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Frontiers in Endocrinology 2024This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept...
Aflibercept 5+PRN with retinal laser photocoagulation is more effective than retinal laser photocoagulation alone and aflibercept 3+PRN with retinal laser photocoagulation in patients with high-risk proliferative diabetic retinopathy and diabetic macular edema: a 12-month clinical trial.
OBJECTIVE
This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept 5+PRN in patients with both high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).
METHODS
Overall, 170 patients with high-risk PDR and DME (170 eyes from 170 patients) who visited our ophthalmology clinic from December 2018 to December 2020 were divided into the PRP (n=58), aflibercept 5+PRN with PRP (n=53), and aflibercept 3+PRN with PRP (n= 59) groups. General information, such as age, sex, and eye category, was obtained. Moreover, best-corrected visual acuity (BCVA), baseline central macular foveal thickness (CFT), microaneurysm (MA), area of neovascularization (NV), area of hard exudate (HE), and cytokine levels in atrial fluid before and after treatment, were assessed. The χ test was used for comparison between groups for statistical data. Analysis of variance was used for the statistical description of measurement data, independent samples were analyzed using Student's -test, and Student-Newman-Keuls test was used for group comparisons. Differences were considered statistically significant at P < 0.05.
RESULTS
After treatment, no significant improvement in the BCVA (logMAR) of patients in the PRP group was observed. The BCVA (log MAR) decreased from 0.72 ± 0.17 and 0.74 ± 0.17 to 0.50 ± 0.13 and 0.53 ± 0.17 in PRP with aflibercept 5+PRN and PRP with aflibercept 3+PRN groups, respectively, with a statistically significant difference compared to those in the PRP group (P<0.05 in all cases). However, no statistically significant difference was observed between the combined treatment groups (P>0.05). The CFT in the PRP-only group decreased slightly from 361.80 ± 36.70 μm to 353.86 ± 40.88 μm, with no statistically significant difference (P>0.05), whereas the CFT in the aflibercept 5+PRN with PRP and aflibercept 3+PRN with PRP groups decreased from 356.57 ± 37.57 μm and 358.17 ± 44.66 μm to 284.87 ± 31.52 μm and 303.19 ± 37.00 μm, respectively, with statistically significant differences before and after treatment (P<0.05 for both groups). Statistically significant differences were observed in CFT between the three groups after treatment (P<0.05 in all cases). The number of MA (pcs) in the PRP, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups decreased from 118.34 ± 27.96, 118.60 ± 33.34, and 116.59 ± 28.95 to 92.95 ± 29.04, 44.60 ± 20.73, and 54.26 ± 25.43, respectively. The two-way comparison of the three groups revealed statistically significant differences in MA (P<0.05 in all cases). In the three groups, NV decreased from 1.00 ± 0.21 mm², 1.01 ± 0.18 mm², and 0.98 ± 0.20 mm² before treatment to 0.49 ± 0.17 mm², 0.31 ± 0.16 mm², and 0.38 ± 0.14 mm², respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, 13, 18, and 18 patients had reduced HE area in the PRP-only, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups, respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, vascular endothelial growth factor, monocyte chemoattractant protein-1, and glial fibrilliary acidic protein levels (pg/mL) in the aqueous humor decreased in both combined treatment groups compared with that at baseline, with statistically significant differences; however, no significant difference was observed between the two combined treatment groups (P>0.05).
CONCLUSION
Aflibercept 5+PRN combined with PRP was safe and effective in treating patients with high-risk PDR and DME, and was more effective than PRP-only and aflibercept 3+PRN with PRP in improving CFT and MA.
Topics: Humans; Diabetic Retinopathy; Macular Edema; Angiogenesis Inhibitors; Vascular Endothelial Growth Factor A; Retina; Laser Coagulation; Neovascularization, Pathologic; Lasers; Diabetes Mellitus; Recombinant Fusion Proteins; Receptors, Vascular Endothelial Growth Factor
PubMed: 38455651
DOI: 10.3389/fendo.2024.1286736 -
Frontiers in Cell and Developmental... 2024With the aim of optimizing the balance of maintaining a safe oxygen saturation and reducing the risk of retinopathy of prematurity in human neonates with fetal growth...
With the aim of optimizing the balance of maintaining a safe oxygen saturation and reducing the risk of retinopathy of prematurity in human neonates with fetal growth restriction (FGR), the present study investigated the distinct effects of oxygen supplementation on the retinal neovasculature using a murine premature neonatal oxygen-induced retinopathy (OIR) model with or without fetal growth restriction. For comparison with normal birth-weight neonates, maternal low-protein diet-induced FGR neonates were subjected to fluctuating oxygen levels to generate oxygen-induced retinopathy. The retinal neovasculature was histologically evaluated, and comprehensive transcriptome analysis was conducted. Compared to OIR neonates with normal birth weight, significant amelioration of the neovasculature, as indicated by decreases in the number of branch junctions, vascular distribution, maximal vascular radius and microaneurysm-like tufts, was observed in OIR mice with FGR. The results of retinal RNA-sequencing revealed downregulation of angiogenic factors that trigger pathological retinal neovascularization, such as the mitogen-activated protein kinase pathway and corresponding upstream signaling pathways in OIR mice with FGR. : Our findings demonstrated that FGR neonates have a higher capacity for retinal oxygen stress, and the risk of OIR development is attenuated compared to that in mature neonates with normal birth weight.
