Influencing factors of telangiectasia secondary to diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the influencing factors of abnormal telangiectasia secondary to diabetic retinopathy(DR).METHODS: Prospective studies. A total of 153 cases(240 eyes)with DR treated in our hospital from January 2021 to January 2023 were selected to analyze the risk factors of abnormal telangiectasia secondary to DR and its predictive efficacy.RESULTS: The patients were divided into dilated group(77 eyes of 40 cases)and non-dilated group(163 eyes of 113 cases)according to whether they had secondary abnormal telangiectasia. There were significant differences in diabetic macular edema, hard exudates grade and fasting blood glucose level between the two groups(P<0.05). Logistic regression analysis showed that diabetic macular edema, high hard exudates grade and high blood glucose level were the risk factors for abnormal telangiectasia secondary to DR(P<0.05).CONCLUSION: The occurrence of telangiectasia secondary to DR may be related to diabetic macular edema, grade 3 hard exudates and high blood glucose level.

New Method of Quantitative Analysis of Hard Exudate Using Optical Coherence Tomography: Application in Diabetic Macular Edema

PURPOSE: In the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed. METHODS: The medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed. RESULTS: A total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm³ at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm² at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area. CONCLUSIONS: In the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.

Pearl necklace sign in diabetic macular edema: Evaluation and significance.

Purpose: (1) The purpose of this study was to describe significance and prevalence of the newly reported pearl necklace spectral domain optical coherence tomography (SDOCT) sign, in diabetic macular edema (DMO), (2) to track the course of this sign over a period of at least 10 months. Materials and Methods: The pearl necklace SDOCT sign refers to hyperreflective dots in a contiguous ring around the inner wall of cystoid spaces in the retina, recently described for the first time in 21 eyes with chronic exudative maculopathy. A retrospective analysis was performed of SDOCT images of all patients presenting to the DMO referral clinic of a tertiary eye care center, over a period of 24 months. Images of patients displaying this sign were sequentially analyzed for at least 10 months to track the course of the sign. Results: Thirty‑five eyes of 267 patients (13.1%) were found to display the pearl necklace sign. Twenty‑eight eyes responded to intravitreal ranibizumab treatment with resolution of edema. In 21 eyes, the dots coalesced to form a clump, visible in the infrared fundus photograph as hard exudates; in seven eyes, dots disappeared without leaving visible exudates. In three eyes, the sign was seen in subfoveal cystoid spaces, with subsequent development of hard exudates, and drop in visual acuity of 20 letters or more. Conclusion: Pearl necklace SDOCT sign is not infrequent in DMO. This sign is a precursor to hard exudates in the majority of cases. If this sign is seen subfoveally, drop in visual acuity can be expected, despite treatment.

Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema

PURPOSE: To investigate the outcome of intravitreal bevacizumab (IVB) combined with posterior subtenon triamcinolone acetonide injections compared to IVB injection alone in patients with diabetic macular edema (DME). METHODS: IVB injection (IVB group) and combination therapy injection (combination group) were administered to 35 eyes and 31 eyes, respectively, diagnosed with proliferative diabetic retinopathy combined with DME. Changes in best corrected visual acuity (BCVA), central macular thickness (CMT), total macular volume (TMV), amount of hard exudates and intraocular pressure (IOP) were compared retrospectively between groups prior to injection and 1, 2 and 3 months after injection. RESULTS: BCVA changes in both groups were only statistically significant at 4 weeks after injection. Reduction of CMT and TMV was maintained for 1 month after treatment in all groups, but CMT and TMV deteriorated 2 months after treatment. No significant differences in BCVA, CMT or TMV were detected between the IVB and combination groups. The amount of hard exudates were only significantly decreased at month 3 in the combination group whereas the amount of hard exudates was not significantly different at 3 months in the IVB group (at baseline 2,899 ± 2,314 pixels vs. at 3 months 2,536 ± 1,981 pixels, p-value = 0.041). IOP showed no significant difference between the groups. Elevated IOP or endophthalmitis were not observed. CONCLUSIONS: In terms of BCVA improvement, subtenon triamcinolone provided no additional benefit on CMT and TMV reduction. However, combination therapy was effective in reducing the amount of hard exudates at 3 months.

