Prevalence of Diabetic Retinopathy in Mainland China: A Meta-Analysis

Background

Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-analysis to investigate the pooled prevalence of DR in mainland China.

Methodology/Principal Findings

We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline, EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the pooled general population was 1.3% (95%CI: 0.5%–3.2%), 1.1% (95%CI: 0.6%–2.1%), and 0.1% (95%CI: 0.1%–0.3%), respectively, but was 23% (95%CI: 17.8%–29.2%), 19.1% (95%CI: 13.6%–26.3%), and 2.8% (95%CI: 1.9%–4.2%) in the diabetic group. The prevalence rate of DR in the pooled rural population was higher than that in the urban population, 1.6% (95%CI: 1.3%–2%), and the diabetic population, 29.1% (95%CI: 20.9%–38.9%). The prevalence of DR was higher in the Northern region compared with the Southern region.

Conclusions/Significance

The prevalence of DR in mainland China appeared a little high, and varied according to area. NPDR was more common. This study highlights the necessity for DR screening in the rural areas of China.     

Diabetic retinopathy in the Eastern Morocco: Different stage frequencies and associated risk factors

Diabetes is a major cause of morbidity and mortality worldwide. It can affect many organs and, over time, leads to serious complications. Diabetic retinopathy (DR), a specific ocular complication of diabetes, remains the leading cause of vision loss and vision impairment in adults. This work is the first in Eastern Morocco aimed at identifying the different stages of DR and to determine their frequencies and associated risk factors. It is a case-control study conducted from December 2018 to July 2019 at the ophthalmology department of Al-Irfane Clinic (Oujda). Data were obtained from a specific questionnaire involving 244 diabetic patients (122 cases with retinopathy vs 122 controls without retinopathy). All results were analyzed by the EPI-Info software. This study shows a predominance of proliferative diabetic retinopathy (PDR) with 57.4% of cases (uncomplicated proliferative diabetic retinopathy (UPDR): 23.8%; complicated proliferative diabetic retinopathy (CPDR): 33.6%). The non-proliferative diabetic retinopathy (NPDR) represents 42.6% (minimal NPDR: 8.2%; moderate NPDR: 26.2%; severe NPDR: 8.2%). The determinants of DR were insulin therapy, high blood pressure, poor glycemic control and duration of diabetes. Regarding the chronological evolution, retinopathy precedes nephropathy. Diabetic nephropathy (DN) was present in 10.6% of cases especially in patients with PDR. In summary, the frequency of PDR was higher than that of NPDR. DR appears before DN with a high frequency of DN in patients with PDR. Good glycemic control and blood pressure control, as well as early diagnosis are the major preventive measures against DR.     

A Multi-Branch Convolutional Neural Network for Screening and Staging of Diabetic Retinopathy Based on Wide-Field Optical Coherence Tomography Angiography

BackgroundDiabetic retinopathy (DR) is one of the major causes of blindness in adults suffering from diabetes. With the development of wide-field optical coherence tomography angiography (WF-OCTA), it is to become a gold standard for diagnosing DR. The demand for automated DR diagnosis system based on OCTA images have been fostered due to large diabetic population and pervasiveness of retinopathy cases.Materials and methodsIn this study, 288 diabetic patients and 97 healthy people were imaged by the swept-source optical coherence tomography (SS-OCT) with 12 mm × 12 mm single scan centered on the fovea. A multi-branch convolutional neural network (CNN) was proposed to classify WF-OCTA images into four grades: no DR, mild non-proliferative diabetic retinopathy (NPDR), moderate to severe NPDR, and proliferative diabetic retinopathy (PDR).ResultsThe proposed model achieved a classification accuracy of 96.11%, sensitivity of 98.08% and specificity of 89.43% in detecting DR. The accuracy of the model for DR staging is 90.56%, which is higher than that of other mainstream convolution neural network models.ConclusionThis technology enables early diagnosis and objective tracking of disease progression, which may be useful for optimal treatment to reduce vision loss.     

Relationship between C-Reactive Protein Level and Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Objectives

To date, the relationship between C-reactive protein (CRP) level and diabetic retinopathy (DR) remains controversial. Therefore, a systematic review and meta-analysis was used to reveal the potential relationship between CRP level and DR.

