorded to assess safety. Results During the 12-month follow-up period, the mean number of injections was 6.12 ± 1.89 on demand. From baseline to the 12-month follow-up, the BCVA of patients with NPDR increased from 0.71 ± 0.20 logMAR to 0.43 ± 0.16 logMAR, CFT decreased from 424.26 ± 64.89 μm to 269.27 ± 44.79 μm, and the number of MAs declined from 79.53 ± 27.18 to 33.34 ± 16.53. Moreover, the area of HE was significantly reduced after 9 months of treatment. There were no serious systemic adverse events during the follow-up. Conclusions Intravitreal injection of conbercept has a stable and robust effect on patients with NPDR over a 12-month follow-up period. Thus, conbercept is an effective and feasible treatment for NPDR.
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Affiliation(s)
- Jing Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China.,Department of Ophthalmology, Shandong Provincial ENT Hospital affiliated to Shandong University, Jinan, 250023, P.R. China
| | - Peng-Fei Jiang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China.,Department of Ophthalmology, yantai yuhuangding hospital, Yantai, 264001, China
| | - Min Liu
- Department of Ophthalmology, Jinan lixia district people's hospital, Jinan, 250012, P.R. China
| | - Ming-Rong Kou
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Jia-Ying Lei
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Xiao-Ting Yu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Ying Zhao
- Department of Ophthalmology, Qihe county people's hospital of shandong province, Dezhou, 251100, P.R. China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Lin-Na Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
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20
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Jiang Y, Pan J, Yuan M, Shen Y, Zhu J, Wang Y, Li Y, Zhang K, Yu Q, Xie H, Li H, Wang X, Luo Y. Segmentation of Laser Marks of Diabetic Retinopathy in the Fundus Photographs Using Lightweight U-Net. J Diabetes Res 2021; 2021:8766517. [PMID: 34712739 PMCID: PMC8548126 DOI: 10.1155/2021/8766517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a prevalent vision-threatening disease worldwide. Laser marks are the scars left after panretinal photocoagulation, a treatment to prevent patients with severe DR from losing vision. In this study, we develop a deep learning algorithm based on the lightweight U-Net to segment laser marks from the color fundus photos, which could help indicate a stage or providing valuable auxiliary information for the care of DR patients. We prepared our training and testing data, manually annotated by trained and experienced graders from Image Reading Center, Zhongshan Ophthalmic Center, publicly available to fill the vacancy of public image datasets dedicated to the segmentation of laser marks. The lightweight U-Net, along with two postprocessing procedures, achieved an AUC of 0.9824, an optimal sensitivity of 94.16%, and an optimal specificity of 92.82% on the segmentation of laser marks in fundus photographs. With accurate segmentation and high numeric metrics, the lightweight U-Net method showed its reliable performance in automatically segmenting laser marks in fundus photographs, which could help the AI assist the diagnosis of DR in the severe stage.
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Affiliation(s)
- Yukang Jiang
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Jianying Pan
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Ming Yuan
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Yanhe Shen
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Jin Zhu
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Yishen Wang
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Yewei Li
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Ke Zhang
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Qingyun Yu
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
| | - Huirui Xie
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Huiting Li
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Xueqin Wang
- Department of Statistical Science, School of Mathematics, Southern China Research Center of Statistical Science, Sun Yat-Sen University, Guangzhou 510275, China
- Department of Statistics and Finance, School of Management, University of Science and Technology of China, Hefei, Anhui 230026, China
- Xinhua College, Sun Yat-Sen University, Guangzhou 510520, China
| | - Yan Luo
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
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21
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Pearce E, Sivaprasad S. A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models. Clin Ophthalmol 2020; 14:3285-3296. [PMID: 33116380 PMCID: PMC7569040 DOI: 10.2147/opth.s267521] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ~35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.
