Diabetic retinopathy in Lesotho

Diabetic retinopathy was found in 47.8% of 153 consecutive diabetic clinic patients examined in Maseru, Lesotho. Background retinopathy was present in 78% of patients with retinopathy, compared with 22% with proliferative changes. While no difference in prevalence of diabetic retinopathy could be demonstrated between the sexes, an association between diabetic retinopathy and hypertension and peripheral neuropathy was observed. The prevalence and severity of diabetic retinopathy was significantly related to the duration of disease. The pitfalls inherent in comparing the results of the current study with other published reports are considered. Better epidemiological surveys are required to determine the true prevalence of diabetic retinopathy among different racial, ethnic, religious, and tribal groups in Africa.     

糖尿病视网膜病变的药物治疗

糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病(diabetes mellitus,DM)最为常见和严重的微血管并发症之一,已成为四大主要致盲病因之一,传统的DR治疗方法包括激光光凝和玻璃体手术等。虽然这些方法大大降低了DR的致盲率。然而其提高视力的可能性很小。因此,治疗效果并不理想。随着对DR发病机制认识的提高,药物治疗可以阻断DR发病机制的各个途径,已经成为DR治疗研究的热点,是目前一个重要的研究方向。我们对蛋白激酶C抑制剂、抗血小板聚集药、抗氧化剂、糖皮质激素、醛糖还原酶抑制剂、3-羟基-3甲基-戊二酰辅酶A抑制剂、免疫相关因子IL-1β以及中药等治疗进展作一综述。     

Diabetic retinopathy management by Australian optometrists

Background: To survey the current diabetic retinopathy screening and management practices of Australian optometrists following the release of the 1997 National Health Medical Research Council Diabetic Retinopathy Management Guidelines. Design: Cross‐sectional national survey, primary care setting. Participants: 1000 Australian optometrists across different states. Methods: A self‐administered questionnaire was sent to 1000 optometrists across all states during 2007/2008. Main outcome measures: Use of retinal camera, screening practices/attitudes and behaviour in diabetic retinopathy management. Results: 568 optometrists (57%) responded to the survey. Patients' unpreparedness to drive post dilation (51%) and the fear of angle closure glaucoma (13%) were the two main barriers to optometrists not performing dilated ophthalmoscopy. Those who had strong desire to screen for diabetic retinopathy were more likely to use a retinal camera (p < 0.005). Use of a retinal camera was significantly associated with an increased confidence in detecting clinical signs of diabetic retinopathy including macular oedema (P < 0.001). Optometrists who read the guidelines at least once were 2.5‐times (P < 0.001) more likely to have confidence in detecting macular oedema than those who had never read the guidelines. Although they may be confident in diagnosis, and may use retinal cameras for screening, nearly 60% of optometrists would not refer patients with macular oedema to an ophthalmologist. Conclusions: Despite their self‐reported desire for involvement in diabetic retinopathy, the management of macular oedema by Australian optometrists needs improvement. The use of retinal cameras and promotion of the 2008 NHMRC guidelines should be encouraged to improve overall optometric diabetic retinopathy management, particularly with macular oedema.     

