AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabe...AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.展开更多
Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deteri...Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.展开更多
Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in th...Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.展开更多
AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This...AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This retrospective study involved 65 RVO patients(65 eyes)who received IVR and were followedup for more than 3mo.ME was categorized into cystoid macular edema(CME),diffuse retinal thickening(DRT),and serous retinal detachment(SRD)according to optical coherence tomography(OCT)images.The comparison of best corrected visual acuity(BCVA;logMAR)and central macular thickness(CMT)among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test.The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.RESULTS:BCVA tended to improve in all groups,with marked improvement in CME and DRT groups.CMT showed the greatest reduction after 1wk,and remained stable over the following 3mo.DRT patients had the worst BCVA and the highest CMT at baseline,but the differences became smaller after IVR treatment.CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR.Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up.DRT patients were most likely to transform into the other morphological groups,while SRD patients showed minimal transitions.BCVA at baseline was identified as the most important prognostic indicator in all 3 groups.Additionally,DRT patients with a longer clinical course,higher CMT and central retinal vein occlusion(CRVO)tend to exhibit worse BCVA after treatment.In addition,CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion(BRVO)patients in CME group.SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.CONCLUSION:The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups.Baseline parameters including clinical course,CMT,and RVO position are also useful in predicting the BCVA at different time points after treatment.展开更多
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter le...Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.展开更多
AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RV...AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.展开更多
AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).ME...AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.展开更多
AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retr...AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.展开更多
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
AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 ...AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 to March 2024,72 patients diagnosed with DME at the outpatient clinic were enrolled.The patients were divided into two groups:the simple group(treated with conbercept alone)and the combination group(treated with 577 nm STML combined with conbercept).The following itmes were compared between the two groups:best corrected visual acuity(BCVA),central macular thickness(CMT),foveal avascular zone(FAZ),vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP),retinal mean sensitivity(RMS),injection numbers,and the number of cases with adverse effects.RESULTS:The mean age of patients was 57.13±8.76(range 34-77)y with DR history of 0.89±0.55y.With the progression of treatment,both groups showed significant improvements in BCVA,CMT,DCP vessel density,and RMS compared to baselines(all,P<0.05).At 3 and 6mo after treatment,the combination group exhibited significantly better outcomes in BCVA,CMT,DCP vessel density,and RMS than the simple group(P<0.05).During the treatment period,neither group showed significant improvements in FAZ and SCP vessel density(P>0.05),and no significant differences in FAZ and SCP vessel density were observed between the two groups(P>0.05).The average number of injections required in the combination group was lower than that in the simple group(3.33±0.68 vs 4.06±0.96,P<0.05).No other serious ophthalmic adverse events were observed in either group.CONCLUSION:Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.展开更多
AIM:To investigate the impact of renal dysfunction on clinical response to intravitreal conbercept injection(IVC)for diabetic macular edema(DME).METHODS:This retrospective study included a total of 100 eyes from 100 p...AIM:To investigate the impact of renal dysfunction on clinical response to intravitreal conbercept injection(IVC)for diabetic macular edema(DME).METHODS:This retrospective study included a total of 100 eyes from 100 patients with DME treated with IVC with 3+PRN regimen.Based on the estimated glomerular filtration rate(eGFR),the patients were divided into normal renal function group(n=37),impaired renal function group(n=27),and renal insufficiency group(n=36).The main outcome measures were best-corrected visual acuity(BCVA)and central subfield macular thickness(CST).Clinical parameters included blood urea nitrogen,serum creatinine,serum uric acid,glycosylated hemoglobin(HbA1c),and hemoglobin.RESULTS:The mean follow-up time was 3.9mo.The mean number of IVCs was 2.07±1.22 in the three groups.Mean BCVA improved significantly from 0.81±0.49 logMAR at baseline to 0.72±0.52 logMAR in the three groups at the final visit(P<0.001).Mean CST decreased significantly from 427.85±148.99μm at baseline to 275.31±108.31μm at final visit(P<0.001).Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group(all P<0.001).Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group(all P<0.001).The three groups had no differences in baseline HbA1c levels(P>0.05).Good baseline BCVA(logMAR,P=0.001)and thicker baseline CST(P=0.041)were associated with visual acuity improvement.Higher eGFR(P<0.001),hemoglobin(P=0.032)and thicker baseline CST(P=0.017)were associated with macular edema retrogression in the conbercept-treated diabetic patients,which showed better anatomical response to IVC.CONCLUSION:Our results indicate that the renal dysfunction is the risk factor associated with the efficacy of IVC for DME.展开更多
AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic r...AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.展开更多
BACKGROUND Diabetic macular edema(DME)is the most common cause of vision loss in people with diabetes.Tight junction disruption of the retinal pigment epithelium(RPE)cells has been reported to induce DME development.S...BACKGROUND Diabetic macular edema(DME)is the most common cause of vision loss in people with diabetes.Tight junction disruption of the retinal pigment epithelium(RPE)cells has been reported to induce DME development.SMAD-specific E3 ubiquitin protein ligase(SMURF)1 was associated with the tight junctions of cells.However,the mechanism of SMURF1 in the DME process remains unclear.AIM To investigate the role of SMURF1 in RPE cell tight junction during DME.METHODS ARPE-19 cells treated with high glucose(HG)and desferrioxamine mesylate(DFX)for establishment of the DME cell model.DME mice models were constructed by streptozotocin induction.The trans-epithelial electrical resistance and permeability of RPE cells were analyzed.The expressions of tight junction-related and autophagy-related proteins were determined.The interaction between insulin like growth factor 2 mRNA binding protein 2(IGF2BP2)and SMURF1 mRNA was verified by RNA immunoprecipitation(RIP).SMURF1 N6-methyladenosine(m6A)level was detected by methylated RIP.RESULTS SMURF1 and vascular endothelial growth factor(VEGF)were upregulated in DME.SMURF1 knockdown reduced HG/DFX-induced autophagy,which protected RPE cell tight junctions and ameliorated retinal damage in DME mice.SMURF1 activated the Wnt/β-catenin-VEGF signaling pathway by promoting WNT inhibitory factor(WIF)1 ubiquitination and degradation.IGF2BP2 upregulated SMURF1 expression in an m6A modification-dependent manner.CONCLUSION M6A-modified SMURF1 promoted WIF1 ubiquitination and degradation,which activated autophagy to inhibit RPE cell tight junctions,ultimately promoting DME progression.展开更多
AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups....AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups.Twenty-six eyes of 26 patients with diabetes but no retinopathy(DR;group 1),17 eyes of 17 patients with DR but no DME(group 2),and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery(group 3),and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery(group 4).The patients’best corrected visual acuity,intraocular pressure,central and mean macular thickness(CMT and MMT)values were noted on the day of surgery,postoperative day 1,week 1,and month 1.RESULTS:There was a significant increase of CMT after cataract surgery in groups 1,2,and 3(P<0.001,P=0.044,and P=0.034,respectively)but not in group 4(P=0.948).The change in MMT was the same as CMT(P=0.009,P=0.006,P=0.011,and P=0.172,respectively).There was a higher increase in CMT and MMT in group 2 compared to group 1 at the 1st month after surgery(P=0.002 and P=0.001,respectively).CONCLUSION:In eyes with DME undergoing cataract surgery,preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.展开更多
AIM： To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema（DME） determined with optical coherence tomography（OCT）. METHODS： In this cross-sectional study, D...AIM： To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema（DME） determined with optical coherence tomography（OCT）. METHODS： In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness（DRT）, cystoid macular edema（CME） and serous retinal detachment（SRD） and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS： Of the 57 patients with DME, 21（36.8%） had DRT, 24（42.1%） had CME and 12（21.0%） had SRD. Microor macro-albuminuria was significantly higher in the DRT pattern（61.9%） compared with the SRD（50.0%） and CME patterns（25.0%; P=0.040）. Hemoglobin A1 c（Hb A1 c） level was significantly higher and patients were younger in the DRT pattern group（P=0.034, P=0.032）. Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION： Micro-or macro-albuminuria may be more frequent and Hb A1 c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.展开更多
