Decorin Concentrations in Aqueous Humor of Patients with Diabetic Retinopathy

Diabetic retinopathy (DR) is a microvascular complication of diabetes in the retina. Chronic hyperglycemia damages retinal microvasculature embedded into the extracellular matrix (ECM), causing fluid leakage and ischemic retinal neovascularization. Current treatment strategies include intravitreal anti-vascular endothelial growth factor (VEGF) or steroidal injections, laser photocoagulation, or vitrectomy in severe cases. However, treatment may require multiple modalities or repeat treatments due to variable response. Though DR management has achieved great success, improved, long-lasting, and predictable treatments are needed, including new biomarkers and therapeutic approaches. Small-leucine rich proteoglycans, such as decorin, constitute an integral component of retinal endothelial ECM. Therefore, any damage to microvasculature can trigger its antifibrotic and antiangiogenic response against retinal vascular pathologies, including DR. We conducted a cross-sectional study to examine the association between aqueous humor (AH) decorin levels, if any, and severity of DR. A total of 82 subjects (26 control, 56 DR) were recruited. AH was collected and decorin concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Decorin was significantly increased in the AH of DR subjects compared to controls (p = 0.0034). AH decorin levels were increased in severe DR groups in ETDRS and Gloucestershire classifications. Decorin concentrations also displayed a significant association with visual acuity (LogMAR) measurements. In conclusion, aqueous humor decorin concentrations were found elevated in DR subjects, possibly due to a compensatory response to the retinal microvascular changes during hyperglycemia.

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Quantifying vascular density and morphology using different swept-source optical coherence tomography angiographic scan patterns in diabetic retinopathy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-311942 ◽

2018 ◽

Vol 103 (2) ◽

pp. 216-221 ◽

Cited By ~ 35

Author(s):

Takao Hirano ◽

Jyunya Kitahara ◽

Yuichi Toriyama ◽

Hirotsugu Kasamatsu ◽

Toshinori Murata ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Characteristic Curve ◽

Vascular Density ◽

Optical Coherence ◽

Image Size ◽

Healthy Individuals ◽

Cross Sectional ◽

Swept Source ◽

Retinal Microvasculature

AimsTo evaluate quantitative metrics of the retinal microvasculature in eyes with diabetic retinopathy (DR) using various en face swept-source optical coherence tomography angiography (SS-OCTA) image sizes.MethodsNon-segmented and segmented images were acquired using an SS-OCTA device (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, California, USA). The scanning protocols included the 3×3 mm, 6×6 mm and 12×12 mm fields of view. Quantitative analysis of the perfusion density (PD), vessel length density (VLD) and fractal dimension (FD) was performed. The area under the receiver operating characteristic curve was estimated to assess the ability of each image size to predict DR.ResultsThis prospective, cross-sectional study included 60 eyes, (non-DR, 13 eyes; non-proliferative DR (NPDR), 24 eyes; proliferative DR (PDR), 23 eyes) of 46 patients with diabetes and 21 eyes of 16 healthy individuals. In the 12×12 mm images, the PD of healthy individuals was significantly greater than that of patients with NPDR or PDR for all layers (NPDR, p<0.05; PDR, p<0.001 0.001; FD, p<0.001) or PDR (VLD, p<0.001; FD, p<0.001 for all layers). The results were similar for the 3×3 mm and 6×6 mm images. Overall, PD, VLD and FD progressively decreased with worsening DR severity in segmented and non-segmented layers for all SS-OCTA scan sizes. For detecting DR, 3×3 mm images best predicted DR for all evaluated quantitative parameters.ConclusionsVascular changes in DR can be monitored in detail through quantitative evaluations that combine different SS-OCTA scan sizes and parameters.

