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Postgraduate Medicine Aug 2015Diabetic retinopathy is the leading cause of vision loss in working-age adults; it is a highly prevalent cause of vision loss overall and has a potent impact on the... (Review)
Review
INTRODUCTION
Diabetic retinopathy is the leading cause of vision loss in working-age adults; it is a highly prevalent cause of vision loss overall and has a potent impact on the quality of life in those with diabetes mellitus and public health in general. Diabetic macular edema (DME) is the most common cause of vision loss from diabetic retinopathy. In patients with diabetes mellitus, chronic hyperglycemia leads to activation of the inflammatory cascade and retinal capillary damage that result in microaneurysm formation in the retina. In addition to the possibility of associated ischemia, microaneurysms are hyperpermeable; the resultant loss of the blood-retinal barrier leads to vision loss if consequent edema involves the center of the fovea. The standard of DME therapy for >25 years was focal laser photocoagulation applied to or near the microaneurysms. However, results from clinical trials of intravitreal vascular endothelial growth factor (VEGF) blockers and corticosteroids for the treatment of DME have led to a dramatic paradigm shift away from laser therapy to primary treatment with these pharmacologic agents.
METHODS
Medline literature search of approaches for treating DME.
RESULTS
Intravitreal pharmacologic treatments with anti-VEGF agents and corticosteroids have recently been shown to be superior to laser treatment of DME.
CONCLUSION
The existence of pharmacologic treatment of DME, shown to be superior to laser monotherapy, has created a seismic change in the approach of treatment of these patients. This review provides a summary of the therapies and the rationale regarding the current pharmacologic therapy of DME.
Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Aptamers, Nucleotide; Bevacizumab; Diabetic Retinopathy; Glucocorticoids; Humans; Intravitreal Injections; Macular Edema; Ranibizumab
PubMed: 26036708
DOI: 10.1080/00325481.2015.1052523 -
Frontiers in Physiology 2018Diabetic retinopathy (DR) is a leading cause of vision loss worldwide. Microaneurysms (MAs), which are abnormal outpouchings of the retinal vessels, are early and...
Diabetic retinopathy (DR) is a leading cause of vision loss worldwide. Microaneurysms (MAs), which are abnormal outpouchings of the retinal vessels, are early and hallmark lesions of DR. The presence and severity of MAs are utilized to determine overall DR severity. In addition, MAs can directly contribute to retinal neural pathology by leaking fluid into the surrounding retina, causing abnormal central retinal thickening and thereby frequently leading to vision loss. Vascular perfusion parameters such as shear rate (SR) or wall shear stress (WSS) have been linked to blood clotting and endothelial cell dysfunction, respectively in non-retinal vasculature. However, despite the importance of MAs as a key aspect of diabetic retinal pathology, much remains unknown as to how structural characteristics of individual MAs are associated with these perfusion attributes. MA structural information obtained on high resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) was utilized to estimate perfusion parameters through Computational Fluid Dynamics (CFD) analysis of the AOSLO images. The HemeLB flow solver was used to simulate steady-state and time-dependent fluid flow using both commodity hospital-based and high performance computing resources, depending on the degree of detail required in the simulations. Our results indicate that WSS is lowest in MA regions furthest away from the feeding vessels. Furthermore, areas of low SR are associated with clot location in saccular MAs. These findings suggest that morphology and CFD estimation of perfusion parameters may be useful tools for determining the likelihood of clot presence in individual diabetic MAs.