Methods

A systematic search of PubMed, Embase.com, and Web of Science was performed to identify all comparative studies that compared the CRP level of two groups (case group and control group). We defined that diabetic patients without retinopathy and /or matched healthy persons constituted the control group, and patients with DR were the case group.

Results

Two cross sectional studies and twenty case control studies including a total of 3679 participants were identified. After pooling the data from all 22 studies, obvious heterogeneity existed between the studies, so a subgroup analysis and sensitivity analysis were performed. Removing the sensitivity studies, the blood CRP levels in the case group were observed to be higher than those in the control group [SMD = 0.22, 95% confidence interval (CI), 0.11–0.34], and the blood CRP levels in the proliferative diabetic retinopathy (PDR) group were also higher than those in the non-proliferative diabetic retinopathy (NPDR) group [SMD = 0.50, 95% CI, 0.30–0.70].

Conclusions

The results from this current meta-analysis indicate that the CRP level might be used as a biomarker to determine the severity of DR.     

Peripapillary Retinal Nerve Fiber Layer Changes in Preclinical Diabetic Retinopathy: A Meta-Analysis

BackgroundDiabetic retinopathy is a microvascular neurodegenerative disorder in diabetic patients. Peripapillary retinal nerve fiber layer changes have been described in patients with preclinical diabetic retinopathy, but study results have been inconsistent.ObjectiveTo assess changes in peripapillary retinal nerve fiber layer thickness in diabetic patients with preclinical diabetic retinopathy.MethodsA literature search was conducted through PubMed, EMBASE, Web of Science and Cochrane Library. Case-control studies on RNFL thickness in preclinical diabetic retinopathy patients and healthy controls were retrieved. A meta-analysis of weighted mean difference and a sensitivity analysis were performed using RevMan 5.2 software.ResultsThirteen case-control studies containing 668 diabetic patients and 556 healthy controls were selected. Peripapillary RNFL thickness was significantly reduced in patients with preclinical diabetic retinopathy compared to healthy controls in studies applying Optical Coherence Tomography (-2.88μm, 95%CI: -4.44 to -1.32, P = 0.0003) and in studies applying Scanning Laser Polarimeter (-4.21μm, 95%CI: -6.45 to -1.97, P = 0.0002). Reduction of RNFL thickness was significant in the superior quadrant (-3.79μm, 95%CI: -7.08 to -0.50, P = 0.02), the inferior quadrant (-2.99μm, 95%CI: -5.44 to -0.54, P = 0.02) and the nasal quadrant (-2.88μm, 95%CI: -4.93 to -0.82, P = 0.006), but was not significant in the temporal quadrant (-1.22μm, 95%CI: -3.21 to 0.76, P = 0.23), in diabetic patients.ConclusionPeripapillary RNFL thickness was significantly decreased in preclinical diabetic retinopathy patients compared to healthy control. Neurodegenerative changes due to preclinical diabetic retinopathy need more attention.     

High-Resolution Imaging of Parafoveal Cones in Different Stages of Diabetic Retinopathy Using Adaptive Optics Fundus Camera

PurposeTo assess cone density as a marker of early signs of retinopathy in patients with type II diabetes mellitus.MethodsAn adaptive optics (AO) retinal camera (rtx1^™; Imagine Eyes, Orsay, France) was used to acquire images of parafoveal cones from patients with type II diabetes mellitus with or without retinopathy and from healthy controls with no known systemic or ocular disease. Cone mosaic was captured at 0° and 2°eccentricities along the horizontal and vertical meridians. The density of the parafoveal cones was calculated within 100×100-μm squares located at 500-μm from the foveal center along the orthogonal meridians. Manual corrections of the automated counting were then performed by 2 masked graders. Cone density measurements were evaluated with ANOVA that consisted of one between-subjects factor, stage of retinopathy and the within-subject factors. The ANOVA model included a complex covariance structure to account for correlations between the levels of the within-subject factors.ResultsTen healthy participants (20 eyes) and 25 patients (29 eyes) with type II diabetes mellitus were recruited in the study. The mean (± standard deviation [SD]) age of the healthy participants (Control group), patients with diabetes without retinopathy (No DR group), and patients with diabetic retinopathy (DR group) was 55 ± 8, 53 ± 8, and 52 ± 9 years, respectively. The cone density was significantly lower in the moderate nonproliferative diabetic retinopathy (NPDR) and severe NPDR/proliferative DR groups compared to the Control, No DR, and mild NPDR groups (P < 0.05). No correlation was found between cone density and the level of hemoglobin A_1c (HbA_1c) or the duration of diabetes.ConclusionsThe extent of photoreceptor loss on AO imaging may correlate positively with severity of DR in patients with type II diabetes mellitus. Photoreceptor loss may be more pronounced among patients with advanced stages of DR due to higher risk of macular edema and its sequelae.     