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Affiliation(s)
- Elizabeth Pearce
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK
| | - Sobha Sivaprasad
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK.,Medical Retina Department, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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22
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Rajagopal S, Madhivanan N, Mayilvakanam L, Nivean P. Choroidal Detachment Following Multi-spot Double Frequency Nd-YAG Retinal Photocoagulation - A Case Report. J Lasers Med Sci 2020; 11:345-347. [PMID: 32802296 DOI: 10.34172/jlms.2020.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Panretinal photocoagulation (PRP) remains the gold standard treatment for severe non-proliferative and proliferative diabetic retinopathy (PDR), as it reduces the risk of severe visual loss by more than 50%. In the conventional single-spot laser, the procedure involves the application of moderate-intensity burns of 200-500 microns, placed one spot-size apart to achieve a total of 1200-2000 applications in 2 or 3 sessions. The more advanced retina lasers like the Pattern Scan Laser (PASCAL) and the VITRA multi-spot laser are 532 nm frequency-doubled (Nd: YAG) solid-state lasers. These modern lasers enable the application of multiple laser burns in a rapid pre-determined sequence with reduced pulse duration (10-20 ms) to facilitate the PRP to be completed in a single sitting with lesser collateral tissue damage. Case Report: Though multi-spot lasers have significantly reduced the adverse events when compared with the conventional single-spot lasers, we report a case of rare adverse events (serous choroidal detachment) following PRP with the VITRA multi-spot double frequency NdYAG (532 nm) laser. Conclusion: Most of the serious choroidal detachments following PRP are self-limiting. We recommend complete retinal evaluation post laser procedure even with modern multisport laser to look for such adverse events.
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23
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Khalkhal E, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Heidari Beigvand H, Rezaei Tavirani M. Evaluation of Laser Effects on the Human Body After Laser Therapy. J Lasers Med Sci 2020; 11:91-97. [PMID: 32099633 DOI: 10.15171/jlms.2020.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lasers have wide applications in the treatment and diagnosis of diseases and various medical fields. Laser therapy like the other methods has advantages and disadvantages. Some risks such as bleeding, pain, and infection are created after laser therapy. Explanation and evaluation of laser effects on cell function, tissue, and the body are the aims of this study. We reviewed papers available from 1986 to 2019 about the effects of lasers on cells and tissue. An online search of PubMed, Science Direct and Google scholar using such keywords as "laser", "cell", "tissue", "body" and "side effects" was performed. The laser photons are absorbed by chromophores, resulting in the target heating and localized damage. Laser irradiation alters cellular metabolism and cellular functions. These alterations may be accompanied by undesired side effects which can be monitored via metabolites level change in the body. Based on this finding, laser therapy may be associated with several side effects and complications; therefore, before treatment, the determination of laser types and their properties is necessary to avoid creating side effects. The advantages and disadvantages of the treatment type should be considered in order to choose the best treatment with the least side effects. The patients' awareness of possible side effects before treatment and also an effective follow-up and management of patients after action are two important points in laser therapy. Training curriculum definition should be determined for laser applicant qualifications in different medical fields.
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Affiliation(s)
- Ensieh Khalkhal
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Rezaei-Tavirani
- Firoozabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hazhir Heidari Beigvand
- Firoozabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Meng W, Li R, Xie X. Conbercept and Retinal Photocoagulation in the treatment of Diabetic Macular Edema. Pak J Med Sci 2019; 35:1493-1498. [PMID: 31777481 PMCID: PMC6861463 DOI: 10.12669/pjms.35.6.512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore the clinical efficacy of intravitreal injection of conbercept in combination with retinal laser photocoagulation in the treatment of diabetic macular edema. METHODS Ninety patients with diabetic macular edema were selected and grouped into an observation group and a control group using random number table, 45 patients (45 eyes) each group. The control group was given retinal laser photocoagulation, while the observation group was given intravitreal injection of Conbercept on the basis of panretinal photocoagulation. The Best Corrected Visual Acuity (BCVA), thickness of retinal nerve fibre layer (RNFL) and macular thickness were measured through relevant examinations before and after treatment. The intraocular pressures of patients in the two groups were evaluated, and moreover the complications were recorded. RESULTS The RNFL thickness and macular thickness of the two groups had no statistically significant differences before treatment (P>0.05) and decreased significantly after treatment; the decrease amplitude of the observation group was significantly larger than that of the control group (P<0.05). The BCVA of both groups significantly increased in the 1st, 2nd and 4th week after treatment (P<0.05); the increase amplitude of BCVA of the observation group was more significant than that of the control group at different time points after treatment (P<0.05). The intraocular pressure of the observation group was not significantly different with that of the control group in the 1st, 2nd and 4th week after treatment (P>0.05). There were no severe eye complications and systemic adverse reactions in both groups in the process of follow up. CONCLUSION Intravitreal injection of conbercept in combination with retinal laser photocoagulation performs better in improving the BCVA and central macular thickness of patients with diabetic macular edema compared to retinal laser photocoagulation and has high safety.