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Risk Factors for Diabetic Retinopathy

Sriwijaya Journal of Ophthalmology ◽

10.37275/sjo.v3i2.46 ◽

2021 ◽

Vol 3 (2) ◽

pp. 66-74

Author(s):

Naufallah Dinda Harumi ◽

Ramzi Amin

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Total Cholesterol ◽

Vision Loss ◽

Significant Risk ◽

Sampling Technique ◽

P Value ◽

Cross Sectional ◽

Chronic Hyperglycemia ◽

Hba1c Levels

Abstract Introduction.Diabetic retinopathy is a progressive microangiopathy characterized by damage and occlusion of small blood vessels. The earliest pathologic changes are thickening of the capillary endothelial basement membrane and a reduction in the number of pericits. Diabetic retinopathy is the main cause of vision loss in type 1 of DM patients and has various risk factors such as chronic hyperglycemia, hypertension, hypercholesterolemia, and elevated HbA1C levels. Methods.This research was conducted using a descriptive observational analytic method with a cross sectional approach at The Eye Polyclinic (RSUP) Dr. Mohammad Hoesin Palembang used secondary data on diabetic retinopathy patients. The sample consisted of 64 patients with a total sampling technique, there were 50 patients who met the inclusion criteria. Results.There was a significant relationship between HbA1C levels (p value = 0.050) with a PR value = 1.463 and total cholesterol (p value = 0.038) with a PR value = 1.667 for diabetic retinopathy. Conclusion.HbA1C levels and total cholesterol are significant risk factors for diabetic retinopathy.

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IFG-1 PLASMA LEVELS ARE ALTERED IN PATIENTS WITH ALZHEIMER’S DIASEASE AND DIABTES MELLITUS TYPE 2

10.5327/1980-5764.rpda045 ◽

2021 ◽

Author(s):

Palomali Zanarel ◽

Marina Grigoli ◽

Danielle de Oliveira ◽

Patrícia Manzine ◽

Márcia Cominetti

Keyword(s):

Plasma Levels ◽

Neuronal Damage ◽

Brain Activity ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Assessment Instruments ◽

Compensatory Response ◽

Cross Sectional ◽

Healthy Older Adults

Background: Insulin plays an important role in mechanisms related to brain activity and in memory formation. Alterations in the insulin pathway may be related to Alzheimer’s disease (AD) and patients with type 2 diabetes mellitus (DM2) are more likely to develop AD, compared to metabolically and cognitively healthy individuals. Objectives: To evaluate the IGF-1 levels in plasma samples from individuals with AD or DM2 isolated or with both diseases concomitantly and to compare with the levels from cognitively and metabolically healthy older adults. Methods: This is a cross-sectional, descriptive and comparative study ethically approved (CAAE: 31634720.9.0000.5504) that has been developed in the city of São Carlos with a sample of 36 participants, aged over 60 years, users of health services in the municipality. Specific inclusion and exclusion criteria and cognitive assessment instruments were applied to participants from all groups. The quantification of plasma levels of IGF-1 was performed using the ELISA (Enzyme-Linked Immunosorbent Assay) technique. Results: Participants with AD and DM concomitantly had higher levels of IGF-1 when compared with the individuals in the control group (p=0.0003) and with participants with DM (p=0.0167). Conclusions: The significant increase in IGF-1 plasma levels in the AD+DM and DM groups may indicate an initial compensatory response against neuronal damage in these patients.

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Neurovascular cross talk in diabetic retinopathy: Pathophysiological roles and therapeutic implications

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00005.2016 ◽

2016 ◽

Vol 311 (3) ◽

pp. H738-H749 ◽

Cited By ~ 49

Author(s):

Elizabeth P. Moran ◽

Zhongxiao Wang ◽

Jing Chen ◽

Przemyslaw Sapieha ◽

Lois E. H. Smith ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Cross Talk ◽

