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Medicina (Kaunas, Lithuania) Jan 2024: The role and the levels of ghrelin in diabetes-induced retinal damage have not yet been explored. The present study aimed to measure the serum levels of total ghrelin...
: The role and the levels of ghrelin in diabetes-induced retinal damage have not yet been explored. The present study aimed to measure the serum levels of total ghrelin (TG), and its acylated (AG) and des-acylated (DAG) forms in patients with the two stages of diabetic retinopathy (DR), non-proliferative (NPDR) and proliferative (PDR). Moreover, the correlation between serum ghrelin and neutrophil elastase (NE) levels was investigated. : The serum markers were determined via enzyme-linked immunosorbent assays in 12 non-diabetic subjects (CTRL), 15 diabetic patients without DR (Diabetic), 15 patients with NPDR, and 15 patients with PDR. : TG and AG serum levels were significantly decreased in Diabetic (respectively, < 0.05 and < 0.01 vs. CTRL), NPDR ( < 0.01 vs. Diabetic), and in PDR patients ( < 0.01 vs. NPDR). AG serum levels were inversely associated with DR abnormalities (microhemorrhages, microaneurysms, and exudates) progression (r = -0.83, < 0.01), serum neutrophil percentage (r = -0.74, < 0.01), and serum NE levels (r = -0.73, < 0.01). The latter were significantly increased in the Diabetic ( < 0.05 vs. CTRL), NPDR ( < 0.01 vs. Diabetic), and PDR ( < 0.01 vs. PDR) groups. : The two DR stages were characterized by decreased AG and increased NE levels. In particular, serum AG levels were lower in PDR compared to NPDR patients, and serum NE levels were higher in the PDR vs. the NPDR group. Together with the greater presence of retinal abnormalities, this could underline a distinctive role of AG in PDR compared to NPDR.
Topics: Humans; Leukocyte Elastase; Diabetic Retinopathy; Ghrelin; Enzyme-Linked Immunosorbent Assay; Exudates and Transudates; Diabetes Mellitus
PubMed: 38256379
DOI: 10.3390/medicina60010118 -
Romanian Journal of Ophthalmology 2023Diabetic retinopathy (DR) is a vision-threatening complication of diabetes, necessitating early and accurate diagnosis. The combination of optical coherence tomography... (Review)
Review
Diabetic retinopathy (DR) is a vision-threatening complication of diabetes, necessitating early and accurate diagnosis. The combination of optical coherence tomography (OCT) imaging with convolutional neural networks (CNNs) has emerged as a promising approach for enhancing DR diagnosis. OCT provides detailed retinal morphology information, while CNNs analyze OCT images for automated detection and classification of DR. This paper reviews the current research on OCT imaging and CNNs for DR diagnosis, discussing their technical aspects and suitability. It explores CNN applications in detecting lesions, segmenting microaneurysms, and assessing disease severity, showing high sensitivity and accuracy. CNN models outperform traditional methods and rival expert ophthalmologists' results. However, challenges such as dataset availability and model interpretability remain. Future directions include multimodal imaging integration and real-time, point-of-care CNN systems for DR screening. The integration of OCT imaging with CNNs has transformative potential in DR diagnosis, facilitating early intervention, personalized treatments, and improved patient outcomes. DR = Diabetic Retinopathy, OCT = Optical Coherence Tomography, CNN = Convolutional Neural Network, CMV = Cytomegalovirus, PDR = Proliferative Diabetic Retinopathy, AMD = Age-Related Macular Degeneration, VEGF = vascular endothelial growth factor, RAP = Retinal Angiomatous Proliferation, OCTA = OCT Angiography, AI = Artificial Intelligence.
Topics: Humans; Diabetic Retinopathy; Tomography, Optical Coherence; Macular Edema; Vascular Endothelial Growth Factor A; Artificial Intelligence; Neural Networks, Computer; Macular Degeneration; Diabetes Mellitus
PubMed: 38239418
DOI: 10.22336/rjo.2023.63 -
Asian Journal of Neurosurgery Dec 2023This study compared intraoperative findings with preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) analysis of perianeurysmal...
