scholarly journals Current multimodal diagnostic tools for diabetic macular edema to select a management strategy

2021 ◽  
Vol 21 (4) ◽  
pp. 210-214
Author(s):  
M.V. Pshenichnov ◽  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Management Strategy ◽  
Low Vision ◽  
Management Strategies ◽  
Developed Countries ◽  
Diagnostic Tools ◽  
Published Data ◽  
Working Age ◽  
Diagnostic Approaches

Diabetes is a severe chronic disease that significantly affects the quality of life of individuals, their families, and society worldwide. Diabetic retinopathy, particularly diabetic macular edema (DME), is the leading cause of blindness and low vision among adults of working age in developed countries and Russia. A recent multimodal approach to diagnose DME resulted in new classifications of this disorder and slightly modified earlier views. The analysis of DME biomarkers allows for selecting management strategies for each patient, prescribing adequate medical treatment, and predicting potential treatment response. This paper aimed to analyze published data and up-to-date diagnostic approaches to DME. These tools provide a correct therapeutic strategy based on the DME pattern. Keywords: diabetic macular edema, optical coherence tomography, anti-VEGF treatment. For citation: Pshenichnov M.V. Current multimodal diagnostic tools for diabetic macular edema to select a management strategy. Russian Journal of Clinical Ophthalmology. 2021;21(4):210–214 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-210-214.

Aflibercept for the Treatment of Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 147-154
Keyword(s):  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Developed Countries ◽  
Inhibitory Effect ◽  
Duration Of Action ◽  
Anti Vegf ◽  
Working Age

Diabetic macular edema (DME) is a common complication of diabetic retinopathy (DR) and is a leading cause of vision loss in developed countries during the working age. Understanding the role of vascular endothelial growth factor (VEGF) in the pathogenesis of DME has emphasized the importance of using anti-VEGF agents in treatment. Anti-VEGF drugs such as pegaptanib, ranibizumab, bevacizumab, and aflibercept have been studied in the treatment of DME. Aflibercept is a recombinant fusion protein with an inhibitory effect on VEGF-A, VEGF-B, placental growth factor (PIGF) 1 and 2. It is believed that this agent has a longer duration of action than other anti-VEGF molecules due to its high-affinity binding to the VEGF molecule. This review summarizes the pharmacological properties of aflibercept in terms of clinical efficacy, use, and tolerability in the treatment of DME.

scholarly journals The Evolving Treatment Options for Diabetic Macular Edema

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Atul Jain ◽  
Neeta Varshney ◽  
Colin Smith
Keyword(s):  
Diabetic Retinopathy ◽  
Visual Impairment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Treatment Options ◽  
Previous Treatment ◽  
Common Cause ◽  
Working Age

Diabetic retinopathy (DR) is the leading cause of vision loss in working-age adults, and diabetic macular edema (DME) is the most common cause of visual impairment in individuals with DR. This review focuses on the pathophysiology, previous treatment paradigms, and emerging treatment options in the management of DME.

scholarly journals Deciphering Reparative Processes in the Inflamed Dental Pulp

2021 ◽  
Vol 2 ◽  
Author(s):  
Ikhlas A. El karim ◽  
Paul R. Cooper ◽  
Imad About ◽  
Phillip L. Tomson ◽  
Fionnuala T. Lundy ◽  
...  
Keyword(s):  
Conservative Management ◽  
Dental Pulp ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Diagnostic Tools ◽  
Pulp Tissue ◽  
Evidence Analysis ◽  
Diagnostic Approaches ◽  
Pulp Biology ◽  
Biology Research

Research over several decades has increased our understanding of the nature of reparative and regenerative processes in the dental pulp, at both the cellular and molecular level. However, advances in scientific knowledge have not translated into novel clinical treatment strategies for caries-induced pulpitis. This narrative review explores the evidence regarding the ability of inflamed pulp tissue to heal and how this knowledge may be used therapeutically. A literature search and evidence analysis covering basic, translational and clinical pulp biology research was performed. The review focuses on (1) the regenerative and defense capabilities of the pulp during caries-induced inflammation; (2) the potential of novel biomaterials to harness the reparative and regenerative functions of the inflamed pulp; and (3) future perspectives and opportunities for conservative management of the inflamed pulp. Current conservative management strategies for pulpitis are limited by a combination of unreliable diagnostic tools and an outdated understanding of pulpal pathophysiological responses. This approach leads to the often unnecessary removal of the entire pulp. Consequently, there is a need for better diagnostic approaches and a focus on minimally-invasive treatments utilizing biologically-based regenerative materials and technologies.

