scholarly journals Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sung Uk Baek ◽  
Min Seon Park ◽  
Bum-Joo Cho ◽  
In Won Park ◽  
Soonil Kwon
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Platelet Count ◽  
Multivariate Logistic Regression Analysis ◽  
Panretinal Photocoagulation ◽  
Lower Baseline ◽  
Uncontrolled Diabetes ◽  
High Platelet Count ◽  
Baseline Visual Acuity

AbstractUncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

Risk Factors Associated With Progression of Diabetic Retinopathy in Eyes Treated With Panretinal Photocoagulation

2021 ◽  
Author(s):  
Sung Uk Baek ◽  
Min Seon Park ◽  
Bum-Joo Cho ◽  
In Won Park ◽  
Soonil Kwon
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Platelet Count ◽  
Multivariate Logistic Regression Analysis ◽  
Panretinal Photocoagulation ◽  
Lower Baseline ◽  
Uncontrolled Diabetes ◽  
High Platelet Count ◽  
Baseline Visual Acuity

Abstract Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). DR patients who had completed PRP in at least one eye with a 3-year follow-up after PRP were included. A total of 243 eyes of 243 subjects (mean age 52.6±11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P=0.019); lower baseline visual acuity (P<0.001); and higher platelet count (P=0.048), hemoglobin (P=0.044), and hematocrit, (P=0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P<0.001) and platelet count (HR: 1.215, P=0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

scholarly journals Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kei Takayama ◽  
Hideaki Someya ◽  
Hiroshi Yokoyama ◽  
Yoshihiro Takamura ◽  
Masakazu Morioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Multicenter Study ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Uncontrolled Diabetes ◽  
Surgical Options ◽  
25 Gauge Vitrectomy

Abstract Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

scholarly journals Triamcinolone and Bevacizumab as Adjunctive Therapies to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
F. Lopez-Lopez ◽  
F. Gomez-Ulla ◽  
M. J. Rodriguez-Cid ◽  
L. Arias
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Contrast Sensitivity ◽  
Proliferative Diabetic Retinopathy ◽  
Panretinal Photocoagulation ◽  
Central Macular Thickness ◽  
Intravitreal Triamcinolone ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P=0.064), 1.11 (P=0.000), and 1.11 (P=0.002), and there was a mean loss of 2,6 (P=0.055), 3.9 (P=0.011), and 0.9 letters (P=0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P=0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.

scholarly journals RISK FACTORS FOR THE OCCURRENCE OF PRIMARY OPEN-ANGLE GLAUCOMA IN PATIENTS WITH DIABETIC RETINOPATHY AND TYPE 2 DIABETES

2021 ◽  
Vol 77 (3) ◽  
pp. 37-46
Author(s):  
K. A. Gudzenko ◽  
S. Yu. Mogilevskyy ◽  
М. L. Kyryliuk ◽  
D. S. Ziablitsev
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Duration Of Diabetes