This study compared intraoperative findings with preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) analysis of perianeurysmal findings for the indication of possible vessel wall thinning. Participants comprised 38 patients with unruptured middle cerebral artery aneurysms treated by surgical clipping at our hospital between May 2020 and April 2021. We defined parent artery radiation sign (PARS) as the presence of each of the following three findings in CFD analysis based on preoperative CTA: (1) impingement of the stream line on the outer parent vessel wall of the aneurysm; (2) radiation of wall shear stress vectors outwards from the same site; and (3) increased wall pressure compared with the surrounding area. CFD analysis showing PARS was compared with intraoperative findings. In all nine cases with PARS, no morphological abnormalities were found in the same area on CTA. However, intraoperative findings showed thinning of the parent artery wall in one of the nine cases and formation of a very small mass in three cases, differing from CTA findings. All nine patients underwent additional clipping and/or wrapping and coating at the site of PARS. Detecting thinning of the vessel wall or the presence of a microaneurysm may be difficult in endovascular therapy, which is based on the visualization of the vessel lumen. CFD analysis suggests the necessity of confirming findings for the vessel wall around an aneurysm by direct manipulation, as the presence of PARS may indicate partial thinning of the vessel wall or formation of a microaneurysm.
PubMed: 38161604
DOI: 10.1055/s-0043-1771367 -
Journal of Personalized Medicine Dec 2023The objective of this study was to determine the correlation between topographic vessel density (VD) and retinal thickness (RT) reductions induced by vascular...
Correlation between Topographic Vessel Density and Retinal Thickness Changes in Patients with Diabetic Macular Edema Treated with Anti-VEGF Therapy: Is It a Suitable OCTA Biomarker?
The objective of this study was to determine the correlation between topographic vessel density (VD) and retinal thickness (RT) reductions induced by vascular endothelial growth factor inhibitors (anti-VEGF) in patients with diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). This was a prospective, interventional case series. VD and RT measurements were separately taken in four parafoveal subfields at baseline and after six months of treatment. This correlation was statistically assessed using Spearman's rho correlation coefficient after adjustment for multiple comparisons. The study included a total of 48 eyes in the final analysis. Mean VD decreased from baseline to month 6 (from 45.2 (±3.5) to 44.6% (±3.2) in the superficial capillary plexus and from 50 (±3.3) to 49% (±3.9) in the deep capillary plexus). Statistically significant reductions in RT were observed in all ETDRS sectors ( < 0.0001). No significant association was found between RT and VD, even when analyzing responders and non-responders separately. After six months of anti-VEGF treatment, no significant correlation was observed between the topographic VD and RT values. These findings suggest that reductions in VD values may not solely result from a reduction in microaneurysms, also being affected by the repositioning of displaced vessels due to edema and a reduction in their caliber. Therefore, VD changes may not be a suitable indirect OCTA biomarker of microaneurysm turnover and treatment response.
PubMed: 38138945
DOI: 10.3390/jpm13121718 -
Bioengineering (Basel, Switzerland) Dec 2023Diabetic retinopathy (DR) is a microvascular complication of diabetes. Microaneurysms (MAs) are often observed in the retinal vessels of diabetic patients and represent...
Diabetic retinopathy (DR) is a microvascular complication of diabetes. Microaneurysms (MAs) are often observed in the retinal vessels of diabetic patients and represent one of the earliest signs of DR. Accurate and efficient detection of MAs is crucial for the diagnosis of DR. In this study, an automatic model (MA-YOLO) is proposed for MA detection in fluorescein angiography (FFA) images. To obtain detailed features and improve the discriminability of MAs in FFA images, SwinIR was utilized to reconstruct super-resolution images. To solve the problems of missed detection of small features and feature information loss, an MA detection layer was added between the neck and the head sections of YOLOv8. To enhance the generalization ability of the MA-YOLO model, transfer learning was conducted between high-resolution images and low-resolution images. To avoid excessive penalization due to geometric factors and address sample distribution imbalance, the loss function was optimized by taking the Wise-IoU loss as a bounding box regression loss. The performance of the MA-YOLO model in MA detection was compared with that of other state-of-the-art models, including SSD, RetinaNet, YOLOv5, YOLOX, and YOLOv7. The results showed that the MA-YOLO model had the best performance in MA detection, as shown by its optimal metrics, including recall, precision, F1 score, and AP, which were 88.23%, 97.98%, 92.85%, and 94.62%, respectively. Collectively, the proposed MA-YOLO model is suitable for the automatic detection of MAs in FFA images, which can assist ophthalmologists in the diagnosis of the progression of DR.
PubMed: 38135996
DOI: 10.3390/bioengineering10121405 -
Indian Journal of Ophthalmology Jan 2024To assess the utility of pre-defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME)... (Clinical Trial)
Clinical Trial
PURPOSE
To assess the utility of pre-defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME) following anti-vascular endothelial growth factor (anti-VEGF) therapy in determining visual and anatomical outcomes.
