Effect of focal laser photocoagulation in eyes with mild to moderate non-proliferative diabetic retinopathy

AIM：To report the effect of focal laser photocoagulation on both the severity of hard exudates（HEs） and the rate of disease progression in eyes with mild to moderate non-proliferative diabetic retinopathy（NPDR）.METHODS： We retrospectively reviewed the medical records of 33 patients（60 eyes） who had been diagnosed with mild to moderate NPDR between January 2006 and December 2012.The patients were divided into 2 groups：Group A（38 eyes in 20 patients treated using focal laser photocoagulation） and Group B（treated without laser photocoagulation）.We also reviewed the best corrected visual acuity measurements,and the fundus photographs taken at both baseline and follow-up visits. RESULTS： In Group A,HE severity grade had decreased significantly from baseline to the final visit（P 〈0.05）,but this was not the case in Group B（P =0.662）.The cumulative probabilities of retinopathy progression at 5y were 26% in Group A and 30% in Group B.KaplanMeier survival curves showed no significant difference between the groups with regard to retinopathy progression（P =0.805）.CONCLUSION： Focal laser photocoagulation reduced the levels of HEs in eyes with mild to moderate NPDR.However,the treatment was not able to decelerate the progression of DR.

Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment

BACKGROUND Non-proliferative diabetic retinopathy(NPDR)poses a significant challenge in diabetes management due to its microvascular changes in the retina.Laser photocoagulation,a conventional therapy,aims to mitigate the risk of progressing to proliferative diabetic retinopathy(PDR).AIM To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients.METHODS Forty-nine NPDR patients(86 eyes)treated between September 2020 and July 2022 were included.They were randomly allocated into single-spot(n=23,40 eyes)and multi-spot(n=26,46 eyes)groups.Treatment outcomes,including bestcorrected visual acuity(BCVA),central macular thickness(CMT),and mean threshold sensitivity,were assessed at predetermined intervals over 12 months.Adverse reactions were also recorded.RESULTS Energy levels did not significantly differ between groups(P>0.05),but the multi-spot group exhibited lower energy density(P<0.05).BCVA and CMT improvements were noted in the multi-spot group at one-month posttreatment(P<0.05).Adverse reaction incidence was similar between groups(P>0.05).CONCLUSION While energy intensity and safety were comparable between modalities,multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients,with reduced laser-induced damage.

Reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy patients by two different OCTA sweep modes

·AIM:To assess the reproducibility of macular perfusion parameters in non-proliferative diabetic retinopathy(NPDR)patients measured by different examiners and two different sweep modes of optical coherence tomography angiography(OCTA).·METHODS:Ninety-eight(98 eyes)patients with NPDR were included in this study.All participates were performed three times using Cirrus OCTA with Angiography 3×3 mm^(2)and 6×6 mm^(2)sweep mode by two examiners.The macular foveal avascular zone(FAZ)and vessel density(VD)in the superficial retinal layer(SRL)were measured.The reproducibility of the measurements was evaluated with intraclass correlation coefficients(ICC)and coefficient of variation(CoV).·RESULTS:The intra-mode ICCs of Angiography 3×3 mm^(2)and 6×6 mm^(2)sweep mode were 0.957 to 0.959 and 0.964 to 0.977,respectively;and the inter-mode ICCs were 0.962 to 0.970.The intra-examiner ICCs of macular perfusion parameters were>0.950;and the inter-examiner ICCs were0.928 to 0.969.All CoVs were<1.0%.·CONCLUSION:Cirrus OCTA can measure macular perfusion parameters in NPDR patients with excellent reproducibility.The measurements of FAZ and VD in the SRL determined by Angiography 3×3 mm^(2)and 6×6 mm^(2)sweep mode are highly consistent and both sweep modes are suitable for macular perfusion parameters measurement.

Evaluation of VEGF gene polymorphisms and proliferative diabetic retinopathy in Mexican population

AIM： To assess if the included vascular endothelial growth factor （VEGF） polymorphisms rs3025035, rs3025021 and rs2010963 are associated to proliferative retinopathy in a Mexican population with type 2 diabetes mellitus （T2DM）. METHODS： A case-control study was conducted in adult individuals with T2DM associated to proliferative retinopathy or non-proliferative retinopathy from Oct. 2014 to Jun. 2015 from the Retina Department of the Asociation to Prevent Blindness in Mexico. The selected patients were adults with a diagnosis of T2DM ≥5y. All subjects had a comprehensive ocular examination and the classification of the retinopathy severity was made considering the Early Treatment Diabetic Retinopathy Study （ETDRS） standardization protocols. Genomic DNA was extracted from whole fresh blood. All samples were genotyped by qPCR for selected VEGF polymorphisms. Hardy-Weinberg equilibrium was calculated by comparing Chi-square values between the expected and the observed values for genotype counts.RESULTS： In total 142 individuals were enrolled, 71 individuals with T2DM and associated proliferative retinopathy and 71 individuals with non-proliferative retinopathy. One-sided Fisher’s exact test was performed for rs3025021 [OR （95% CI）=0.44（0.08-2.2）; P=0.25] and rs2010963 [OR （95% CI）=0.63（0.25-1.6）; P=0.23]. The minor allelic frequencies obtained were 26% for rs3025021, 10% for rs3025035 and 61% for rs2010963. The pairwise linkage disequilibrium between the three SNP was assessed, and was as follows： rs3025021 vs rs3025035： D’=1.0, r2=0.1043, P≤0.0001; rs3025021 vs rs2010963： D’=0.442, r2=0.0446, P=0.149; rs3025035 vs rs2010963： D’=0.505, r2=0.0214, P=0.142.CONCLUSION： This is the first analysis involving VEGF polymorphisms and proliferative diabetic retinopathy in a Mexican population. A major finding of the present study is that none of the polymorphisms studied was significantly associated with proliferative retinopathy. Based on these results, we can infer that different populations have different associations for the same polymorphisms.

