Effect of intravitreal anti-VEGF injection on choroidal thickness in patients with diabetic macula edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate for any detectable change in sub-foveal choroidal thickness following intravitreal injections of Ranibizumab or Aflibercept in patients with central involving diabetic macula edema(DME), evidenced by optical coherence tomography(OCT).<p>METHODS: Totally 17 patients with central involving DME who required and agreed to intravitreal anti-VEGF injection were invited to be the subject of this study. These injection-naive subjects were undergone three loading doses of monthly intravitreal anti-VEGF(Ranibizumab 0.5 mg/0.05 mL for 9 patients or Aflibercept 2 mg/0.05 mL for 8 patients)injection, and a clinic review appointment 1mo after the third injection. The changes of foveal choroidal thickness, visual acuity and central retinal thickness at 1mo were observed before and after treatment in 2 groups by enhanced depth image-optical coherence tomography(EDI-OCT). <p>RESULTS: We recorded a significant sub-foveal choroidal thinning and vision improvement after three loading doses of anti-VEGF(all <i>P</i><0.05). The thinning effect between Ranibizumab and Aflibercept group was insignificant(all <i>P</i>>0.05). There was no significant correlation between pre-treatment sub-foveal choroidal thickness and vision improvement(<i>r_s</i>=-0.269, <i>P</i>=0.296). There was also no significant correlation between choroidal thickness changes with vision improvement, central retinal thickness change and age of subjects(all <i>P</i> >0.05).<p>CONCLUSION: Intravitreal Ranibizumab and Aflibercept injections both leads to significant sub-foveal choroidal thinning in DME subjects. It was accompanied with significant vision improvement with no evidence of immediate detrimental effect of choroidal thinning. Future research with a longer study duration would help in establishing the duration and long term effect of choroidal thinning.

Association of glycemic control with progression of diabetic retinopathy in type 2 diabetes mellitus patients in Malaysia

Abstract The risk of having microvascular complication is high among Type 2 Diabetes Mellitus (T2DM) patients. However, factors associated with the glycemic control and progression of diabetic retinopathy (DR) in T2DM patients is limited. This study aims to determine association between anti-diabetic agents, glycemic control and progression of diabetic retinopathy in a Malaysian population. A retrospective study conducted in a tertiary teaching hospital in Malaysia, from January 2009 until March 2014. This study enrolled 104 patients aged 40-84 years, with a mean age 63.12 ± 9.18 years. patients had non-proliferative diabetic retinopathy (NPDR, 77%) and 35% had proliferative diabetic retinopathy (PDR). Diabetic macula edema (DME) was present in 20% of NPDR patients, compared with 7% in PDR. Alpha-glucosidase inhibitor (p=0.012), age (p=0.014) and number of antidiabetic agents used (p=0.015) were significantly associated with stages of diabetic retinopathy. Family history of T2DM (p=0.039) was associated with DME. Identifying factors influencing the progression of diabetic retinopathy may aid in optimizing the therapeutic effects of anti-diabetic agents in T2DM patients.

Vision impairment following macular edema secondary to diabetes combined with branch retinal vein occlusion and its potential risk factors / 眼科新进展

Objective To compare visual impairment following secondary macular edema between diabetic and non-diabetic patients with branch retinal vein occlusion (BRVO) and assess the potential risk factors.Methods All 92 eyes in 87 patients with BRVO and secondary macular edema were recruited from Shaanxi provincial people's hospital and their clinical data were retrospectively analyzed.The patients were divided into 2 groups based on their blood glucose level:diabetic group including 38 patients (40 eyes) with diabetes mellitus and non-diabetic group including 49 patients (52 eyes) without diabetes.Baseline demographic assessments of vascular risk factors were evaluated at the beginning,including gender,age,medical history,BMI,blood pressure,serum lipid,HbAlc and ischemic heart disease.Visual acuity,axial length,intraocular pressure and central macular thickness (CMT) were observed when patients were admitted and at 1 month,3 months and 6 months during follow-up in the both groups,and logistic regression analysis was used to determine the related risk factors for visual impairment.Results There was no significant difference in the best corrected visual acuity between the two groups before treatment (P ＜ 0.05).The visual acuity of the nondiabetic group improved significantly during 1-month follow-up when compared with the diabetic group (t =2.22,P ＜ 0.05).However,no difference in visual acuity was found between the two groups during 3-month and 6-month follow-up.With " long-distance visual acuity ＞ 0.5 logMAR" as the dependent variable and various risk factors as the independent variable,univariate logistic regression analysis showed that diabetes mellitus (P =0.000),hyperlipidemia (P =0.000) BMI and axial length (P =0.000) were significantly associated with visual impairment following BRVO.According to the logistic regression analysis,hyperglycaemia (OR =8.222,P =0.014),hyperlipidemia (OR =25.247,P =0.002) and overweight (OR =1.388,P =0.014) were associated with the increased risk for final vision impairment,and axial length (OR =O.213,P =0.000) was proved to be a protective factor,which could alleviated the vision impairment.Conclusion Severe vision impairment following BRVO occurs more often in diabetic patients than non-diabetic patients,and controlling weight,glucose and lipid level may be an effective method for preventing vision impairment.

Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment.

Aim: A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD). Materials and Methods: Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test. Results: The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001). Conclusions: The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.