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Diabetic Retinopathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Diabetic macular edema involves edema of the macula that threatens or involves the fovea, the center of the macula. Vision loss is a common result. Macular edema is an outcome, in diabetic retinopathy, of abnormal retinal vascular permeability (see Figure 5.1).
Pars plana vitrectomy for diabetic macular edema associated with posterior hyaloidal traction
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Sophie J Bakri, Peter K Kaiser, Hilel Lewis
Diabetic macular edema occurs due to a breakdown in the blood–retinal barrier, resulting in leakage of intraretinal fluid from microaneurysms and abnormal retinal capillaries.2 The pathogenesis of diabetic macular edema is multi-factorial, involving an interplay between various biochemical messengers and permeability factors (such as vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and histamine), tissue hypoxia, and vitreomacular attachments.
Ophthalmic Complications in Older Adults with Diabetes
Published in Medha N. Munshi, Lewis A. Lipsitz, Geriatric Diabetes, 2007
Jerry D. Cavallerano, Deborah K. Schlossman, Rola N. Hamam, Lloyd Lloyd
The comprehensive eye examination is the mainstay of such evaluation and is necessary on a repetitive, lifelong basis for patients with diabetes (64,126). Dilated ophthalmic examination is superior to undilated evaluation because only 50% of eyes are correctly classified with respect to the presence and severity of retinopathy through undilated pupils (127,128). Because of the complexities of the diagnosis and treatment of PDR and CSME, ophthalmologists with specialized knowledge and experience in the management of DR are required to determine and provide appropriate surgical intervention (129). Thus, it is recommended that all patients with diabetes should have dilated ocular examinations by an experienced eye care provider (ophthalmologist or optometrist), and diabetic patients should be under the direct or consulting care of an ophthalmologist experienced in the management of DR at least by the time severe NPDR or diabetic macular edema is present (64). Effort must be made to help the elderly patient overcome their additional barriers to acquiring timely and consistent quality eye care.
Comparison of Regional Differences in the Choroidal Thickness between Patients with Pachychoroid Neovasculopathy and Classic Exudative Age-related Macular Degeneration
Published in Current Eye Research, 2021
Young Ho Kim, Boram Lee, Edward Kang, Jaeryung Oh
In this retrospective study, we reviewed consecutive patients with MNV from the SS-OCT database between March 2016 and December 2019 who were seen at Korea University Medical Center. We only included patients older than 50 years who had unilateral MNV due to ceAMD or PNV. We also included normal subjects with normal fundus as a normal control group. Patients with advanced AMD in both eyes and patients with polypoidal choroidal vasculopathy (PCV) in either eye were excluded. In addition, we excluded eyes with prior anti-vascular endothelial growth factor (anti-VEGF) therapy due to other cause such as central serous chorioretinopathy within the last 6 months. Other exclusion criteria were as follows: 1) patients with high myopia (axial length ≥ 28.0 mm); 2) patients with geographic atrophy or disciform scarring; 3) prior history of photodynamic therapy and laser photocoagulation; 4) history of glaucoma, refractive or vitreoretinal surgery; and 5) history of cataract surgery in the 6 months prior to thickness evaluation; 6) history of optic nerve disorders, vascular disease, uveitis, use of diuretics; and 7) patients with diabetic macular edema and diabetic retinopathy that complicate the evaluation of images.
Ischemia-Modified Albumin Levels and Thiol-Disulphide Homeostasis in Diabetic Macular Edema in Patients with Diabetes Mellitus Type 2
Published in Current Eye Research, 2021
Mustafa Kalayci, Ersan Cetinkaya, Kenan Yigit, Mehmet Cem Sabaner, Reşat Duman, Ahmet Rifat Balik, Özcan Erel
Diabetic retinopathy (DR) is a condition characterized by retinal angiopathy and neuropathy that occurs as a result of dysregulated blood glucose, and if left untreated, it may cause blindness.1 Diabetic retinopathy is the leading cause of untreatable vision losses in the population aged 20 to 65 years in developed countries.2 Long-term hyperglycemia-related toxicity is the primary mechanism in the development of DR. Long-term exposition to hyperglycemia is believed to result in a series of biochemical and physiological changes that ultimately lead to endothelial damage. Specific retinal capillary changes include capillary occlusion and thickening of basement membrane leading to retinal non-perfusion and decompensation of endothelial barrier function that results in pericyte losses and serum leakage, namely macular edema.3 The main cause of visual impairment in diabetic patients is diabetic macular edema. In general, macular edema is an indicator of fluid accumulation in the extracellular area in the retina in the macular region and threatens visual acuity if the retinal region in the macular center becomes thicker. Prevalence and severity of DR and macular edema show a positive correlation with abnormal hematological and biochemical parameters. However, the exact role of these abnormalities, either individually or in combination, in the pathogenesis of retinopathy has not been clearly defined yet.
Emerging corticosteroid delivery platforms for treatment of diabetic macular edema
Published in Expert Opinion on Emerging Drugs, 2020
Janika Shah, Anagha Vaze, Timothy Tang Lee Say, Mark C Gillies, Samantha Fraser-Bell
Diabetic macular edema is a known microvascular complication of diabetes, characterized by accumulation of excess fluid and lipid exudates intracellularly and extracellularly leading to increase in retinal thickening. It is secondary to inner retinal barrier rupture, which is in turn secondary to a range of metabolic changes brought about by hyperglycemia [45]. Glycemic control and systemic blood pressure are important in the prevention of diabetic microvascular complications [46,47]. Although VEGF is an important molecule in retinal barrier disruption, around 25% of patients with DME are resistant to intravitreal treatment with VEGF inhibitors [48]. Topical delivery of VEGF inhibitors is challenging because it has to traverse various layers of cornea, bypass dynamic barriers such as dilution by tear film and systemic clearance through conjunctival vessels and penetrate the inner layers of the retina to reach the blood vessels. VEGF inhibitors are proteins that require the preservation of their fragile tertiary and quaternary structures for its activity and sensitive to various environmental factors, including heat, pH changes, and proteolytic enzymes making it difficult for sustained drug delivery implant [49].