Lack of relationship between Alu repetitive elements in angiotensin converting enzyme and the severity of diabetic retinopathy

BackgroundAngiotensin-converting enzyme (ACE) stimulates angiogenesis that leads to the development of diabetic retinopathy (DR). Alu repetitive elements in ACE gene increase the expression of this enzyme. We investigated the frequency of Alu repetitive elements, insertion/deletion (I/D) polymorphism, in angiotensin-converting enzyme among diabetic retinopathy patients and whether this polymorphism is associated with the severity of retinopathy in Jordanians with type 2 diabetes.MethodsA total of 277 subjects participated in this case/ control study (100 diabetic patients without DR, 82 diabetic patients with DR, and 95 healthy control). Blood samples were withdrawn, followed by DNA extraction. Alu repetitive elements were examined by polymerase chain reaction followed by gel electrophoresis.ResultsThe genotype and allele frequencies among diabetic patients, were close to healthy controls (genotypes, II 44.4 vs. 44.7%, ID 44.4 vs. 42.6%, DD 12.2 vs. 12.8%, P = 0.402 and 0.677 respectively, alleles, I 65.6 vs. 66%, D 34.4 vs. 34%, P=0.863). Complicated diabetics with retinopathy showed similar genotype and allele frequency to those without complications. The severity of diabetic retinopathy in affected individuals was not correlated with I/D polymorphism (P=0.862).ConclusionsWe conclude that the presence of Alu repetitive elements did not increase the development or progression risk to retinopathy in Jordanian type 2 diabetic patients. No association between I or D alleles with the severity of DR was detected.     

Investigation of Variants in UCP2 in Chinese Type 2 Diabetes and Diabetic Retinopathy

Purpose

The aim of this study was to investigate variants in UCP2 genes in type 2 diabetes mellitus (DM) and diabetic retinopathy (DR) in Chinese population.

Materials and Methods

We conducted a single nucleotide polymorphism-based and haplotype-based case-control study between the variants of UCP2 and DM and between the variants of UCP2 and DR in 479 Chinese patients with type 2 DM and 479 control subjects without DM. Two SNPs (rs660339 and rs659366) were selected as genetic markers.

Results

The risk allele C at UCP2 rs660339 was closely associated with DM in Chinese population. There was significant difference in rs660339 between DM and controls (P = 0.0016; OR [95%CI]  = 1.37 (1.14–1.65)). Subjects who were homozygous of the C allele were more likely to develop DM. The frequency of C allele was higher in DM (58%) than in control (51%). But this locus didn''t have a definite effect on the onset of non-proliferative diabetic retinopathy (NPDR) (P = 0.44; OR [95%CI]  = 0.80 (0.56–1.14)) and proliferative diabetic retinopathy (PDR) (P = 1.00; OR [95%CI]  = 0.99 (0.74–1.34)) comparing to subjects with DM without retinopathy (DWR), respectively. Moreover, the UCP2 rs659366 polymorphism showed no significant difference between DM and control (P = 0.66; OR [95%CI]  = 1.10 (0.91–1.32)). However, there was a significant difference between PDR and DWR (P = 0.016; OR [95%CI]  = 0.66 (0.49–0.90)), but there was no difference between NPDR and DWR (P = 1.00; OR [95%CI]  = 0.96 (0.67–1.37)). Participants who carried the G allele at rs659366 were more likely to develop PDR. For the haplotype, C-A was present more frequently in DM than in control (16% vs 7%), indicating that it was risky, and T-A was present less in DM than in control (29% vs 35%). Haplotype frequencies in DR and DWR showed no significant difference (P = 0.068).