Long-term effects of pattern scan laser pan-retinal photocoagulation on diabetic retinopathy in Chinese patients: a retrospective study

●AIM:To evaluate the long-term effects of pattern scan laser(PASCAL)pan-retinal photocoagulation(PRP)on diabetic retinopathy(DR)in Chinese patients.●METHODS:In this retrospective study,we evaluated clinical data of 29 patients(53 eyes)with severe non-proliferative DR(SNPDR)or proliferative DR(PDR)who received PRP and follow-up at our hospital from 2008 to 2013.Sixteen patients(29 eyes)received PASCAL PRP and 13 patients(24 eyes)received 100-ms conventional laser PRP.●RESULTS:After long-term follow-up(mean,min-max days:719.8,290-1666 for PASCAL PRP vs 743.5,240-1348 for conventional PRP,P=0.569),patients receiving PASCAL PRP required fewer photocoagulation sessions than the conventional PRP group(2.6±1.0 vs 3.9±0.9,P<0.01).Best corrected visual acuity(BCVA)was reduced slightly in PASCAL PRP group while reduced significantly in conventional PRP group.At last visit,24 eyes in the PASCAL group(88.9%)and 21 eyes in the conventional group(91.7%)were improved or stable.Two eyes in PASCAL PRP group(7.4%)and 3 eyes in the conventional PRP group(12.5%)developed vitreous hemorrhage or vitreous fibrovascular proliferation.●CONCLUSION:PASCAL PRP is as effective and may be more conducive to maintaining visual acuity with less treatment sessions for DR treatment compared to conventional laser PRP.

Treatment effects of captopril on non-proliferative diabetic retinopathy

Background Diabetic retinopathy （DR） is one of the most common complications of diabetes.Angiotensin-converting enzyme inhibitor is thought to play an important role in preventing and treating retinal diseases in animal models of DR.The aim of the present study was to investigate the role of angiotensin-converting enzyme inhibitor （ACEI,captopril） in the treatment of patients with non-proliferative DR.Methods Three hundred and seventeen type 2 diabetic patients （88.05% of participants） without or with mild to moderate non-proliferative retinopathy were randomly divided into captopril group （n=202） and placebo group （n=115）.All subjects received 24-month follow-up.General clinical examinations,including blood pressure and glycated hemoglobin,as well as comprehensive standardized ophthalmic examinations were performed.Color fundus photography and optical coherence tomography （OCT） were used to grade diabetic retinopathy and detect macular edema respectively.Results The levels of blood pressure and glycated hemoglobin in the two groups of patients remained within the normal range during the entire follow-up and no significant difference was found between the initial and last visits,suggesting that ACEI drugs play a protective role on the DR patients independent of its anti-blood pressure role.DR classification showed that 169 eyes （83.66%） remained unchanged and the DR grade of 33 eyes （16.34%） increased in captopril group,while 84 eyes （73.04%） remained unchanged and the grade of 31 eyes （26.96%） increased in placebo group （P=0.024）.Captopril treatment improved macular edema in 55.45% eyes,which was significantly higher than the 37.39% improvement in placebo group （P=0.002）.No significant difference was found in the visual acuity between the two groups （P=0.271）.Conclusion Captopril can improve or delay the development of DR and macular edema,which can be used in the early treatment of DR patients with type 2 diabetic mellitus.