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Affiliation(s)
- Weizhe Meng
- Weizhe Meng, Binzhou People’s Hospital, Shandong, 256610, China
| | - Ronghua Li
- Ronghua Li, Binzhou People’s Hospital, Shandong, 256610, China
| | - Xiufen Xie
- Xiufen Xie, Department of Intervention, The First Hospital Affiliated with Shandong First Medical University, 250014. China
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25
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Spencer BG, Estevez JJ, Liu E, Craig JE, Finnie JW. Pericytes, inflammation, and diabetic retinopathy. Inflammopharmacology 2019; 28:697-709. [PMID: 31612299 DOI: 10.1007/s10787-019-00647-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
Diabetic retinopathy (DR) is a frequent complication of diabetes mellitus, and a common cause of vision impairment and blindness in these patients, yet many aspects of its pathogenesis remain unresolved. Furthermore, current treatments are not effective in all patients, are only indicated in advanced disease, and are associated with significant adverse effects. This review describes the microvascular features of DR, and how pericyte depletion and low-grade chronic inflammation contribute to the pathogenesis of this common ophthalmic disorder. Existing, novel and investigational pharmacological strategies aimed at modulating the inflammatory component of DR and ameliorating pericyte loss to potentially improve clinical outcomes for patients with diabetic retinopathy, are discussed.
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Affiliation(s)
- Benjamin G Spencer
- TMOU, Flinders Medical Centre, Southern Adelaide Local Health Network, SA Health, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Jose J Estevez
- Flinders Centre for Ophthalmology, Eye and Vision Research, Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - Ebony Liu
- Flinders Centre for Ophthalmology, Eye and Vision Research, Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - Jamie E Craig
- Flinders Centre for Ophthalmology, Eye and Vision Research, Department of Ophthalmology, Flinders University, Adelaide, Australia
| | - John W Finnie
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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Gupta SK, Sharma HP, Das U, Velpandian T, Saklani R. Effect of rutin on retinal VEGF, TNF-α, aldose reductase, and total antioxidant capacity in diabetic rats: molecular mechanism and ocular pharmacokinetics. Int Ophthalmol 2019; 40:159-168. [DOI: 10.1007/s10792-019-01165-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022]
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Gonzalez VH, Wang PW, Ruiz CQ. Panretinal Photocoagulation for Diabetic Retinopathy in the RIDE and RISE Trials: Not "1 and Done". Ophthalmology 2019; 128:1448-1457. [PMID: 31668888 DOI: 10.1016/j.ophtha.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate panretinal photocoagulation (PRP) treatment and re-treatment patterns in patients with diabetic retinopathy (DR) and diabetic macular edema (DME). DESIGN Post hoc analysis of the phase 3 RIDE (clinicaltrials.gov identifier, NCT00473382) and RISE (clinicaltrials.gov identifier, NCT00473330) clinical trials of ranibizumab for the treatment of DME. PARTICIPANTS Seven hundred fifty-nine patients were randomized for treatment. METHODS Panretinal photocoagulation treatment patterns and clinical experiences were assessed by baseline PRP treatment status. MAIN OUTCOME MEASURES Number and timing of on-study PRP treatment sessions undergone through month 24. Time to new proliferative event (composite end point) was also assessed. RESULTS At baseline, approximately 25% of patients in RIDE and RISE had undergone PRP treatment before enrollment (22.2%, 24.4%, and 25.4% of patients in the sham, ranibizumab 0.3 mg, and ranibizumab 0.5 mg arms, respectively). In patients without prior PRP at baseline (n = 577), 9.5% of sham-treated patients underwent 1 or more PRP treatments through month 24, compared with 1.1% and 1.6% of patients receiving ranibizumab 0.3 mg and ranibizumab 0.5 mg, respectively (P < 0.001 for both ranibizumab arms vs. sham). In patients with prior PRP at baseline (n = 182), 19.3% of sham-treated patients underwent 1 or more PRP treatments through month 24. No ranibizumab-treated patients with prior PRP at baseline required additional on-study PRP through month 24 (P < 0.001 for both ranibizumab arms vs. sham). Ranibizumab treatment also significantly reduced clinical DR progression among patients who underwent prior PRP. By month 24 in patients with prior PRP at baseline, the probability of experiencing a new proliferative event was 10.3% and 9.9% in patients receiving ranibizumab 0.3 mg and ranibizumab 0.5 mg treatment, respectively, compared with 39.4% in sham-treated patients (P < 0.0001). Overall, sham-treated patients, including those patients who were PRP naïve at baseline who went on to require PRP, experienced more clinical events than ranibizumab-treated patients. CONCLUSIONS In RIDE and RISE, PRP treatment was not a "1 and done" procedure, with on-study PRP re-treatment occurring in patients both with and without prior PRP treatment at baseline. Ranibizumab treatment reduced on-study PRP treatment and DR progression regardless of prior PRP treatment status at baseline.
