Application of OCTA in screening microvascular changes in non-proliferative diabetic retinopathy / 西安交通大学学报(医学版)

【Objective】 To investigate the clinical effect of optical coherence tomography angiograph (OCTA) applied in retinal microvascular screening in patients with non-proliferative diabetic retinopathy (NPDR). 【Methods】 Thirty patients with NPDR (NPDR group) diagnosed at The Third Affiliated Hospital of Soochow University and 30 healthy volunteers (control group) were selected to receive OCTA examination. The area, perimeter, and circularity of the fovea avascular zone (FAZ) were measured and blood flow density in the superior, inferior, nasal, temporal quadrants of the macular superficial retinal capillary layer (SCP) and the peripapillary radial capillary layer (RPC) of the optic disc were quantified. 【Results】 In NPDR group, blood flow density in the four quadrants of macular SCP and RPC were decreased significantly compared with that in control group (43.68±3.03 vs. 46.98±3.04, 42.79±3.17 vs. 50.45±2.25, 43.21±2.67 vs. 47.44±2.42, 44.21±3.22 vs. 51.72±5.32, 46.43±3.54 vs. 53.02±2.62, 45.97±3.67 vs. 52.53±2.82, 44.63±2.73 vs. 48.19±3.67, 41.73±3.15 vs. 45.12±3.31) (all P<0.01). The area and perimeter of FAZ in NPDR group were significantly higher than those in control group [(0.50±0.06 vs. 0.43±0.47) mm2, (3.10±0.21 vs. 2.87±0.22) mm]. The circularity of FAZ was significantly lower in NPDR group than in control group [(0.63±0.05 vs. 0.67±0.05)%, P<0.01]. 【Conclusion】 OCTA can detect early retinal microstructure changes in NPDR, and thus can be used as an auxiliary screening of NPDR to provide information for early diagnosis and treatment.

Correlation of Risk Factors with Severity of Diabetic Retinopathy - A Retrospective Study.

Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It is the most common cause of blindness in the working-age population in developed countries. We wanted to analyse the correlation between risk factors of blindness like duration of diabetes, dyslipidaemia, hypertension, HbA1c with severity of diabetic retinopathy in order to design appropriate strategies for prevention and treatment of diabetic retinopathy.METHODSThis was a retrospective study of all diabetic patients with diabetic retinopathy who presented to the eye OPD at KS Hegde Medical Academy from April 1st 2018 to March 31st 2019 that fulfilled the inclusion criteria. A dilated fundus examination was done to note the grade of diabetic retinopathy. The demographic data along with the duration of diabetes, HbA1c values, Cholesterol levels and Blood pressure were documented and correlated with the severity of diabetic retinopathy.RESULTSThe study included 92 patients, of which 63 were males and 29 were females with a mean age of 54.5±2.8 years. We found that there was statistically significant association between the duration of diabetes and HbA1c levels with severity of diabetic retinopathy (p= 0.022 and 0.034 association), whereas there was no statistically significant correlation between blood pressure and cholesterol levels with severity of diabetic retinopathy (p= 0.52 and 0.456 respectively)CONCLUSIONSDiabetic retinopathy showed a male preponderance, with risk factors like duration of diabetes and HbA1c levels having a significant association with the severity of diabetic retinopathy. Therefore, it is essential to have a good systemic control of diabetes with diet and suitable medications. Diabetic retinopathy is a preventable cause of blindness when diagnosed early and screening of diabetic retinopathy must be done in all diabetics to prevent the progression of the disease.

Clinical effects of Safflor Yellow Sodium Chloride Injection combined with Compound Anisodine Injection on patients with NPDR / 中成药

AIM To observe the therapeutic effects of Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection on patients with non-proliferative diabetic retinopathy (NPDR).METHODS Sixty-eight pa-tients (102 eyes) were randomly divided into control group (32 cases,48 eyes) and observation group (36 cases,54 eyes).The observation group was given Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection in addition to conventional therapy administered to the control group,and yet patients of both groups had their changes of vision,fundus hemorrhage,effusion,microaneurysm and central macular thickness checked and compared before and after the treatment.RESULTS The observation group displayed better post-treatment vision recovery,fundus improvement and central macular thickness control than the control group (P ＜ 0.05,P ＜ 0.01).CONCLUSION The combination therapy of Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection can be an appropriate option for NPDR patients to improve vision and slow progression.

