AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients wit...AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients with type 2 diabetes.METHODS:Data were retrospectively collected from the medical records of patients with diabetic retinopathy(DR)taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022.We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i.Propensity score matching was performed using the following variables:age,duration of diabetes,blood glucose control(HbA1c)level,and severity of DR.RESULTS:A total of 268 patients with DR were included in this study.More DPP4i users needed IVT than SGLT2i users(35.3%vs 18.0%,P=0.011),while the prevalence of DME was not different.The use of SGLT2i was associated with a lower need for IVT than DPP4i[odds ratio(OR)0.404,95%confidence interval(CI)0.198-0.823],and similar trends were observed after propensity score matching(OR 0.419,95%CI 0.181-0.970).However,this tendency was not significant in multiple logistic regressions.For DME,the use of DPP4i was not a significant risk factor compared to SGLT2i.CONCLUSION:The use of SGLT2i may be associated with a lower need for IVT for overall DR complications,while other factors may contribute to this effect.The effect of SGLT2i on the prevention of DME is not evident.展开更多
Dear Editor,Acute subhyaloid hemorrhage causes sudden profound vision loss in the macular region.This is a term that designates ocular hemorrhages lying between the posterior hyaloid membrane and the retina,often pres...Dear Editor,Acute subhyaloid hemorrhage causes sudden profound vision loss in the macular region.This is a term that designates ocular hemorrhages lying between the posterior hyaloid membrane and the retina,often presented as a‘boat’or‘D’shaped hemorrhage[1].The development of optical coherence tomography(OCT)had enabled detailed differentiation of subhyaloid hemorrhage,allowing the term sub-internal limiting membrane(ILM)hemorrhage to be applied in selected cases where the blood is located beneath the ILM[1-2].However,it is not always possible to distinguish the location of the hemorrhage due to the attenuation of the retinal structures on OCT.Accordingly,subhyaloid hemorrhage remains a widely used term,implying both subhyaloid and sub-ILM hemorrhage[1].展开更多
Cystoid macular edema(CME) is the abnormal collection of intraretinal fluid in the macular region, especially in the inner nuclear and outer plexiform layers. CME leads to severe visual impairment in patients with var...Cystoid macular edema(CME) is the abnormal collection of intraretinal fluid in the macular region, especially in the inner nuclear and outer plexiform layers. CME leads to severe visual impairment in patients with various retinal diseases, such as diabetic retinopathy, retinal vascular occlusion, choroidal neovascularization, and uveitis. Although various retinal conditions lead to CME, a shared pathogenesis of CME is involved in these diseases. Accordingly, the pathogenesis of CME based on vasogenic mechanisms is first discussed in this review, including vascular hyperpermeability, leukostasis, and inflammation. We then describe cytotoxic mechanisms based on retinal Müller cell dysfunction. This comprehensive review will provide an understanding of the pathogenesis of CME for potential therapeutic strategies.展开更多
Dear Editor,Ocular toxoplasmosis,caused by Toxoplasma gondii infection,is one of the most common causes of posterior uveitis worldwide[1].It typically manifests as white focal retinitis with overlying vitreous inflamm...Dear Editor,Ocular toxoplasmosis,caused by Toxoplasma gondii infection,is one of the most common causes of posterior uveitis worldwide[1].It typically manifests as white focal retinitis with overlying vitreous inflammation that results in a chorioretinal scar and associated scotoma[2].However,the diagnosis of ocular toxoplasmosis can be challenging when it presents as an isolated papillitis without other typical signs of retinochoroiditis or vitritis[2].Although optic nerve involvement in ocular toxoplasmosis was present in 5.3%of cases,isolated papillitis was extremely rare(3 eyes out of 926 patients)and was only considered a presumed diagnosis in such cases given the presence of old toxoplasmic retinochoroiditis lesions[3].Few reports have described optic nerve involvement preceding toxoplasmic retinochoroiditis,while perineuritis,an uncommon form of orbital inflammatory disease involving the optic nerve sheath,has not been reported at all[4-5].Herein,we describe a case of ocular toxoplasmosis that initially presented with optic perineuritis followed by typical retinochoroidal inflammation.To our knowledge,this is the first case report of ocular toxoplasmosis with perineuritis in an immunocompetent individual.展开更多
Dear Editor,The review of Chung et al[1]regarding the pathogenesis of cystoid macular edema(CME)raises valid postulates of shared pathogenesis which is based on inflammation and associated permeability.Albeit recogniz...Dear Editor,The review of Chung et al[1]regarding the pathogenesis of cystoid macular edema(CME)raises valid postulates of shared pathogenesis which is based on inflammation and associated permeability.Albeit recognizing diverse etiological conditions,the definition of common pathways has the potential to improve interventionist strategies.One further mechanism for CME that is less appreciated,however,is the cascade of reactions induced or modulated by eicosanoids.展开更多