Metabolic Stress ◽

Neurovascular Coupling ◽

Developed Countries ◽

Therapeutic Implications ◽

Vascular Abnormalities ◽

Guidance Cues ◽

Chronic Hyperglycemia ◽

Retinal Microvasculature

Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population in developed countries, and its prevalence will increase as the global incidence of diabetes grows exponentially. DR begins with an early nonproliferative stage in which retinal blood vessels and neurons degenerate as a consequence of chronic hyperglycemia, resulting in vasoregression and persistent retinal ischemia, metabolic disequilibrium, and inflammation. This is conducive to overcompensatory pathological neovascularization associated with advanced proliferative DR. Although DR is considered a microvascular complication, the retinal microvasculature is intimately associated with and governed by neurons and glia; neurodegeneration, neuroinflammation, and dysregulation of neurovascular cross talk are responsible in part for vascular abnormalities in both early nonproliferative DR and advanced proliferative DR. Neuronal activity directly regulates microvascular dilation and blood flow in the process of neurovascular coupling. Retinal neurons also secrete guidance cues in response to injury, ischemia, or metabolic stress that may either promote or suppress vascular outgrowth, either alleviating or exacerbating DR, contingent on the stage of disease and retinal microenvironment. Neurodegeneration, impaired neurovascular coupling, and dysregulation of neuronal guidance cues are key events in the pathogenesis of DR, and correcting these events may prevent or delay development of advanced DR. The review discusses the mechanisms of neurovascular cross talk and its dysregulation in DR, and their potential therapeutic implications.

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Intercellular adhesive molecule-1 (ICAM-1) in proliferative diabetic retinopathy

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i1.516 ◽

2020 ◽

Vol 17 (1) ◽

pp. 120-127

Author(s):

Andi A. Victor ◽

Tjahjono D. Gondhowiardjo ◽

Rahayuningsih Dharma ◽

Sri W. A. Jusman ◽

Vivi R. Yandri ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Cross Sectional Study ◽

Intercellular Adhesion Molecule ◽

Enzyme Linked Immunosorbent Assay ◽

Affecting Factors ◽

Intercellular Adhesion Molecule 1 ◽

Cross Sectional ◽

Adhesive Molecule ◽

Significant Difference

Purpose: To determine the level of intercellular adhesion molecule-1 (ICAM-1) in vitreous fluid of patients with proliferative diabetic retinopathy (PDR) and its affecting factors including HbA1c level, duration of diabetes mellitus (DM) and insulin usage. Methods: A cross-sectional study was conducted in Cipto Mangunkusumo National General Central Hospital, Jakarta, Indonesia from June 2015 to August 2016. Thirty-three consecutive vitreous samples harvested from PDR patients underwent vitrectomy. The level of vitreous ICAM-1 was determined by enzyme-linked immunosorbent assay. Results: Based on the glycemic status, vitreous ICAM-1 level in the uncontrolled glycemic group (21.61 ng/ml) was lower than controlled glycemic group (24.20 ng/ml). Patients with DM for more than 10 years had higher level of vitreous ICAM-1 (26.30 ng/ml). Vitreous ICAM-1 level in DM patients with insulin was higher than those without insulin (27.07 ng/ml vs. 24.17 ng/ml). There was no statistically significant difference between vitreous ICAM-1 levels among all groups (p > 0.05). Conclusion: The concentration of vitreous ICAM-1 may not be influenced by glucose control and conventional insulin therapy.

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Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside

Journal of Diabetes Research ◽

10.1155/2017/2562759 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Søren Leer Blindbæk ◽

Thomas Lee Torp ◽

Kristian Lundberg ◽

Kerstin Soelberg ◽

Anna Stage Vergmann ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Treatment Outcome ◽

Vascular System ◽

Structural Features ◽

University Hospital ◽

Cross Sectional ◽

Retinal Microvasculature ◽

Department Of Ophthalmology

The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber and fractals with micro- and macrovascular dysfunction in diabetes. Likewise, the retinal metabolism can be evaluated by retinal oximetry, and higher retinal venular oxygen saturation has been demonstrated in patients with diabetic retinopathy. So far, most studies have been cross-sectional, but these can only disclose associations and are not able to separate cause from effect or to establish the predictive value of retinal vascular dysfunction with respect to long-term complications. Likewise, retinal markers have not been investigated as markers of treatment outcome in patients with proliferative diabetic retinopathy and diabetic macular edema. The Department of Ophthalmology at Odense University Hospital, Denmark, has a strong tradition of studying the retinal microvasculature in diabetic retinopathy. In the present paper, we demonstrate the importance of the retinal vasculature not only as predictors of long-term microvasculopathy but also as markers of treatment outcome in sight-threatening diabetic retinopathy in well-established population-based cohorts of patients with diabetes.