AIM:To estimate the prevalence of diabetic macular edema(DME) and clinically significant macular edema(CSME),and to assess their risk factors in a population with type 2 diabetic mellitus(T2DM) located in northeast Ch...AIM:To estimate the prevalence of diabetic macular edema(DME) and clinically significant macular edema(CSME),and to assess their risk factors in a population with type 2 diabetic mellitus(T2DM) located in northeast China.METHODS:Patients were included from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT),a community-based study conducted in northeast China.The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale of fundus photographs.The age-standardized prevalence of DME and CSME was estimated.The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis.RESULTS:A total of 292(15.4%) and 166(8.8%) patients were diagnosed as DME and CSME,yielding the age and sex standardized prevalence of 13.5%(95%CI:11.9%-15.0%),and 7.1%(95%CI:5.9%-8.3%),respectively.Female patients had a higher prevalence of DME compared to their male counterparts(15.7% vs 10.4%,P=0.03).Multivariable Logistic regression analysis showed that younger age,insulin use,proteinuria,longer duration of diabetes,and higher glycosylated hemoglobin A1c,were associated with the prevalence of DME and CSME.Patients with higher fasting plasma glucose,systolic blood pressure,and blood urea nitrogen were also found to be associated with DME.CONCLUSION:Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort,those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.展开更多
AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective s...AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.展开更多
AIM: To explore a more accurate quantifying diagnosis method of diabetic macular edema(DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness(CRT) and ap...AIM: To explore a more accurate quantifying diagnosis method of diabetic macular edema(DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness(CRT) and apply it in follow-up of DME patients.METHODS: Optical coherence tomography(OCT) scans of 229 eyes from 160 patients were collected.We manually annotated cystoid macular edema(CME), subretinal fluid(SRF) and fovea as ground truths.Deep convolution neural networks(DCNNs) were constructed including U-Net, sASPP, HRNetV2-W48, and HRNetV2-W48+Object-Contextual Representation(OCR) for fluid(CME+SRF) segmentation and fovea detection respectively, based on which the thickness maps of CME, SRF and retina were generated and divided by Early Treatment Diabetic Retinopathy Study(ETDRS) grid.RESULTS: In fluid segmentation, with the best DCNN constructed and loss function, the dice similarity coefficients(DSC) of segmentation reached 0.78(CME), 0.82(SRF), and 0.95(retina).In fovea detection, the average deviation between the predicted fovea and the ground truth reached 145.7±117.8 μm.The generated macular edema thickness maps are able to discover center-involved DME by intuitive morphometry and fluid volume, which is ignored by the traditional definition of CRT>250 μm.Thickness maps could also help to discover fluid above or below the fovea center ignored or underestimated by a single OCT B-scan.CONCLUSION: Compared to the traditional unidimensional indicator-CRT, 3D macular edema thickness maps are able to display more intuitive morphometry and detailed statistics of DME, supporting more accurate diagnoses and follow-up of DME patients.展开更多
Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pa...Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pathogenesis of DME is multifactorial.Several therapeutic modalities have been proposed for the treatment of DME.Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities,due to anti-inflammatory,anti-vascular endothelial growth factor and anti-proliferative effects.Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME.Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease.Steroid-related side effects include elevated intraocular pressure,cataract,and injection related complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment particularly with intravitreal steroid injections.In order to reduce the risks,complications and frequent dosing of intravitreal steroids,intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.展开更多
文摘AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.
文摘Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.
基金Supported by National Natural Science Foundation of China(No.82171062No.82301222)Zhejiang Provincial Natural Science Foundation of China(No.LY20H120002).
文摘Dear Editor,Diabetic macular edema(DME)is a major cause of visual loss in diabetic patients,which is mainly caused by disruption of the blood-retinal barrier and loss of pericytes and endothelial cells,resulting in the leakage of plasma and lipids[1].Nowadays,laser photocoagulation,intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)drugs and dexamethasone implant.