METHODS
In this prospective, non-randomized, and interventional study, 17 patients with treatment-naive DME were included. OCT biomarkers [size/reflectivity of cysts, disorganization of retinal inner layers, integrity of ellipsoid zone or external limiting membrane, subfoveal serous retinal detachment, hyper-reflective foci (HRF)] and OCTA [vascular density (VD), foveal avascular zone (FAZ), and total micro-aneurysms in superficial capillary plexus and deep capillary plexus (DCP)] were analyzed at baseline and after three monthly intravitreal anti-VEGF injections. Response was defined as a decrease of 10% or more in central macular thickness from the baseline after three injections.
RESULTS
13/17 (76.47%) patients were categorized as responders to anti-VEGF therapy. Non-responders had significantly greater hyper-reflectivity of cysts (P = 0.015), larger cystic spaces (P = 0.023), and an increased number of HRF (P = 0.04) at baseline. On OCTA, non-responders showed larger FAZ in DCP (1.35 ± 0.21 versus 1.14 ± 0.28 mm2) (P = 0.042) and lower VD (61.17 ± 0.45 versus 62.73 ± 3.32) in DCP at baseline. At 3 months, the VD increased in responders (63.10 ± 3.42) compared to a decrease in non-responders (60.82 ± 1.13) (P = 0.032).
CONCLUSIONS
Non-responders show a higher number of micro-aneurysms, larger FAZ, and lower VD in the DCP on OCTA and higher cyst hyper-reflectivity and HRF and larger cystic spaces on OCT imaging.
Topics: Humans; Macular Edema; Diabetic Retinopathy; Endothelial Growth Factors; Prospective Studies; Fluorescein Angiography; Retrospective Studies; Tomography, Optical Coherence; Biomarkers; Cysts; Aneurysm; Retinal Vessels; Diabetes Mellitus
PubMed: 38131536
DOI: 10.4103/IJO.IJO_893_23 -
American Journal of Ophthalmology Case... Mar 2024To report two cases of diabetic macular edema (DME) treated with intravitreal faricimab injections (IVFs), including the assessment of retinal microaneurysms and extent...
PURPOSE
To report two cases of diabetic macular edema (DME) treated with intravitreal faricimab injections (IVFs), including the assessment of retinal microaneurysms and extent of retinal capillary non-perfusion using fluorescein angiography (FA) and indocyanine green angiography (IA).
OBSERVATIONS
Case 1: A 72-year-old man presented with aflibercept-resistant DME in the left eye, with a best-corrected visual acuity (BCVA) of 20/16. FA showed areas of retinal capillary non-perfusion and focal leakage in the macular area of the left eye. IA revealed numerous microaneurysms in the temporal region of the macula. Four consecutive monthly IVFs were administered to the left eye, and DME eventually diminished. After the loading phase, the BCVA was maintained at 20/16 with reduced visual distortion. FA showed improvement of macular leakage and stable retinal capillary non-perfusion areas, and the foveal avascular zone was clearly observed. The disappearance of numerous microaneurysms was confirmed on IA images.Case 2: An 80-year-old woman developed DME with macular vein occlusion in the left eye after panretinal laser photocoagulation for proliferative diabetic retinopathy. The patient's BCVA was 20/32. DME was resistant to subtenon triamcinolone injections. FA revealed focal areas of retinal capillary non-perfusion and persistent leakage in the macular area of the left eye. IA revealed scattered microaneurysms within the retinal arcade. Four consecutive monthly IVFs were administered to the left eye, and DME eventually diminished. After the loading phase, the BCVA was maintained at 20/32. FA showed improvement of macular leakage and stable retinal capillary non-perfusion areas. The reduction of microaneurysms was confirmed on IA images.
CONCLUSIONS AND IMPORTANCE
These case reports highlight the potential of faricimab as an alternative anti-vascular endothelial growth factor drug for treatment-resistant DME, including reduction of retinal microaneurysms and stabilization of the areas of retinal capillary non-perfusion. However, continuation of a robust treatment regimen may be required to achieve these objectives.
PubMed: 38116329
DOI: 10.1016/j.ajoc.2023.101973 -
International Journal of Ophthalmology 2023To evaluate the efficacy of retinal laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for hemorrhagic retinal...
AIM
To evaluate the efficacy of retinal laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for hemorrhagic retinal arterial macroaneurysm (RAM).