scholarly journals Diabetic Macular Edema Characterization and Visualization Using Optical Coherence Tomography Images

2020 ◽  
Vol 10 (21) ◽  
pp. 7718
Author(s):  
Plácido L. Vidal ◽  
Joaquim de Moura ◽  
Macarena Díaz ◽  
Jorge Novo ◽  
Marcos Ortega
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Serous Retinal Detachment ◽  
Developed Countries ◽  
Adequate Treatment ◽  
Robust Detection ◽  
Average Accuracy ◽  
Clinical Literature ◽  
Voting Strategy

Diabetic Retinopathy and Diabetic Macular Edema (DME) represent one of the main causes of blindness in developed countries. They are characterized by fluid deposits in the retinal layers, causing a progressive vision loss over the time. The clinical literature defines three DME types according to the texture and disposition of the fluid accumulations: Cystoid Macular Edema (CME), Diffuse Retinal Thickening (DRT) and Serous Retinal Detachment (SRD). Detecting each one is essential as, depending on their presence, the expert will decide on the adequate treatment of the pathology. In this work, we propose a robust detection and visualization methodology based on the analysis of independent image regions. We study a complete and heterogeneous library of 375 texture and intensity features in a dataset of 356 labeled images from two of the most used capture devices in the clinical domain: a CIRRUSTM HD-OCT 500 Carl Zeiss Meditec and 179 OCT images from a modular HRA + OCT SPECTRALIS® from Heidelberg Engineering, Inc. We extracted 33,810 samples for each type of DME for the feature analysis and incremental training of four different classifier paradigms. This way, we achieved an 84.04% average accuracy for CME, 78.44% average accuracy for DRT and 95.40% average accuracy for SRD. These models are used to generate an intuitive visualization of the fluid regions. We use an image sampling and voting strategy, resulting in a system capable of detecting and characterizing the three types of DME presenting them in an intuitive and repeatable way.

scholarly journals Comorbidity and health care visit burden in working-age commercially insured patients with diabetic macular edema

2016 ◽  
Vol Volume 10 ◽  
pp. 2443-2453 ◽  
Author(s):  
Szilard Kiss ◽  
Hitesh Chandwani ◽  
Ashley Cole ◽  
Vaishali Patel ◽  
Orsolya Lunacsek ◽  
...  
Keyword(s):  
Health Care ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Care Visit ◽  
Health Care Visit ◽  
Working Age ◽  
Insured Patients

scholarly journals Update on the Management of Diabetic Macular Edema

2017 ◽  
Vol 10 (01) ◽  
pp. 52
Author(s):  
Shawn M Iverson ◽  
W Lloyd Clark ◽  
◽  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Options ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Vascular Endothelial ◽  
Clinical Practices ◽  
Working Age ◽  
Endothelial Growth Factor ◽  
Review Current

Diabetic macular edema (DME) is a treatable sequela of diabetic retinopathy and a significant cause of visual morbidity among working age individuals worldwide. While anti-vascular endothelial growth factor (anti-VEGF) agents are first-line agents in the management of DME, corticosteroids and laser therapy can play a role as well. Despite a growing understanding of best clinical practices, many patients respond unpredictably to therapy. This article will briefly review current treatment modalities and discuss future treatment options for managing DME.

scholarly journals Psychophysical Exams as Early Indicators of Diabetic Retinopathy

2014 ◽  
Vol 10 (01) ◽  
pp. 30
Author(s):  
Nicola Pescosolido ◽  
Giuseppe Buomprisco ◽  
◽  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Contrast Sensitivity ◽  
Developed Countries ◽  
Macular Function ◽  
Patients With Diabetes ◽  
Diagnostic Role ◽  
Working Age ◽  
Fixation Stability ◽  
Clinically Significant

Retinopathy is a serious and common complication of diabetes that represents the leading cause of blindness, among people of working age, in developed countries. It is estimated that the number of people with diabetic retinopathy (DR) will increase from 126.6 million in 2011 to 191 million by 2030. The visual function that seems to be affected first in the course of DR is probably the contrast sensitivity; in addition, being mainly a macular function, the perception of color is also compromised. Moreover, the duration of the disease, the levels of glycated hemoglobin (HbA1c) and the presence of cystoid macular edema are strongly associated with the impairment of fixation stability in patients with diabetes with clinically significant macular edema, suggesting the possible diagnostic role of microperimetry. The test of contrast sensitivity and the microperimetry and the chromatic sensitivity tests have proved to be useful, safe, reproducible, and inexpensive tools to diagnose the