基金Supported by the Suzhou Medical Innovation Application Research Project(SZM2023027).
文摘AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This retrospective study involved 65 RVO patients(65 eyes)who received IVR and were followedup for more than 3mo.ME was categorized into cystoid macular edema(CME),diffuse retinal thickening(DRT),and serous retinal detachment(SRD)according to optical coherence tomography(OCT)images.The comparison of best corrected visual acuity(BCVA;logMAR)and central macular thickness(CMT)among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test.The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.RESULTS:BCVA tended to improve in all groups,with marked improvement in CME and DRT groups.CMT showed the greatest reduction after 1wk,and remained stable over the following 3mo.DRT patients had the worst BCVA and the highest CMT at baseline,but the differences became smaller after IVR treatment.CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR.Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up.DRT patients were most likely to transform into the other morphological groups,while SRD patients showed minimal transitions.BCVA at baseline was identified as the most important prognostic indicator in all 3 groups.Additionally,DRT patients with a longer clinical course,higher CMT and central retinal vein occlusion(CRVO)tend to exhibit worse BCVA after treatment.In addition,CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion(BRVO)patients in CME group.SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.CONCLUSION:The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups.Baseline parameters including clinical course,CMT,and RVO position are also useful in predicting the BCVA at different time points after treatment.
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
文摘Dear Editor,Posterior reverse encephalopathy syndrome(PRES),manifests as a confusional state/delirium,convulsion,or acute blindness which illustrates in magnetic resonance imaging(MRI)typical bilateral white matter lesions.These clinical and radiological changes are reversible in two to three weeks,usually generated by acute hypertension,preeclampsia,eclampsia,immunosuppression,septicemia,and end-stage renal disease.PRES is commonly diagnosed in patients in their thirties.
基金Supported by the National Nature Science Foundation of China(No.82301211)Beijing Natural Science Foundation(No.J230028).
文摘AIM:To evaluate the efficacy and safety of concurrent intravitreal ranibizumab(IVR)and extended-release dexamethasone injections(Dex-I)in naïve and refractory patients with retinal vein occlusion macular edema(RVO-ME).METHODS:This was a prospective,interventional,and open-label clinical trial.There were two groups:naïve and refractory patients(received≥5 times of previous IVR within one year prior to enrollment)enrolled.Patients received IVR and Dex-I concurrently and re-combination therapy was required if one or more retreatment criteria were met.IVR and Dex-I were given pro re nata(PRN).The mean changes in best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured as main outcomes.RESULTS:Totally 63 patients(63 eyes)completed the entire follow-up(31 naïve and 32 refractory patients).At month 12,the change in BCVA was greater in the naïve group than in the refractory group[19.67±11.7(95%CI:15.03,24.31)letters vs 11.74±11.18(95%CI:7.32,16.16)letters,P=0.014].There was no difference between the two groups of mean macular thickness reduction[364.26±215.29(95%CI:279.09,449.43)μm vs 410.19±204.34(95%CI:329.35,491.02)μm,P=0.43].The mean co-injection numbers were 2.52±0.58(95%CI:2.29,2.75)and 2.33±0.55(95%CI:2.11,2.55)in both groups(P=0.24),respectively.The retreatment interval was 115.81±13.79 d(95%CI:110.36,121.27)and 122.74±14.06 d(95%CI:119.93,133.56)in both groups(P=0.073).There was no significant difference in the incidence of glaucoma or the progression of cataracts between the two groups.CONCLUSION:In both naïve and refractory RVO-ME patients,IVR combined with Dex-I is effective.The initial combination therapy for naïve patients demonstrates more efficient improvement in BCVA and may reduce total injection numbers compared to refractory patients.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-037A)Tianjin Key Laboratory of Retinal Functions and Diseases Independent and Open Project(No.2023tjswmm004)Tianjin Medical University Eye Hospital High-level Innovative Talent Programme(No.YDYYRCXM-B2023-02).