Early diagnosis diabetic retinopathy / Монголын Анагаах Ухаан

IntroductionThere are an estimated 246 million people with diabetes mellitus globally and this figure is predictedto rise to 380 million by 2025, with the most rapid growth in developing countries, among the workingage group of the population.Now in Mongolia, the more than half of population live in cities and settlements, following thisurbanization the population`s diet and lifestyle has been changed to more western style and morepeople affected by diabetes mellitus.Diabetic retinopathy is the most common chronic and devastating complication of diabetes whichleads to visual impairment and blindness. Diabetic retinopathy develops in nearly all persons withtype 1 diabetes and in more than 77% those with type 2 who survive over 20 years with disease. Thecurrent estimates of the prevalence of diabetic retinopathy vary in different countries. The WHO hasestimated that diabetic retinopathy is responsible for 4.8% of 37 million cases of blindness throughoutthe world.Significant independent predictors of proliferative diabetic retinopathy determined by multivariableanalysis were fasting plasma glucose level, duration diabetes, plasma cholesterol, systolic bloodpressure and therapeutic regimen.In recent years a number of randomized clinical trials have shown that interventions to improvemetabolic control, careful monitoring and treatment reduce late diabetic complications.GoalTo establish the prevalence, severity and risk factors of diabetic retinopathy type 2 diabetic patientsin Ulaanbaatar.Materials and MethodsThe study conducted by cross sectional study. Randomly selected 235 patients type 2 diabetic patientsfrom Bayanzurh districts of city Ulaanbaatar. Participants provided a detailed medical and personalhistory, underwent an ocular examination including funduscopy. Fasting blood glucose-FBG, totalcholesterols, triglyceride, HDL were determined by methods of laboratory in venous plasma.ResultsThe prevalence of diabetic retinopathy among people with type 2 diabetes was 37.4%. The prevalencenon-proliferative diabetic retinopathy was 17% (40), pre-proliferative diabetic retinopathy was 8.1%(19), and of proliferative diabetic retinopathy was 12.3 %( 29).The mean age of participants with diabetic retinopathy was 57.4 years (range 26-79). The meanage of participants with non-diabetic retinopathy was 53.6 years (range 26-76). The prevalence of diabetic retinopathy did not vary significantly with age. Retinopathy was positively associated with alonger reported duration of diabetes and with higher fractions of blood glucose (p<0.05).Progression of diabetic retinopathy positively associated with high level fasting blood glucose (6.2mmol/l), total cholesterol (4.5 mmol/l), systolic pressure (130 mm Hg) diastolic pressure (90 mm Hg),triglyceride (2.2 mmol.l) and low level HDL (1.1 mmol/l).ConclusionRisk factors for diabetic retinopathy were found to be high level of blood glucose, longer duration ofdiabetes. Diabetes poor control was significantly associated with progression of diabetic retinopathy.

The Therapeutic Effects of Angiotensin-Converting Enzyme Inhibitors in Severe Non-proliferative Diabetic Retinopathy

PURPOSE: To evaluate the effects of angiotensin-converting enzyme inhibitors (ACE-I) in retarding progression of severe non-proliferative diabetic retinopathy (NPDR) in normotensive type 2 diabetic patients. METHODS: This was a retrospective case control study of 128 patients with normotensive type 2 diabetes with lower than +1 dipstick proteinuria and severe NPDR who were classified into either an ACE-I treated group (Enalapril maleate 10 mg, n=12 , Ramipril 5 mg, n=17) or an ACE-I untreated group (n=99). Medical records were reviewed for endpoints of (a) occurrence of proliferative diabetic retinopathy (PDR) or macular edema (ME) for which laser phototherapy was necessary or (b) development of proteinuria of higher than +1 level requiring medication of ACE-I. RESULTS: From the total of 128 patients, there were 29 ACE-I treated patients and 99 ACE-I untreated patients. There were no differences in the average age, duration of diabetes, body mass indices, blood pressure and levels of hyperglycemia or HbA1C between the two groups. Blood pressure and HbA1C levels in both groups remained unchanged during the study. The mean follow-up period was 41.6 months. In the ACE-I group, 6 patients progressed to PDR, 5 to ME and 6 developed proteinuria of greater than +1 over the follow-up period. In the control group, 30 patients progressed to PDR, 6 to ME and 9 developed proteinuria of greater than +1 over the follow-up period. CONCLUSIONS: Small doses of ACE-I did not yield any beneficial effects in retarding the progression of severe NPDR.

Clinical Results of Primary Posterior Continuous Curvilinear Capsulorhexis

PURPOSE: To evaluate the outcome of posterior continuous curvilinear capsulorhexis (PCCC) performed simultaneously with cataract surgery to inhibit after-cataract. METHODS: Among patients who underwent phacoemulsification and posterior chamber intraocular lens implantation from December 1999 through December 2001, we had followed on 94 eyes of 80 patients who underwent PCCC intraoperatively and 100 eyes in 92 patients without PCCC as control group. Both groups were divided into 4 categories: nonproliferative diabetic retinopathy(NPDR); uveitis; below 60 years without ocular and systemic disease; over 60 years without ocular and systemic disease. Preoperative and postoperative visual acuity and complications were analyzed from 6 months to 12 months. RESULTS: There was statistically no difference in the best corrected visual acuity at 6 months between PCCC and control group in all categories. Transient increase in the intraocular pressure was noted in 5 eyes (5%) of PCCC group and 3 eyes (3%) in control group. Vitreous prolapse into anterior chamber was found in 2 eyes (2%) of PCCC group. Cystoid macular edema was found in only 1 eye (1%) in NPDR patients of PCCC group. Progression of diabetic retinopathy was found in 1 eye (5.6%) and 3 eyes (12.5%) in each group respectively. There was no statistically significant difference in progression of diabetic retinopathy after surgery between the two groups. CONCLUSIONS: Primary PCCC is a safe procedure to perform in patient who has a predisposition to after-cataract.

Effect of PRP on Visual Acuity, Visual Field and Subjective Symptoms in Very Severe NPDR

PURPOSE: To evaluate the effect of panretinal photocoagulation (PRP) on visual acuity, visual field and subjective symptoms in very severe non-proliferative diabetic retinopathy (NPDR) patients. METHODS: Forty eyes of 20 patients with NPDR were evaluated. Complete ophthalmic examination, visual acuity, Humphrey field test and interview of questionnaire were evaluated before, 2 and 8 weeks after PRP. RESULTS: The mean corrected visual acuity was not significantly changed from before PRP to 2, 8 weeks after PRP (p>0.05). Visual field deteriorated in 2 weeks and then improved in 8 weeks after PRP, however the recovery did not reach to pre-PRP level (p0.05). Thoses number decreased in 15~30degrees field (p<0.01) following PRP. In spite of deterioration of visual field after PRP, subjective symptoms was rarely noted. CONCLUSIONS: Our result suggest that early PRP may be advisable for very severe NPDR patients to prevent the development of possible visual field deterioration following PRP.