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Affiliation(s)
| | - Pin-Wen Wang
- Genentech, Inc., South San Francisco, California
| | - Carlos Quezada Ruiz
- Genentech, Inc., South San Francisco, California; Clinica de Ojos Garza Viejo, San Pedro Garza Garcia, NL, Mexico
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Sivaprasad S, Pearce E. The unmet need for better risk stratification of non-proliferative diabetic retinopathy. Diabet Med 2019; 36:424-433. [PMID: 30474144 PMCID: PMC6587728 DOI: 10.1111/dme.13868] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 12/14/2022]
Abstract
Diabetic retinopathy is a common microvascular complication of diabetes and remains one of the leading causes of preventable blindness in working-age people. Non-proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy and is typically asymptomatic. Currently, the severity of diabetic retinopathy is assessed using semi-quantitative grading systems based on the presence or absence of retinal lesions. These methods are well validated, but do not predict those at high risk of rapid progression to sight-threatening diabetic retinopathy; therefore, new approaches for identifying these people are a current unmet need. We evaluated published data reporting the lesion characteristics associated with different progression profiles in people with non-proliferative diabetic retinopathy. Based on these findings, we propose that additional assessments of features of non-proliferative diabetic retinopathy lesions may help to stratify people based on the likelihood of rapid progression. In addition to the current classification, the following measurements should be considered: the shape and size of lesions; whether lesions are angiogenic in origin; the location of lesions, including predominantly peripheral lesions; and lesion turnover and dynamics. For lesions commonly seen in hypertensive retinopathy, a detailed assessment of potential concomitant diseases is also recommended. We believe that natural history studies of these changes will help characterize these non-proliferative diabetic retinopathy progression profiles and advance our understanding of the pathogenesis of diabetic retinopathy in order to individualize management of people with diabetic retinopathy.
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Affiliation(s)
- S. Sivaprasad
- Moorfields Eye HospitalLondonUK
- University College LondonLondonUK
| | - E. Pearce
- Moorfields Eye HospitalLondonUK
- University College LondonLondonUK
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Santiago AR, Boia R, Aires ID, Ambrósio AF, Fernandes R. Sweet Stress: Coping With Vascular Dysfunction in Diabetic Retinopathy. Front Physiol 2018; 9:820. [PMID: 30057551 PMCID: PMC6053590 DOI: 10.3389/fphys.2018.00820] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/12/2018] [Indexed: 12/15/2022] Open
Abstract
Oxidative stress plays key roles in the pathogenesis of retinal diseases, such as diabetic retinopathy. Reactive oxygen species (ROS) are increased in the retina in diabetes and the antioxidant defense system is also compromised. Increased ROS stimulate the release of pro-inflammatory cytokines, promoting a chronic low-grade inflammation involving various signaling pathways. An excessive production of ROS can lead to retinal endothelial cell injury, increased microvascular permeability, and recruitment of inflammatory cells at the site of inflammation. Recent studies have started unraveling the complex crosstalk between retinal endothelial cells and neuroglial cells or leukocytes, via both cell-to-cell contact and secretion of cytokines. This crosstalk is essential for the maintenance of the integrity of retinal vascular structure. Under diabetic conditions, an aberrant interaction between endothelial cells and other resident cells of the retina or invading inflammatory cells takes place in the retina. Impairment in the secretion and flow of molecular signals between different cells can compromise the retinal vascular architecture and trigger angiogenesis. In this review, the synergistic contributions of redox-inflammatory processes for endothelial dysfunction in diabetic retinopathy will be examined, with particular attention paid to endothelial cell communication with other retinal cells.