The aim of this work was to identify risk factors for the occurrence of primary open-angle glaucoma in patients with diabetic retinopathy and type 2 diabetes mellitus by conducting a regression analysis of the mutual influence of these diseases. We examined 649 patients (649 eyes), among whom 301 patients (301 eyes) had diabetic retinopathy and glaucoma; 164 patients (164 eyes) had diabetic retinopathy only; 81 patients (81 eyes) had only glaucoma and 103 patients (103 eyes) did not have these diseases (control). The construction of logistic regression models was carried out in the GLZ module of the Statistica 10 software (StatSoft, Inc. USA). It was found that the development of primary open-angle glaucoma directly depended on the duration of diabetes and the intraocular pressure level, and vice versa — on visual acuity (p < 0.001). The development of diabetic retinopathy did not depend on the presence of glaucoma, but it was directly dependent on the blood content of glucose and glycated hemoglobin. Men had a lower risk of developing diabetic retinopathy than women(OR = 0.800; 95% CI 0.76-0.84). Also, men had a lower risk of glaucoma (OR = 0.95; 95% CI 0.94–0.96). Stratification by stages of diabetic retinopathy showed the effect of intraocular pressure, decreased visual acuity and glaucoma stages on the development of proliferative diabetic retinopathy (p < 0.001). Increased intraocular pressure was an independent factor in the development of retinopathy. The development of glaucoma of the initial stage was directly influenced by an increase of blood glycated hemoglobin and by the stage of diabetic retinopathy. The occurrence of stage 2 glaucoma was influenced by the duration of diabetes and visual acuity, stage 3 glaucoma — by visual acuity, and stage 4 glaucoma – by the age and duration of diabetes. Independent risk factors for glaucoma were duration of diabetes, increased intraocular pressure, and low visual acuity. When stratified by stage, there was no evidence of a reduction in the risk of developing diabetic retinopathy and glaucoma in men. Thus, the features of the mutual influence of the development of diabetic retinopathy and primary open-angle glaucoma in type 2 diabetes mellitus have been established.

scholarly journals Immediate Pre-Splenectomy Platelet Count Predicts Splenectomy Response in Adult Immune Thrombocytopenia Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
O. A. Soboleva ◽  
K. I. Ntanisian ◽  
E. K. Egorova ◽  
A. L. Melikyan ◽  
E. G. Gemdzhian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Complete Response ◽  
Preoperative Treatment ◽  
Female Ratio ◽  
Factors Associated

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia. Splenectomy remains an effective and safe treatment for ITP. Objective: Identify and estimate risk factors associated with no response (platelet count &lt; 30 x 109/L) to splenectomy for adult ITP patients. Patients and Methods: The study conducted at National Research Center for Hematology (Moscow) from 03/2015 to 11/2019 included all patients (in total, 111) with ITP, who underwent laparoscopic splenectomy. Median (Med) platelet count at admission was 12 x 109/L (range from 1 to 239 x 109/L). The time from diagnosis of ITP to splenectomy varied from 3 months to 51 years. All patients had received from 1 to 3 lines of treatment prior to splenectomy. Pre-splenectomy treatment was carried out at platelet count &lt; 20 x 109/L and/or in the presence of bleeding. Results: Of the 111 patients 31 were male (Med age 43 years [IQR 27-55]) and 80 were female (Med age 37 [IQR 29-49]). The male/female ratio was 1:2.6. Complete response to splenectomy (platelet count &gt; 100 x 109/L) was achieved in 79/111 (71.2%) cases, 11/111 (9.9%) patients had partial response (platelet count: 30-100 x 109/L) and 21/111 (18.9%) failed to respond (platelet count &lt; 30 x 109/L). Patients who achieved complete response to splenectomy had a significantly higher immediate pre-splenectomy platelet count than non-responders: Med platelet count (95% CI): 47 (35-58) vs 16 (9-20) (x 109/L), Mann-Whitney U test, P &lt; 0.001 (CI, confidence interval) (Figure 1). Multivariate logistic regression analysis was carried out to identify factors associated with splenectomy outcome (response/no response). Multivariate analysis included patient's gender and age, duration of ITP, grade of bleeding at admission, platelet count at admission, preoperative platelet count and number of prior lines of therapy. Continuous variables were dichotomized using ROC analysis, in particular, cut-off point for preoperative platelet count was 23 x 109/L. As a result, following statistically significant (Wald test) factors were selected: • an unfavorable predictor: immediate pre-splenectomy platelet count &lt; 23 x 109/L, RR (95% CI): 2.5 (1.1-8.6), P = 0.001 (RR, relative risk) (Figure 1) and • combined unfavorable risk factor: male gender in the age over 60 (compared to men in the age ≤60 and women in general), RR (95% CI): 2.0 (0.9-7.1), P = 0.05 (Figure 2). Response rate was negatively correlated (in univariate analysis) with the number of treatment lines prior to splenectomy (negative Spearman's rank correlation coefficient, −0.30; P = 0.01). When preoperative platelet count ≥ 23 x 109/L was achieved, probability of complete response to splenectomy was 80% (Figure 3). The rate of postoperative complications was 12.6%. According to our follow-up data (up to 5 years) 66/79 (83.5%) patients maintained complete response. Conclusions: High-risk groups were identified: patients with immediate pre-splenectomy platelet count &lt; 23 x 109/L (i.e. with no effect of preoperative treatment) and men over the age of 60. Identified risk factors could be taken into account in decision-making process. Disclosures No relevant conflicts of interest to declare.

