ABSTRACT
RESUMEN Fundamento: la retinopatía diabética es una enfermedad ocular a consecuencia de la diabetes mellitus y causada por una alteración microvascular de los vasos retinianos. Es la principal causa de pérdida de visión entre los 30 y los 60 años de edad. La autofluorescencia es una prueba importante en la detección temprana de las complicaciones de la retinopatía diabética, se puede actuar a tiempo para disminuir la incidencia de alteraciones visuales irreversibles. Objetivo: realizar una revisión actualizada sobre la retinopatía diabética y las indicaciones de la autofluorescencia en esta enfermedad. Métodos: se realizó una revisión bibliográfica en las bases de datos LILACS, MEDLINE y SciELO. Los descriptores utilizados fueron: retinopatía diabética, autofluorescencia, complicaciones, terapia diagnóstica por imagen. Con los datos bibliográficos obtenidos en 80 artículos publicados se seleccionaron 34 (27publicados en los últimos cinco años y siete de años anteriores). Resultados: se contemplaron aspectos establecidos tradicionalmente y otros que se encuentran en discusión por muchos autores. Conclusiones: la retinopatía diabética es una causa importante de pérdida visual en adultos, con consecuencias médicas, sociales y financieras significativas. Sus complicaciones son evitables en el 80-90 % de los casos. La autofluorescencia es una prueba importante en la detección temprana de las complicaciones de la retinopatía diabética, que permite actuar a tiempo para disminuir la incidencia de alteraciones visuales irreversibles.
ABSTRACT Background: diabetic retinopathy is an ocular disease due to diabetes mellitus and caused by a microvascular alteration of the retinal vessels. It is the main cause of vision loss between 30 and 60 years of age. Auto-fluorescence is an important test in the early detection of complications of diabetic retinopathy, and it can act in time to reduce the incidence of irreversible visual alterations. Objective: to carry out an updated review on diabetic retinopathy and the indications of auto-fluorescence in this pathology. Methods: a literature review was carried out in the Lilacs, Medline and Scielo databases. The descriptors used were: Diabetic retinopathy, auto-fluorescence, complications, diagnostic imaging therapy. With the bibliographic data obtained in 80 published articles, 34 (27 published in the last 5 years and 7 of previous years) were selected. Results: traditionally established aspects and others that are under discussion by many authors were contemplated. Conclusions: diabetic retinopathy is an important cause of visual loss in adults, with significant medical, social and financial consequences. Its complications are avoidable in 80-90 % of cases. Auto-fluorescence is an important test in the early detection of complications of diabetic retinopathy, which allow to act in time to reduce the incidence of irreversible visual alterations.
ABSTRACT
Diabetic macular edema is the leading cause of central vision loss and even blindness in diabetic retinopathy.Compared to FFA,OCT can obtain the high-resolution 3D image quickly,easily to reflect the details of the tissue and realize the quantitative measurement.As a novel technology,OCT angiography (OCTA) can display microvascular structure from different layers of retina and choroid,having its advantage of quantifying the vessel density and the lesion area.By detecting fundus morphology,quantifying and quantitating the retinal vessels and vessel density,the combination of OCT and OCTA could play a guiding role in diagnosis,classification,treatment and prognosis of diabetic macular edema.
ABSTRACT
Objective To observe the effect ofconbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME).Methods A prospective randomized controlled clinical study.From June 2016 to June 2017,68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study.The patients were randomly assigned to two different treatment groups:36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group).All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before.BCVA was measured by ETDRS charts.The central macular thickness (CMT),total macular volume (TMV) were measured by Topcon 3D-OCT 2000.The BCVA,CMT and TMV in the combined treatment group and the drug treatment group were 57.9 ± 12.4 letters,427.8± 129.4 μm,10.14± 1.50 mm3 and 59.0± 16.0 letters,441.0 ±135.7 μm,10.43 ±2.10 mm3,respectively.There was no significant difference (t=0.321,0.410,0.641;P=0.749,0.683,0.524).The follow-up period was more than 12 months.The changes of BCVA,CMT and TMV were compared between the two groups.Comparison ofBCVA,CMT,TMV before and after treatment in and between groups using repeated measures analysis of variance.Results The average annual injection times was 5.8 ± 1.9 in the combined treatment group and 8.5± 2.4 in the drug treatment group.The difference was statistically significant (t=5.12,P=0.000).The BCVA in the 3rd,6th,9th and 12th month were 64.9± 11.1,65.6± 10.5,67.0± 10.8,66.6± 10.7 letters and 65.7± 15.8,66.9 ± 15.7,66.4 ± 13.0,67.3 ± 16.4 letters,respectively,and there were significant differences compared with BCVA before treatment (F=34.234,10.137;P=0.000,0.000).The CMT were 335.2± 105.9,352.6± 106.6,336.2± 120.8,305.9±97.0 μm and 323.9±92.8,325.5±90.2,327.6± 108.2,312.2± 106.8 μm,respectively.The TMV were 9.20± 1.08,9.26± 1.20,9.20± 1.63,9.05± 1.18 mm3 and 9.19± 1.21,9.35± 1.69,9.09± 1.20,8.92± 1.10 mm3,respectively.Compared with the CMT (F=12.152,12.917;P=0.000,0.000) and TMV (F=11.198,11.008;P=0.000,0.000) before treatment,the differences were statistically significant.Conclusion Conbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT,TMV and improve BCVA in patients with DME,but combination therapy can reduce the injection times of conbercept.