频域OCT与FFA在糖尿病视网膜病变患者中的应用

目的 对比频域光学相干断层扫描(optical coherence tomography,OCT)及眼底荧光血管造影(fundus fluorescein angiography,FFA)在各期糖尿病视网膜病变患者中的应用.方法 选择2型糖尿病患者80例152眼为研究对象,其中糖尿病正常视网膜(normal diabetes retina,NDR)组28例54眼、非增生性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)组31例56眼、增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组21例42眼.所有患眼均行频域OCT及FFA检查,频域OCT测量记录以黄斑中心凹为中心的6 mm直径区域内视网膜形态及厚度,FFA检查按常规进行,所有检查结果均由同一位有经验的眼底病医师判读,并对两种检查记录结果进行比较.结果 所有患眼行FFA检查确诊有糖尿病黄斑水肿(diabetic macular edema,DME)者8眼(58.6％),未发现DME者63眼(41.4％),其中黄斑局限性水肿31眼,弥漫性水肿28眼,弥漫性水肿伴囊样变性30眼.频域OCT检查NDR组、NPDR组、PDR组黄斑中心凹6 mm直径区域内视网膜厚度分别为(289.45±11.19)μm、(332.31±39.71) μm、(390.20±64.17) μm,与NDR组相比,NPDR组、PDR组黄斑部视网膜厚度均增加(均为P＜0.05);频域OCT确诊有DME者102眼(67.1％),未发现DME者50眼(32.9％).其中视网膜海绵样肿胀42眼,黄斑部囊样水肿14眼,浆液性神经上皮的脱离4眼,视网膜海绵样肿胀+黄斑部囊样水肿24眼,视网膜海绵样肿胀+浆液性神经上皮的脱离18眼.频域OCT及FFA检出阳性率间差异有统计学意义(P＜0.05).结论 DME在DR的各期均有分布,频域OCT和FFA在各期DR中表现不同,二者相结合能更有效地了解糖尿病患者黄斑部的结构和生理功能.     

递法明片对糖尿病视网膜病变暗适应功能的保护作用

目的：观察糖尿病视网膜病变( diabetic retinopathy, DR)患者行全视网膜光凝( panretinal photocoagulation, PRP)后服药前及服药2 mo 后患眼的全视野视网膜电图( full-field electroretinogram, ERG)变化,探讨递法明片对DR暗适应功能的保护作用。
　　方法：选择在我医院就诊的重度非增殖性糖尿病视网膜病变( nonproliferative diabetic retinopathy, NPDR)患者55例55眼,随机分为治疗组和对照组。两组均行全视网膜光凝,治疗组光凝后口服递法明片,对照组口服维生素B1片2次/d,10mg/次。 PRP后服药前及服药2mo后行全视野视网膜电图检查,观察其暗视视杆反应的变化并进行统计学处理。
　　结果：两组患者服药前及服药2 mo后,暗视视杆反应bT值组内及组间比较差异均无统计学意义(P>0.05);治疗组bA值服药2 mo后与服药前相比振幅升高,差异有统计学意义(P<0.05),与对照组相比治疗组振幅升高较大,差异有统计学意义(P<0.05)。
　　结论：递法明片可减轻PRP治疗对视网膜的损害,改善患者的暗适应功能。     

Diabetic retinopathy in Joslin Clinic patients with adult-onset diabetes

While only a small proportion of adult-onset diabetic patients develop vision threatening retinopathy, this group makes up a major portion of those diabetics seeking ophthalmologic care. Fifty-three percent of patients having fundus photographs at the W.P. Beetham Eye Unit of the Joslin Clinic developed diabetes at the age of 20 or over, and almost 30% at the age of 40 or over. Twenty-two percent of all patients seen with proliferative retinopathy were in this latter group. Ten of 54 patients with proliferative retinopathy in the greater than or equal to 40 onset group were not taking insulin. The older onset patients who developed proliferative retinopathy did so after shorter durations of diabetes and with more visual disability than younger onset patients. Macular edema was more common in adult-onset patients, and its presence in a patient less than 50 years old was usually associated with proliferative or preproliferative retinopathy.     

Diabetic retinopathy: an update

Diabetes mellitus is a major cause of avoidable blindness in both the developing and the developed countries. Significant technological advances have taken place to improve the diagnostic accuracy of diabetic retinopathy. In the last three decades, the treatment strategies have been revised to include, besides laser photocoagulation, early surgical interventions and pharmacotherapies.     

Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy

AIM: To propose an algorithm for automatic detection of diabetic retinopathy (DR) lesions based on ultra-widefield scanning laser ophthalmoscopy (SLO). METHODS: The algorithm utilized the FasterRCNN (Faster Regions with CNN features)+ResNet50 (Residua Network 50)+FPN (Feature Pyramid Networks) method for detecting hemorrhagic spots, cotton wool spots, exudates, and microaneurysms in DR ultra-widefield SLO. Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate. Feature fusion was carried out by the feature pyramid network FPN, which significantly improved lesion detection rates in SLO fundus images. RESULTS: By analyzing 1076 ultra-widefield SLO images provided by our hospital, with a resolution of 2600×2048 dpi, the accuracy rates for hemorrhagic spots, cotton wool spots, exudates, and microaneurysms were found to be 87.23%, 83.57%, 86.75%, and 54.94%, respectively. CONCLUSION: The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO, providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.     

Diabetic retinopathy screening using deep neural network

Importance

There is a burgeoning interest in the use of deep neural network in diabetic retinal screening.

Background

To determine whether a deep neural network could satisfactorily detect diabetic retinopathy that requires referral to an ophthalmologist from a local diabetic retinal screening programme and an international database.

Design

Retrospective audit.

Participants

Diabetic retinal photos from Otago database photographed during October 2016 (485 photos), and 1200 photos from Messidor international database.

Methods

Receiver operating characteristic curve to illustrate the ability of a deep neural network to identify referable diabetic retinopathy (moderate or worse diabetic retinopathy or exudates within one disc diameter of the fovea).

Main Outcome Measures

Area under the receiver operating characteristic curve, sensitivity and specificity.

Results

For detecting referable diabetic retinopathy, the deep neural network had an area under receiver operating characteristic curve of 0.901 (95% confidence interval 0.807–0.995), with 84.6% sensitivity and 79.7% specificity for Otago and 0.980 (95% confidence interval 0.973–0.986), with 96.0% sensitivity and 90.0% specificity for Messidor.

Conclusions and Relevance

This study has shown that a deep neural network can detect referable diabetic retinopathy with sensitivities and specificities close to or better than 80% from both an international and a domestic (New Zealand) database. We believe that deep neural networks can be integrated into community screening once they can successfully detect both diabetic retinopathy and diabetic macular oedema.     

Diabetic retinopathy equity profile in a multi-ethnic, deprived population in Northern England

Purpose

Equity profiles are an established public health tool used to systematically identify and address inequity within health and health services. Our aim was to conduct an equity profile to identify inequity in eye health across Leeds and Bradford. This paper presents results of findings for diabetic retinopathy in Bradford and Airedale.

Methods

A variety of routine health data were included and sub-analysed by measures of equity, including age, sex, ethnicity, and deprivation to identify inequity in eye health and healthcare. The Spearman Rank Correlation Coefficient was used to determine the association between variables.

Results

The prevalence of diagnosed diabetes in Bradford and Airedale district is 6.6% compared to 4.3% in nearby Leeds and 5.1% nationally. The age-standardised prevalence of diagnosed diabetic retinopathy within Bradford and Airedale is 2.21% (95% CI 1.54–2.26%), with a disproportionately high prevalence of disease in the Pakistani population and the most deprived parts of the population. There was a poorer uptake of diabetic retinopathy screening in more deprived parts of the district and the proportions with a higher rate of referral to ophthalmology following the screening in Black and Minority Ethnic populations compared with the white population (13.2% vs6.9%). Uptake of secondary care outpatient appointments is much lower in more deprived populations.

Conclusion

Inequalities are inherent in diabetic retinopathy prevalence, diagnosis, and treatment. The reasons for these inequities are multi-factorial and further investigation of reasons for poor uptake of services is required. Addressing the inequalities in eye health and healthcare requires cross-organisational collaboration.     

