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Background/Aim: Diabetic retinopathy is a leading cause of blindness worldwide, characterized by neurovascular dysfunction. This study aimed to investigate the impact of brimonidine, a selective adrenoceptor agonist, on diabetic retinal neurodegeneration, recognizing the critical role of neurodegeneration in diabetic retinopathy. Materials and Methods: Streptozotocin-induced diabetes was established in adult male Sprague-Dawley rats to mimic diabetic retinopathy. Rats, except non-diabetic control rats, received topical applications of 0.15% brimonidine tartrate (treatment group) or balanced salt solution (diabetic control group) twice daily following diabetes induction. Each group comprised six randomly assigned animals. Retinal samples were analyzed using immunofluorescence staining, apoptosis assay, and western blot. Results: Topical brimonidine treatment reduced apoptosis of retinal ganglion cells at 8 weeks after induction of diabetes (p<0.05). Glial activation induced by diabetes was reduced by brimonidine treatment. Immunoblot and immunofluorescence assay revealed that the decrease in phospho-protein kinase B (AKT) level resulting from diabetes was also attenuated by brimonidine (p<0.05). Furthermore, brimonidine alleviated the decrease in antiapoptotic proteins [BCL2 apoptosis regulator (BCL2) and BCL-xl] induced by diabetes (p<0.05). Elevation of phospho-p38 mitogen-activated protein kinase (p38MAPK) and p53 in diabetic rats were reduced by brimonidine (p<0.05). Additionally, brimonidine treatment attenuated the upregulation of the pro-apoptotic molecule BCL-2 associated X in retinas of diabetic rats (p<0.05). Conclusion: These findings suggest that topical brimonidine treatment may protect retinal ganglion cells in experimental diabetes by modulating the AKT pathway and reducing pro-apoptotic p38MAPK levels. This presents a potential neuroprotective approach in diabetes, offering the advantage of localized treatment without the added burden of oral medication. [ABSTRACT FROM AUTHOR]

Background and Objective: We investigated the reliability of near-infrared reflectance (NIR) imaging as a method of assessing severity of diabetic retinopathy (DR). Patients and Methods: One hundred ninety-five NIR images were reviewed by two graders for the number of hyporeflective foci, presence or absence of vascular abnormalities, and presumptive DR stage; these were correlated to fundus photography-defined DR stage. Interrater reliability was confirmed via one-way random effects model of intraclass correlation coefficients. Analysis of variance was used in subgroup analysis, receiver operating characteristic (ROC) curves were created to validate reliability of the model, and logistic regression was used to model foci and vascular abnormalities as predictors for moderate or worse disease. Results: A statistically significant difference in mean number of hyporeflective foci was found between no DR and moderate non-proliferative DR (NPDR; P < 0.0001), no DR and severe NPDR (P < 0.001), no DR and proliferative DR (PDR; P < 0.0001), mild and moderate NPDR (P = 0.008), mild and severe NPDR (P < 0.001), and mild NPDR and PDR (P < 0.001). The area under the ROC curve was 0.849 (CI: 0.792 to 0.905). The threshold for detection of moderate NPDR or worse was 4.75 foci, with a sensitivity of 79.0% and a false positive rate of 20.0%. Multivariate logistic regression model incorporating hyporeflective foci with vascular abnormalities (odds ratio [OR] = 1.592, 95% CI: 1.381 to 1.835; P < 0.001) was able to accurately predict moderate disease or worse, just moderate disease (OR = 1.045, 95% CI: 1.003 to 1.089; P = 0.035), severe disease (OR = 1.050, 95% CI: 1.006 to 1.096; P = 0.027), and proliferative disease (OR = 1.050, 95% CI: 1.008 to 1.095; P = 0.018). Conclusions: NIR imaging may be an adjunct tool in screening for DR. [Ophthalmic Surg Lasers Imaging Retina 2024;55:318–325.] [ABSTRACT FROM AUTHOR]

Purpose: Antivascular endothelial growth factor (anti-VEGF) medications find extensive utilization in addressing diabetic macular edema (DME). In December 2018, the Social Security Institution of Türkiye introduced the requirement of a loading dose of bevacizumab and subsequent unresponsiveness criteria for the application of other intravitreal drugs in retinal diseases. The aim of this study is to perform a cost analysis of bevacizumab use in the loading dose for DME treatment compared to the use of aflibercept and ranibizumab. Methods: Patients diagnosed with DME between 2019 and 2022, who received three consecutive doses of bevacizumab at 4-6 week intervals, were included in the study. The prices of anti-VEGF drugs were calculated in US dollars (USD) by taking the average of prices for the respective years. The average prices for the bevacizumab vials were 178.28 USD, 153.12 USD, 149.08 USD, and 138.83 USD for the years 2019, 2020, 2021, and 2022, respectively. Results: A total of 671 eyes were included in the study. The mean age of the patients was 67.8±10.2 (range 42-86) years. The mean best-corrected visual acuity improved from 0.21±0.13 (range 0.05-0.4) before injections to 0.45±0.11 (range 0.2-0.7) after three doses. No cases of retinal tear/detachment or endophthalmitis were observed. The total cost of 2013 doses of bevacizumab administered intravitreally to 671 eyes was 322.894,50 USD. The cost would be 791,640.96 USD if ranibizumab was used and 800,491.53 USD if aflibercept was used. Conclusion: In the study, it was determined that bevacizumab is more affordable than other anti-VEGF drugs in the treatment of DME. Health-care systems may prefer less costly drugs to use their resources more effectively. However, the final decision in drug selection should always be made by doctors based on effectiveness for the benefit of the patient. [ABSTRACT FROM AUTHOR]

Background: Our purpose is to investigate the demographic, clinical, and haematological parameters of patients diagnosed with diabetic retinopathy (DRP) without coronary artery disease and control group. Materials and Method: This study was retrospective and the information of all patients was retrospectively scanned and their anamnesis was noted from the medical record files. A total of 151 patients, 75 with DRP and 76 in the control group without diabetes and a history of coronary artery disease, were included in the study. For all statistics, a p-value below 0.05 was considered significant. Results: There was no distinction between the DRP and the other group in terms of clinical and demographic features. The serum glucose (p<0.001), creatinine (p=0.029), and triglyceride (p=0.047) were higher in patients with the DRP group However, eosinophil level (p=0.009) and eosinophil-to-monocyte ratio (EMR) (p=0.003) values were lower in DRP patients. Multivariable linear regression analyses showed serum glucose (OR:1.241, 95% CI [1.087 – 1.418], p<0.001) and EMR (OR:0.966, 95% CI [0.440–2.117], p= 0.030) were potential risk factors for DRP. Conclusion: In our research, we observed that the serum eosinophil level and EMR in patients with DRP were lower than in other patients and that this, together with the high glucose level, had an independent predictive value for DRP. Future large-scale studies will shed light on this topic. [ABSTRACT FROM AUTHOR]

