Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema

Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.

Analysis of normal human retinal vascular network architecture using multifractal geometry

AIM：To apply the multifractal analysis method as a quantitative approach to a comprehensive description of the microvascular network architecture of the normal human retina.METHODS：Fifty volunteers were enrolled in this study in the Ophthalmological Clinic of Cluj-Napoca,Romania,between January 2012 and January 2014. A set of 100 segmented and skeletonised human retinal images,corresponding to normal states of the retina were studied. An automatic unsupervised method for retinal vessel segmentation was applied before multifractal analysis. The multifractal analysis of digital retinal images was made with computer algorithms,applying the standard boxcounting method. Statistical analyses were performed using the Graph Pad In Stat software.RESULTS：The architecture of normal human retinal microvascular network was able to be described using the multifractal geometry. The average of generalized dimensions（D_q）for q=0,1,2,the width of the multifractal spectrum（Δα=α_（max）-α_（min））and the spectrum arms＇ heights difference（│Δf│）of the normal images were expressed as mean±standard deviation（SD）：for segmented versions,D_0=1.7014±0.0057; D_1=1.6507±0.0058; D_2=1.5772±0.0059; Δα=0.92441±0.0085; │Δf│= 0.1453±0.0051; for skeletonised versions,D_0=1.6303±0.0051; D_1=1.6012±0.0059; D_2=1.5531± 0.0058; Δα=0.65032±0.0162; │Δf│= 0.0238±0.0161. The average of generalized dimensions（D_q）for q=0,1,2,the width of the multifractal spectrum（Δα）and the spectrum arms＇ heights difference（│Δf│）of the segmented versions was slightly greater than the skeletonised versions.CONCLUSION：The multifractal analysis of fundus photographs may be used as a quantitative parameter for the evaluation of the complex three-dimensional structure of the retinal microvasculature as a potential marker for early detection of topological changes associated with retinal diseases.