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Affiliation(s)
- Ana R Santiago
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Raquel Boia
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Inês D Aires
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - António F Ambrósio
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Rosa Fernandes
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
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Heo MG, Byun JH, Kim J, Choung SY. Treatment of Dendropanax morbifera leaves extract improves diabetic phenotype and inhibits diabetes induced retinal degeneration in db/db mice. J Funct Foods 2018. [DOI: 10.1016/j.jff.2018.04.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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RETINAL LASER AND PHOTOGRAPHY PRACTICE EYE MODEL: A Cost-Effective Innovation to Improve Training Through Simulation. Retina 2018; 38:207-210. [PMID: 28991866 DOI: 10.1097/iae.0000000000001885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takamura Y, Matsumura T, Arimura S, Gozawa M, Morioka M, Inatani M. Direct Photocoagulation Guided by Merged Retinal Images for the Treatment of Focal Diabetic Macular Edema. Int J Endocrinol 2018; 2018:2401094. [PMID: 29721014 PMCID: PMC5867680 DOI: 10.1155/2018/2401094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/31/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To introduce a novel laser photocoagulation (PC) protocol named merged image-guided PC (MIG-PC), which included merging the images of the fundus, optical coherence tomography (OCT) map, and fluorescein angiography (FA). We compared the anatomical and functional results between MIG-PC and FA-guided PC (FG-PC) for the treatment of focal diabetic macular edema (DME). METHOD We examined the treatment outcomes in 27 consecutive eyes treated with MIG-PC compared with 28 matched eyes treated with FG-PC. We identified the microaneurysms (MAs) located in the focal edema areas and ablated them using focal PC. Best-corrected visual acuity (BCVA) and retinal thickness (RT) measured using OCT were compared between the groups at baseline and 2, 4, 8, 12, and 24 weeks after treatment. RESULTS The foveal and perifoveal RT were reduced after treatment in both the groups, and the perifoveal RT in the MIG-PC group was significantly lower than that in the FG-PC group at 4 weeks and thereafter. BCVA in the MIG-PC group was significantly higher than that in the FG-PC group at 12 and 24 weeks. The numbers of laser spots (p = 0.0001), additional laser treatments (p = 0.0121), and intravitreal injection of ranibizumab (p = 0.0012) in the MIG-PC group were significantly lower than those in the FG-PC group (Mann-Whitney test). CONCLUSION MIG-PC contributed to the improvement in BCVA and reduction in RT, number of laser shots required, and retreatment rates. Based on our data, MIG-PC can be recommended for the treatment of focal DME. This trial is registered with ID UMIN000030390.
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Affiliation(s)
- Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
| | - Shogo Arimura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui-ken 910-1193, Japan
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Chan DFF, Herrera-Arroyo M, Santiago DE, Castillo TR, Fajardo-Gomez MFQ. Panuveitis-like reaction following encircling laser retinopexy/cerclage in a 21-year-old male. J Ophthalmic Inflamm Infect 2017; 7:21. [PMID: 29038978 PMCID: PMC5643585 DOI: 10.1186/s12348-017-0139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Severe vision-impairing ocular inflammation is rarely reported following extensive laser. Previous cases have involved retinal photocoagulation for diabetic retinopathy resolving over days. This report documents a rare instance of this where encircling retinopexy/cerclage was done as fellow eye retinal detachment prophylaxis in a patient with no overt comorbidities. Results A panuveitis-like reaction with severe, near-total visual impairment was documented 1 day following single-sitting encircling laser retinopexy/cerclage done as fellow eye prophylaxis for a 21-year-old male presenting with total retinal detachment in the other eye. Pre-laser findings were unremarkable, other than an equatorial ring of fine vitreous condensations. Pre-laser vision of 20/20 uncorrected decreased to hand motion, light perception on all quadrants, accompanied by severe anterior segment inflammation with hypopyon, retrolental membranes, vitreous cells, and choroidal effusion/suspicious exudative retinal detachment on B-scan ultrasound and ultrasound biomicroscopy. Combination of oral, topical, and depot steroids resulted in restoration of vision by 1 month post-laser, but with persistent anterior segment inflammation and retrolental membranes at month 2 post-laser. Conclusions The atypically inordinate degree of post-laser inflammation and multiple sequelae following encircling retinopexy/cerclage as retinal detachment prophylaxis, in this case, demonstrate the potency and risks of retinal photocoagulation. The value of pre-laser assessment for potential risk factors, caution and mindfulness in conducting the intervention, and, the value of prudent and thorough follow-up are exhibited in this case.