Background. Diabetes mellitus is a leading cause of death, disability, and adult blindness from diabetic retinopathy worldwide. Recent studies have provided a better understanding of the disease process and have opened new doors for prevention and treatment. The aim of our study is to evaluate the effectiveness of the current screening methods for prevention and control of diabetic retinopathy and to create a program for optimization. Material and methods. We included 123 patients with type 1 and type 2 diabetes mellitus. Clinical characteristics of the population were collected from patients' files. The HbA1c level was measured. Results. Among examined cohort group - 45% are with diabetes type 1 and 55% with diabetes type 2. In distribution by gender the prevalence is for males. The biggest part of the participants in our study is in the age group 45-66 years old. In 94% of the patients the duration of the disease is between 3-10 years. 22% of the patients are with non-proliferative diabetic retinopathy (NPDR), 45% with proliferative diabetic retinopathy (PDR) and 33% with diabetic macular edema (DME). Conclusion. Our opinion is that the current ophthalmologic devices, such as fundus cameras and OCT (multimodal imaging), should be incorporated in the process of screening for diabetic retinopathy due to the detailed information they provide and the short time to perform the procedure. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes and the leading cause of blindness and severe visual impairment in adults. The high levels of glucose trigger multiple intracellular oxidative stress pathways, such as POLDIP2, resulting in excessive reactive oxygen species (ROS) production and increased expression of vascular cell adhesion molecule-1 (VCAM-1), hypoxia-inducible factor 1α (HIF-1α), and vascular endothelial growth factor (VEGF), causing microvascular dysfunction. Dihydromyricetin (DMY) is a natural flavonoid small molecule antioxidant. However, it exhibits poor solubility in physiological environments, has a short half-life in vivo, and has low oral bioavailability. In this study, we present, for the first time, the synthesis of ultra-small Fe-DMY nano-coordinated polymer particles (Fe-DMY NCPs), formed by combining DMY with low-toxicity iron ions. In vitro and in vivo experiments confirm that Fe-DMY NCPs alleviate oxidative stress-induced damage to vascular endothelial cells by high glucose, scavenge excess ROS, and improve pathological features of DR, such as retinal vascular leakage and neovascularization. Mechanistic validation indicates that Fe-DMY NCPs can inhibit the activation of the Poldip2-Nox4-H2O2 signaling pathway and downregulate vital vascular function indicators such as VCAM-1, HIF-1α, and VEGF. These findings suggest that Fe-DMY NCPs could serve as a safe and effective antioxidant and microangio-protective agent, with the potential as a novel multimeric drug for DR therapy.

Background • Diabetic retinopathy (DR) is the most prevalent microvascular complication of diabetes. Panretinal photocoagulation (PRP) is the established treatment for mitigating severe visual impairment resulting from proliferative DR. Objective • This study aims to investigate the impact of PRP on the macular region in patients with DR, utilizing optical coherence tomography (OCT) for assessment. Design • An experimental study was meticulously designed, implementing PRP as the primary intervention. Setting • The investigation was conducted within the Department of Ophthalmology at the Affiliated Huaian No.1 People’s Hospital, Huai’an, Jiangsu, China. Participants • A total of 120 participants diagnosed with DR and undergoing treatment at our hospital were enrolled in the study. Interventions • The participants were randomly assigned to either the control group (CG, n=60) or the study group (SG, n=60). The CG received conventional drug treatment involving oral iodized lecithin, while the SG received PRP. OCT was employed to monitor changes in macular fovea volume and macular retinal thickness. Primary Outcome Measures • Evaluation criteria encompassed clinical efficacy, macular fovea volume, macular retinal thickness, IL-6 and VEGF levels, incidence of adverse reactions, and quality of life in both groups. Results • The study resulted in a higher total effective rate in the SG (96.67%) compared to the CG (80.00%) (χ2 = 8.09, P < .05). Post-treatment, reductions were observed in macular fovea volume and macular retinal thickness, with significantly lower SG values than CG values (P < .05). Both serum IL-6 and VEGF levels exhibited reductions in both groups after treatment, with the SG displaying a more significant decrease compared to the CG (P < .05). The occurrence of adverse reactions significantly decreased in the SG relative to the CG (P < .05). Quality of life scores for the SG was notably elevated compared to the CG (P<.05). Conclusions • PRP emerges as a highly valuable approach in the management of DR. It contributes to retinal thickness improvement within the macular region and inflammation reduction, and also enhances therapeutic outcomes, minimizes adverse reactions, and optimizes patients’ quality of life. These findings warrant further clinical adoption and widespread promotion. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes and the leading cause of blindness and severe visual impairment in adults. The high levels of glucose trigger multiple intracellular oxidative stress pathways, such as POLDIP2, resulting in excessive reactive oxygen species (ROS) production and increased expression of vascular cell adhesion molecule-1 (VCAM-1), hypoxia-inducible factor 1α (HIF-1α), and vascular endothelial growth factor (VEGF), causing microvascular dysfunction. Dihydromyricetin (DMY) is a natural flavonoid small molecule antioxidant. However, it exhibits poor solubility in physiological environments, has a short half-life in vivo, and has low oral bioavailability. In this study, we present, for the first time, the synthesis of ultra-small Fe-DMY nano-coordinated polymer particles (Fe-DMY NCPs), formed by combining DMY with low-toxicity iron ions. In vitro and in vivo experiments confirm that Fe-DMY NCPs alleviate oxidative stress-induced damage to vascular endothelial cells by high glucose, scavenge excess ROS, and improve pathological features of DR, such as retinal vascular leakage and neovascularization. Mechanistic validation indicates that Fe-DMY NCPs can inhibit the activation of the Poldip2-Nox4-H 2 O 2 signaling pathway and downregulate vital vascular function indicators such as VCAM-1, HIF-1α, and VEGF. These findings suggest that Fe-DMY NCPs could serve as a safe and effective antioxidant and microangio-protective agent, with the potential as a novel multimeric drug for DR therapy. [Display omitted] • We report for the first time the synthesis and validation of ultra-small Fe-DMY NCPs particles. • We confirmed its ability of alleviating oxidative stress damage and ameliorating pathological features of DR. • Fe-DMY NCPs could inhibit the activation of Poldip2-Nox4-H2O2 signaling pathway and down-regulate VCAM-1, HIF-1α, and VEGF. • Fe-DMY NCPs may be a novel polymeric drug for DR as a safe and efficient antioxidant and microangio-protective agent. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is the most prevalent type of retinal vasculopathy and the most widespread cause of preventable blindness in adults. Excessive increases in reactive oxygen species (ROS) and vascular endothelial growth factor are major initiators and drivers of DR progression, respectively. However, current DR treatment options remain limited, particularly for early DR. Nanotechnology‐mediated antioxidant strategies are gaining increasing popularity to treat ocular diseases. Quercetin has excellent ROS scavenging efficiency but poor stability and low bioavailability in physiological environments. In this study, ultrasmall Fe‐Quer nanozymes (NZs) formed by coupling quercetin with low‐toxic iron ions are reported that can mimic the activities of three important antioxidant enzymes, superoxide dismutase, catalase, and peroxidase, thereby exhibiting excellent water dispersion and efficient ROS scavenging ability. In vitro and in vivo assays validate the effects of Fe‐Quer NZs against inflammation, oxidative stress damage, microvascular leakage, and angiogenesis, particularly their vascular protective effect in early DR. Transcriptomic analysis further reveals a potential multitarget‐specific therapeutic mechanism of Fe‐Quer NZs against DR. These observations open avenues for Fe‐Quer NZs, composed of molecules of a natural product and metal ions with artificial NZ activity, as microvascular protective agents for DR and other ROS‐related diseases. [ABSTRACT FROM AUTHOR]

