Clinical Diagnosis and New Classification of Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 119-123
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Diabetic Patients ◽  
Common Causes ◽  
Diagnosis Classification

Diabetic retinopathy and diabetic macular edema are the most common causes of preventable blindness among the working class in many countries. The prevalence of diabetic macular edema, which is frequently associated with vision loss, is increasing. Classification of diabetic retinopathy is essential for precise and punctual treatment and follow-up, and ultimately for enhancing the quality of life of diabetic patients. Studies in recent years have shared protocols for diagnosis, classification, and follow-up.

scholarly journals Classifications of diabetic macular edema

2019 ◽  
Vol 30 (1) ◽  
pp. 6-7
Author(s):  
Lee M Jampol
Keyword(s):  
Clinical Trials ◽  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Clinical Care ◽  
Diabetic Patients ◽  
Diabetic Maculopathy ◽  
Experimental Trials

Diabetic retinopathy is a major cause worldwide of vision loss from diabetic maculopathy or proliferative retinopathy. Without widely accepted classifications of diabetic retinopathy and diabetic maculopathy, it is difficult to compare results of clinical trials or monitor clinical care. The European School of Advanced Studies in Ophthalmology has developed an international classification of diabetic maculopathy based upon spectral domain optical coherence tomography, which could be helpful for both initial evaluation and subsequent follow-up of diabetic patients in both clinical practice and experimental trials.

scholarly journals Postmarketing safety surveillance of dexamethasone intravitreal implant in the treatment of visual impairment due to diabetic macular edema in India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Unnikrishnan Nair ◽  
◽  
Vishali Gupta ◽  
Mohita Sharma ◽  
Shrinivas Joshi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Adverse Events ◽  
Visual Impairment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Surveillance Study ◽  
World Health ◽  
Diabetic Patients

Abstract Background Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. As India has the second largest population of diabetic patients worldwide, availability of various treatment options for DME is essential. This postmarketing surveillance study was conducted to fulfill a commitment to the Regulatory Authority of India to examine the safety of dexamethasone intravitreal (DEX) implant over 1 year in Indian patients with DME receiving ≥1 DEX implant for DME-related visual impairment in clinical practice. Methods This observational, prospective, non-interventional study enrolled patients aged ≥18 years scheduled to receive DEX implant for DME-related visual impairment. Baseline demographics, medical history, date of last DEX implant injection, detailed information about adverse events (AEs), AEs of special interest (AESIs), serious AEs (SAEs), and adverse drug reactions (ADRs) reported during postinjection visits and investigator telephone calls were collected. Primary outcome measures were treatment-emergent AE (TEAE), AESI, SAE, and ADR occurrences. Results Of the enrolled patients (19 sites throughout India; n = 250), 84 had received DEX implant previously; mean (standard deviation; SD) duration between prior and study entry dose was 199.4 (156.0) days, and 91 (36.4%) had ≥1 prior ophthalmic condition. Over a mean of 182.6 (88.6) follow-up days (min–max: 0–364 days), 22 TEAEs were reported by 7 (2.8%) patients, 6 of whom had previously received DEX. AESIs of increased IOP (n = 3, 6 events) and glaucoma (n = 1, 1 event) were considered non-serious, of mild/moderate severity, and related to DEX treatment. Eyelid ptosis was reported in 1 patient (1 event). Nonocular AEs included cardiac AEs (n = 3, 4 events), pyrexia (n = 1, 2 events), and dyspnea (n = 1, 2 events). Three (1.2%) patients had 12 serious AEs; most were cardiac disorders; all were unrelated to DEX treatment. Two (0.8%) deaths were considered unrelated to treatment. Conclusions Based on voluntary reporting of adverse events in this surveillance study, DEX implant for treatment of DME-related visual impairment in the Indian population demonstrated a favorable safety profile with few treatment-related TEAEs (none were considered serious) during the 1-year follow-up. These data supplement previous findings and confirm the safety of DEX implant in this population during usual clinical practice. Trial registration World Health Organization Clinical Trials Registry: CTRI/2017/04/008396. Registered 24 April 2017.

scholarly journals Bevacizumab and Treatment Regimes in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 155-159
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Vision Loss ◽  
Intravitreal Bevacizumab ◽  
Retinal Neovascularization ◽  
Diabetic Patients ◽  
Treatment Regimes ◽  
Endothelial Growth Factor

