A Study of Risk Factors of Clinically Significant Macular Edema in Diabetic Individuals

Introduction: Diabetic retinopathy is the commonest micro vascular complication in patients with diabetes and remains a leading cause of blindness in people of working age group. Objective: to determine the prevalence of clinically significant macular edema (CSME) and the influence of systemic risk factors Materials and methods: It is a hospital based comparative study conducted in 220 eyes of 110 diabetic patients. DR was graded according to International Clinical Diabetic Retinopathy Severity Scale and CSME was defined according to Early Treatment Diabetic Retinopathy Study (ETDRS) system. The patients were grouped as 1) CSME group (DR and CSME in one or both eyes) and 2) Non- CSME group(CSME in none of the eyes but with any grade of DR).Level of glycosylated hemoglobin (HbA1C), serum total cholesterol, triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and urine for albumin were studied in both groups. Results: CSME was present in 36% of 110 patients. Poor glycemic control and high total cholesterol level showed positive association with CSME (p<0.05). LDL and TG levels were higher and HDL lower in CSME group. However, no statistical significance was found. Conclusion: The CSME is significantly associated with poorer glycemic control and elevated total cholesterol level.

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CATARACT SURGERY AND PROGRESSION OF DIABETIC RETINOPATHY

Journal of Nepal Medical Association ◽

10.31729/jnma.782 ◽

2003 ◽

Vol 41 (143) ◽

pp. 433-437

Author(s):

Sudesh Subedi

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Retinopathy ◽

Cataract Surgery ◽

Cataract Extraction ◽

Extracapsular Cataract Extraction ◽

Vitreous Loss ◽

Clinically Significant Macular Edema ◽

Clinically Significant ◽

Form Type

Patient with diabetes mellitus have a higher prevalence of lens opacity 1and cataractdevelopment at an earlier age than non diabetic.2Cataract in diabetes mellitus decreasesthe visual acuity, makes posterior segment evaluation and laser treatment difficult.Several studies have shown that there is progression of diabetic retinopathy after cataractsurgery. In all studies, criteria for progression of diabetic retinopathy are:a) progression of any form/type or stage of diabetic eye (DE), nonproliferative diabeticretinopathy (NPDR) or proliferative diabetic retinopathy (PDR) to any advanced,recurrent form/ type or stage of NPDR or PDR andb) development of new clinically significant macular edema (CSME) and/or worsening/recurrent of preexisting CSME defined by Early Treatment Diabetic RetinopathyStudy (ETDRS).• More severe the preexisting diabetic retinopathy (DR), much worse the DR aftercataract extraction. The progression of DR after cataract extraction is severe inIntracapsular Cataract Extraction (ICCE) than Extracapsular Cataract Extraction(ECCE) with Intraocular Lens (IOL) and Sutureless Small Incision CataractSurgery (SICS) and Phacoemulcification.• Progression of DR increases with complicated cataract surgery, like posteriorcapsular rupture (PCR), vitreous loss and prolonged surgery.• The first 6 months period is crucial as a minimum period of follow up to detectprogression of DR.• There are other several local and systemic risk factors for the progression of DR,like hypertension, renal failure, ischemic heart disease, high cholesterol andtriglyceride level, pregnancy etc.Key Words: Diabetic retinopathy, cataract surgery, risk factors

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Management of Diabetic Retinopathy

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2131137 ◽

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.

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