ABSTRACT
Objective To analyze the influencing factors on clinical response to conbercept for diabetic maeular edema (DME).Methods A total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study.The general information (age,sex,body mass index,smoking history,drinking history),blood glucose indicators (duration of diabetes,fasting blood glucose,HbA 1 c),blood pressure indicators (history of hypertension,systolic blood pressure,diastolic blood pressure),lipid indicators [total cholesterol (TC),high-density lipoprotein (HDL),apolipoprotein A (APOA)],biochemical indicators [neutrophil concentration,hemoglobin (HB),serum creatinine (Scr)] were collected.The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed.CMT reduced not less than 20％ and BCVA increased by 2 lines as effective standards.Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy ofintravitreal injection ofconbercept in patients with DME.Results Univariate analysis showed that diastolic blood pressure,HDL,serum neutrophil concentration,baseline CMT and baseline BCVA were associated with edema regression (P＜ 0.05);HbA 1 c was associated with vision improvement (P＜ 0.05).Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122,95％ CI 0.017-0.887),low diastolic blood pressure (OR=0.850,95％CI 0.748-0.966),low HDL (OR=0.007,95％CI 0.000 1-0.440),thin baseline CMT (OR=0.986,95％CI 0.977-0.995) were independent risk factors for failure outcome of edema regression (P＜0.05);long duration of diabetes (OR=1.191,95％CI 1.011-1.404),high APOA (OR=l.007,95％ CI 1.000-1.013) were independent risk factors for failure outcome of vision improvement.Age,fasting blood glucose,systolic blood pressure,TC,HB,Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P＞ 0.05).Conclusions Smoking history,long duration of diabetes,low diastolic blood pressure,low HDL level,high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.
ABSTRACT
Diabetic macular edema is the major cause of vision impairment in patients with nonproliferative diabetic retinopathy.Thickness and pathological alterations in each retina layer of diabetic macular edema (DME) patients can be performed by optical coherence tomography (OCT) device.And retinal light sensitivity at specific retinal point and fixation state can be detected by microperimetry qualitatively and quantitatively.Moreover,OCT can discover pathological anatomical changes in the retina of DME patients,thus facilitating the interpretation of the structure-function relationship in DME with combination of microperimetry results.At present,there are various therapies for DME patients,and the primary method in evaluating therapeutic efficacy is to compare the pathological changes in the retina before and after treatment by OCT.Besides,microperimetry can provide information in visual function restoration.The combined application of OCT and microperimetry has broad prospects in the diagnosis and treatment of DME patients.
ABSTRACT
Objective To investigate the correlation of visual sensitivity,best corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME).Methods A retrospectives study.Forty-five eyes of 30 patients in DME were included.There were 20 eyes of 16 males,25 eyes of 14 females,with an average age of 54.49±7.45 years.All the patients had type 2 diabetes;the average duration of diabetes was over 10 years.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logarithmic logarithm (logMAR) visual acuity.The following parameters provided by the MAIA microperimetric device were evaluated,including average threshold (AT),macular integrity index (MI),fixation indexes (P1 and P2),bivariate contour ellipse area (BCEA) for 63％ and 95％ of points,and horizontal and vertical axes of the ellipse of fixation (H63,H95,V63,V95).The CRT was measured and the integrity of the ellipsoidal band was observed by optical coherence tomography (OCT).The integrity of the ellipsoid band was divided into continuous smooth (group A):fully visible;part of the light band was interrupted (B group):not completely visible;missing light band (C group):completely invisible.Pearson correlation analysis was used to analyze the correlation between the factors;non-parametric tests were used to compare the logMAR BCVA,AT,and CRT between the different ellipsoid zone integrity groups;multiple linear regression analysis was used to analyze factors related to AT.Results Pearson correlation analysis showed that the logMAR BCVA was positively correlated with MI (r=0.303,P=0.04) and CRT (r=0.342,P=0.02),negatively correlated with AT (r=-0.59,P=0.00) and P1 (r=-0.38,P=0.01).There was negative correlation between AT and MI (r=-0.55,P=0.00).The result of multivariate linear regression analysis showed that the logMAR BCVA is inversely correlated with AT (t=-3.53,P=0.001).Group A,B and C were 23,17 and 5 eyes in the 45 eyes,respectively.There were significant differences in logMAR BCVA,AT,and CRT between the three groups ofeyes (P=0.045,0.049,0.018).Conclusions In DME patients,the logMAR BCVA was positively correlated with CRT,negatively correlated with AT and P1.The logMAR BCVA is inversely correlated with AT.Microperimetry combined with OCT and visual acuity can be used to assess the visual function of patients with DEM.