Subretinal lipid exudation associated with untreated choroidal melanoma.

Subretinal lipid exudation in an untreated choroidal melanoma is very rare. It is seen following plaque radiotherapy in choroidal melanoma. There is only one case report of untreated choroidal melanoma with massive lipid exudation in a patient with metastatic hypernephroma. We report here a rare case of untreated choroidal melanoma with lipid exudation. Subretinal exudation that is rarely seen following plaque brachytherapy was noted at the borders of this untreated tumor. Lipid exudation partially resolved following brachytherapy.

Association of serum lipid profile with retinal hard exudates among patients with type 2 diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the association between lipid profile and retinal hard exudates in diabetic retinopathy (DR) and the association between oxidized-LDL with systemic diseases among type 2 diabetic patients.another 40 patients without DR. Demographic data was collected and comprehensive ocular examination was performed. Nine mL venous blood was taken for fasting serum cholesterol, triglycerides, HDL, LDL, ox-LDL, and for HbA1C. Compared to patients without retinopathy 5.0±1.03mmol/L (P=0.001). The mean serum LDL was 3.6±1.69mmol/L in retinopathy group compared to 3.0±1.02mmol/L in the contol group (P=0.005). There was a higher concentration of serum cholesterol, triglyceride and LDL in patients with severe retinal hard exudates compared to those with mild and moderate, however it was not statistically significant (P=0.082, 0.116, 0.218) respectively. The mean serum oxidized-LDL concentration was higher in DR with severe retinal hard exudates compared to mild and moderate. There was no statistically significant difference in the mean oxidized LDL with other systemic diseases or duration of diabetes.and LDL with DR. However there was no association between serum lipid profile with the severity of retinal hard exudates. Serum ox-LDL was also not associated with DR and other systemic co-morbidities in our study.

A long-term follow-up for diabetic retinopathy with diffuse retinal edema and massive subretinal hard exudates / 解放军医学杂志

Objective To evaluate the clinical effects of surgical treatment for diabetic retinopathy(DR)with diffuse diabetic retinal edema(DDRE)and massive subretinal hard exudates(MSHE)by vitrectomy,endolaser retinal photocoagulation and long acting gas tamponade via analyzing the long term results.Methods Thirty eyes of twenty five patients with DR with DDRE and MSHE were recruited from October 2001 to December 2006.Among them,17 eyes belonged to 14 male patients and 13 eyes of 11 females.The patients' age was from 36 to 68 years(mean 54.6).The best corrected visual acuity(BCVA),color fundus photography,fundus fluorescein angiography(FFA)and optic coherence tomography(OCT)were performed preoperatively.Pars plana vitrectomy,posterior hyaloid removal,endolaser photocoagulation and long acting gas tamponade were used to treat the affected eyes.Results Preoperative BCVA was finger counting to 0.05 in all the 30 eyes.During 12-23 months of follow up period,2 eyes showed no change in BCVA,vision improvement was observed in 28 eyes(93.3%)with BCVA rising to 0.03-0.04 in 3 eyes,≥0.09 in 25 eyes,and among them the BCVA rose from 0.04 to 1.0 in one eye.The macular retina thickness thinned from preoperative ≥450?m to postoperative 160 220?m,intra-retinal and pre-retinal hemorrhage as well as MSHE was absorbed markedly or completely.Visual acuity decreased in 7 eyes(23.3%)during 24-42 months of follow up,anterior ischemic opticneuropathy occurred in 3 eyes(10%),macular edema recurred in 4 eyes(sub-macular hard exudates appeared in 2 eyes),and macular thickness measured 310-410?m.Scars in sub-fovea and peri-fovea sub-retina were noted in 5 eyes,in which the visual acuity was improved from finger counting to 0.04.Conclusion Vitrectomy,including posterior hyaloid removal,endolaser retinal photocoagulation and long acting gas tamponade may offer satisfactory effects in the treatment for DR complicated with DDME and MSHE.