EFFECT OF INTRAVITREAL TRIAMCINOLONE ACETONIDE IN REFRACTORY DIABETIC MACULAR EDEMA

Objective: To investigate the effects of intravitreal triamcinolone for refractory diabetic maculopathy after 03 unsuccessful intravitreal bevacizumab injections. Study Design: Prospective observational study. Place and Duration of Study: Retina department of Al-Shifa Trust Eye Hospital Rawalpindi, from Jun 2016 to Jul 2017. Methodology: Total 35 eyes of 35 patients who were diagnosed with diabetic maculopathy and having history of minimum three intravitreal Bevacizumab injections were included. Detailed eye examinations included visual acuity, anterior and posterior segment examination and intraocular pressure measurement was performed in all patients. Central macular thickness was also measured. Then intravitreal triamcinolone was administered to eyes by principal researcher (Ophthalmologist). After one month, follow up examination of patient’s eyes was done to assess the effects of injection. Results: Majority of the participants were males 19 (55%) in this research. There was statistically significant difference between means of intra ocular pressure (mean difference= 4.30 ± 5.41), Visual acuity (mean difference=2.8 ± 2.4) and central macular thickness (mean difference = 236.4 ± 13) pre and post injection was found (p-value<0.05). Conclusion: There was statistically significant difference of central macular thickness and visual acuity, pre and post intravitreal triamcinolone acetonide injection was found.

Modern vitreoretinal interventions in the treatment of diabetic maculopathy: delicacy or maximalism?

Background. Diabetic retinopathy, one of the major complications of diabetes, is one of the leading causes of low vision and blindness. One of the main causes of decreased central vision in patients with diabetic retinopathy and type 2 diabetes mellitus is diabetic maculopathy (DMP). DMP with possible development of diabetic maculopathy edema can be detected even in patients with initial changes in the fundus. The purpose was to investigate the safety profile and effectiveness of various modern vitreoretinal interventions in the treatment of diabetic maculopathy. Materials and methods. We observed 313 patients with type 2 diabetes mellitus (313 eyes) with DMP and initial (group I; n = 40), moderate-to-severe non-proliferative (group II; n = 92) and proliferative diabetic retinopathy (group III; n = 181). All patients underwent conventional ophthalmological examinations. Three hundred and thirteen patients (313 eyes) who underwent surgical treatment were divided into 4 observation groups: group 1 — 78 people (78 eyes) who underwent pars plana vitrectomy 25G (PPV); group 2 — 85 individuals (85 eyes) who underwent PPV and internal limiting membrane (ILM) peeling; group 3 — 81 patients (81 eyes) who underwent PPV, ILM peeling and panretinal photocoagulation (PPC); group 4 — 69 people (69 eyes) who underwent PPV, ILM peeling, PPC and phacoemulsification. The nature and frequency of surgical, postoperative complications and the effectiveness of different vitreoretinal interventions were studied. Terms of observation were 1, 3, 6 months and 1 year after surgery. Results. The effectiveness of different vitreoretinal interventions was studied 1, 3 and 6 months after surgery. High efficiency of intervention for all types of vitrectomy is established. Modern vitreoretinal interventions in the treatment of DMP and diabetic maculopathy edema is effective after 1 month in 60.7, 82.4, 85.2 and 68.12 % of cases, and after one year — in 76.0, 75.0, 73.1 and 73.5 %, respectively. The recurrence rate of DMP one year after vitreoretinal interventions was 24.0–27.0 % and did not depend on their modification. The effectiveness of DMP treatment depended on the stage of diabetic retinopathy and was 72.5 % in the initial non-proliferative diabetic retinopathy, 77.2 % with moderate-to-severe non-proliferative diabetic retinopathy and 66.3 % with proliferative diabetic retino-pathy. Recurrences of DMP were divided into three types: early transient, early persistent and late. The most frequent were early persistent relapses, which ranged from 16.1 to 25.6 % taking into account different methods of treatment. Conclusions. All stages of surgery must be strictly justified. The risks of each stage of the intervention should always be considered to obtain optimal functional results, especially in the long-term follow-up.