ABSTRACT
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients.It mainly includes focal DME and diffuse DME,while DME of clinical significance needs timely intervention treatment.Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME.Currently,the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation.Among them,anti-VEGF injection is becoming the first-line therapeutic,and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients.During the diagnosis and treatment of DME,attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME.With the appearance of heterogeneity in the efficacy of anti-VEGF drugs,it remains to be further studied how to choose alternative therapeutics and when to replace them.
ABSTRACT
Objective To investigate the correlation of microperimetric parameters,best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME) eyes.Methods It is a prospective,no controlled,open study.Twenty-four consecutive patients (40 eyes) with DME were included.There were 10 males (18 eyes),14 females (22 eyes);aged from 41 to 79 years,with the mean age of (56.84±8.96) years.All the patients were type 2 diabetes,the average duration of diabetes was 8 years.BCVA was evaluated using the international Snellen E vision test chart,and then recorded as logarithm of the minimum angle of resolution (logMAR).CRT was measured by Cirrus HD-OCT4000.MAIA microperimetric parameters were evaluated,including average threshold (AT) of retinal sensitivity,macular integrity index (MI),fixating points within a circle of 1° (P1) and 2° of radius (P2),bivariate contour ellipse area (BCEA) considering 63％ and 95％ of fixating points (A63,A95),and horizontal and vertical axes of that ellipse (H63,H95,V63,V95).Pearson correlation analysis was performed to evaluate the association between these variables.The independent factor influenced the type of fixation was analyzed by multiple linear regression analysis.Results Strong correlations of logMAR BCVA with CRT (r=0.58,P=0.000),V63 (r=0.44,P=0.004),V95 (r=0.41,P=0.008),MI (r=0.36,P=0.024),AT (r=-0.61,P=0.000),P1 (r=-0.41,P=0.009),P2 (r=-0.38,P=0.015) were found.AT was correlations with P1 (r=0.53,P=0.000),P2 (r=0.51,P=0.001),A63 (r=-0.39,P=0.012),A95 (r=-0.40,P=0.012),V63 (r=-0.53,P=0.000),V95 (r=-0.46,P=0.003),MI (r=-0.50,P=0.001).There was no correlation between AT and CRT (r=-0.21,P=0.190).Forty eyes were included in this study,8 eyes (20％) had stable fixation,14 eyes (35％) had relatively unstable fixation,18 eyes (45％)had unstable fixation.Multiple linear regression analysis showed that fixation classification was independently affected by P 1.Conclusions In DME eyes,logMAR BCVA was positively correlated with CRT,negatively correlated with AT,P1 and P2.There is no correlation between AT and CRT.The fixation classification was independently affected by P 1.
ABSTRACT
Background Diabetic macular edema (DME) is one of serious ocular complications of diabetes mellitus and is often treated by laser photocoagulation,peribulbar injection of triamcinolone acetonide (TA) and intravitreal injection of ranibizumab.However,some adverse responses occur in each approach.To seek a safe,effective and ecnomic therapy for DME is of clinical significance.Objective This study was to observe the safety and efficacy of post-sclera injection of TA with a self-made innovative device for DME and compare the outcome with peribulbar injection of TA and the intravitreal injection of ranibizumab.Methods A prospective non-randomized controlled study was performed.This study protocol was approved by Ethic Committee of Southwest Hospital of Third Military Medical University and complied with Helsinki declaration.Written informed consent was obtained from each patient before any medical treatment.Sixty eyes of 60 patients with DME were included in Southwest Hospital of Third Military Medical University from March 2013 to July 2016.The eyes were divided into post-sclera injection group,peribulbar injection group and intravitreal injection group,with 20 eyes for each group.TA at the dose of 20 mg was injected via posterior sclera with a self-made divice in the post-sclera injection group and via periphery of eyeball in the peribulbar injection group,and 0.5 mg ranibizumab was intravitreally injected in the intravitreal injection group.Best corrected visual acuity (BCVA) was examined and retinal thickness at macular area was measured by OCT in 1 month and 3 months after injection respectively.The outcome and complication were grouply compared.Results The BCVA was significantly improved 1 month and 3 months after injection in comparison with before injection in the post-sclera injection group and intravitreal injection group,and BCVA in the post-sclera injection group and intravitreal injection group was superior to that in the peribulbar injection group (all at P =0.000).No significant difference was found in post-injected BCVA between post-sclera injection group and intravitreal injection group (P =0.244,0.397).Retinal edema at macular area was gradually disappeared in the post-sclera injection group and intravitreal injection group and that in the peribulbar injection group was still visible after injection.The retinal thickness at macula was (321.85±31.98),(382.75±39.28) and (315.75 ± 40.43) μm at 1 month and was (311.95±32.73),(393.65±33.84) and (302.65±38.99) μm at 3 months after injection in the post-sclera injection group,peribulbar injection group and intravitreal injection group respectively,and the retinal thickness values at macula in the post-sclera injection group and intravitreal injection group were significantly lower than those in the peribulbar injection group (all at P =0.000).The decrease rate of retinal thickness was higher in the post-sclera injection group and intravitreal injection group than that in the peribulbar injection group at various time points after injection (all at P＜0.01).Conclusions The efficacy and safety of post-sclera injection of TA for DME are similar to intravitreal injection of ranibizumab,which are superior to peribulbar injection of TA.
