scholarly journals Juvenile diabetes eye complications and treatment

2009 ◽  
Vol 66 (9) ◽  
pp. 729-732 ◽  
Author(s):  
Mirjana Dujic ◽  
Zora Ignjatovic
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Disease Onset ◽  
Clinical Signs ◽  
Onset Time ◽  
Vitreous Hemorrhage ◽  
Juvenile Diabetes ◽  
Treatment Modalities ◽  
Panretinal Photocoagulation ◽  
The Mean

Background/Aim. Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. The aim of this study was to explore the prognosis of patients with juvenile DM regarding diabetic eye complications, as well as the course of the diabetic eye disease related to the treatment undertaken. Methods. The study series involved 33 patients with juvenile DM during the period 1992-2007. The influence of the following factors on the course of the disease was estimated: age, the age of the disease onset, time when eye complications appeared, treatment modalities. Results. Of the total of 33 diabetics 15 patients were followed for 10 or more years and 18 from 5 to 9 years. At the time of their first visit the mean age was 23.12 ? 6.39 and the mean duration of DM was 17.42 ? 7.42 years. On their first visit, 7 eyes were without any complication. Most of the patients already developed clinical signs of proliferative diabetic retinopathy (41.39%), the signs of nonproliferative diabetic retinopathy (13.13%) and macula involvement (10.10%). Diabetic cataract was found in 8.8% as well as tractional retinal detachment. Eleven out of 66 eyes were with vitreous hemorrhage. Two patients (5.5%) suffered neovascular glaucoma. There was 1 (2.2%) patient with developed rubeosis iridis and simplex glaucoma. Panretinal photocoagulation was performed in 65% of patients, focal photocoagulation in 15%, 12% patients underwent pars plana vitrectomy and 4% had cataract surgery with intraocular lens implantation and peripheral retinal kryopexy. Conclusion. Total vision loss due to eye complications of juvenile DM may be prevented if timely diagnosed with regular check ups and early treatment.

scholarly journals Comparison of Visual Outcomes between Panretinal Photocoagulation and Panretinal Photocoagulation Plus Intravitreal Bevacizumab in Proliferative Diabetic Retinopathy Patients Treated at Northen Zonal Hospital

2020 ◽  
pp. 34-43
Author(s):  
Filemon Darabe ◽  
William Makupa
Keyword(s):  
Diabetic Retinopathy ◽  
Retinal Detachment ◽  
Proliferative Diabetic Retinopathy ◽  
Intravitreal Bevacizumab ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Panretinal Photocoagulation ◽  
Pan Retinal Photocoagulation ◽  
The Mean ◽  
Retinal Photocoagulation

Introduction: Diabetic retinopathy is one of the rigorous microvascular complications of diabetes mellitus is the significant cause of visual impairment and consequently blindness affecting about 36% of the diabetic population. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are two prime manifestations of DR that are responsible for visual morbidity. The basis of the treatment in PDR is Laser photocoagulation as accomplished by Diabetic retinopathy treatment study (DRS) and early treatment diabetic retinopathy study (ETDRS) for the last two decades. The dawn of intravitreal anti-VEGF agents has revolutionized the management of diabetic eye disease for more than the last decade. The aim of the study is to compare the visual outcomes of diabetic retinopathy patients between pan-retinal photocoagulation and pan-retinal photocoagulation plus intravitreal Bevacizumab. Methodology: A hospital-based cross-section study using medical record information for all DR patients treated by PRP and IVB at the KCMC eye. Data were analyzed using SPSS version 20. Results: A number of 204 patients were included in the study. The mean age was 59.26 (SD=9.6) years; 75.4% were male. Most of the patients 71.1% are from Arusha and Kilimanjaro. Among all, 51% had PRP alone and the duration of Diabetes was 5-10 years in the majority. The mean VA for PRP alone was 0.89 (SD=0.89) before treatment while it was 1 (SD=0.99) in PRP plus Bevacizumab. At 3 months after treatment VA for PRP alone was 0.947 (SD=0.93) and 0.96 (SD=1.01) for PRP plus Bevacizumab. The mean difference was not statistically significant. VA improved by 49% and it deteriorated by 27.7%. The majority had early proliferated DR 49.7%, 42.8% high risk proliferated DR and advanced proliferated DR was 7.5%. The complications were found in 5.6% and they included: vitreous hemorrhage (4.6%) and retinal detachment (1%) in PRP plus Bevacizumab and none in PRP alone. Conclusion: With respect to this study there is no significant difference in visual outcome for PRP alone and PRP plus injection Bevacizumab, though PRP plus Bevacizumab in treatment of DR had better visual outcome over PRP alone. PRP plus injection Bevacizumab is associated with a higher and early rate of regression of active NVs than PRP alone in patients with PDR. Further studies will be needed to determine whether IVB plus PRP is a satisfactory treatment for the prevention of vision-threatening complications such as vitreous hemorrhage and tractional retinal detachment.