Subthreshold Laser and Subliminal (Micropulse) Laser in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 177-184
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Collateral Damage ◽  
Micropulse Laser ◽  
Working Age ◽  
Visual Acuity Loss ◽  
Subthreshold Laser ◽  
Conventional Laser

Diabetic macular edema (DME) is one of the main causes of a significant reduction in visual acuity in working-age adults and is the most common cause of visual acuity loss from diabetic retinopathy. Most of the studies have shown that the ability of the conventional laser to maintain or improve visual acuity is limited, possibly because of the development of retinal scars, which decrease the potential for improved visual acuity. Subthreshold laser and subliminal (micropulse) laser has the potential to reduce DME with better visual acuity results compared with conventional laser, as it does not cause collateral damage in the retina. These lasers cannot cause permanent damage to the retina. This article mentions subthreshold laser, and subliminal (micropulse) laser in diabetic retinopathy and diabetic macular edema.

scholarly journals A Transfer Learning Approach for Diabetic Retinopathy and Diabetic Macular Edema Severity Grading

2021 ◽  
Vol 35 (6) ◽  
pp. 497-502
Author(s):  
Nida Nasir ◽  
Neda Afreen ◽  
Ranjeeta Patel ◽  
Simran Kaur ◽  
Mustafa Sameer
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Transfer Learning ◽  
Learning Approach ◽  
Learning Technique ◽  
Working Age ◽  
Severity Grading ◽  
Aided Diagnosis

Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) are complication that occurs in diabetic patient especially among working age group that leads to vision impairment problem and sometimes even permanent blindness. Early detection is very much needed for diagnosis and to reduce blindness or deterioration. The diagnosis phase of DR consumes more time, effort and cost when manually performed by ophthalmologists and more chances of misdiagnosis still there. Research community is working on to design computer aided diagnosis system for prior detection and for DR grading based on its severity. Ongoing researches in Artificial Intelligence (AI) have set out the advancement of deep learning technique which comes as a best technique to perform analysis and classification of medical images. In this paper, research is applied on Resnet50 model for classification of DR and DME based on its severity grading on public benchmark dataset. Transfer learning approach accomplishes the best outcome on Indian Diabetic Retinopathy Image Dataset (IDRiD).

scholarly journals Behavior of SD-OCT Detectable Hyperreflective Foci in Diabetic Macular Edema Patients after Therapy with Anti-VEGF Agents and Dexamethasone Implants

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Anne Rübsam ◽  
Laura Wernecke ◽  
Saskia Rau ◽  
Dominika Pohlmann ◽  
Bert Müller ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Inflammatory Cells ◽  
Favourable Outcome ◽  
Hard Exudates ◽  
Retinal Layers ◽  
Hyperreflective Foci ◽  
Anti Vegf ◽  
Working Age ◽  
Sd Oct

Purpose. Diabetic macular edema (DME) is the most common cause of blindness in the working-age population. Spectral-domain optical coherence tomography (SD-OCT) allows detection and monitoring of the edema and a detailed analysis of the retinal structure. Hyperreflective foci (HF) are small, circumscribed lesions on OCT, and their origin is yet to be determined. Our study was aimed to shed light on HF pathophysiology, by analyzing their number and location in DME patients at baseline and after therapy. Methods. A prospective, observational study on 59 eyes of 51 DME patients who were treated with antivascular endothelial growth factor (VEGF) therapy (VEGF group, n = 40 eyes) or dexamethasone implant (DEX group, n = 19 ). HF and hard exudates (HE) were discriminated by their appearance on fundus photographs and their size on OCT. Quantity and location of HF and HE were analyzed at baseline and after therapy. Results. DME decreased in 75% of patients in the VEGF (455.5 μm vs. 380.8 μm, p = 0.02 ) and in 95% of patients in the DEX group (471.6 μm vs. 381.9 μm, p = 0.007 ). The number of foci decreased in 62.5% of patients after anti-VEGF (130.6 vs. 111.1, p = 0.07 ) and in 68% of patients after dexamethasone injection ((123.4 vs. 94.9, p = 0.02 ) 5.1). A subgroup of 15% of eyes, all treated with anti-VEGF, showed accumulation of larger HF in outer retinal layers to visible HE during DME resolution, whereas smaller HF, found in all retinal layers, remained unchanged. There was a trend towards a dynamic shift of the foci from inner to outer retinal layers. Conclusion. The dynamic rearrangement of the small HF and their slightly greater reduction after anti-inflammatory therapy suggest inflammatory cells as their origin, whereas larger HF in the outer retinal layers correspond to microexudates. Furthermore, we found a more favourable outcome in patients with HF after treatment with dexamethasone implants compared to anti-VEGF agents.

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