Conclusion

It was indicated that UCP2 may be implicated in the pathogenesis of type 2 DM and DR in Chinese population.     

Validation of Smartphone Based Retinal Photography for Diabetic Retinopathy Screening

Aim

To evaluate the sensitivity and specificity of “fundus on phone’ (FOP) camera, a smartphone based retinal imaging system, as a screening tool for diabetic retinopathy (DR) detection and DR severity in comparison with 7-standard field digital retinal photography.

Design

Single-site, prospective, comparative, instrument validation study.

Methods

301 patients (602 eyes) with type 2 diabetes underwent standard seven-field digital fundus photography with both Carl Zeiss fundus camera and indigenous FOP at a tertiary care diabetes centre in South India. Grading of DR was performed by two independent retina specialists using modified Early Treatment of Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined by the presence of proliferative DR(PDR) or diabetic macular edema. The sensitivity, specificity and image quality were assessed.

Results

The mean age of the participants was 53.5 ±9.6 years and mean duration of diabetes 12.5±7.3 years. The Zeiss camera showed that 43.9% had non-proliferative DR(NPDR) and 15.3% had PDR while the FOP camera showed that 40.2% had NPDR and 15.3% had PDR. The sensitivity and specificity for detecting any DR by FOP was 92.7% (95%CI 87.8–96.1) and 98.4% (95%CI 94.3–99.8) respectively and the kappa (ĸ) agreement was 0.90 (95%CI-0.85–0.95 p<0.001) while for STDR, the sensitivity was 87.9% (95%CI 83.2–92.9), specificity 94.9% (95%CI 89.7–98.2) and ĸ agreement was 0.80 (95%CI 0.71–0.89 p<0.001), compared to conventional photography.

Conclusion

Retinal photography using FOP camera is effective for screening and diagnosis of DR and STDR with high sensitivity and specificity and has substantial agreement with conventional retinal photography.     

Phacoemulsification, vitrectomy and the implantation of an intraocular lens in diabetic patients

The purpose of this study was to evaluate results of combined phacoemulsification, intraocular lens implantation and pars plana vitrectomy in patients with advanced diabetic retinopathy. We retrospectively evaluated postoperative outcomes and complications in 102 eyes of 102 patients who underwent a combined procedure. All patients had a visually significant cataract. Forty two patients had vitreous hemorrhage and mild proliferative diabetic retinopathy. Sixty patients had a mild tractional retinal detachment. The median follow up was 14 months (range 6-36 months). 80% of patients had an increase of visual acuity of at least 2 Snellen lines. The most frequent early postoperative complication was elevated intraocular pressure, followed by mild fibrinous reaction. The most frequent late postoperative complication was the presence of posterior synechia, followed by glaucoma. Eleven patients required a repeated pars plana vitrectomy. Combined phacoemulsification, posterior chamber intraocular lens implantation and pars plana vitrectomy can be successfully performed in selected diabetic patients with favorable postoperative outcome.     

Role of ACE and PAI-1 Polymorphisms in the Development and Progression of Diabetic Retinopathy

In the present study we determined the association of angiotensin converting enzyme (ACE) and plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms with diabetic retinopathy (DR) and its sub-clinical classes in Pakistani type 2 diabetic patients. A total of 353 diabetic subjects including 160 DR and 193 diabetic non retinopathy (DNR) as well as 198 healthy controls were genotyped by allele specific polymerase chain reaction (PCR) for ACE Insertion/Deletion (ID) polymorphism, rs4646994 in intron 16 and PAI-1 4G/5G (deletion/insertion) polymorphism, rs1799768 in promoter region of the gene. To statistically assess the genotype-phenotype association, multivariate logistic regression analysis was applied to the genotype data of DR, DNR and control individuals as well as the subtypes of DR. The ACE genotype ID was found to be significantly associated with DR (p = 0.009, odds ratio (OR) 1.870 [95% confidence interval (CI) = 1.04–3.36]) and its sub-clinical class non-proliferative DR (NPDR) (p = 0.006, OR 2.250 [95% CI = 1.098–4.620]), while PAI polymorphism did not show any association with DR in the current cohort. In conclusion in Pakistani population the ACE ID polymorphism was observed to be significantly associated with DR and NPDR, but not with the severe form of the disease i.e. proliferative DR (PDR).     