Objective • To investigate the value of Doppler ultrasound in evaluating the efficacy of diabetic retinopathy. Methods • A retrospective analysis was conducted on 90 hospitalized patients with type 2 diabetes from January 2019 to January 2020. The patients were divided into two groups: 34 cases without retinopathy and 56 cases with diabetic retinopathy. Clinical data and Doppler ultrasonography results were collected and analyzed to evaluate the value of Doppler ultrasound. Results • After treatment, various indicators, including blood glucose, HbA1c, FPG, 2hFPG, HOMA-IR, and FINS, showed significant improvement in both groups (P < .05). There was no significant difference before and after treatment (P > .05). Before treatment, the retinopathy group exhibited significantly different central artery parameters: PSA (8.35 ± 1.08), EDV (5.80±0.62), RI (1.53 ± 0.25), compared to patients without retinopathy: PSA (13.61 ± 1.80), EDV (7.23 ± 0.51), RI (0.85 ± 0.02) (t = 12.019, 11.631, 11.461, P = .01, .01, .00), respectively. After treatment, the central artery parameters improved in both groups. The retinopathy group showed PSA (10.44 ± 0.26), EDV (6.84 ± 0.85), RI (1.01 ± 0.04), while patients without retinopathy exhibited PSA (15.13 ± 1.20), EDV (8.50 ± 0.80), RI (0.71 ± 0.08) (t = 15.94, 12.01, 13.32, P = .01, .01, .01), respectively. Similarly, before treatment, the retinopathy group had different central artery parameters: PSA (30.35 ± 5.15), EDV (8.85 ± 1.67), RI (1.53 ± 0.25), compared to patients without retinopathy: PSA (34.41 ± 5.20), EDV (11.34 ± 2.56), RI (0.88 ± 0.15) (t = 12.108, 11.542, 11.57, P = .01, .01, .01), respectively. After treatment, the central artery parameters improved in both groups. The retinopathy group showed PSA (33.26 ± 4.27), EDV (9.37 ± 1.86), RI (0.98 ± 0.35), while patients without retinopathy exhibited PSA (36.15 ± 4.24), EDV (13.51 ± 2.13), RI (0.76 ± 0.23) (t = 13.84, 12.14, 10.11, P = .01, .01, .01), respectively. Conclusions • Color Doppler ultrasound monitoring of fundus hemodynamic parameters can accurately reflect the changes in blood vessels in diabetic eyes. It provides real-time and objective evaluation of fundus hemodynamic indexes. This technology demonstrates high repeatability and simple operation, making it valuable for the noninvasive detection of early retinopathy. [ABSTRACT FROM AUTHOR]

Objectives: The objcetive is to compare the anatomic and functional outcomes of vitrectomy between internal limiting membrane (ILM) peeling and non-ILM peeling in diabetic tractional retinal detachment (TRD). Methods: Twenty-three eyes with diabetic TRD with ILM peeling were compared with twenty-four eyes with non-ILM peeling. Best-corrected visual acuity (BCVA) was recorded at baseline and 3, 6, 9, 12 months, and end of follow-up. The mean retinal thickness across nine different regions that defined in the Early Treatment Diabetic Retinopathy Study (ETDRS) were obtained. The ETDRS grid was used to determine the extent of macular involvement. Results: In the 1st month postoperatively, the mean BCVA of eyes with ILM peeling (1.08±0.63 LogMAR) was significantly better than eyes with ILM non-peeling (1.69±0.75 LogMAR, p=0.003). There was also a significant difference at 9 and 12 months between groups in BCVA, in favor of ILM peeling (p=0.012 and p=0.047, respectively). Seven patients (29.2%) developed epiretinal membrane (ERM), and one patient (4.1%) had ERM with the lamellar macular hole in the ILM nonpeeling group, while only one patient developed ERM in ILM peeling group during the follow-up. Conclusion: ILM removal may be considered in diabetic TRD surgery, as it can provide rapid visual recovery. Moreover, post-operative ERM formation was less frequent in ILM peeled eyes within 1 year after surgery. [ABSTRACT FROM AUTHOR]

Objective: Indigenous Australians are nearly three times more likely to have diabetes than non‐Indigenous Australians. The prevalence of diabetes‐related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non‐Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best‐practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. Setting: All states, territories and geographic remoteness categories in Australia. Participants: Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. Design: Semi‐structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. Results: Seven best‐practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. Conclusion: The findings from this study identified seven best‐practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end‐user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best‐practice diabetic retinopathy treatment approaches. [ABSTRACT FROM AUTHOR]

Diabetic macular edema (DME) is the leading cause of blindness in the working populations, with patients requiring 10.7 intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents per year. The high rate of non-compliance of anti-VEGF injection in patients with DME and the unmet need in current regimen may result in suboptimal visual outcome. Brolucizumab, an antibody fragment anti-VEGF-A agent, has been approved to treat neovascular agerelated macular degeneration, as illustrated in the HAWK and HARRIER trials. Similarly, the KESTREL and KITE DME trials have shown that brolucizumab 6 mg achieves greater improvement in best-corrected visual acuity and greater reduction in central subfield thickness at week 52, compared with aflibercept 2 mg. Fewer patients with brolucizumab have intraretinal and subretinal fluid. Careful monitoring, prompt diagnosis, and timely intervention enable early management of adverse effects including intraocular inflammation and retinal artery occlusion. Moreover, in the BOULEVARD trial, patients with DME on faricimab 1.5 and 6.0 mg have demonstrated greater gain in Early Treatment Diabetic Retinopathy Study letters and greater reduction in central subfield thickness, compared with patients on ranibizumab 0.3 mg. The YOSEMITE and RHINE trials have demonstrated greater improvement in best-corrected visual acuity and two-step Diabetic Retinopathy Severity Scale at week 52 after faricimab 6 mg than after aflibercept 2 mg. Thus, brolucizumab and faricimab are efficacious, durable, and well tolerated, with improved treatment outcome and patient compliance. [ABSTRACT FROM AUTHOR]

Abstract Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.