Diabetic macular edema and proliferative diabetic retinopathy is the most important cause of vision loss in diabetic patients. Vascular endothelial growth factor has been shown to play a major role in retinal neovascularization and vascular hyperpermeability in eyes with diabetic patients. Recent studies have demonstrated the usefulness of an intravitreal injection of bevacizumab in the reduction of diabetic macular edema, vascular permeability, and fibrovascular proliferation in retinal neovascularization secondary to proliferative diabetic retinopathy. This review aimed to evaluate the intravitreal bevacizumab in diabetic retinopathy and diabetic macular edema.

scholarly journals Modern aproaches to diabetic macular edema diagnosticks

2020 ◽  
Vol 23 (3) ◽  
pp. 260-266
Author(s):  
A. V. Doga ◽  
P. L. Volodin ◽  
E. V. Ivanova ◽  
D. A. Buryakov ◽  
O. I. Nikitin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Early Diagnosis ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Diagnostic Methods ◽  
Diabetic Patients ◽  
Timely Treatment

Diabetic macular edema (DME) continues to be an important problem of modern ophthalmology and endocrinology. Therisk of edema is higher in patients with type 2 diabetes. Thus, this is the main cause of irreversible vision loss in these patients. DME is one of the prognostically unfavorable and difficult to treat manifestations of diabetic retinopathy. As themain cause of vision loss in diabetic patients, diabetic macular edema is often not diagnosed immediately, which causes difficulties in the treatment of pathology. Thus, early diagnosis and timely treatment of this disease is the key to successfully counteract the uncontrolled decline in the patients visual functions. In this article, the team of authors highlighted the possibilities of informative instrumental research methods available in the Arsenal of modern ophthalmological services. Based on the analysis of modern literature, the main principles of these diagnostic methods were indicated, their key capabilities and limitations compared to each other were highlighted. Knowledge of these characteristics is, in our opinion, an integral and most important tool in the Arsenal of a practicing ophthalmologist who supervises patients with this pathology.

scholarly journals The Evolving Treatment Options for Diabetic Macular Edema

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

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

scholarly journals A Multitask Deep-Learning System to Classify Diabetic Macular Edema for Different Optical Coherence Tomography Devices: A Multicenter Analysis

2021 ◽  
Author(s):  
Fangyao Tang ◽  
Xi Wang ◽  
An-ran Ran ◽  
Carmen KM Chan ◽  
Mary Ho ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Deep Learning ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Three Dimensional ◽  
Learning System ◽  
Optical Coherence ◽  
Automated Classification

<a><b>Objective:</b></a> Diabetic macular edema (DME) is the primary cause of vision loss among individuals with diabetes mellitus (DM). We developed, validated, and tested a deep-learning (DL) system for classifying DME using images from three common commercially available optical coherence tomography (OCT) devices. <p><b>Research Design and Methods:</b> We trained and validated two versions of a multi-task convolution neural network (CNN) to classify DME (center-involved DME [CI-DME], non-CI-DME, or absence of DME) using three-dimensional (3D) volume-scans and two-dimensional (2D) B-scans respectively. For both 3D and 2D CNNs, we employed the residual network (ResNet) as the backbone. For the 3D CNN, we used a 3D version of ResNet-34 with the last fully connected layer removed as the feature extraction module. A total of 73,746 OCT images were used for training and primary validation. External testing was performed using 26,981 images across seven independent datasets from Singapore, Hong Kong, the US, China, and Australia. </p> <p><b>Results:</b> In classifying the presence or absence of DME, the DL system achieved area under the receiver operating characteristic curves (AUROCs) of 0.937 (95% CI 0.920–0.954), 0.958 (0.930–0.977), and 0.965 (0.948–0.977) for primary dataset obtained from Cirrus, Spectralis, and Triton OCTs respectively, in addition to AUROCs greater than 0.906 for the external datasets. For the further classification of the CI-DME and non-CI-DME subgroups, the AUROCs were 0.968 (0.940–0.995), 0.951 (0.898–0.982), and 0.975 (0.947–0.991) for the primary dataset and greater than 0.894 for the external datasets. </p> <p><b>Conclusion:</b> We demonstrated excellent performance with a DL system for the automated classification of DME, highlighting its potential as a promising second-line screening tool for patients with DM, which may potentially create a more effective triaging mechanism to eye clinics. </p>

scholarly journals Fundus Fluorescein Angiography and Optical Coherence Tomography Angiography Findings in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 130-137
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Fluorescein Angiography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Imaging Technique ◽  
Diabetic Patients ◽  
Type I ◽  
Optical Coherence