METHODS
This was a retrospective clinical study. Patients with hemorrhagic RAM were divided into 4 groups defined by different treatments: a retinal laser photocoagulation therapy monotherapy group, an anti-VEGF intravitreal injection monotherapy group, a laser and anti-VEGF combination therapy group, and an observation group. Visual acuity (VA), central macular thickness (CMT), and retinal hemorrhage area (RHA) were collected.
RESULTS
Forty-seven eyes of 47 patients were enrolled. VA improved and had a significant difference between baseline and final in each treatment group (logMAR; laser group: 1.90±0.53 1.05±0.63, <0.001; anti-VEGF group: 1.75±0.63 1.12±0.54, =0.009; combination group: 1.76±0.38 1.01±0.52, <0.001); however, VA decreased and had no significant difference in observation group (1.63±0.51 1.76±0.61, =0.660). CMT decreased and had a significant difference between baseline and final in each group (laser group: 815.16±310.83 252.05±83.90 µm, <0.001; anti-VEGF group: 725.00±290.79 203.56±69.89 µm, =0.001; combination group: 595.50±186.51 253.13±55.06 µm, =0.001; observation group: 758.88±195.65 267.00±120.90 µm, =0.001). RHA were 28.99±28.15, 25.94±11.58, 19.64±8.97, and 27.45±13.76 mm in laser group, anti-VEGF group, combination group and observation group, respectively. RHA was statistically correlated with final VA (=0.032) in the observation group.
CONCLUSION
Both laser and anti-VEGF treatments are effective for hemorrhagic RAM. Combination therapy reduces the number of injections of anti-VEGF. RHA is a visual prognosis predictor in the natural history of hemorrhagic RAM.
PubMed: 38111952
DOI: 10.18240/ijo.2023.12.17 -
OTO Open 2023We investigated the association between retinal microvascular changes and hearing loss based on the hypothesis that both may result from shared microvascular pathology....
We investigated the association between retinal microvascular changes and hearing loss based on the hypothesis that both may result from shared microvascular pathology. Data from 536 older adults from the National Health and Nutritional Examination Survey 2005 to 2006 including sociodemographic and health characteristics, pure-tone hearing thresholds, and retinal pathologies were collected and analyzed. Associations between retinal and hearing pathologies were modeled with multivariable-adjusted linear regressions. 75% of participants had hearing loss and 15% of participants had retinopathy. The association between retinopathy, microaneurysms, and blot hemorrhages with better speech-frequency pure tone average was -2.81 (95% confidence interval [CI]: -5.72 to 0.10), -4.75 (95% CI: -8.73 to -0.78), and -5.34 (95% CI: -8.68 to -2.00), respectively. The presence of retinopathy, microaneurysms, and blot hemorrhages was inversely associated with hearing loss. Further studies are needed to better understand the potential relationship between microvascular pathologies of the eye and ear.
PubMed: 38093719
DOI: 10.1002/oto2.99 -
Nature Communications Dec 2023We report the case of a 79-year-old woman with Alzheimer's disease who participated in a Phase III randomized controlled trial called CLARITY-AD testing the experimental...
We report the case of a 79-year-old woman with Alzheimer's disease who participated in a Phase III randomized controlled trial called CLARITY-AD testing the experimental drug lecanemab. She was randomized to the placebo group and subsequently enrolled in an open-label extension which guaranteed she received the active drug. After the third biweekly infusion, she suffered a seizure characterized by speech arrest and a generalized convulsion. Magnetic resonance imaging revealed she had multifocal swelling and a marked increase in the number of cerebral microhemorrhages. She was treated with an antiepileptic regimen and high-dose intravenous corticosteroids but continued to worsen and died after 5 days. Post-mortem MRI confirmed extensive microhemorrhages in the temporal, parietal and occipital lobes. The autopsy confirmed the presence of two copies of APOE4, a gene associated with a higher risk of Alzheimer's disease, and neuropathological features of moderate severity Alzheimer's disease and severe cerebral amyloid angiopathy with perivascular lymphocytic infiltrates, reactive macrophages and fibrinoid degeneration of vessel walls. There were deposits of β-amyloid in meningeal vessels and penetrating arterioles with numerous microaneurysms. We conclude that the patient likely died as a result of severe cerebral amyloid-related inflammation.
Topics: Aged; Female; Humans; Alzheimer Disease; Amyloid beta-Peptides; Arteritis; Brain; Cerebral Amyloid Angiopathy; Iatrogenic Disease; Vasculitis, Central Nervous System; Clinical Trials, Phase III as Topic; Randomized Controlled Trials as Topic
PubMed: 38086820
DOI: 10.1038/s41467-023-43933-5