The focus of capacity building for screening and treatment of diabetic retinopathy (DR) is on health professionals who are nonophthalmologists. Both physicians and nonphysicians are recruited for screening DR. Although there is no standardization of the course syllabus for the capacity building, it is generally accepted to keep their sensitivity >80%, specificity >95%, and clinical failure rate <5% for the nonophthalmologists, if possible. A systematic literature search was performed using the PubMed database and the following search terms: diabetic retinopathy, diabetic retinopathy screening, Asia, diabetic retinopathy treatment, age-related macular degeneration, capacity building, deep learning, artificial intelligence (AI), nurse-led clinic, and intravitreal injection (IVI). AI may be a tool for improving their capacity. Capacity building on IVIs of antivascular endothelial growth factors for DR is focused on nurses. There is evidence that, after a supervision of an average of 100 initial injections, the trained nurses can do the injections effectively and safely, the rate of endophthalmitis ranges from 0.03 to 0.07%, comparable to ophthalmologists. However, laws and regulations, which are different among countries, are challenges and barriers for nonophthalmologists, particularly for nonphysicians, for both screening and treatment of DR. Even if nonphysicians or physicians who are nonophthalmologists are legally approved for these tasks, sustainability of the capacity is another important challenge, this may be achieved if the capacity building can be part of their career development. Patient acceptability is another important barrier for initiating care provided by nonophthalmologists, particularly in Asia. There are also collaborations between national eye institutes of high-income countries, nongovernment organizations, and local eye institutes to improve both the quality and quantity of ophthalmologists and retinal specialists in low-income countries in Asia. This approach may require more labor, cost, and time consuming than training nonophthalmologists. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the anatomical and functional results of 23-G transconjunctival sutureless vitrectomy (TSV) in diabetic retinopathy (DR) patients with a variety of vitreoretinal diseases. Methods: Consecutive patients who underwent 23-G TSV for complications of DR were evaluated retrospectively. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. Results: A total of 42 eyes of 41 patients were included and followed up for a mean of 15.64±10.0 months. The mean patient age was 59.33±7.4 years. Indications for surgery were nonclearing vitreous hemorrhage (VH) (n=10), tractional retinal detachment (TRD) (n=8), TRD+VH (n=12), epiretinal membrane (n=5), diabetic macular edema (n=3), submacular hemorrhage (n=2), macular hole (n=1), or vitreomacular traction (n=1). There was a significant improvement in the BCVA at the postoperative first and third months, and at the last visit compared with the preoperative value (p<0.001). There was no significant change in the mean IOP measured on the postoperative first day, first week, first month, third month, or the last visit (p>0.05). In the postoperative period, the VH resolved spontaneously in 9 eyes. Repeat 23-G vitrectomy was performed in 6 eyes: 4 with recurrent retinal detachment and 2 with VH. Conclusion: The results indicate that 23-G TSV is an effective technique for vitreoretinal disease in patients with DR. [ABSTRACT FROM AUTHOR]

Background: Peroxisome proliferator-activated receptor alpha (PPARα) is associated with diabetic retinopathy (DR), and the underlying mechanism is still unclear. Aim of this work was to investigate the mechanism of PPARα in DR. Methods: Human retinal capillary pericytes (HRCPs) were treated with high glucose (HG) to induce DR cell model. DR mouse model was established by streptozotocin injection, and then received 5-Aza-2-deoxycytidine (DAC; DNA methyltransferase inhibitor) treatment. Hematoxylin–eosin staining was performed to assess retinal tissue damage. PPARα methylation was examined by Methylation-Specific PCR. Flow cytometry and DCFH-DA fluorescent probe was used to estimate apoptosis and reactive oxygen species (ROS). The interaction between DNA methyltransferase-1 (DNMT1) and PPARα promoter was examined by Chromatin Immunoprecipitation. Quantitative real-time PCR and western blot were performed to assess gene and protein expression. Results: HG treatment enhanced the methylation levels of PPARα, and repressed PPARα expression in HRCPs. The levels of apoptotic cells and ROS were significantly increased in HRCPs in the presence of HG. Moreover, DNMT1 was highly expressed in HG-treated HRCPs, and DNMT1 interacted with PPARα promoter. PPARα overexpression suppressed apoptosis and ROS levels of HRCPs, which was rescued by DNMT1 up-regulation. In DR mice, DAC treatment inhibited PPARα methylation and reduced damage of retinal tissues. Conclusion: DNMT1-mediated PPARα methylation promotes apoptosis and ROS levels of HRCPs and aggravates damage of retinal tissues in DR mice. Thus, this study may highlight novel insights into DR pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment.Methods: A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti-vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities.Results: Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye.Conclusion: Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage. [ABSTRACT FROM AUTHOR]

Background Diabetes mellitus (DM) is a worldwide, growing epidemic, with an estimated 415 million adults globally. Patients with diabetes are at increased risk of death and a triad of serious diabetes-specific complications (neuropathy, nephropathy, and retinopathy) and other associated complications. So, it becomes important to prioritize research on prevention and primary care of diabetic complications. Poor glycemic control has been associated with retinopathy. Hence, we evaluated serum magnesium level in type 2 DM with and without retinopathy. Magnesium is an intracellular cation and coenzyme for various reactions of glycolytic pathway, so hypomagnesemia has been shown to precipitate hyperglycemia. Objectives To assess serum magnesium level in type 2 diabetic patients and its correlation with retinopathy. Patients and methods This is a cross-sectional study that was carried out on 25 patients of type 2 diabetes with retinopathy and 25 patients of type 2 diabetes without retinopathy attending ophthalmology clinic of Al-Zahraa University Hospital. All patients were subjected to the following: detailed history taking, full ophthalmological examination, and investigations like fundus fluorescein angiography and serum magnesium. Results The results of the study revealed that there was a significant more decrease in serum magnesium level in diabetic patients with retinopathy than diabetic patients without retinopathy (P=0.028). Conclusion As magnesium level decreases in patients with type 2 DM, the prevalence of retinopathy increases. Hypomagnesemia correlated significantly with glycated hemoglobin. Timely monitoring of serum magnesium levels and glycated hemoglobin as well as appropriate interventions would be beneficial in early detection and treatment of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Oral intake of steroids has been associated with central serous chorio-retinopathy (CSCR) for long time. We report a 23 years old male who had exposure to green laser pointer after which he developed laser maculopathy. The treating ophthalmologist started oral steroids with patient developing CSCR in his left eye. He was referred to our retina clinic for further evaluation. On examination his vision was 6/6 part in his right eye and 6/9 part in his left eye. His dilated fundus examination revealed small foveal scar in his right eye and dull foveal reflex in his left eye. On OCT he had laser maculopathy in the right eye and left fundus findings coincided with diagnosis of central serous chorio-retinopathy (CSCR). Patient was called for review after 3 weeks with instructions to discontinue his deltacortil tablets. His vision improved and sub retinal fluid was absorbed. Later he went back to his primary ophthalmologist who restarted deltacortil tablets and he presented to us with recurrence of CSCR. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO), about 285 million people are visually impaired, and, of those, around 39 million are blind and 246 million have low vision. About 90% of the world's visually impaired people live in low-income settings while 82% of people living with blindness are aged 50 and above; this age group represents 20% of the world's population. Age-related macular degeneration (AMD), glaucoma, cataract and diabetic retinopathy are the most common causes of legal blindness and visual impairment in Ukraine, and, today, the role of free radicals in the development of these disorders is indisputable. Astaxanthin is a powerful antioxidant, more effective than lutein or zeaxanthin. Since astaxanthin has a beneficial molecular structure and multifaceted mechanism of action, is highly bioavailable and capable of crossing the blood brain barrier, it might be promising in the treatment of chronic incapacitating disorders such as glaucoma, diabetic retinopathy and AMD. [ABSTRACT FROM AUTHOR]