Plasma angiogenesis and oxidative stress markers in patients with diabetic retinopathy

Abstract

Background: Neovascularization in the retina and hyperglycaemia-induced oxidative stress are implicated in the pathogenesis of diabetic retinopathy (DR). In this study, we hypothesized that the plasma angiogenic and oxidative stress markers associated with these derangements could aid in the screening of diabetic patients who are at an increased risk of developing retinopathy.

Methods: This study included normal (n?=?148), type2 diabetes without retinopathy (DNR; n?=?148), proliferative DR (PDR; n?=?74) and non-PDR (NPDR; n?=?148) subjects. Plasma concentrations of vascular endothelial growth factor-A (VEGF-A), hypoxia-inducible factor-1α (HIF-1α), matrix metalloproteinase-9 (MMP-9), pigment epithelium-derived factor (PEDF), nitric oxide (NO), soluble receptors for advanced glycation end products (sRAGE), malondialdehyde (MDA) and protein thiols were estimated.

Results: A statistically significant increase was observed in the plasma concentrations of pro-angiogenic factors and markers of oxidative stress in both retinopathy groups. By contrast, the concentrations of anti-angiogenic factors and antioxidants were decreased significantly in these groups. Receiver operating characteristic analysis indicated that the plasma thresholds of HIF-1α and PEDF can be suitable markers in case of NPDR. However, in PDR, HIF-1α, NO, MMP-9 and PEDF showed high sensitivity and specificity.

Conclusions: The factors associated with hypoxia, matrix degradation and angiogenic inhibition play a crucial role in predicting DR.     

激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床效果及机制研究

目的:探讨激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床效果及可能机制。方法:选取2017年1月至2017年12月我院收治的糖尿病视网膜病变伴黄斑水肿患者92例作为研究对象,随机分为观察组46例(46眼)及对照组46例(46眼)。对照组患者实施激光治疗,观察组在注射康柏西普1周后再进行激光治疗。比较两组患者治疗后的临床疗效,治疗前后最佳矫正视力(BCVA)、黄斑中心厚度(CMT)、血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)及红细胞生成素(EPO)水平的变化。结果:治疗后,观察组的总有效率为91.30%,显著高于对照组(69.57%,P0.05);两组患者的BCVA均较治疗前明显提高(P0.05),CMT均低于治疗前(P0.05),但观察组BCVA较对照组更高(P0.05);CMT较对照组更低(P0.05)。治疗后,两组患者的VEGF、IGF-1、EPO均较治疗前明显降低,且观察组的VEGF、IGF-1、EPO均显著低于对照组(P0.05)。结论:激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床疗效显著优于单用激光治疗,并可有效改善VEGF、IGF-1、EPO水平,这可能对抑制血管新生产生积极作用。     

2型糖尿病视网膜病变患者血清和肽素、脂质运载蛋白2水平的表达及其临床意义

摘要 目的：探讨2型糖尿病（T2DM）视网膜病变（DR）患者血清和肽素（copeptin）、脂质运载蛋白2（LCN2）的表达及其临床意义。方法：选取2021年1月~2023年1月期间江南大学附属医院接收的2型糖尿病（T2DM）患者141例，将所有患者分为不合并糖尿病视网膜病变（DR）组（NDR组，n=49）、非增生期DR组（NPDR组，n=45）和增生期DR组（PDR组，n=47），另选取同期行健康体检的志愿者50例作为对照组。比较各组临床指标、生化指标及血清copeptin、LCN2水平，采用Pearson相关性分析血清copeptin、LCN2水平与临床指标及生化指标的相关性，采用多因素Logistic回归分析DR的危险因素。结果：对照组、NDR组、NPDR组、PDR组的血清copeptin、LCN2水平呈逐渐升高趋势（P<0.05）。NDR组、NPDR组、PDR组的体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）均高于对照组（P<0.05）；对照组、NDR组、NPDR组、PDR组的糖化血红蛋白（HbAlc）、胰岛素抵抗指数（HOMA-IR）呈逐渐升高趋势（P<0.05）；NDR组、NPDR组、PDR组糖尿病病程呈逐渐递增趋势（P<0.05）。Pearson相关性分析显示，copeptin、LCN2水平与HbAlc、HOMA-IR、糖尿病病程呈正相关（P<0.05），与血压、血脂、FPG、BMI无明显相关性（P>0.05）。多因素Logistic回归分析结果显示：糖尿病病程、HbAlc、HOMA-IR、copeptin、LCN2均为DR发生发展的独立危险因素（P<0.05）。结论：高水平copeptin、LCN2可能与DR的发生、发展有关，且与患者糖尿病病程、HbAlc、HOMA-IR关系密切，可用于DR患者的早期诊断及判断其病情的严重程度。     