文摘AIM:To investigate the prevalence and clinical implications of hyperreflective walls(HRW)in foveal cystoid spaces in patients with cystoid macular edema(CME)caused by retinal diseases and noninfectious uveitis(NIU).METHODS:This retrospective cross-sectional study included 443 eyes with CME secondary to diabetic macular edema(DME),retinal vein occlusion(RVO),retinitis pigmentosa(RP),neovascular age-related macular degeneration(nAMD),and NIU.Demographic data,HRW features,and other spectral domain optical coherence tomography(SD-OCT)biomarkers were analyzed.RESULTS:HRW was observed in 40.9%of DME eyes(present,n=77,38 males,58.30±12.04y;absent,n=111,50 males,55.95±10.56y),32.5%of RVO eyes(present,n=49,22 males,64.53±11.90y;absent,n=102,42 males,60.67±11.73y),31.4%of nAMD eyes(present,n=16,8 males,70.13±7.75y;absent,n=35,13 males,73.91±9.11y),57.1%of RP eyes(present,n=12,4 males,40.50±12.06y;absent,n=9,4 males,44.11±14.32y),and 18.8%of uveitic macular edema(UME)eyes(present,n=6,3 males,30.83±16.23y;absent,n=26,12 males,43.46±17.58y).HRW was significantly associated with vitreoretinal abnormalities[odds ratio(OR),2.202;95%confidence interval(95%CI),1.342–3.613;P=0.002],hyperreflective foci(OR,3.33;95%CI,1.884–5.883;P<0.001),inner retinal layer disorganization(OR,1.816;95%CI,1.087–3.035;P=0.023),external limiting membrane disruptions(OR,3.476;95%CI,1.839–6.574;P<0.001),and disrupted ellipsoid zone length(OR,1.001;95%CI,1.000–1.002;P=0.04),and a high HRW height in the foveal cystoid spaces(OR,1.003;95%CI,1.001–1.006;P=0.003).CONCLUSION:HRW in foveal cystoid spaces is a common OCT finding in CME and is associated with more severe retinal structural damage and worse visual acuity.HRW may be utilized as a prognostic OCT biomarker for disease severity and treatment response in patients with CME.This study suggests that early detection of HRW and optimization of treatment strategies may improve patient prognosis.
文摘AIM:To investigate the efficacy and safety of repeated dexamethasone implants with real-life data in eyes with naive retinal vein occlusion(RVO)with macular edema(ME)at a minimum of 60mo follow-up.METHODS:In this retrospective cohort study,the data about best corrected visual acuity(BCVA),central macular thickness(CMT),serous macular detachment(SMD),hard exudate,hyperreflective foci(HRF),cystoid degeneration,pearl necklace sign,epiretinal membrane(ERM),disorganization of retinal inner layers(DRIL),ellipsoid zone and external limiting membrane(EZ-ELM)integrity,intraocular pressure(IOP)and lens condition were recorded.RESULTS:Thirty-eight eyes of 38 patients were included in the study.Thirteen patients presented with central RVO(CRVO)and 25 with branch RVO(BRVO).The mean follow-up time was 69.9±15.8mo,and the mean number of injections was 7.9±4.0.The mean BCVA gain was 25.0±36 letters,and this difference was statistically significant(P=0.021).The BCVA gain was 19.4±20.4 letters in the CRVO group,and 26.5±38.6 letters in the BRVO group(P=0.763).Besides,21(55.2%)of the patients achieved≥15 letters improvement.At the end of the follow-up period,SMD was not observed in any of the patients(P=0.016).Hard exudate,HRF number were decreased;while DRIL,ERM and EZ-ELM defects were increased but not significantly.CONCLUSION:Intravitreal dexamethasone monotherapy is an effective and safe treatment option for the treatment-naive RVO-ME patients in the long-term follow-up.
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.
基金Supported by Henan Province Youth Health Science and Technology Innovation Talent Training Project(No.LJRC2023008)The Key Scientific Research Projects Plan of Universities in Henan Province(No.24A320040).