Screening and delivering treatment to the ophthalmic disease like Diabetic Retinopathy is a tedious and highly risky process because the longer one has diabetes, the greater is the risk of developing diabetic retinopathy. Also, the need for a physician to meet the requirement is impossible. So it has been proposed a method that adds a solution to the problem by readily diagnosing the patient to detect NPDR (Non - Proliferative Diabetic Retinopathy) which is a prior stage of DR so that loss of vision can be prevented. The experimental analysis deals with the study fundus images which includes both positive and negative NPDR as input image which undergoes vessel segmentation in MATLAB platform is primarily finding Exudates, Haemorrhage and Microaneurysms. After morphological operations like pre-processing steps, segmenting, masking, arithmetical operations on the fundus image, the exudates and haemorrhages can be detected. Based on the study on a different set of DRIVE (Digital Retinal Image for vessel Extraction) images, the resultant processed image can be interpreted with the visible information about the complexity of the ailment which also includes the healthy samples. The parametric analysis of Exudates, Haemor-rhages and Aneurysms concerning the threshold values through which NPDR can be predicted. The output of the proposed method describes whether the person subjected to test have the abnormalities for NPDR or not. This also interpreted by the study results on various DRIVE datasets to arrive at this accuracy. [ABSTRACT FROM AUTHOR]

Panretinal photocoagulation (PRP) is a standard treatment for proliferative diabetic retinopathy. Conventional laser (CL) therapy is performed in one or more sessions in single spot mode. Visual disabilities have been reported after treatment with CL, including central vision loss due to macular edema and peripheral visual field loss resulting from extensive inner retinal scarring. Multispot laser (MSL) photocoagulation has recently been introduced to clinical practice. Studies comparing PRP conducted with MSL and CL have reported that MSLs resulted in less retinal tissue damage and pain, and greater patient comfort compared to CL. The aim of this review was to compare the efficacy and side effects of MSLs and CLs for diabetic retinopathy treatment.

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes and the leading cause of blindness and severe visual impairment in adults. The high levels of glucose trigger multiple intracellular oxidative stress pathways, such as POLDIP2, resulting in excessive reactive oxygen species (ROS) production and increased expression of vascular cell adhesion molecule-1 (VCAM-1), hypoxia-inducible factor 1α (HIF-1α), and vascular endothelial growth factor (VEGF), causing microvascular dysfunction. Dihydromyricetin (DMY) is a natural flavonoid small molecule antioxidant. However, it exhibits poor solubility in physiological environments, has a short half-life in vivo, and has low oral bioavailability. In this study, we present, for the first time, the synthesis of ultra-small Fe-DMY nano-coordinated polymer particles (Fe-DMY NCPs), formed by combining DMY with low-toxicity iron ions. In vitro and in vivo experiments confirm that Fe-DMY NCPs alleviate oxidative stress-induced damage to vascular endothelial cells by high glucose, scavenge excess ROS, and improve pathological features of DR, such as retinal vascular leakage and neovascularization. Mechanistic validation indicates that Fe-DMY NCPs can inhibit the activation of the Poldip2-Nox4-H 2 O 2 signaling pathway and downregulate vital vascular function indicators such as VCAM-1, HIF-1α, and VEGF. These findings suggest that Fe-DMY NCPs could serve as a safe and effective antioxidant and microangio-protective agent, with the potential as a novel multimeric drug for DR therapy., Competing Interests: The authors declare that there are no conflicts of interest., (© 2023 The Author(s).)

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Objective. To evaluate the efficacy of Yiqi Yangyin Huoxue method in the treatment of diabetic retinopathy (DR) with meta-analysis. Method. A randomized controlled trial of Yiqi Yangyin Huoxue method in the treatment of diabetic retinopathy in PubMed, Medline, Cochrane Library, Weipu Journal, China Knowledge Network, and Wanfang database was conducted. Two reviewers independently extracted data and methodological quality assessment. Data analysis was performed using Rev Man 5.3 software for statistical analysis. Results. A total of 10 randomized controlled trials, including 661 patients, were included. The results showed that Yiqi Yangyin Huoxue method could significantly improve the vision [risk ratio (RR)=1.32, 95% confidence interval (CI) (1.18, 1.47), P<0.00001] and change the eye fundus [RR=1.23, 95% CI (1.10, 1.37), P=0.0002], fundus fluorescence angiography (FFA) [RR=1.33, 95% CI (1.11, 1.60), P=0.002], traditional Chinese medicine syndromes [RR=1.31, 95% CI (1.15, 1.49), P<0.0001], and hemorheological parameters [mean difference (MD) =-0.37, 95% CI (-0.41, -0.32), P<0.00001]. Conclusion. Yiqi Yangyin Huoxue method showed beneficial effects for DR on improving vision, eye fundus, FFA, TCM syndromes, and hemorheological parameters. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy is a common microvascular complication of diabetes and remains one of the leading causes of preventable blindness in working‐age people. Non‐proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy and is typically asymptomatic. Currently, the severity of diabetic retinopathy is assessed using semi‐quantitative grading systems based on the presence or absence of retinal lesions. These methods are well validated, but do not predict those at high risk of rapid progression to sight‐threatening diabetic retinopathy; therefore, new approaches for identifying these people are a current unmet need. We evaluated published data reporting the lesion characteristics associated with different progression profiles in people with non‐proliferative diabetic retinopathy. Based on these findings, we propose that additional assessments of features of non‐proliferative diabetic retinopathy lesions may help to stratify people based on the likelihood of rapid progression. In addition to the current classification, the following measurements should be considered: the shape and size of lesions; whether lesions are angiogenic in origin; the location of lesions, including predominantly peripheral lesions; and lesion turnover and dynamics. For lesions commonly seen in hypertensive retinopathy, a detailed assessment of potential concomitant diseases is also recommended. We believe that natural history studies of these changes will help characterize these non‐proliferative diabetic retinopathy progression profiles and advance our understanding of the pathogenesis of diabetic retinopathy in order to individualize management of people with diabetic retinopathy. What's new?: Diabetic retinopathy, one of the leading causes of preventable blindness in working‐age people, is assessed based on the presence or absence of retinal lesions in the fundus.Current classifications of non‐proliferative diabetic retinopathy are not predictive of the risks of rapid progression to sight‐threatening diabetic retinopathy.Non‐proliferative retinopathy progression profiles may benefit from assessments of the following lesion characteristics: shape and size of lesion; angiogenic origin; location, including peripheral retina; turnover and dynamics; and concomitant hypertensive retinopathy.Natural history studies of these changes may improve our understanding of the pathogenesis, progression and management of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR), a chronic microvascular retinal disorder leading to retinal nonperfusion and ischemia, is one of the leading causes of blindness among individuals of working age. Inflammation and neovascularization play important roles in the development of DR, especially proliferative DR (PDR). Therapies with Chinese medicines (CMs) that improve microcirculation complementary to conventional treatments increase the chances of delaying PDR development and improving visual acuity in diabetes patients. This review aimed to introduce promising CMs targeting DR patients in clinical practice, together with their underlying molecular mechanisms. [ABSTRACT FROM AUTHOR]

Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments. [ABSTRACT FROM AUTHOR]

Highlights • A sparse multi-kernel multi-instance learning is proposed for diabetic retinopathy diagnosis. • An under-sampling at instance level and an over-sampling at bag level are proposed to improve the performance of the multi-instance learning in the diagnosis of DR. • We have conducted extensive experiments to investigate our proposed methods. The proposed method achieve an overall classification accuracy of 0.916 and an AUC of 0.957. It could be applied for the detection of many other disease diagnosis where data is weakly supervised. Abstract Objective Diabetic retinopathy (DR) is one of the most serious complications of diabetes. Early detection and treatment of DR are key public health interventions that can significantly reduce the risk of vision loss. How to effectively screen and diagnose the retinal fundus image in order to identify retinopathy in time is a major challenge. In the traditional DR screening system, the accuracy of micro-aneurysm (MA) and hemorrhagic (H) lesion detection determines the final screening performance. The detection method produced a large number of false positive samples for guaranteeing high sensitivity, and the classification model was not effective in removing false positives since the suspicious lesions lack label information. Methods In order to solve the problem of supervised learning in the diagnosis of DR, we formulate weakly supervised multi-class DR grading as a multi-class multi-instance problem where each image (bag) is labeled as healthy or abnormal and consists of unlabeled candidate lesion regions (instances). Specifically, we proposed a multi-kernel multi-instance learning method based on graph kernel. Moreover, we develop an under-sampling from instance level and over-sampling from bag level to improve the performance of the multi-instance learning in the diagnosis of DR. Results Through empirical evaluation and comparison with different baselinemethods and the state-of-the-art methods on data from Messidor, we illustrate that the proposed method reports favorable results, with an overall classification accuracy of 0.916 and an AUC of 0.957. Conclusions The experiments results demonstrate that the proposed multi-kernel multi-instance learning framework with bi-level re-sampling can solve the problem in the imbalanced and weakly supervised data for grading diabetic retinopathy, and it improves the diagnosis performance over several state-of-the-art competing methods. [ABSTRACT FROM AUTHOR]

Purpose To identify baseline factors associated with change in visual acuity or development of vision-impairing central-involved diabetic macular edema (DME) over 2 years when treating proliferative diabetic retinopathy (PDR) with ranibizumab or panretinal photocoagulation (PRP). Design Post hoc analyses of randomized, multicenter clinical trial data. Participants Eyes completing the 2-year visit (n = 328) or without vision-impairing central-involved DME at baseline (n = 302) in Diabetic Retinopathy Clinical Research Network Protocol S. Methods Intravitreous ranibizumab (0.5 mg/0.05 ml) or PRP. Main Outcome Measures Change in visual acuity (area under the curve) and development of vision-impairing (20/32 or worse) central-involved DME over 2 years. Results After multivariable model selection with adjustment for baseline visual acuity and central subfield thickness, no factors were identified as associated with change in visual acuity or development of vision-impairing central-involved DME within the ranibizumab group. In the PRP group, worse change in visual acuity was more likely with higher hemoglobin A 1c level (–0.6 letters per 1% increase; 95% confidence interval [CI], –1.2 to –0.1 letters; continuous P = 0.03), more severe diabetic retinopathy (difference between high-risk PDR or worse vs. moderate PDR or better, –2.8 letters [95% CI, –5.5 to –0.2 letters]; continuous P = 0.003), and higher mean arterial pressure (difference between ≥100 mmHg vs. <100 mmHg, –2.0 letters [95% CI, –4.6 to 0.5 letters]; continuous P = 0.009). Development of vision-impairing central-involved DME was more likely with higher hemoglobin A 1c level (hazard ratio [HR] per 1% increase, 1.31 [95% CI, 1.13–1.52]; continuous P < 0.001), more severe diabetic retinopathy (HR for high-risk PDR or worse vs. moderate PDR or better, 1.46 [95% CI, 0.73–2.92]; continuous P = 0.03), and the presence of cystoid abnormalities within 500 μm of the macula center (HR, 2.90 [95% CI, 1.35–6.24]; P = 0.006). Conclusions For eyes managed with PRP, higher hemoglobin A 1c level and more severe diabetic retinopathy were associated with less vision improvement and an increased risk of vision-impairing central-involved DME developing. When managing PDR with ranibizumab, eyes gained vision, on average, with no baseline characteristics identified as associated with visual acuity or central-involved DME outcomes. [ABSTRACT FROM AUTHOR]

Acupoint therapy is one of the therapeutic means in Traditional Chinese Medicine (TCM) concerning acupoints and meridians, including manual acupuncture, electroacupuncture, moxibustion, external application, acupoint injection, and catgut embedding. In the treatment of diabetes and its common chronic complications, acupoint therapy has proved to have specific curative effect and notable advantages. Single or combined with western medicine, it has superior efficacy and less side effects than western medicine alone. Studying its mechanism can provide experimental basis for clinical treatment. Relevant researches in the recent 5 years mainly focused on the mechanism of electroacupuncture, point injection, catgut embedding, etc. in the treatment of diabetes and common diabetic complications such as neuropathy, nephropathy, and hepatopathy. The possible theories involve the regulation of nerve conduction, signal pathways, hormone level, protein expression, oxidative stress level, structure restoration, etc. The most studied acupoints are Zusanli (ST36), Shenshu (BL23), Sanyinjiao (SP6), Yishu (EX-B3), and Zhongwan (CV12). However, most of the studies have been based on diabetes model rats rather than clinical trials. Moreover, the mechanism of acupoint therapy treating other chronic complications like diabetic retinopathy and that of other effective methods like pressing ear with beans, auricular points plaster therapy, and external application remain unclear. Therefore, this aspect still awaits further research. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR), one of the most common microvascular complications of diabetic mellitus, is currently the main cause of adult-acquired blindness. The pathogenesis of DR is complex and the current clinical application of various treatment methods cannot completely prevent the development of this disease. Many reports have been published regarding the treatment of DR with Traditional Chinese Medicine (TCM), which has received increasing attention from medical practitioners worldwide. Studies published between 1994 and April 2017 were collected from the CNKI, VIP, Medline and Web of Science databases, as well as from Chinese traditional books and Chinese Pharmacopoeia, subsequently obtaining more than 550 studies. Thereafter, the status quo of DR treatment using TCM had been summarized according to four aspects — compound formula therapy, Chinese herbal medicine extracts and monomer therapy, integrated traditional Chinese and Western medicine therapy, and Chinese medicine external treatment. According to the literature reviewed herein, TCM has had definite effects on the prevention and treatment of DR, especially when used in combination with modern medical methods. However, the lack of a unified standard on the syndrome differentiation of DR and the lack of support of evidence-based medicine theory in clinical practice have been consistent concerns in previous research studies and needs to be addressed in subsequent studies. [ABSTRACT FROM AUTHOR]