Regression to the Mean and Predictors of MRI Disease Activity in RRMS Placebo Cohorts - Is There a Place for Baseline-to-Treatment Studies in MS?

BackgroundGadolinium-enhancing (GD+) lesions and T2 lesions are MRI outcomes for phase-2 treatment trials in relapsing-remitting Multiple Sclerosis (RRMS). Little is known about predictors of lesion development and regression-to-the-mean, which is an important aspect in early baseline-to-treatment trials.ObjectivesTo quantify regression-to-the-mean and identify predictors of MRI lesion development in placebo cohorts.Methods21 Phase-2 and Phase-3 trials were identified by a systematic literature research. Random-effects meta-analyses were performed to estimate development of T2 and GD+ after 6 months (phase-2) or 2 years (phase-3). Predictors of lesion development were evaluated with mixed-effect meta-regression.ResultsThe mean number of GD+-lesions per scan was similar after 6 months (1.19, 95%CI: 0.87-1.51) and 2 years (1.19, 95%CI: 1.00-1.39). 39% of the patients were without new T2-lesion after 6 month and 19% after 2 years (95%CI: 12-25%). Mean number of baseline GD+-lesions was the best predictor for new lesions after 6 months.ConclusionBaseline GD-enhancing lesions predict evolution of Gd- and T2 lesions after 6 months and might be used to control for regression to the mean effects. Overall, proof-of-concept studies with a baseline to treatment design have to face a regression to 1.2 GD+lesions per scan within 6 months.     

2型糖尿病性视网膜病变临床因素分析

目的:探讨影响2型糖尿病视网膜病变(DR)发病的相关临床因素。方法:回顾性分析483例2型糖尿病患者的临床资料。结果:2型糖尿痛DR患病率为35%(169/483),其中非增殖型视网膜病变(NPDR)73.4%(124/169),增殖型视网膜病变(PDR)26.6% (45/169)。DR患者的病程、SBP、合并肾脏病变、合并心脏病变、HbA1c、TC、TG、LDL-c、BUN和Cr均显著高于NDR患者(P<0.05);Logistic回归分析显示病程、年龄、SBP、TC、LDL-c、合并心脏病变和/或肾脏病变是DR发病的危险因素。结论:DM病程、患病年龄、SBP、HbA1c、TC、LDL-c、合并心脏病变和/或肾脏病变、肾功能是DR发生发展的危险因素。     

玻璃体腔抗VEGF治疗不同光学相干层析成像技术分型下的糖尿病黄斑水肿临床疗效分析

摘要 目的：研究玻璃体腔内抗血管内皮生长因子（VEGF）抗体治疗不同光学相干层析成像技术（OCT）分型下的糖尿病黄斑水肿临床疗效。方法：选取2019年1月到2021年3月在我院进行治疗的糖尿病黄斑水肿患者60例,根据OCT检测分为分弥漫性黄斑水肿（DRT）组、囊样黄斑水肿（CME）组和浆液性视网膜脱离（SRD）组,每组20例。所有患者均接受玻璃体腔内注射抗VEGF抗体治疗,比较三组患者临床治疗疗效、黄斑水肿形态、最佳矫正视力（BCVA）、黄斑中心凹厚度（CMT）以及不良反应发生率。结果：（1）DRT、CME和SRD组患者临床治疗有效率分别为85.0 %、75.0 %和50.0 %,治疗后黄斑水肿消退率分别为55.0 %、25.0 %和10.0 %,且组间比较差异显著（P<0.05）;（2）三组患者治疗前BCVA和CMT均无差异（P>0.05）,治疗后三组患者BCVA和CMT均降低（P<0.05）,并且治疗后DRT和CME组患者BCVA和CMT均低于SRD组（P<0.05）;（3）DRT、CME和SRD组患者治疗期间不良反应发生率分别为10.0 %、10.0 %和25.0 %,但三组患者治疗期间不良反应发生率比较无差异（P>0.05）。结论：不同OCT分型的糖尿病黄斑水肿经玻璃体腔抗VEGF抗体治疗后临床疗效不同,其中DRT患者临床治疗疗效最好,而SRD患者疗效最差。     