文摘AIM:To investigate the effects of dipeptidyl peptidase-4 inhibitors(DPP4i)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)on diabetic macular edema(DME)and the need for intravitreal injections(IVT)in patients with type 2 diabetes.METHODS:Data were retrospectively collected from the medical records of patients with diabetic retinopathy(DR)taking either DPP4i or SGLT2i as secondary oral hypoglycemic agents in addition to metformin between January 2019 and July 2022.We compared the prevalence of DME and the need for IVT among patients treated with DPP4i or SGLT2i.Propensity score matching was performed using the following variables:age,duration of diabetes,blood glucose control(HbA1c)level,and severity of DR.RESULTS:A total of 268 patients with DR were included in this study.More DPP4i users needed IVT than SGLT2i users(35.3%vs 18.0%,P=0.011),while the prevalence of DME was not different.The use of SGLT2i was associated with a lower need for IVT than DPP4i[odds ratio(OR)0.404,95%confidence interval(CI)0.198-0.823],and similar trends were observed after propensity score matching(OR 0.419,95%CI 0.181-0.970).However,this tendency was not significant in multiple logistic regressions.For DME,the use of DPP4i was not a significant risk factor compared to SGLT2i.CONCLUSION:The use of SGLT2i may be associated with a lower need for IVT for overall DR complications,while other factors may contribute to this effect.The effect of SGLT2i on the prevention of DME is not evident.
文摘Dear Editor,Acute subhyaloid hemorrhage causes sudden profound vision loss in the macular region.This is a term that designates ocular hemorrhages lying between the posterior hyaloid membrane and the retina,often presented as a‘boat’or‘D’shaped hemorrhage[1].The development of optical coherence tomography(OCT)had enabled detailed differentiation of subhyaloid hemorrhage,allowing the term sub-internal limiting membrane(ILM)hemorrhage to be applied in selected cases where the blood is located beneath the ILM[1-2].However,it is not always possible to distinguish the location of the hemorrhage due to the attenuation of the retinal structures on OCT.Accordingly,subhyaloid hemorrhage remains a widely used term,implying both subhyaloid and sub-ILM hemorrhage[1].
基金Supported by Basic Science Research Program through the NRF funded by the Ministry of Education(NRF-2017R1D1A1A02018439)
文摘Cystoid macular edema(CME) is the abnormal collection of intraretinal fluid in the macular region, especially in the inner nuclear and outer plexiform layers. CME leads to severe visual impairment in patients with various retinal diseases, such as diabetic retinopathy, retinal vascular occlusion, choroidal neovascularization, and uveitis. Although various retinal conditions lead to CME, a shared pathogenesis of CME is involved in these diseases. Accordingly, the pathogenesis of CME based on vasogenic mechanisms is first discussed in this review, including vascular hyperpermeability, leukostasis, and inflammation. We then describe cytotoxic mechanisms based on retinal Müller cell dysfunction. This comprehensive review will provide an understanding of the pathogenesis of CME for potential therapeutic strategies.
文摘Dear Editor,Ocular toxoplasmosis,caused by Toxoplasma gondii infection,is one of the most common causes of posterior uveitis worldwide[1].It typically manifests as white focal retinitis with overlying vitreous inflammation that results in a chorioretinal scar and associated scotoma[2].However,the diagnosis of ocular toxoplasmosis can be challenging when it presents as an isolated papillitis without other typical signs of retinochoroiditis or vitritis[2].Although optic nerve involvement in ocular toxoplasmosis was present in 5.3%of cases,isolated papillitis was extremely rare(3 eyes out of 926 patients)and was only considered a presumed diagnosis in such cases given the presence of old toxoplasmic retinochoroiditis lesions[3].Few reports have described optic nerve involvement preceding toxoplasmic retinochoroiditis,while perineuritis,an uncommon form of orbital inflammatory disease involving the optic nerve sheath,has not been reported at all[4-5].Herein,we describe a case of ocular toxoplasmosis that initially presented with optic perineuritis followed by typical retinochoroidal inflammation.To our knowledge,this is the first case report of ocular toxoplasmosis with perineuritis in an immunocompetent individual.
文摘Dear Editor,The review of Chung et al[1]regarding the pathogenesis of cystoid macular edema(CME)raises valid postulates of shared pathogenesis which is based on inflammation and associated permeability.Albeit recognizing diverse etiological conditions,the definition of common pathways has the potential to improve interventionist strategies.One further mechanism for CME that is less appreciated,however,is the cascade of reactions induced or modulated by eicosanoids.