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Prevalence and correlates of microvascular complications among patients with diabetes mellitus: a cross sectional study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203461 ◽

2020 ◽

Vol 8 (8) ◽

pp. 3039

Author(s):

Ashok Kumar ◽

Ardaman Singh ◽

Vikram S. Tanwar ◽

Nikhil Govil

Keyword(s):

Diabetes Mellitus ◽

Metabolic Syndrome ◽

Diabetic Retinopathy ◽

Age Of Onset ◽

Microvascular Complications ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Study Group ◽

Cross Sectional ◽

Chronic Hyperglycemia

Background: Diabetes mellitus is a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia and associated with various microvascular, macrovascular and nonvascular complications leading to increasing morbidity and mortality. Microvascular complications are daibetes specific and their relation with associated comorbidities studied worldwide. To estimate the prevalence of microvascular complications in diabetic patients and to find their relation with various comorbid conditions.Methods: A total of hundred diagnosed patients of diabetes mellitus with age ranging from 18 to 75 years were enrolled in the study. Patients were assessed for the presence of microvascular complications and associated comorbidities. The effect of various comorbidities on frequency of microvascular complications was also determined. Data collected was statistically analyzed.Results: In this study, the mean age of the study group was 55.77±11.75 years. Mean age of onset of the disease was 48.89±11.50 years. Mean duration of the disease in the study group was 6.86±5.02 years. Diabetic retinopathy, neuropathy and nephropathy was found in 76%, 63% and 69% patients, respectively. Among patients with hypertension, 91.7%, 83.3%, and 81.7% cases were found to have retinopathy, neuropathy and nephropathy, respectively. The corresponding figures for those with comorbid IHD were 91.1%, 83.9% and 76.8% respectively whereas among patients with coexisting metabolic syndrome, 92.5%, 80.6%, and 79.1% were found to have retinopathy, neuropathy, and nephropathy, respectively.Conclusions: The most frequent microvascular complication reported by this study was diabetic retinopathy. comorbid conditions like hypertension, ischemic heart disease, and metabolic syndrome were associated with higher prevalence of microvascular complications in diabetic patients.

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Decreased Ratio of VEGF165b/VEGF in Aqueous Humor Predicts Progression of Diabetic Retinopathy

Ophthalmic Research ◽

10.1159/000508250 ◽

2020 ◽

Vol 63 (6) ◽

pp. 517-523

Author(s):

Feng Jiang ◽

Liuyun Chong ◽

Shufang Du ◽

Yajian Duan ◽

Ying Wang ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Aqueous Humor ◽

Predictive Value ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Diabetic Patients ◽

Vascular Endothelial ◽

The Mean ◽

Endothelial Growth Factor ◽

Mean Concentration

Background: Different splicing of vascular endothelial growth factor (VEGF) gene results in 2 families of VEGF, the proangiogenic isoforms (VEGFxxxa) and the antiangiogenic isoforms (VEGFxxxb). VEGF165b is the major antiangiogenic isoform of VEGF and the most studied member of the VEGFxxxb family so far. Objectives: To determine the concentration of VEGF165b and VEGF in the aqueous humor (AH) in diabetic eyes with or without diabetic retinopathy (DR) and to address the predictive value of VEGF165b/VEGF ratio for progression of DR. Methods: AH samples from 20 eyes in healthy controls (CON group), 40 eyes in diabetic patients without DR (nDR group), and 30 eyes in diabetic patients with mild nonproliferative DR (DR group) were collected. All of the patients were followed up for at least 5 years. VEGF165b and VEGF levels of AH samples were measured by enzyme-linked immunosorbent assay (ELISA). The predictive value of the initial VEGF165b/VEGF ratio for progression of DR was studied. Results: The mean concentration of VEGF165b significantly decreased in diabetic eyes vs. controls. The mean concentration of VEGF significantly increased in the DR group vs. the CON group. The VEGF165b/VEGF ratio was significantly lower in diabetic patients compared to the CON group. The VEGF165b/VEGF ratio was significantly lower in diabetic patients compared to the control group. The mean follow-up was 66.1months (range 60–71 months). The risk of DR progression was greater with a lower VEGF165b/VEGF ratio. Conclusion: The VEGF165b/VEGF ratio is lower in the AH of DR patients and the decreased ratio of VEGF165b/VEGF predicts DR progression.