Diabetic retinopathy is an important public health issue as its prevalence has been increasing every year. It is one of the major causes of visual loss which can be preventable with early diagnosis and appropriate treatment. The fundus examination must be done in detail using mydriatics, and digital images must be recorded in all diabetic patients with special emphasis on the disease type (type I and type II), duration, and prognosis. Fluorescein angiography (FA) is a gold standard invasive retinal imaging technique for the diagnosis, monitoring, and evaluating the response of the treatment in diabetic patients, but FA has limitations due to possible side effects. Optical coherence tomography angiography (OCTA) is a recent, non-invasive, dye-free imaging technique that can be used in every visit. It has the capability to image all retinal and choroidal vascular layers (segmentation) and quantify macular ischemia in a short period of time which is beneficial for the patient, and the ophthalmologist. The aim of this review is to address the findings, advantages, and disadvantages of FA and OCTA in patients with diabetic retinopathy and diabetic macular edema.

scholarly journals Differentiating features of OCT angiography in diabetic macular edema

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Reza Mirshahi ◽  
Hamid Riazi-Esfahani ◽  
Elias Khalili Pour ◽  
Kaveh Fadakar ◽  
Parsa Yarmohamadi ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Coherence Tomography Angiography ◽  
Vascular Density ◽  
Diabetic Patients ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Capillary Plexus ◽  
Superficial Capillary Plexus

AbstractThe purpose of current study was to evaluate different optical coherence tomography angiography (OCTA) metrics in eyes with diabetic retinopathy with and without diabetic macular edema (DME). In this retrospective study, macular OCTA images of eyes with non-proliferative or proliferative diabetic retinopathy were evaluated. Vascular density, vascular complexity and non-perfusion densities were compared between eyes with and without DME. One-hundred-thirty-eight eyes of 92 diabetic patients including 49 eyes with DME were included. In multivariate analysis, the presence of DME was positively associated with geometric perfusion deficit (GPD) in superficial capillary plexus (SCP), capillary non-perfusion (CNP) of SCP, and GPD in deep capillary plexus (DCP) (all P < 0.05). In eyes with DME, central foveal thickness was associated with VD ratio (SCP/DCP) (P = 0.001) and FAZ area (P = 0.001). In conclusion, in eyes with diabetic retinopathy, the presence of DME was associated with more extensive capillary non-perfusion compared to those with no macular edema.

scholarly journals Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema

2020 ◽  
Vol 15 (3) ◽  
pp. 188-198
Author(s):  
Ayman G. Elnahry ◽  
Ahmed A. Abdel-Kader ◽  
Ahmed E. Habib ◽  
Gehad A. Elnahry ◽  
Karim A. Raafat ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Case Series ◽  
Diabetic Patients ◽  
Long Term Effects ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Anti Vegf

Background: Diabetic macular edema (DME) is a major cause of vision loss in diabetics worldwide. Anti-vascular endothelial growth factor (anti-VEGF) agents have become the mainstay of treatment of vision loss due to DME. Long-term effects of these agents on the macular perfusion (MP) are a current concern. Objective: To review recently published studies that evaluated the effect of intravitreal injection of anti-VEGF agents on the MP of diabetics with DME. Methods: Different databases were searched including PubMed, Medline, Ovid, Science Direct, and Google Scholar for relevant studies published between 2010 and 2019. All studies found were compared regarding methodology and results and included in this review. Some studies relating to retinal perfusion in general and not strictly MP were also included for comprehensiveness. Results: Several studies utilizing different anti-VEGF agents were identified. All the large randomized controlled clinical trials identified utilized primarily fluorescein angiography (FA) and human graders and found generally no worsening of MP associated with anti-VEGF agents use in diabetic patients with DME. Some of these studies, however, depended on post-hoc analysis. Several more recent, but smaller case series, have utilized the relatively new and non-invasive optical coherence tomography angiography (OCTA) in this evaluation and found more conflicting results. Conclusion: The large clinical trials recently performed depended mainly on FA in the analysis of MP changes following injections and generally found no worsening of MP. More recently, smaller case series have utilized OCTA in this analysis, yielding more conflicting results. Large randomized controlled trials using OCTA are thus needed.

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