文摘AIM:To evaluate the efficacy and safety of conbercept combined with 577 nm subthreshold micropulse laser(STML)for treatment of diabetic macular edema(DME).METHODS:A retrospective study was conducted.From October 2022 to March 2024,72 patients diagnosed with DME at the outpatient clinic were enrolled.The patients were divided into two groups:the simple group(treated with conbercept alone)and the combination group(treated with 577 nm STML combined with conbercept).The following itmes were compared between the two groups:best corrected visual acuity(BCVA),central macular thickness(CMT),foveal avascular zone(FAZ),vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP),retinal mean sensitivity(RMS),injection numbers,and the number of cases with adverse effects.RESULTS:The mean age of patients was 57.13±8.76(range 34-77)y with DR history of 0.89±0.55y.With the progression of treatment,both groups showed significant improvements in BCVA,CMT,DCP vessel density,and RMS compared to baselines(all,P<0.05).At 3 and 6mo after treatment,the combination group exhibited significantly better outcomes in BCVA,CMT,DCP vessel density,and RMS than the simple group(P<0.05).During the treatment period,neither group showed significant improvements in FAZ and SCP vessel density(P>0.05),and no significant differences in FAZ and SCP vessel density were observed between the two groups(P>0.05).The average number of injections required in the combination group was lower than that in the simple group(3.33±0.68 vs 4.06±0.96,P<0.05).No other serious ophthalmic adverse events were observed in either group.CONCLUSION:Conbercept combined with STML has better outcomes for treatment of DME and less intravitreal injections compared to conbercept monotherapy.
基金Supported by Basic and Applied Basic Research Project of Guangzhou Science and Technology Plan(No.202201020008,No.2023A03J0584).
文摘AIM:To investigate the impact of renal dysfunction on clinical response to intravitreal conbercept injection(IVC)for diabetic macular edema(DME).METHODS:This retrospective study included a total of 100 eyes from 100 patients with DME treated with IVC with 3+PRN regimen.Based on the estimated glomerular filtration rate(eGFR),the patients were divided into normal renal function group(n=37),impaired renal function group(n=27),and renal insufficiency group(n=36).The main outcome measures were best-corrected visual acuity(BCVA)and central subfield macular thickness(CST).Clinical parameters included blood urea nitrogen,serum creatinine,serum uric acid,glycosylated hemoglobin(HbA1c),and hemoglobin.RESULTS:The mean follow-up time was 3.9mo.The mean number of IVCs was 2.07±1.22 in the three groups.Mean BCVA improved significantly from 0.81±0.49 logMAR at baseline to 0.72±0.52 logMAR in the three groups at the final visit(P<0.001).Mean CST decreased significantly from 427.85±148.99μm at baseline to 275.31±108.31μm at final visit(P<0.001).Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group(all P<0.001).Patients in the normal renal function group had higher baseline hemoglobin levels and thinner baseline CST than those in the impaired renal function and insufficiency renal function group(all P<0.001).The three groups had no differences in baseline HbA1c levels(P>0.05).Good baseline BCVA(logMAR,P=0.001)and thicker baseline CST(P=0.041)were associated with visual acuity improvement.Higher eGFR(P<0.001),hemoglobin(P=0.032)and thicker baseline CST(P=0.017)were associated with macular edema retrogression in the conbercept-treated diabetic patients,which showed better anatomical response to IVC.CONCLUSION:Our results indicate that the renal dysfunction is the risk factor associated with the efficacy of IVC for DME.
基金Supported by Zhejiang Provincial Highlevel Health Talents Training Project(No.CZ-RC2022010)Wenzhou Basic Medical and Health Technology Project(No.Y2023173)Innovation Project of School of Ophthalmology and Optometry,Eye Hospital of Wenzhou Medical University(No.YNCX3201905).