The Association between Chronic Kidney Disease and Diabetic Retinopathy: The Korea National Health and Nutrition Examination Survey 2008-2010

Purpose

To explore the relationship between chronic kidney disease and diabetic retinopathy in a representative population of Korean diabetic adults.

Methods

We analyzed data from the Korea National Health and Nutrition Examination Surveys (2008-2010). A total of 15,409 individuals (weighted frequency, 32,168,636) aged 19 and over who completed ophthalmologic and renal functional examinations were evaluated. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m² or proteinuria greater than 1+. Seven standard photographs from the Early Treatment for Diabetic Retinopathy Study were obtained from each eye after pharmacological pupil dilatation. Diabetic retinopathy (DR) was defined as the presence of 1 or more retinal microaneurysms or retinal blot hemorrhages with or without more severe lesions. Vision-threatening diabetic retinopathy (VTDR) was defined as the presence of a clinically significant macular edema (CSME) or proliferative diabetic retinopathy.

Results

CKD was significantly associated with DR and VTDR (odds ratio (OR), 95% confidence interval (CI); 2.49(1.43-4.35) and 3.74(1.56-8.95), respectively) in the diabetic population. After controlling for confounders, however, CKD was significantly associated only with DR [adjusted OR (aOR), 95% CI; 2.34(1.04-5.28)]. In the subgroup analysis for CKD, only proteinuria was significantly associated with DR and VTDR (aOR, 95% CI; 4.56(1.51-13.77) and 5.61(1.06-29.87), respectively) in this population.

Conclusions

Our results show that CKD appears to be associated with DR and VTDR in a Korean diabetic population. In particular, proteinuria, not decreased eGFR, is more significantly associated with DR or VTDR.     

Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular oedema

We evaluate the effect of intravitreal injections of Bevacizumab (IVB) alone or combined with triamcinolone (IVT) in the first injection for treatment of refractory diabetic macular oedema (DME). Sixty eyes of sixty patients with refractory DME were included. Half of the receive injections of IVB (1.25 mg/0.05 mL) or combined IVB and IVT (1.25 mg/0.05 mL and 2 mg/0.05 mL respectively). The primary outcome measure was change in central macular thickness (CMT). Secondary outcome measures were change in best-corrected logMAR visual acuity (BCVA) and incidence of potential adverse events. Central macular thickness was reduced significantly in both the IVB and IVB/IVT groups. At week 24, CMT change compared to the baseline was -95.7 microm (95% CI, -172.2 to -19.26) in the IVB group and -92.1 pm (95% CI, -154.4 to -29.7) in the IVB/IVT group. There was not a significant difference between the IVB and the IVB/IVT groups (p = 0.022). Improvement of BCVA was initiated at weeks 6 and 12 in the IVB/IVT and IVB groups respectively. In terms of BCVA change compared to the baseline at 24 weeks, the differences between the IVB and the IVB/IVT groups (p = 0.006) were significant. Anterior Chamber reaction was noticed in six (20%) and six (20%) eyes respectively in the IVB and IVB/IVT groups the day after injection, and it resolved with no sequel. Elevation of IOP occurred in two eyes (6%) in the IVB/ IVT group. Intravitreal injections of Bevacizumab had a beneficial effect on refractory DME in terms of CMT reduction and BCVA improvement. Addition of triamcinolone in the injection seemed to induce earlier visual improvement; however, it did not show any significant additive effect later during follow-up.