复明片治疗轻、中度非增殖性糖尿病视网膜病变的疗效观察

目的:探讨复明片治疗轻、中度非增殖性糖尿病性视网膜病变的临床效果。方法:选取轻、中度非增殖性糖尿病视网膜病变患者120例,以随机数字表法分为2组各60例。在常规控制血糖的基础上,观察组患者口服复明片,对照组口服复方丹参片。观察治疗3个月后2组患者的视力,采用光学相干断层扫描技术观察治疗3个月后2组患者的黄斑厚度。结果:观察组患者视力改善的总有效率为80.00%(48/60),明显高于对照组的58.33%(35/60),差异有统计学意义(P<0.05)。治疗前,2组患者黄斑厚度的差异无统计学意义(P>0.05);治疗3个月后,观察组患者的黄斑厚度为(196.62±25.03)μm,较本组治疗前的(233.62±18.41)μm及对照组治疗后的(229.18±36.52)μm均明显减少,差异均有统计学意义(P<0.05)。结论:复明片治疗轻、中度非增殖性糖尿病视网膜病变安全、有效。

上饶地区中度非增殖期糖尿病性视网膜病变次全视网膜光凝治疗观察

目的探讨中度非增殖期糖尿病性视网膜病变（NPDR）行次全视网膜光凝的疗效，权衡制定上饶地区糖尿病性视网膜病变（DR）的治疗方案。方法选择2006年1月至2013年6月在南昌大学上饶医院眼科门诊经眼底血管造影（FFA）和光学相干断层扫描（OCT）检查诊断的中度非增殖期糖尿病性视网膜病变患者80例（142只眼），并根据病人意愿分为实验组和对照组。实验组40例（70只眼）行次全视网膜激光光凝术，并据FFA结果对黄斑区有微血管渗漏明显的行局部光凝或改良隔栅光凝治疗。对照组40例（72只眼）单纯控制血糖。随访3、6个月、1年和5年，观察患者视力及眼底病变情况。结果1年以上5年以内，视力下降：实验组为9例17只眼，占24.29％（17／70），对照组为28例53只眼，占73.61％（53／72）；眼底病变进入增殖前期、增殖期：实验组为7例13只眼（18.57％，13／70），对照组为31例55只眼（76.39％，55／72）；实验组与对照组进行组间差异比较，均有统计学意义（视力比较X2=34.549，P〈0.05；眼底比较X2=47.544，P〈0.05）。结论采用激光干预治疗中度非增殖期糖尿病性视网膜病变，可以有效控制糖尿病性视网膜病变进入增殖期，保存有效视力，降低致盲率。

周边视网膜光凝治疗中度非增殖期糖尿病视网膜病变的临床疗效观察

目的探讨中度非增殖期糖尿病视网膜病变（NPDR）行周边视网膜光凝的必要性。方法收集2008年10月至2011年10月连云港市第二人民医院眼科收治的106例（106只眼）血糖控制欠佳且眼底处于中度NPDR患者的临床资料。按照治疗方法将65例（65只眼）行视网膜光凝治疗的患者作为光凝组,将41例（41只眼）未行视网膜光凝治疗的患者作为非光凝组。术后6~36个月对所有患者行荧光素眼底血管造影（FFA）检查,观察两组患者的视力情况、眼底情况及中心视野情况。两组患者的视力情况以例数和百分比的形式表示,并采用Kruskal-Wallis H秩和检验的方法进行比较;两组患者的视网膜病变情况以例数和百分比的形式表示,并采用χ2检验的方法进行比较;激光治疗前及治疗6个月光凝组患者视野平均敏感度（MS）以均数±标准差（x珋±s）的形式表示,并采用t检验的方法进行比较。结果治疗后18个月,光凝组患者视力好转者16例（16只眼）,占24.61%;视力稳定者36例（36只眼）,占55.38%;视力下降者13例（13只眼）,占20.00%。非光凝组患者视力稳定者33例（33只眼）,占80.48%;视力下降者8例（8只眼）,占19.52%。两组比较,差异有统计学意义（Hc=14.93,P〈0.05）。治疗后36个月,光凝组患者视力好转者10例（10只眼）,占15.38%;视力稳定者38例（38只眼）,占58.46%;视力下降者17例（17只眼）,占26.16%。非光凝组患者视力稳定者21例（21只眼）,占51.22%;视力下降者20例（20只眼）,占48.78%。两组比较,差异有统计学意义（Hc=10.92,P〈0.05）。治疗后18个月,光凝组患者视网膜病变稳定者59例（59只眼）,占90.77%;视网膜病变进展者6例（6只眼）,占9.23%。非光凝组患者视网膜病变稳定者31例（31只眼）,占75.61%;视网膜病变进展者10例（10只眼）,占24.39%。两组比较,差异有统计学意义（χ2=4.51,P〈0.05）。治疗36个月,光凝组患者视网膜病变稳定者55例（55只眼）,占84.62%;视网膜病变进展者10例（10只眼）,占15.38%;非光凝组患者视网膜病变稳定者22例（22只眼）,占53.66%;视网膜病变进展者19例（19只眼）,占46.34%。两组比较,差异有统计学意义（χ2=12.12,P〈0.05）。激光治疗前,光凝组患者MS为（23.59±0.48）d B;激光治疗后6个月,光凝组患者MS为（23.42±0.50）d B。治疗前后患者MS的比较,差异无统计学意义（t=1.96,P〉0.05）。结论对于血糖控制欠佳的糖尿病患者,其眼底处于中度NPDR时进行激光治疗,可延缓周边部视网膜的病情进展,可防止因后期瞳孔散大不良造成的激光不完全,对保护患者的中心视力有很大帮助。