Diabetic retinopathy in a hospital eye clinic population in Honiara,Solomon Islands

Background: To determine the presence, severity and context of diabetic retinopathy among diabetic adults using hospital eye clinic services in Honiara, Solomon Islands. Methods: Fifty consecutive known diabetic patients aged ≥20 years were interviewed and underwent Snellen distance vision testing and complete ocular examination, including dilated 90 D funduscopy. Diabetic retinopathy was graded according to the International Clinical Diabetic Retinopathy and Macular Oedema Disease Severity Scales. Results: Participants were predominantly Melanesian (94%). Mean age was 53.6 ± 10.7 years; 42% were female; and 34% were rural dwellers. Diabetes had been diagnosed <5, 5–10 and >10 years ago for 42%, 34% and 24% of participants. However, 54% denied ever having had a dilated fundus examination. Proliferative retinopathy, severe non‐proliferative changes and maculopathy were present in 5, 12 and 26 eyes, respectively. For the 32 eyes with pinhole acuity ≤6/12, diabetic eye disease was the cause for 20, with all but one due to maculopathy. Diabetes reduced the pinhole vision of five eyes to ≤6/60. Twenty‐four per cent of participants had diabetes‐related pinhole vision ≤6/12 in at least one eye. Those diagnosed with diabetes 5–10 and >10 years were 17.5 and 58.8 times more likely to have such an eye compared with those recently (<5 years) diagnosed (extended Mantel–Haenszel χ² = 11.570, P < 0.001). Participants were not well informed about diabetic eye disease. Conclusions: Diabetic eye disease is now a significant contributor to this clinic's workload. A population‐based survey is needed to quantify the problem and inform design and delivery of eye services for this chronic disease.     

关于加强患者遵守糖尿病视网膜病变筛选的意义和存在的问题

在中国,糖尿病视网膜病变已经成为主要的致盲疾病之一。大多数盲是可以避免的,因为及时的激光治疗在挽救视力时被证明是有效的。但是许多患者在早期没有症状,到出现症状时,对于有效的激光治疗为时已晚。所以做为糖尿病患者整体护理的一部分,对糖尿病患者仔细的和定期的眼部监测是非常有必要的。但是目前在中国对糖尿病视网膜病变的筛选还远远不够。作为将来糖尿病视网膜病变的干预基础,这篇文章分析了糖尿病视网膜病变筛查的重要性及执行问题。     

大肠杆菌K5多糖对糖尿病视网膜病变小鼠视网膜新生血管形成作用的研究

目的 探究大肠杆菌K5多糖对糖尿病视网膜病变小鼠视网膜新生血管形成的影响.方法 发酵培养大肠杆菌K5菌株,对培养液进行分离纯化制备K5多糖,并分析K5多糖的纯度;雄性ICR小鼠被随机分为正常纽、模型组和干预组,其中正常组是健康小鼠,而模型组和干预组均使用链脲佐菌素建立糖尿病小鼠模型,干预组于造模后使用K5多糖干预4周,造模后8周各组取小鼠眼球组织,行HE染色及视网膜铺片ADPase染色;采用Real-time PCR和Western blotting检测各组小鼠眼球组织血管内皮生长因子(vascular endothelial gTowth factor,VEGF)及基质金属蛋白酶-2(matrix metalloproteinase,MMP-2)的表达情况.结果 HPLC结果显示制备的K5多糖纯度在95％以上:HE染色及ADPase染色结果显示正常组小鼠视网膜只见少量血管,模型组小鼠视网膜血管数目显著高于正常组,而干预组小鼠视网膜血管数目较模型组显著下降(P＜ 0.05);Real-time PCR和Western blot结果显示,模型组小鼠眼球组织VEGF和MMP-2的mRNA及蛋白表达水平显著高于正常组(均为P＜0.05),而干预组VEGF和MMP-2的mRNA及蛋白表达水平显著低于模型组(均为P＜0.05).结论 大肠杆菌K5多糖能够抑制糖尿病视网膜病变小鼠视网膜新生血管形成,其作用机制可能与抑制VEGF及MMP-2的表达有关.     

Diabetic care initiatives to prevent blindness from diabetic retinopathy in India

It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20–50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.     