scholarly journals Need for vitreous surgeries in proliferative diabetic retinopathy in 10 years follow-up: India Retinal Disease Study (IRDS) group Report no.2

2020 ◽  
Author(s):  
Rehana Khan ◽  
Janani Surya ◽  
Ramachandran Rajalakshmi ◽  
Padmaja Kumari Rani ◽  
Giridhar Anantharaman ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Proliferative Diabetic Retinopathy ◽  
Low Risk ◽  
Study Cohort ◽  
Panretinal Photocoagulation ◽  
Vitreous Surgery ◽  
Retinal Surgery

Introduction: To report the 10 - year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus. Methods: Ten centres in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in one or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular edema, use of anti- vascular endothelial growth factor therapy, vitrectomy with or without retinal surgeries over 10 years. Results: Over 10 years, 89 % needed supplemental PRP after initial complete PRP. One – third required retinal surgery, 16 % needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous surgery. Of the group with low risk PDR, 56.8% did not require vitreoretinal surgery, p <0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5% and 28.2% needed subsequent vitreous surgery (VR), p=0.006 and <0.0001 respectively. Independent predictors of need for vitreo-retinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline. Conclusion: Despite initial ‘complete’ PRP, one third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time.

scholarly journals Delay in seeking medical care after the onset of symptoms in patients with sight-threatening diabetic retinopathy

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110132
Author(s):  
Yan Wei ◽  
Fenghua Mi ◽  
Yan Cui ◽  
Ying Li ◽  
Xinyi Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Medical Care ◽  
Diabetic Complications ◽  
Multivariate Logistic Regression Analysis ◽  
Routine Examination ◽  
Clinically Significant Macular Edema ◽  
Clinically Significant ◽  
Poor Outcomes ◽  
Associated Risk Factors

Objective To investigate the reasons for delays in seeking medical care in patients with diabetic retinopathy and associated risk factors. Methods We retrospectively reviewed data for patients with sight-threatening diabetic retinopathy (STDR) who attended a hospital in China. Various forms of STDR were identified, including severe non-proliferative DR, clinically significant macular edema and proliferative DR. Demographic, clinical and socioeconomic information was collected and the associated risk factors were evaluated. Results Of the 127 patients with STDR, 89.2% sought medical care within 1 month of developing symptoms. Those who sought treatment ≥6 months after symptoms developed had significantly lower income and less knowledge of diabetic complications than those who attended earlier. Multivariate logistic regression analysis showed that no or infrequent routine examination for diabetic complications were associated with long delays in seeking medical care (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.05–9.19; and OR 2.91, 95% CI 1.04–8.40, respectively). Conclusions Most patients with STDR sought medical care within 1 month of symptoms developing, but no or infrequent routine examination for diabetic complications was associated with long delays. These results stress the importance of educational programs regarding diabetic complications to encourage timely medical care and prevent poor outcomes.

scholarly journals Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy

JAMA ◽  
2020 ◽  
Vol 324 (23) ◽  
pp. 2383
Author(s):  
Andrew N. Antoszyk ◽  
Adam R. Glassman ◽  
Wesley T. Beaulieu ◽  
Lee M. Jampol ◽  
Chirag D. Jhaveri ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation
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