PubMed: 38434621
DOI: 10.3389/fcell.2024.1288212 -
Journal of Neurology May 2024Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a... (Review)
Review
BACKGROUND
Stroke is a leading cause of morbidity and mortality. Retinal imaging allows non-invasive assessment of the microvasculature. Consequently, retinal imaging is a technology which is garnering increasing attention as a means of assessing cardiovascular health and stroke risk.
METHODS
A biomedical literature search was performed to identify prospective studies that assess the role of retinal imaging derived biomarkers as indicators of stroke risk.
RESULTS
Twenty-four studies were included in this systematic review. The available evidence suggests that wider retinal venules, lower fractal dimension, increased arteriolar tortuosity, presence of retinopathy, and presence of retinal emboli are associated with increased likelihood of stroke. There is weaker evidence to suggest that narrower arterioles and the presence of individual retinopathy traits such as microaneurysms and arteriovenous nicking indicate increased stroke risk. Our review identified three models utilizing artificial intelligence algorithms for the analysis of retinal images to predict stroke. Two of these focused on fundus photographs, whilst one also utilized optical coherence tomography (OCT) technology images. The constructed models performed similarly to conventional risk scores but did not significantly exceed their performance. Only two studies identified in this review used OCT imaging, despite the higher dimensionality of this data.
CONCLUSION
Whilst there is strong evidence that retinal imaging features can be used to indicate stroke risk, there is currently no predictive model which significantly outperforms conventional risk scores. To develop clinically useful tools, future research should focus on utilization of deep learning algorithms, validation in external cohorts, and analysis of OCT images.
Topics: Humans; Stroke; Tomography, Optical Coherence; Retinal Diseases; Retinal Vessels; Risk Assessment; Retina
PubMed: 38430271
DOI: 10.1007/s00415-023-12171-6 -
Bratislavske Lekarske Listy 2024Diabetic Retinopathy (DR) is a widespread intense stage of diabetes mellitus that causes vision-effecting anomalies in the retina. It is a medical health condition on...
BACKGROUND
Diabetic Retinopathy (DR) is a widespread intense stage of diabetes mellitus that causes vision-effecting anomalies in the retina. It is a medical health condition on the strength of fluctuating glucose level in the blood that can result in vision loss in case of severity.
OBJECTIVE
As a result, early detection and treatment with DR is the most significant task which will tremendously reduce the likelihood of vision impairment and is still a difficult challenge. Many conventional methods fail to detect primary causes of formation of Microaneurysms, that are used to determine the Prediagnosis of DR.
METHOD
To overcome this challenge, the proposed model incorporates Harris Hawk Optimization with CNN-Bi-LSTM (HHO-CBL) to extract the features. The Prediagnosis of DR has been achieved through this model by spotting saccular dilations, hyaline like material in the capillary aneurysm wall, kinking of vessels since these are the indications for the creation of microaneurysms that are spotted in the blood vessel of the retina. The recommended model is also used to automatically detect DR and its progression in many phases. Furthermore, in order to identify the severity of DR retina, we used a benchmark Kaggle APTOS dataset to train the HHO-CBL model.
RESULTS
Experimental results reveal that this model obtains the best classification accuracy of 96.4 % for an early diagnosis and 98.8 % for a five-degree classification. In addition to those results, a comparison with previously carried out studies has also shown that this model provides a promising solution for a successful Prediagnosis of DR and its staging.
CONCLUSIONS
In the current research, an innovative HHO-CBL was developed for identifying the primary causes that lead to the formation of microaneurysms and diagnosing all five grades of DR. According to the acquired results presented through the evaluation performance metrics indicates that the pre-early diagnosis and five grade classification using feature embedding technique outperformed the other prevailing approaches (Tab. 4, Fig. 10, Ref. 31).
Topics: Humans; Diabetic Retinopathy; Microaneurysm; Algorithms; Retina; Diabetes Mellitus; Early Diagnosis
PubMed: 38385547
DOI: 10.4149/BLL_2024_24 -
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 -
Neuroscience Bulletin Feb 2024Senile plaque blue autofluorescence was discovered around 40 years ago, however, its impact on Alzheimer's disease (AD) pathology has not been fully examined. We...