Objective To describe the implementation of a diabetic retinopathy referral network incorporating all levels of health care in La Libertad region, Peru. Method The nongovernmental organization Orbis International and the Regional Institute of Ophthalmology established a network of primary, secondary and tertiary health-care facilities for diabetic retinopathy screening and treatment. The programme included the provision of three non-mydriatic retinal cameras for patient examination, the development of a flowchart to guide patient referrals, training of health personnel, investment in laser technology for treatment and the delivery of public awareness activities for blindness prevention and the need for timely screening. Findings From 2014-2017, 11 849 patients with diabetes were screened within the diabetic retinopathy referral network. In primary-care centres, 6012 patients with diabetes mellitus were identified and 5632 patients were referred for diabetic retinopathy screening. A further 4036 patients directly attended two secondary-level hospitals and 2181 attended the tertiary-level hospital for screening. This represented a 138.1% increase in diabetic retinopathy screenings from a baseline of 4977 patients screened at the regional institute of ophthalmology over 2010-2013. A total of 2922 patients (24.7%) were found to have diabetic retinopathy and 923 (31.6%) were treated: 508 with laser photocoagulation, 345 with intravitreal bevacizumab and 70 with vitreoretinal surgery. Conclusion Effective and timely treatment for diabetic retinopathy is possible when patient education, screening and care are fully integrated into the general health-care system across primary-, secondary- and tertiary-level facilities. This requires the integration of professionals at all levels and all relevant specialties. [ABSTRACT FROM AUTHOR]

In India, 73 million people have diabetes and 3.5 million infants are born preterm. Without timely screening, there is a risk of visual loss due to diabetic retinopathy and retinopathy of prematurity in these two groups, respectively. Both conditions are emerging causes of visual impairment in India but there is no public health programme for screening or management. Pilot projects were initiated in 2014 to integrate the screening and management of these conditions into existing public health systems, particularly in rural communities and their referral networks. The World Health Organization's health systems framework was used to develop the projects and strategies were developed with all stakeholders, including the government. Both projects involved hub-and-spoke models of care units around medical schools. For diabetic retinopathy, screening was established at primary health-care facilities and treatment was provided at district hospitals. For retinopathy of prematurity, screening was integrated into sick newborn care units at the district level and treatment facilities were improved at the closest publically funded medical schools. In the first two years, there were substantial improvements in awareness, screening, treatment and partnership between stakeholders, and changes in public health policy. By March 2018, diabetic retinopathy screening was established at 50 facilities in 10 states and treatment had been improved at 10 hospitals, whereas retinopathy of prematurity screening was established at 16 sick newborn care units in district hospital in four states and treatment had been improved at six medical schools. Advocacy within state governments was critical to the success of the initiative. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country’s and population’s resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti–vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level. [ABSTRACT FROM AUTHOR]

Purpose To determine whether there are baseline characteristics that distinguish patients with diabetic macular edema (DME) with coexisting macular nonperfusion (MNP) at baseline and assess these patients’ potential to achieve favorable visual acuity (VA), anatomic, and diabetic retinopathy (DR) outcomes over 24 months. Design Post hoc analysis of RIDE/RISE, 2 phase 3, parallel, randomized, multicenter, double-masked trials (ClinicalTrials.gov : NCT00473382 ; NCT00473330). Participants Study eyes with best-corrected VA (BCVA)/fluorescein angiogram (FA) data at baseline. Methods To measure MNP, the Early Treatment for Diabetic Retinopathy Study (ETDRS) grid was overlaid on FAs of the macula. The MNP area was calculated by estimating the percentage of capillary loss in the central, inner, and outer subfields and converting into disc areas (DAs) using a software algorithm. Summary statistics and P values, respectively, were provided for all outcomes and comparisons of interest. Main Outcome Measures Baseline characteristics; MNP area, BCVA, and central subfield thickness (CST) at months 12 and 24; and incidence of study eyes with ≥2-step DR improvement at months 3, 6, 12, 18, and 24. Results Baseline MNP was detected in 28.2%, 25.8%, and 26.3% of study eyes in the ranibizumab 0.3 mg (n = 213), ranibizumab 0.5 mg (n = 225), and sham (n = 228) arms, respectively. At baseline, patients with MNP were younger and had shorter diabetes duration, worse vision, increased CST, and worse DR severity (P values < 0.01 vs. those without MNP). In the ranibizumab 0.3 mg arm, eyes with baseline MNP had lower mean baseline BCVA (53.4 vs. 57.2 ETDRS letters for those without baseline MNP; P = 0.05), but mean BCVA gain at month 24 was comparable (+15.6 vs. +13.4 ETDRS letters, respectively; P = 0.2). Eyes with baseline MNP had increased CST at baseline, but experienced a greater decrease in CST by month 24. The proportion of eyes with ≥2-step DR improvement was greater for eyes with versus without baseline MNP in each ranibizumab arm. Conclusions Despite having worse vision/increased CST versus those without baseline MNP, eyes with concurrent DME and baseline MNP entering RIDE/RISE experienced robust VA and anatomic improvement with ranibizumab and therefore should not be excluded from therapy. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether visual acuity is related to balance in older adults with peripheral vascular disease (PVD) or diabetes mellitus. Design: Cross‐sectional analysis. Setting: Canada. Participants: Community‐dwelling adults aged 45 to 85 from the Canadian Longitudinal Study on Aging (N=30,097). Measurements: Visual acuity was measured wearing habitual distance correction using the Early Treatment of Diabetic Retinopathy Study chart at a 2‐m distance. Poor balance was defined as being unable to stand on 1 leg for at least 60 seconds. PVD and diabetes mellitus were assessed according to self‐report of a physician diagnosis. Multiple logistic regression was used. Results: People who reported PVD (n=1,295) were more likely to have worse balance than those who did not (odds ratio (OR)=1.50, 95% confidence interval (CI)=1.29–1.77). In those who did not report PVD (n=26,211), a 1‐line worse score on the visual acuity test was associated with 23% higher odds of being unable to stand for at least 60 seconds after adjusting for age, sex, education, province, body mass index, and diabetes mellitus (OR=1.23, 95% CI=1.20–1.26). In those who reported PVD, the odds of being unable to stand was almost double (OR=1.41, 95% CI=1.22–1.62). The interaction between visual acuity and PVD was statistically significant (P=.02). Conclusions: Visual acuity and PVD interact in their relationship with balance. People with poor vision and PVD may be at an especially high risk of mobility difficulties. [ABSTRACT FROM AUTHOR]