scholarly journals Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Pharmaceutics ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1137
Author(s):  
Irini Chatziralli ◽  
Anat Loewenstein
Keyword(s):  
Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Fundus Photography ◽  
Panretinal Photocoagulation ◽  
Wide Field ◽  
Vascular Endothelial ◽  
Keywords Diabetic Retinopathy ◽  
Anti Vegf ◽  
The Impact

Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

scholarly journals Management of Diabetic Retinopathy

2021 ◽  
pp. 95-103
Author(s):  
Marieta Dumitrache ◽  
Rodica Lascu
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Effective Treatment ◽  
Prophylactic Treatment ◽  
Vision Loss ◽  
Vitreous Hemorrhage ◽  
Tractional Retinal Detachment ◽  
Clinically Significant Macular Edema ◽  
Clinically Significant ◽  
Photocoagulation Laser

Management in D.R. through prophylactic treatment (maintaining a glycemic level as close as possible to normal, control hypertension <150/85 mmHg, hyperlipidemia) and curative treatment of D.R. does not cure the disease, but may slow the evolution of D.M. and D.R. AntiVEGF agents are indicated as adjuvant therapy in pan-photocoagulation laser and / or vitrectomy in patients with DR to block angiogenesis by inhibiting VEGF. All antiVEGF agents are an effective treatment for the clinically significant macular edema. Photocoagulation laser is a treatment of choice in preproliferative and proliferative DR and an effective treatment of diabetic macular edema. The indications for laser treatment in diabetic retinopathy are related to the incidence, evolution of neovessels, duration of diabetes, HbA1c level, presence of macular edema, stage of DR. The laser for macular lesions reduces the risk of vision loss in the eyes with incipient and moderate non-proliferative DR and macular edema concomitant; the laser should be applied to all patients with clinically significant macular edema. Vitrectomy in proliferative DR is indicated in vitreous hemorrhage, tractional retinal detachment in order to remove the vitreous hermorrhage and excision of tractional preretinal membranes.

Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

2018 ◽  
Vol 2 (3) ◽  
pp. 127-137
Author(s):  
Dennis M. Marcus ◽  
Harinderjit Singh ◽  
Davis C. Starnes ◽  
Harveen Walia ◽  
Amina Farooq ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation ◽  
Short Term ◽  
Safety And Efficacy ◽  
Intravitreal Aflibercept ◽  
Central Subfield Thickness ◽  
Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

scholarly journals Wide-field imaging in proliferative diabetic retinopathy

2019 ◽  
Vol 5 (S1) ◽  
Author(s):  
T. Y. Alvin Liu ◽  
J. Fernando Arevalo
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vision Loss ◽  
Current Data ◽  
Panretinal Photocoagulation ◽  
Main Body ◽  
Wide Field ◽  
Fundus Imaging ◽  
Field Imaging ◽  
Wide Field Imaging

Abstract Background Diabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. For decades, 7-field 30-degree fundus imaging has been the gold standard for DR classification. The aim of this review article is to discuss how the advent of ultra-wide-field (UWF) fundus imaging has changed the management of proliferative diabetic retinopathy (PDR). Main body Current data suggests that UWF imaging, as compared to conventional Early Treatment Diabetic Retinopathy Study (ETDRS) fields, detects additional and more extensive PDR pathologies. DR lesions, captured by UWF imaging outside of ETDRS fields, likely carry prognostication value. Conclusion UWF imaging represents a major advancement in the detection and management of DR. It remains unclear whether, when and how patients, with PDR changes only peripheral to standard ETDRS fields, should be treated. A larger, prospective, randomized clinical trial is also needed to compare the efficacy of UWF image-guided targeted laser photocoagulation with that of conventional panretinal photocoagulation.

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.