PubMed: 30245632
DOI: 10.3389/fphys.2018.00989 -
Mayo Clinic Proceedings Aug 2021
Topics: Angiography; Diagnosis, Differential; Humans; Male; Microaneurysm; Polyarteritis Nodosa; Renal Artery; Tomography, X-Ray Computed; Young Adult
PubMed: 34353474
DOI: 10.1016/j.mayocp.2021.05.001 -
Journal Francais D'ophtalmologie Mar 2021Diabetic retinopathy (DR) is a disease facilitated by the rapid spread of diabetes worldwide. DR can blind diabetic individuals. Early detection of DR is essential to... (Review)
Review
Diabetic retinopathy (DR) is a disease facilitated by the rapid spread of diabetes worldwide. DR can blind diabetic individuals. Early detection of DR is essential to restoring vision and providing timely treatment. DR can be detected manually by an ophthalmologist, examining the retinal and fundus images to analyze the macula, morphological changes in blood vessels, hemorrhage, exudates, and/or microaneurysms. This is a time consuming, costly, and challenging task. An automated system can easily perform this function by using artificial intelligence, especially in screening for early DR. Recently, much state-of-the-art research relevant to the identification of DR has been reported. This article describes the current methods of detecting non-proliferative diabetic retinopathy, exudates, hemorrhage, and microaneurysms. In addition, the authors point out future directions in overcoming current challenges in the field of DR research.
Topics: Artificial Intelligence; Diabetes Mellitus; Diabetic Retinopathy; Fundus Oculi; Humans; Microaneurysm; Retina
PubMed: 33526268
DOI: 10.1016/j.jfo.2020.08.009 -
Ophthalmic Research 2019To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with... (Observational Study)
Observational Study
PURPOSE
To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO).
METHODS
Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography.
RESULTS
The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = -0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (β: 0.3107, p = 0.0007) and outer retina (β: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not.
CONCLUSION
Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO.
Topics: Aged; Angiogenesis Inhibitors; Anti-Inflammatory Agents; Diagnostic Techniques, Ophthalmological; Female; Fluorescein Angiography; Humans; Ischemia; Macular Edema; Male; Microaneurysm; Middle Aged; Multivariate Analysis; Retinal Vein Occlusion; Retrospective Studies; Tomography, Optical Coherence
PubMed: 30359965
DOI: 10.1159/000493489 -
Clinical Neuropathology 2007The etiology of Charcot-Bouchard microaneurysms (MAs), especially before rupture, has been unclear.
UNLABELLED
The etiology of Charcot-Bouchard microaneurysms (MAs), especially before rupture, has been unclear.
CASE REPORT
A surgical specimen of an MA was removed from an acute intracerebral hemorrhage in a 69-year-old man. The MA was fixed with formalin and embedded in paraffin, and serial sections were cut and stained by the Azan and Elastica van Gieson methods and immunohistochemically. Three-dimensional reconstructive analysis was performed.
RESULTS AND DISCUSSION
The MA presented as local enlargement of an artery with a maximal diameter of 840 microm, but was not ruptured. The wall of the MA consisted of thickened, fine collagen fibrils, which were found to be similar to adventitia immunohistochemically, but with no internal elastic lamina or medial smooth muscle layer. The lumen was empty, with no mural thrombi, but the inner wall endothelial cells had expanded from the normal and/or residual arterial wall, which suggested that the MA had been present for a long period of time. Because the bare wall of the MA consisted of thickened collagen fibrils, the MA was not ruptured, but the possibility of rupture in the future was deemed high, with the risk of intracerebral hemorrhage.
Topics: Aged; Antigens, CD34; Cerebral Arteries; Collagen; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Male; Tomography, X-Ray Computed
PubMed: 17416106
DOI: 10.5414/npp26074 -
Ophthalmology. Retina Feb 2020
Topics: Diabetes Mellitus; Fluorescein Angiography; Humans; Microaneurysm; Retinal Vessels; Tomography, Optical Coherence
PubMed: 32033712
DOI: 10.1016/j.oret.2019.10.014 -
International Ophthalmology Feb 2024The timely diagnosis of medical conditions, particularly diabetic retinopathy, relies on the identification of retinal microaneurysms. However, the commonly used...
BACKGROUND
The timely diagnosis of medical conditions, particularly diabetic retinopathy, relies on the identification of retinal microaneurysms. However, the commonly used retinography method poses a challenge due to the diminutive dimensions and limited differentiation of microaneurysms in images.