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Affiliation(s)
- David Francis Fullon Chan
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines.
| | - Milagros Herrera-Arroyo
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Darby E Santiago
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Teresita R Castillo
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
| | - Ma Florentina Q Fajardo-Gomez
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila-Philippine General Hospital, 5th Floor, Sentro Oftalmologico Jose Rizal, Taft Avenue between Padre Faura and Pedro Gil Streets, Manila, Philippines
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Mbata O, Abo El-Magd NF, El-Remessy AB. Obesity, metabolic syndrome and diabetic retinopathy: Beyond hyperglycemia. World J Diabetes 2017; 8:317-329. [PMID: 28751954 PMCID: PMC5507828 DOI: 10.4239/wjd.v8.i7.317] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/22/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023] Open
Abstract
Diabetic retinopathy (DR) is the most feared ocular manifestation of diabetes. DR is characterized by progressive retinal damage that may eventually result in blindness. Clinically, this blindness is caused by progressive damage to the retinal microvasculature, which leads to ischemia, retinal swelling, and neovascularization. Retinopathy is associated with both type 1 and type 2 diabetes, with DR being the leading cause of new onset blindness in United States adults. Despite this strong association with diabetes, it must be noted that the development of retinopathy lesions is multifactorial and may occur in individuals without an established history of diabetes. Metabolic syndrome is a multifactorial condition of central obesity, hypertriglyceridemia, dyslipidemia, hypertension, fasting hyperglycemia, and insulin resistance. Although several studies examined the individual components observed in the metabolic syndrome in relation to the development of DR, there is conflicting data as to the association of the metabolic syndrome with the development of retinopathy lesions in non-diabetic subjects. This review will summarize the current literature on the evidence of the metabolic syndrome on retinopathy in subjects with and without an established history of diabetes. This review will also discuss some of the mechanisms through which metabolic syndrome can contribute to the development of retinopathy.
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Coucha M, Elshaer SL, Eldahshan WS, Mysona BA, El-Remessy AB. Molecular mechanisms of diabetic retinopathy: potential therapeutic targets. Middle East Afr J Ophthalmol 2015; 22:135-44. [PMID: 25949069 PMCID: PMC4411608 DOI: 10.4103/0974-9233.154386] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Diabetic retinopathy (DR) is the leading cause of blindness in working-age adults in United States. Research indicates an association between oxidative stress and the development of diabetes complications. However, clinical trials with general antioxidants have failed to prove effective in diabetic patients. Mounting evidence from experimental studies that continue to elucidate the damaging effects of oxidative stress and inflammation in both vascular and neural retina suggest its critical role in the pathogenesis of DR. This review will outline the current management of DR as well as present potential experimental therapeutic interventions, focusing on molecules that link oxidative stress to inflammation to provide potential therapeutic targets for treatment or prevention of DR. Understanding the biochemical changes and the molecular events under diabetic conditions could provide new effective therapeutic tools to combat the disease.
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Affiliation(s)
- Maha Coucha
- Department of Clinical Pharmacy, Program in Clinical and Experimental Therapeutics, University of Georgia, Georgia, USA ; Culver Vision Discovery Institute, Georgia Regents University, Georgia, USA ; Research Service, Charlie Norwood VA Medical Center, Augusta 30912, Georgia, USA
| | - Sally L Elshaer
- Department of Clinical Pharmacy, Program in Clinical and Experimental Therapeutics, University of Georgia, Georgia, USA ; Culver Vision Discovery Institute, Georgia Regents University, Georgia, USA ; Research Service, Charlie Norwood VA Medical Center, Augusta 30912, Georgia, USA
| | - Wael S Eldahshan
- Department of Clinical Pharmacy, Program in Clinical and Experimental Therapeutics, University of Georgia, Georgia, USA ; Culver Vision Discovery Institute, Georgia Regents University, Georgia, USA ; Research Service, Charlie Norwood VA Medical Center, Augusta 30912, Georgia, USA
| | - Barbara A Mysona
- Department of Clinical Pharmacy, Program in Clinical and Experimental Therapeutics, University of Georgia, Georgia, USA ; Culver Vision Discovery Institute, Georgia Regents University, Georgia, USA ; Research Service, Charlie Norwood VA Medical Center, Augusta 30912, Georgia, USA
| | - Azza B El-Remessy
- Department of Clinical Pharmacy, Program in Clinical and Experimental Therapeutics, University of Georgia, Georgia, USA ; Culver Vision Discovery Institute, Georgia Regents University, Georgia, USA ; Research Service, Charlie Norwood VA Medical Center, Augusta 30912, Georgia, USA
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