CURVELET FUSION ENHACEMENT BASED EVALUATION OF DIABETIC RETINOPATHY BY THE IDENTIFICATION OF EXUDATES IN OPTIC COLOR FUNDUS IMAGES

2016 ◽  
Vol 28 (06) ◽  
pp. 1650046
Author(s):  
V. Ratna Bhargavi ◽  
Ranjan K. Senapati
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Detection System ◽  
Clinical Signs ◽  
Posterior Part ◽  
Curvelet Transform ◽  
Optic Disk ◽  
Support Vector ◽  
Fundus Images ◽  
Statistical Measures

Rapid growth of Diabetes mellitus in people causes damage to posterior part of eye vessel structures. Diabetic retinopathy (DR) is an important hurdle in diabetic people and it causes lesion formation in retina due to retinal vessel structures damage. Bright lesions (BLs) or exudates are initial clinical signs of DR. Early BLs detection can help avoiding vision loss. The severity can be recognized based on number of BLs formed in the color fundus image. Manually diagnosing a large amount of images is time consuming. So a computerized DR grading and BLs detection system is proposed. In this paper for BLs detection, curvelet fusion enhancement is done initially because bright objects maps to largest coefficients in an image by utilizing the curvelet transform, so that BLs can be recognized in the retina easily. Then optic disk (OD) appearance is similar to BLs and vessel structures are barriers for lesion exact detection and moreover OD falsely classified as BLs and that increases false positives in classification. So these structures are segmented and eliminated by thresholding techniques. Various features were obtained from detected BLs. Publicly available databases are used for DR severity testing. 260 fundus images were used for the performance evaluation of proposed work. The support vector machine classifier (SVM) used to separate fundus images in various levels of DR based on feature set extracted. The proposed system that obtained the statistical measures were sensitivity 100%, specificity 95.4% and accuracy 97.74%. Compared to existing state-of-art techniques, the proposed work obtained better results in terms of sensitivity, specificity and accuracy.

scholarly journals Etiology of vitreous hemorrhage in a tertiary eye care center in Nepal

1970 ◽  
Vol 2 (2) ◽  
pp. 121-126 ◽  
Author(s):  
R Sharma ◽  
SN Joshi ◽  
JK Shrestha
Keyword(s):  
Diabetic Retinopathy ◽  
Retinal Vein Occlusion ◽  
Proliferative Diabetic Retinopathy ◽  
Branch Retinal Vein Occlusion ◽  
Care Center ◽  
Retinal Vasculitis ◽  
Vitreous Hemorrhage ◽  
Cross Sectional ◽  
Vein Occlusion ◽  
The Mean

Introduction: Vitreous hemorrhage is one of the most common differential diagnoses of sudden painless decrease in vision. Objective: To find out the etiology of vitreous hemorrhage in cases of vitreous hemorrhage at a tertiary eye centre in Nepal. Materials and methods: This was a hospital-based cross-sectional study done over a period of one-and-a-half years. One hundred and one subjects with vitreous hemorrhage were evaluated in detail to establish the etiology. Statistics: The mean value and standard deviation were calculated. The data were analyzed using microsoft excel and SPSS 11.5 program. Results: A total of 122 eyes of 101 patients were evaluated. The mean age was 41.90 (± 21.50) years with a range of 2 months to 84 years. Male were 73 %. Bilateral involvement was found in 20.8 %. Proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, rhegmatogenous retinal detachment together with ocular trauma constituted the etilogoy of vitreous hemorrhage in more than 75 % of patients. Conclusion: Proliferative diabetic retinopathy, retinal vasculitis and branch retinal vein occlusion are the most common causes of vitreous hemorrhage in adults whereas in children trauma is the commonest cause. Keywords: vasculitis; vitreous hemorrhage; diabetic retinopathy; Eales disease DOI: 10.3126/nepjoph.v2i2.3718 Nep J Oph 2010;2(2) 121-126

scholarly journals Treatment of diabetic macular edema and proliferative diabetic retinopathy with anti-vascular endothelial growth factor agents under the reimbursement policy of the Taiwan National Health Insurance Bureau: Aflibercept or ranibizumab?

2021 ◽  
Author(s):  
Ming-Chieh Hsieh ◽  
Chieh-Yin Cheng ◽  
Kun-Hsien Li ◽  
Chih-Chun Chuang ◽  
Jian-Sheng Wu ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Incidence Rates ◽  
Panretinal Photocoagulation ◽  
Reimbursement Policy ◽  
Micropulse Laser ◽  
The Mean

Abstract The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.59 ± 6.54. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR -0.38, 95% CI -6.97~-1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.

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