ABSTRACT
Objective To observe the corneal nerve fibres damage in different stage of diabetic retinopathy (DR) with type 2 diabetes.Methods A cross-sectional study.One hundred and twenty eyes of 120 patients with type 2 diabetes served as diabetes group.According to International Clinical Diabetic Retinopathy Disease Severity Scales (2002),diabetes patients were classified into 4 subgroups:patients without diabetic retinopathy (NDR),patients with mild or moderate non-proliferative diabetic retinopathy (mNPDR),patients with severe non-proliferative diabetic retinopathy (sNPDR) and patients with proliferative diabetic retinopathy (PDR),each subgroup has 30 eyes of 30 patients.Another 30 eyes of 30 healthy participants served as control group.All eyes were scanned with HRT3 in vivo corneal confocal microscopy.Images of sub-basal nerve plexus were quantified including nerve fiber length (NFL),nerve fiber density (NFD),nerve fiber branch density (NFB),and nerve tortuosity (NT).The correlations of corneal nerve fiber with age,duration of diabetes and glycated hemoglobin (HbA1 c) were analyzed using Spearman correlation analysis.Results NFL,NFD and NFB were found to be significantly lower in diabetic patients (F=147.315,142.586,65.898;P=0.000,0.000,0.000),NT was significantly greater in diabetic patients (F=39.431,P=0.000),when compared to control group.In diabetic patients,NFL,NFD and NFB were gradually reduced with DR severity,NT was gradually increased with DR severity.While the difference ofNFL,NFD,NFB,NT was not statistically significant between sNPDR and PDR subgroups (P＞.0.05),but was statistically significant between other subgroups (P＜0.05).Spearman correlation analysis results showed that age (r=-0.071,-0.080,0.001,0.100;P=0.391,0.328,0.991,0.224) and HbAlc (r=-0.109,-0.115,-0.126,0.025;P=0.238,0.211,0.169,0.781) had no correlation with NFL,NFD,NFB,NT.Duration of diabetes was negatively correlated with the NFL,NFD (r=-0.212,-0.264;P=0.020,0.004),positive correlated with NT (r=0.261,P=0.004),and had no correlation with NFB (r=-0.119,P=0.194).Conclusions Corneal nerve fiber loss and nerve tortuosity increased were found in patients with type 2 diabetes,and even without diabetic retinopathy.The progress of corneal neuropathy was correlated with the severity of DR,but it was not change significantly between sNPDR and PDR.
ABSTRACT
Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME).Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study.The patients included 12 males and eight females,with a mean age of (47.3± 10.2) years.All the patients were examined documenting best corrected visual acuity (BCVA),spectraldomain optical coherence tomography (OCT) and ophthalmological examination.According to OCT DME morphology,samples are divided into diffuse macular edema,cystoid macular edema,serous retinal detachment and hard exudate groups.The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84 ± 28.80) μm of same age group.Correlation between SFCT and age,diopter,diabetic duration,fasting blood glucose,BCVA and central retinal thickness were analyzed by Pearson Analysis.SFCT of different DME types were analyzed by ANOVA Analysis.Results The mean SFCT of 32 eyes was (223.81±43.74) μm (ranging from 120.50 to 361.50 μm),which was lower by 63.03 μm (95％ confidence interval,-78.80 to-47.26 μm,P＜0.01)from normal SFCT.SFCT was independent of age (r=0.124),diopter (r=0.277),diabetic duration (r=0.286),fasting blood glucose (r=0.408),BCVA (r=0.087),and central retinal thickness (r=0.036).There was no significant difference of SFCT between different DME types (F =0.042,P ＞ 0.05).Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.