文摘AIM:To investigate the change of diabetic macular edema(DME)post vitrectomy and its risk factors.METHODS:This retrospective study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy(PDR)with gradable optical coherence tomography(OCT)imaging from January 2018 to March 2022.The incidence of post vitrectomy DME(PV-DME)was defined as patients with a central retinal thickness(CRT)>300µm by OCT among patients without preoperative DME.RESULTS:The cumulative incidence of PV-DME at 3mo was 40.1%(89/222),with its majority subtype of single diffused retinal thickening(66.2%)followed by single cystoid macular edema(27.0%).Multivariate Cox regression analysis indicated that a thicker preoperative CRT[hazard ratio(HR)=1.01,95%confidence interval(CI)1.00-1.02]and intraoperative internal limiting membrane peeling(HR=3.18,95%CI 1.85-5.47)were associated with the presence of PV-DME,while intraoperative intravitreal injection of triamcinolone acetonide(HR=0.28,95%CI 0.13-0.57)was protective against PV-DME.In eyes with preoperative DME(n=143),the CRT decreased gradually from 468.3±177.7μm preoperatively to 409.5±151.0μm(P=0.027),377.4±141.9μm(P<0.001),and 368.0±157.6μm(P<0.001)at 7d,1 and 3mo postoperatively,respectively.Multivariate linear regression analysis indicated that only a thicker preoperative CRT(β=0.77,95%CI 0.63-0.92)was associated with a decreasing postoperative CRT.CONCLUSION:PV-DME is a very common postoperative complication in patients with PDR.Triamcinolone acetonide could prevent its formation.Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.
基金Supported by Natural Science Foundation of Guangdong Province,No.2022A1515012346.
文摘BACKGROUND Diabetic macular edema(DME)is the most common cause of vision loss in people with diabetes.Tight junction disruption of the retinal pigment epithelium(RPE)cells has been reported to induce DME development.SMAD-specific E3 ubiquitin protein ligase(SMURF)1 was associated with the tight junctions of cells.However,the mechanism of SMURF1 in the DME process remains unclear.AIM To investigate the role of SMURF1 in RPE cell tight junction during DME.METHODS ARPE-19 cells treated with high glucose(HG)and desferrioxamine mesylate(DFX)for establishment of the DME cell model.DME mice models were constructed by streptozotocin induction.The trans-epithelial electrical resistance and permeability of RPE cells were analyzed.The expressions of tight junction-related and autophagy-related proteins were determined.The interaction between insulin like growth factor 2 mRNA binding protein 2(IGF2BP2)and SMURF1 mRNA was verified by RNA immunoprecipitation(RIP).SMURF1 N6-methyladenosine(m6A)level was detected by methylated RIP.RESULTS SMURF1 and vascular endothelial growth factor(VEGF)were upregulated in DME.SMURF1 knockdown reduced HG/DFX-induced autophagy,which protected RPE cell tight junctions and ameliorated retinal damage in DME mice.SMURF1 activated the Wnt/β-catenin-VEGF signaling pathway by promoting WNT inhibitory factor(WIF)1 ubiquitination and degradation.IGF2BP2 upregulated SMURF1 expression in an m6A modification-dependent manner.CONCLUSION M6A-modified SMURF1 promoted WIF1 ubiquitination and degradation,which activated autophagy to inhibit RPE cell tight junctions,ultimately promoting DME progression.
文摘AIM:To investigate the optimal anti-vascular endothelial growth factor(VEGF)treatment time in patients with diabetic macular edema(DME)scheduled for cataract surgery.METHODS:The study was designed to include 4 groups.Twenty-six eyes of 26 patients with diabetes but no retinopathy(DR;group 1),17 eyes of 17 patients with DR but no DME(group 2),and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery(group 3),and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery(group 4).The patients’best corrected visual acuity,intraocular pressure,central and mean macular thickness(CMT and MMT)values were noted on the day of surgery,postoperative day 1,week 1,and month 1.RESULTS:There was a significant increase of CMT after cataract surgery in groups 1,2,and 3(P<0.001,P=0.044,and P=0.034,respectively)but not in group 4(P=0.948).The change in MMT was the same as CMT(P=0.009,P=0.006,P=0.011,and P=0.172,respectively).There was a higher increase in CMT and MMT in group 2 compared to group 1 at the 1st month after surgery(P=0.002 and P=0.001,respectively).CONCLUSION:In eyes with DME undergoing cataract surgery,preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.