Diabetic retinopathy under age 20. A review of 71 cases

A review of the fluorescein angiograms on 4547 diabetic patients with clinically suspected retinopathy was performed. Although only 26 (1%) of the 2013 males and 45 (2%) of the 2534 females were less than 20 years old (71 patients total), proliferative diabetic retinopathy (PDR) was diagnosed in 14 females (31%) and 4 males (15%). The youngest patient, a 13-year-old boy with diabetes for eight years, presented with severe proliferative diabetic retinopathy in both eyes as documented angiographically. He showed no evidence of other systemic complications of diabetes. A review of the literature revealed one other case of proliferative diabetic retinopathy in a patient this young; a 13-year-old girl who was nephrotic and hypertensive upon presentation. This study emphasizes the importance of having prepubescent and teenage diabetics examined for the presence of retinopathy.     

Background adaptation in a rat model of retinopathy of prematurity

Low dark-adapted, scotopic retinal and visual sensitivity in retinopathy of prematurity (ROP) could be due to disease of the inner retina, or the recently described rod photoreceptor abnormalities. Receptoral disease decreases catch of quanta from both test flashes and steady background lights; increment threshold functions are shifted up and right. In diseases with normal receptors but low retinal sensitivity due to abnormal post receptoral processing, the increment threshold functions are shifted up with no horizontal translation. Herein we test the hypothesis that the rod photoreceptors are the site of ROP disease which causes low dark adapted b-wave sensitivity. The effect of steady background light on the ERG b-wave in a rat model of ROP is studied. ERG stimulus/response functions were obtained using full-field stimuli in the dark-adapted state, and in the presence of a steady background light. In each adaptation condition, log , the test flash intensity that produced a half-maximum b-wave amplitude, was calculated. In pilot experiments, the background light selected had raised log about a log unit in controls. In dark-adapted ROP rats log was significantly higher, 0.35 log unit, than in controls. In the presence of the background light, log in ROP and control rats did not differ significantly indicating a relative shift, up and right, of the increment sensitivity function for the less sensitive ROP rats. The effect of the background light is consistent with receptoral disease causing low dark adapted b-wave sensitivity in ROP rats.     

早期糖尿病患者糖尿病视网膜病变发生率的调查分析

为调查早期糖尿病患者（病程＜５年）糖尿病视网膜病变的发生率。对本院内分泌科住院治疗的糖尿病患者（经ＷＨＯＩＤＤＭ诊断标准确诊，病程＜５年）７２例１４４只眼，双眼散瞳详细检查眼底，对可疑及有明确病变的患者行ＦＦＡ检查确诊。结果：７２例患者１４４只眼中眼底镜下有明确病变的４例５只眼，可疑１４例，该１８例患者行眼底荧光血管造影（ＦＦＡ）检查，最后确诊有糖尿病视网膜病变的６例７只眼，占８．３％。结论：要高度重视早期糖尿病患者糖尿病视网膜病变的发生     

Diabetic retinopathy screening guidelines in India: All India Ophthalmological Society diabetic retinopathy task force and Vitreoretinal Society of India Consensus Statement

Diabetic retinopathy (DR) is an emerging preventable cause of blindness in India. All India Ophthalmology Society (AIOS) and Vitreo-Retinal Society of India (VRSI) have initiated several measures to improve of DR screening in India. This article is a consensus statement of the AIOS DR task force and VRSI on practical guidelines of DR screening in India. Although there are regional variations in the prevalence of diabetes in India at present, all the States in India should screen their population for diabetes and its complications. The purpose of DR screening is to identify people with sight-threatening DR (STDR) so that they are treated promptly to prevent blindness. This statement provides strategies for the identification of people with diabetes for DR screening, recommends screening intervals in people with diabetes with and without DR, and describes screening models that are feasible in India. The logistics of DR screening emphasizes the need for dynamic referral pathways with feedback mechanisms. It provides the clinical standards required for DR screening and treatment of STDR and addresses the governance and quality assurance (QA) standards for DR screening in Indian settings. Other aspects incorporate education and training, recommendations on Information technology (IT) infrastructure, potential use of artificial intelligence for grading, data capture, and requirements for maintenance of a DR registry. Finally, the recommendations include public awareness and the need to work with diabetologists to control the risk factors so as to have a long-term impact on prevention of diabetes blindness in India.