PROBLEM STATEMENT
Automated identification of microaneurysms becomes crucial, necessitating the use of comprehensive ad-hoc processing techniques. Although fluorescein angiography enhances detectability, its invasiveness limits its suitability for routine preventative screening.
OBJECTIVE
This study proposes a novel approach for detecting retinal microaneurysms using a fundus scan, leveraging circular reference-based shape features (CR-SF) and radial gradient-based texture features (RG-TF).
METHODOLOGY
The proposed technique involves extracting CR-SF and RG-TF for each candidate microaneurysm, employing a robust back-propagation machine learning method for training. During testing, extracted features from test images are compared with training features to categorize microaneurysm presence.
RESULTS
The experimental assessment utilized four datasets (MESSIDOR, Diaretdb1, e-ophtha-MA, and ROC), employing various measures. The proposed approach demonstrated high accuracy (98.01%), sensitivity (98.74%), specificity (97.12%), and area under the curve (91.72%).
CONCLUSION
The presented approach showcases a successful method for detecting retinal microaneurysms using a fundus scan, providing promising accuracy and sensitivity. This non-invasive technique holds potential for effective screening in diabetic retinopathy and other related medical conditions.
Topics: Humans; Diabetic Retinopathy; Microaneurysm; Algorithms; Image Interpretation, Computer-Assisted; Machine Learning; Fundus Oculi
PubMed: 38367192
DOI: 10.1007/s10792-024-02982-5 -
Orphanet Journal of Rare Diseases Jul 2023To determine whether the rare NLRP3-Associated Autoinflammatory Disease (NLRP3-AID) is associated with retinal changes and to assess the ocular involvement.
PURPOSE
To determine whether the rare NLRP3-Associated Autoinflammatory Disease (NLRP3-AID) is associated with retinal changes and to assess the ocular involvement.
METHODS
A retrospective cohort study of 20 patients(40 eyes) diagnosed with rare NLRP3-AID at Peking Union Medical College Hospital, from April 2015 to August 2022. Patients underwent a comprehensive ophthalmological examination, including visual acuity, intraocular pressure examination, slit-lamp examination, fundus photography, optical coherence tomography(OCT), and fluorescence angiography (FA). Some patients also underwent optical coherence tomography angiography (OCTA).
RESULTS
This study analyzed 40 eyes of 20 patients (11 [55.0%] male; median age, 25.0 years [range, 12-52 years]) and 13 patients (26 eyes, 65%) demonstrated ocular involvement. The most common ophthalmologic manifestation was conjunctivitis (22 eyes, 84.6%), followed by papilledema (14 eyes, 53.8%), retinopathy (10 eyes, 38.5%), optic atrophy (6 eyes, 23.1%), uveitis (4 eyes, 15.4%), reduced pupil light reflex (3 eyes, 11.5%) and cataracts (2 eyes, 7.7%). Ocular involvement was bilateral in 11 patients (55.0%). Five kinds of retinal lesions were seen in 5 patients (10 eyes, 25%) with NLRP3-AID, including peripheral retinal vascular leakage, microaneurysms, macular ischemia, macular epiretinal membrane formation and drusen.
CONCLUSIONS
Peripheral retinal vascular leakage, macular ischemia, microaneurysms and drusen are newly identified retinal findings in patients with NLRP3-AID, which suggests the importance of detailed retinal examination in these patients.
Topics: Humans; Male; Adult; Female; NLR Family, Pyrin Domain-Containing 3 Protein; Retrospective Studies; Microaneurysm; Retinal Diseases; Tomography, Optical Coherence; Ischemia; Hereditary Autoinflammatory Diseases
PubMed: 37480029
DOI: 10.1186/s13023-023-02815-1 -
Medicina (Kaunas, Lithuania) Jul 2023: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with,... (Review)
Review
: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). : A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. : Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. : Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.
Topics: Humans; Macular Edema; Diabetic Retinopathy; Microaneurysm; Laser Coagulation; Laser Therapy; Treatment Outcome; Diabetes Mellitus
PubMed: 37512130
DOI: 10.3390/medicina59071319