文摘AIM： To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema（DME） determined with optical coherence tomography（OCT）. METHODS： In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness（DRT）, cystoid macular edema（CME） and serous retinal detachment（SRD） and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS： Of the 57 patients with DME, 21（36.8%） had DRT, 24（42.1%） had CME and 12（21.0%） had SRD. Microor macro-albuminuria was significantly higher in the DRT pattern（61.9%） compared with the SRD（50.0%） and CME patterns（25.0%; P=0.040）. Hemoglobin A1 c（Hb A1 c） level was significantly higher and patients were younger in the DRT pattern group（P=0.034, P=0.032）. Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION： Micro-or macro-albuminuria may be more frequent and Hb A1 c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China (No.LQ18H120004)Wenzhou Basic Medical and Health Technology Project (No.Y2020364)。
文摘AIM:To estimate the prevalence of diabetic macular edema(DME) and clinically significant macular edema(CSME),and to assess their risk factors in a population with type 2 diabetic mellitus(T2DM) located in northeast China.METHODS:Patients were included from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT),a community-based study conducted in northeast China.The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale of fundus photographs.The age-standardized prevalence of DME and CSME was estimated.The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis.RESULTS:A total of 292(15.4%) and 166(8.8%) patients were diagnosed as DME and CSME,yielding the age and sex standardized prevalence of 13.5%(95%CI:11.9%-15.0%),and 7.1%(95%CI:5.9%-8.3%),respectively.Female patients had a higher prevalence of DME compared to their male counterparts(15.7% vs 10.4%,P=0.03).Multivariable Logistic regression analysis showed that younger age,insulin use,proteinuria,longer duration of diabetes,and higher glycosylated hemoglobin A1c,were associated with the prevalence of DME and CSME.Patients with higher fasting plasma glucose,systolic blood pressure,and blood urea nitrogen were also found to be associated with DME.CONCLUSION:Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort,those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.
文摘AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.
文摘AIM: To explore a more accurate quantifying diagnosis method of diabetic macular edema(DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness(CRT) and apply it in follow-up of DME patients.METHODS: Optical coherence tomography(OCT) scans of 229 eyes from 160 patients were collected.We manually annotated cystoid macular edema(CME), subretinal fluid(SRF) and fovea as ground truths.Deep convolution neural networks(DCNNs) were constructed including U-Net, sASPP, HRNetV2-W48, and HRNetV2-W48+Object-Contextual Representation(OCR) for fluid(CME+SRF) segmentation and fovea detection respectively, based on which the thickness maps of CME, SRF and retina were generated and divided by Early Treatment Diabetic Retinopathy Study(ETDRS) grid.RESULTS: In fluid segmentation, with the best DCNN constructed and loss function, the dice similarity coefficients(DSC) of segmentation reached 0.78(CME), 0.82(SRF), and 0.95(retina).In fovea detection, the average deviation between the predicted fovea and the ground truth reached 145.7±117.8 μm.The generated macular edema thickness maps are able to discover center-involved DME by intuitive morphometry and fluid volume, which is ignored by the traditional definition of CRT>250 μm.Thickness maps could also help to discover fluid above or below the fovea center ignored or underestimated by a single OCT B-scan.CONCLUSION: Compared to the traditional unidimensional indicator-CRT, 3D macular edema thickness maps are able to display more intuitive morphometry and detailed statistics of DME, supporting more accurate diagnoses and follow-up of DME patients.
文摘Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pathogenesis of DME is multifactorial.Several therapeutic modalities have been proposed for the treatment of DME.Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities,due to anti-inflammatory,anti-vascular endothelial growth factor and anti-proliferative effects.Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME.Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease.Steroid-related side effects include elevated intraocular pressure,cataract,and injection related complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment particularly with intravitreal steroid injections.In order to reduce the risks,complications and frequent dosing of intravitreal steroids,intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.