Background: Microvascular complications in type 2 diabetes (T2DM), including diabatic retinopathy (DR), diabetic kidney disease (DKD), diabetic peripheral neuropathy (DPN) are the leading causes of visual loss, end-stage renal disease or amputation, while the current therapies are still unsatisfactory. Chinese medicine (CM) has been widely used for treating diabetic mellitus. However, most of the previous studies focused on the single complication. The role of CM treatment in T2DM patients with 2 or multiple microvascular complications is not clear.Objective: To appraise the curative effect of CM in T2DM patients with 2 or multiple microvascular complications, and to compare the effects of stationary treatment and individualized treatment in T2DM patients with microvascular complications.Methods: This trial will be an 8-center, randomized, controlled study with 8 parallel groups. A total of 432 patients will be randomized to 8 groups: DR study group (32 cases) and a corresponding control group (32 cases), DR+DKD study group (64 cases) and a corresponding control group (64 cases), DR+DPN study group (64 cases) and a corresponding control group (64 cases), DR+DKD+DPN study group (56 cases) and a corresponding control group (56 cases). The control group will receive stationary treatment, and the study group will receive individualized treatment based on CM syndrome differentiation in addition to stationary treatment. The study duration will be 50 weeks, comprising a 2-week run-in period, 24 weeks of intervention, and 24 weeks of follow-up. The outcomes will assess efficacy of treatment, improvement in CM symptoms, safety assessments, adherence to the treatment, and adverse events.Conclusion: This study will provide evidence of evidence-based medicine for CM treatment in two or multiple microvascular complications caused by T2DM. (Registration No. ChiCTR-IPR-15007072) [ABSTRACT FROM AUTHOR]

The authors reflect on a study which assessed the effectiveness of the anti-vascular endothelial growth factor (anti-VEGF) agent aflibercept versus vitrectomy with panretinal photocoagulation in treating patients with proliferative diabetic retinopathy with vitreous hemorrhage. Based on the results, it is recommended that patients should have access to early rescue vitrectomy surgery if aflibercept is used as initial treatment. Diabetic retinopathy is the leading cause of blindness.

Aim: To assess the level of awareness and provision of screening and treatment for Diabetic Eye Disease (DED) comprising Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) among health care professionals.Methods: The study was conducted in two phases. The first phase consisted of a qualitative study, based on semi-structured face-to-face and telephone interviews in 8 countries. The second phase used a quantitative approach utilising online surveys in 41 countries. The survey for health care professionals comprised of 43 questions covering provider information, practice characteristics, management of adults with diabetes and specific information from ophthalmologists on screening and treatments for DR.Results: There were 2329 health care professionals who participated in the online survey. More than one third of diabetes specialists surveyed reported that they did not discuss eye care with their diabetes patients. Nearly two-thirds of all health care professionals surveyed reported that they had written information about diabetes for patients available in their practice. Only one in five (22%, n = 58) primary care providers reported they had material that contained sufficient information on eye complications, and 37% (n = 252) of ophthalmologists reported that they had sufficient information on eye complications. Sixty-five percent (n = 378) of ophthalmologists reported that most of their patients presented when visual problems had already occurred. Six percent (n = 36) stated that most of their patients presented when it was already too late for effective treatment. The most substantial barriers to eye health mentioned by health care professionals responding to the survey were: a patients' lack of knowledge and/or awareness about eye complications (43%), followed by lack of importance given to eye examinations by patients (33%), and the high cost of care (32%). Ophthalmologists also reported late screening (66%), and lack of patient education materials (55%) as obstacles for improving eye health outcomes.Conclusion: Health care professionals need to be appropriately supported and trained so they can provide adults with diabetes with information about the risks of DR, support them in reducing their risk, and advocate for the provision of affordable DR screening and treatment as required. [ABSTRACT FROM AUTHOR]

Purpose To evaluate costs and cost-utility of early vitrectomy (pars plana vitrectomy [PPV]) compared with panretinal photocoagulation (PRP) and intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR) without diabetic macular edema. Design A decision analysis model of cost-utility. Participants There were no participants. Methods A decision analysis was based on results from the Diabetic Retinopathy Clinical Research Network Protocol S comparing treatment of PRP with IVR (0.3 mg) in PDR without incident macular edema to model the total 2-year costs and outcomes for each treatment scenario. These values were compared with the 2-year hypothetical costs of early PPV for PDR. Centers for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility setting. Cost-utility was calculated on the basis of the preserved visual utility and estimated life years remaining. In addition, costs for lifetime treatment were modeled for all scenarios and used to calculate lifetime quality-adjusted life years (QALY) costs for each scenario. Sensitivity analyses were performed to evaluate the impact of the model’s assumptions. Main Outcome Measures Cost of treatment, utility, and cost per QALY. Results The modeled cost per QALY of treatment for PDR for 2 years of utility in the facility (nonfacility) setting was $163 988 ($102 559) in the PRP group, $436 992 ($326 424) in the IVR group, and $181 144 ($107 965) in the PPV group. Sensitivity analysis showed that both IVR and PPV groups would have equivalent costs per QALY over the first 2 years if 78% (facility) and 80% (nonfacility) of patients in the PPV group required additional treatment with IVR (at the dose of 10.1 injections as in Protocol S). Beyond 2 years, the cost per QALY in the facility (nonfacility) setting was calculated as $61 695 ($21 752) in the PRP group, $338 348 ($239 741) in the IVR group, and $63 942 ($22 261) in the PPV group. Conclusions Early PPV as a strategy for treatment of PDR without macular edema demonstrates cost-utility similar to management with PRP and more favorable cost-utility compared with IVR in the short term. This advantage over IVR continues when lifetime costs are factored. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is the most common cause of blindness in the working age population. Early events of DR are accompanied by neurodegeneration of the inner retina resulting in ganglion cell loss. These findings together with reduced retinal thickness are observed within the first weeks of experimental DR. Besides, an inflammatory process is triggered in DR in which the innate immune response plays a relevant role. Alpha 1 antitrypsin (AAT), an inhibitor of serine proteases, has shown anti-inflammatory properties in several diseases. We aimed at evaluating the use of AAT to prevent the early changes induced by DR. Diabetic AAT-treated mice showed a delay on ganglion cell loss and retinal thinning. These animals showed a markedly reduced inflammatory status. AAT was able to preserve systemic and retinal TNF-α level similar to that of control mice. Furthermore, retinal macrophages found in the AAT-treated diabetic mouse exhibited M2 profile (F4/80 + CD206 + ) together with an anti-inflammatory microenvironment. We thus demonstrated that AAT-treated mice show less retinal neurodegenerative changes and have reduced levels of systemic and retinal TNF-α. Our results contribute to shed light on the use of AAT as a possible therapeutic option in DR. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a common and devastating microvascular complication of diabetes and a major cause of acquired blindness in young adults. Advanced glycation end products (AGEs) accumulated under hyperglycemic conditions are thought to play an important role in the pathogenesis of DR. AGEs can exert their deleterious effects by acting directly to induce aberrant crosslinking of extracellular matrix proteins, to increase vascular stiffness, altering vascular structure and function. Moreover, AGEs binding to the receptor for AGEs (RAGE) evokes intensive intracellular signaling cascades that leading to endothelial dysfunction, elaboration of key proinflammatory cytokines and proangiogenic factors, mediating pericyte apoptosis, vascular inflammation and angiogenesis, as well as breakdown of the inner blood-retinal barrier (BRB), the end result of all these events is damage to the neural and vascular components of the retina. Elucidation of AGE-induced mechanisms will help in the understanding of the complex cellular and molecular pathogenesis associated with DR. Novel anti-AGEs agents or AGE crosslink “breakers” are being investigated, it is hoped that in next few years, some of these promising therapies will be successfully applied in clinical context, aiming to reduce the major economical and medical burden caused by DR. [ABSTRACT FROM AUTHOR]