Senile plaque blue autofluorescence was discovered around 40 years ago, however, its impact on Alzheimer's disease (AD) pathology has not been fully examined. We analyzed senile plaques with immunohistochemistry and fluorescence imaging on AD brain sections and also Aβ aggregation in vitro. In DAPI or Hoechst staining, the nuclear blue fluorescence could only be correctly assigned after subtracting the blue plaque autofluorescence. The flower-like structures wrapping dense-core blue fluorescence formed by cathepsin D staining could not be considered central-nucleated neurons with defective lysosomes since there was no nuclear staining in the plaque core when the blue autofluorescence was subtracted. Both Aβ self-oligomers and Aβ/hemoglobin heterocomplexes generated blue autofluorescence. The Aβ amyloid blue autofluorescence not only labels senile plaques but also illustrates red cell aggregation, hemolysis, cerebral amyloid angiopathy, vascular plaques, vascular adhesions, and microaneurysms. In summary, we conclude that Aβ-aggregation-generated blue autofluorescence is an excellent multi-amyloidosis marker in Alzheimer's disease.
PubMed: 38345691
DOI: 10.1007/s12264-023-01175-x -
Journal of Clinical Medicine Jan 2024: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. : This study extracted diabetic retinopathy feature...
: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. : This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen-Dice coefficients were calculated to compare the location of different features. : Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. : Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening.
PubMed: 38337501
DOI: 10.3390/jcm13030807 -
American Journal of Ophthalmology Case... Mar 2024In this study, we report a patient who presented with both chronic myelocytic leukemia (CML) and Susac syndrome (SS).
PURPOSE
In this study, we report a patient who presented with both chronic myelocytic leukemia (CML) and Susac syndrome (SS).
OBSERVATIONS
A 45-year-old male diagnosed with CML in the blast phase sought consultation due to a deterioration in vision in his right eye. He also had hearing loss and severe migraneous headaches. Best corrected visual acuity was light perception and 20/20 in the right and left eyes, respectively. The slit lamp examination and intraocular pressure were within normal ranges for both eyes. Upon dilated fundoscopy, organized vitreous hemorrhage was observed in the right eye, while the left eye exhibited extensive sclerotic vessels with retinal neovascularization in the periphery. Ultrasound of the right eye showed tractional retinal detachment. Optical coherence tomography of the left retina showed thinning of the retina in temporal macula. Fluorescein angiography revealed a substantial nonperfused region in the peripheral left retina, accompanied by arterioarterial and arteriovenous collaterals, along with microaneurysms. MRI showed scattered foci of hyperintensity within the supratentorial white matter, mostly subcortical on T2-weighted and fluid-attenuated inversion-recovery. The patient received a diagnosis of SS and was subsequently referred to the neurology service for further assessment and potential treatment.
CONCLUSION AND IMPORTANCE
SS may manifest as a presentation of CML. It is advisable to conduct investigations for SS in CML patients experiencing neurological, ophthalmological, or otological symptoms.
PubMed: 38318442
DOI: 10.1016/j.ajoc.2024.101996 -
International Journal of Retina and... Jan 2024Diabetic retinopathy (DR) is a leading cause of blindness and involves retinal capillary damage, microaneurysms, and altered blood flow regulation. Optical coherence...
BACKGROUND
Diabetic retinopathy (DR) is a leading cause of blindness and involves retinal capillary damage, microaneurysms, and altered blood flow regulation. Optical coherence tomography angiography (OCTA) is a non-invasive way of visualizing retinal vasculature but has not been used extensively to study blood flow heterogeneity. The purpose of this study is to detect and quantify blood flow heterogeneity utilizing en-face swept source OCTA in patients with DR.
METHODS
This is a prospective clinical study which examined patients with either type 1 or 2 diabetes mellitus. Each included eye was graded clinically as no DR, mild DR, or moderate-severe DR. Ten consecutive en face 6 × 6 mm foveal SS-OCTA images were obtained from each eye using a PLEX Elite 9000 (Zeiss Meditec, Dublin, CA). Built-in fixation-tracking, follow-up functions were utilized to reduce motion artifacts and ensure same location imaging in sequential frames. Images of the superficial and deep vascular complexes (SVC and DVC) were arranged in temporal stacks of 10 and registered to a reference frame for segmentation using a deep neural network. The vessel segmentation was then masked onto each stack to calculate the pixel intensity coefficient of variance (PICoV) and map the spatiotemporal perfusion heterogeneity of each stack.
RESULTS
Twenty-nine eyes were included: 7 controls, 7 diabetics with no DR, 8 mild DR, and 7 moderate-severe DR. The PICoV correlated significantly and positively with DR severity. In patients with DR, the perfusion heterogeneity was higher in the temporal half of the macula, particularly in areas of capillary dropout. PICoV also correlates as expected with the established OCTA metrics of perfusion density and vessel density.
CONCLUSION
PICoV is a novel way to analyze OCTA imaging and quantify perfusion heterogeneity. Retinal capillary perfusion heterogeneity in both the SVC and DVC increased with DR severity. This may be related to the loss of retinal capillary perfusion autoregulation in diabetic retinopathy.
PubMed: 38273321
DOI: 10.1186/s40942-024-00528-6 -
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