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2D alpha-shapes to quantify retinal microvasculature morphology and their application to proliferative diabetic retinopathy characterisation in fundus photographs

Scientific Reports ◽

10.1038/s41598-021-02329-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Emma Pead ◽

Ylenia Giarratano ◽

Andrew J. Tatham ◽

Miguel O. Bernabeu ◽

Baljean Dhillon ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Imaging Biomarkers ◽

Cross Sectional ◽

Vascular Abnormalities ◽

Small Vessels ◽

Alpha Shapes ◽

Retinal Microvasculature ◽

Fundus Photographs ◽

Sectional Analysis

AbstractThe use of 2D alpha-shapes (α-shapes) to quantify morphological features of the retinal microvasculature could lead to imaging biomarkers for proliferative diabetic retinopathy (PDR). We tested our approach using the MESSIDOR dataset that consists of colour fundus photographs from 547 healthy individuals, 149 with mild diabetic retinopathy (DR), 239 with moderate DR, 199 pre-PDR and 53 PDR. The skeleton (centrelines) of the automatically segmented retinal vasculature was represented as an α-shape and the proposed parameters, complexity ($${Op\alpha }_{min}$$ O p α min ), spread (OpA), global shape (VS) and presence of abnormal angiogenesis (Gradα) were computed. In cross-sectional analysis, individuals with PDR had a lower $${Op\alpha }_{min}$$ O p α min , OpA and Gradα indicating a vasculature that is more complex, less spread (i.e. dense) and the presence of numerous small vessels. The results show that α-shape parameters characterise vascular abnormalities predictive of PDR (AUC 0.73; 95% CI [0.73 0.74]) and have therefore potential to reveal changes in retinal microvascular morphology.

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Perceived Voice Disorders in Older Adults and Impact on Social Interactions

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00059 ◽

2021 ◽

pp. 1-8

Author(s):

Connie K. Porcaro ◽

Clare Singer ◽

Boris Djokic ◽

Ali A. Danesh ◽

Ruth Tappen ◽

...

Keyword(s):

Older Adults ◽

Social Interactions ◽

Social Engagement ◽

Leisure Activities ◽

Treatment Strategies ◽

Voice Disorders ◽

Community Dwelling ◽

Vocal Performance ◽

Older Individuals ◽

Cross Sectional

Purpose Many aging individuals, even those who are healthy, report voice changes that can impact their ability to communicate as they once did. While this is commonly reported, most do not seek evaluation or management for this issue. The purpose of this study was to investigate the prevalence and differences in voice disorders in older adults, along with the effect of fatigue on their social interactions. Method This is a cross-sectional investigation of a community-dwelling sample of individuals aged 60 years or older. Participants completed the Questionnaire on Vocal Performance, the Social Engagement Index subset “Engagement in Social or Leisure Activities,” and the Fatigue Severity Scale. Results Results indicated 32.5% of the 332 participants reported symptoms of voice problems with no difference found between male and female respondents. A slight increase in report of voice problems was noted with each year of age. Participants who self-reported voice problems indicated less interaction in social activities involving communication than those who did not. Finally, as severity of self-reported voice problems increased, an increase was reported by the same individuals for signs of fatigue. Conclusions Voice problems and resulting decreased social interaction are commonly experienced by older individuals. Voice symptoms in older adults have been found to benefit from evidence-based treatment strategies. It is critical to provide education to encourage older individuals to seek appropriate evaluation and management for voice issues through a speech-language pathologist or medical professional.

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