High-Risk Diabetic Maculopathy: Features and Management

A substantial group of patients with diabetic macular edema in our clinical practice is at high risk for profound and irreversible vision deterioration. Early identification of modifiable factors with long-term negative impact and their management, close monitoring and timely adjustments in the treatment can significantly reduce the probability of visual disability in the individual patient. This approach can also provide important guidelines for proactive decision making in order to avoid the risk of suboptimal response and unsatisfactory outcome.

Distribution of diabetic retinopathy in diabetes mellitus patients and its association rules with other eye diseases

The study aims to explore the distribution characteristics and influencing factors of diabetic retinopathy (DR) in diabetes mellitus (DM) patients and association rules of eye diseases in these patients. Data were obtained from 1284 DM patients at Henan Provincial People’s Hospital. Association rules were employed to calculate the probability of the common occurrence of eye-related diseases in DM patients. A web visualization network diagram was used to display the association rules of the eye-related diseases in DM patients. DR prevalence in people aged < 40 years (≥ 58.5%) was higher than that in those aged 50–60 years (≤ 43.7%). Patients with DM in rural areas were more likely to have DR than those in urban areas (56.2% vs. 35.6%, P < 0.001). DR prevalence in Pingdingshan City (68.4%) was significantly higher than in other cities. The prevalence of DR in patients who had DM for ≥ 5 years was higher than in other groups (P < 0.001). About 33.07% of DM patients had both diabetic maculopathy and DR, and 36.02% had both diabetic maculopathy and cataracts. The number of strong rules in patients ≥ 60 years old was more than those in people under 60 in age, and those in rural areas had more strong rules than those in urban areas. DM patients with one or more eye diseases are at higher risks of other eye diseases than general DM patients. These association rules are affected by factors such as age, region, disease duration, and DR severity.

Clinical Study of Risk Factors for Diabetic Maculopathy

Aim: To determine the association between various systemic risk factors with diabetic maculopathy. Methodology: A prospective observational study was conducted on 50 patients having diabetic maculopathy. Patients with maculopathies secondary to Vitreous Haemorrhage, Ocular disorders like Glaucoma, Uveitis, Advanced Diabetic Eye Disease, Vitreo-macular traction, maculopathy along with proliferative diabetic retinopathy, ischemic maculopathy, and history of laser treatment in last six months were excluded from the study. Data was collected using a structured proforma that included name, age, sex, occupation, height, weight, history of other systemic diseases like hypertension, investigations and treatment taken in past, family history, duration of DM, smoking, hyperlipidemia, hyperglycemia and nephropathy. Results: Out of 50 patients, 38 (76%) were males and 12 (24%) were females suggestive of male predominance. Mean age of the patient was 57.36±11.65 years in males and 56.67±10.17 years in females. Among 50 patients, 19 patients had diabetes mellitus for 6-10 years duration, 14 patients had diabetes mellitus for 1-5 years, in 12 patients for 11-15 years, in 2 patients for 16-20 years, in 2 patients for 21-25 years and only 1 patient more than 25 years. Mean duration of DM was 12.2±6.1 years. Majority of patients having maculopathy had duration of DM up to 20 years. Among 50 patients, 27 patients (54%) had systemic hypertension, 37 patients (74%) had uncontrolled blood sugar level, 29 patients (58%) were found to have hyperlipidemia and 20 patients (40%) had nephropathy. Among 50 patients, pseudophakia was noted in 7 patients (14%), obesity was noted in 21patients (42%). Eleven patients (22%) were found to have anemia, 6 patients (12%) had family history of DM and 13 patients (26%) had history of smoking. Conclusion: Hyperglycemia, hypertension, duration of DM, hyperlipidemia are the major risk factors for the development and progression of diabetic maculopathy. While anemia, smoking, and obesity, family history of DM are the less significant risk factors.

Diabetic maculopathy: multicolour and SD-OCT versus fundus photography

ObjectiveThe English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening.Methods and analysisThis cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.ResultsIntergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema.ConclusionMulticolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.