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.

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.

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.

红花黄色素氯化钠注射液联合复方樟柳碱注射液对NPDR患者的临床疗效

目的观察红花黄色素氯化钠注射液联合复方樟柳碱注射液对非增殖型糖尿病视网膜病变(NPDR)患者的临床疗效。方法 68例(102只眼)患者随机分为对照组(32例,48只眼)和观察组(36例,54只眼),对照组予以常规治疗,观察组在常规治疗基础上予以红花黄色素氯化钠注射液联合复方樟柳碱注射液,比较2组治疗前后视力、眼底出血、渗出、微血管瘤和黄斑中心厚度的变化。结果治疗后观察组视力恢复、眼底改善、黄斑中心厚度控制显著优于对照组(P<0.05,P<0.01)。结论红花黄色素氯化钠注射液联合复方樟柳碱注射液可有效改善NPDR患者的视力,延缓疾病进展。

561 nm与532 nm激光光凝治疗重度非增生性糖尿病视网膜病变的临床疗效比较

目的比较561 nm、532 nm激光光凝治疗重度非增生性糖尿病视网膜病变(NPDR)的临床疗效。方法招募2021年6月至2022年8月惠州市第三人民医院收治的重度NPDR不合并黄斑水肿的患者46例(82眼),均行全视网膜激光光凝(PRP)治疗。采用随机数字表法将其分为观察组(23例,42眼)和对照组(23例,40眼)。观察组和对照组激光光凝治疗波长分别为561 nm和532 nm。比较两组治疗前,以及治疗后2周、1个月、3个月、6个月的最佳矫正视力(BCVA)、中央黄斑厚度(CMT)、视网膜神经纤维层(RNFL)厚度。比较两组不良反应发生情况。结果治疗后两组BCVA较治疗前显著提高(P<0.05),但两组各时间点BCVA比较差异无统计学意义(P>0.05)。治疗后,两组患眼CMT、RNFL厚度均呈下降趋势(P<0.05),且观察组在治疗后2周、1个月、3个月、6个月的CMT较对照组薄,RNFL厚度较对照组厚,差异有统计学意义(P<0.05)。治疗后两组继发黄斑水肿、玻璃体积血和新生血管性青光眼发生率比较差异无统计学意义(P>0.05)。结论561 nm激光光凝治疗重度NPDR安全、有效,对CMT及RNFL厚度影响较532 nm激光小,有利于保存视功能。

光学相干断层血管造影成像应用于非增殖期糖尿病视网膜病变微血管的临床筛查

目的探讨光学相干断层血管造影成像(OCTA)应用于非增殖期糖尿病视网膜病变(NPDR)患者视网膜微血管筛查中的临床效果。方法选取在苏州大学附属第三医院确诊的30例NPDR患者(NPDR组)和30例健康志愿者(对照组)行OCTA检查,对其黄斑中心凹无血管区(FAZ)的面积、周长、圆度变化以及黄斑区视网膜浅层毛细血管层(SCP)和视盘盘周放射状毛细血管层(RPC)上侧、下侧、鼻侧、颞侧4个象限的血流密度进行量化分析。结果NPDR组患者黄斑区SCP和视盘RPC 4个象限的血流密度较对照组均显著下降(43.68±3.03vs.46.98±3.04、42.79±3.17vs.50.45±2.25、43.21±2.67vs.47.44±2.42、44.21±3.22vs.51.72±5.32、46.43±3.54vs.53.02±2.62、45.97±3.67vs.52.53±2.82、44.63±2.73vs.48.19±3.67、41.73±3.15vs.45.12±3.31),差异均有统计学意义(均P<0.01)。NPDR组患者FAZ面积和周长较正常对照组均明显增大[(0.50±0.06vs.0.43±0.47)mm2、(3.10±0.21vs.2.87±0.22)mm],圆度较对照组明显变小[(0.63±0.05vs.0.67±0.05)%],差异也均有统计学意义(均P<0.01)。结论OCTA可检测出NPDR的早期视网膜微结构改变,可作为NPDR的辅助筛查,为早期诊治提供信息。

口服羟苯磺酸钙联合和血明目片治疗非增殖性糖尿病视网膜病变临床观察

目的:研究口服羟苯磺酸钙联合和血明目片治疗非增殖性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)的临床效果。方法:根据随机数表法将176例NPDR患者分为对照组和研究组,每组各88例。所有患者均接受降脂、降糖及降压等常规对症治疗,同时对照组患者加服羟苯磺酸钙治疗,研究组患者采用口服羟苯磺酸钙联合和血明目片治疗。比较两组患者治疗前后出血吸收时间、血糖水平及治疗效果。结果:研究组出血吸收时间少于对照组,差异有统计学意义(t=12.798,P=0.001);治疗后两组患者的空腹血糖(FBG)、糖化血红蛋白(HbA1C)水平均较治疗前降低,研究组患者低于对照组(P<0.05);研究组治疗总显效率为86.4%,高于对照组的65.9%,差异有统计学意义(P<0.05)。结论:口服羟苯磺酸钙联合和血明目片治疗NPDR效果显著,能有效调节血糖水平,控制病情进展,值得临床推广。

止血散瘀明目汤治疗非增殖期糖尿病视网膜病变的疗效研究

目的 :观察止血散瘀明目汤治疗非增殖糖尿病视网膜病变(NPDR)的临床治疗效果。方法 :本次研究对象选取我院2014年3月-2016年7月收治的106例非增殖期糖尿病视网膜病变患者,并按治疗方法不同分为对照组与观察组,其中对照组52例采用常规治疗包括控制血糖、饮食、运动等;观察组54例在对照组的基础上加用止血散瘀明目汤,比较两组用药前后患者视力水平变化,评估疾病治疗效果,对两组治疗前后患者视网膜血液微循环情况[视网膜中央静脉(CRV)、视网膜中央动脉(CRA)血液流变指标]进行检测比较。结果 :两组治疗效果比较,观察组中、重度总有效率分别为93.5%,91.3%,显著高于对照组的80.0%,68.2%,两组比较差异有统计学意义(P<0.05);治疗后观察组CRV、CRA血液流变指标以及视力水平改善效果均优于对照组,差异具有统计学意义(P<0.05)。结论 :止血散瘀明目汤治疗NPDR,能有效改善患者视力,促进血液流变学恢复正常,提高临床的治疗效果。

羟苯磺酸钙治疗非增殖性糖尿病视网膜病变的临床效果

目的探讨羟苯磺酸钙治疗非增殖性糖尿病视网膜病变(NPDR)的临床效果。方法将2016年1月至2017年1月在我院治疗的120例NPDR患者随机分为两组,各60例。对照组给予常规控制血糖治疗,观察组在此基础上给予羟苯磺酸钙治疗。比较两组患者的临床疗效及治疗前、后的视野敏感度、相关细胞因子、眼底血管造影。结果观察组临床治疗有效率(93.33%)明显高于对照组(75.00%)(P<0.05);治疗后,观察组VEGF、IGF-1、PEDG水平均较治疗前及对照组明显改善(P<0.05);治疗后,观察组微血管瘤数、出血灶面积、渗出灶面积较治疗前及对照组明显减少(P<0.05)。结论羟苯磺酸钙治疗NPDR疗效显著,有助于减轻病变,改善视网膜功能,提高视力,扩大视野,具有积极的临床意义。

中药治疗阴虚燥热型糖尿病视网膜病变的疗效观察

目的:探讨中药治疗阴虚燥热型糖尿病性视网膜病变的疗效。方法:纳入本研究的糖尿病性视网膜病变患者病变临床分级为重度非增殖性糖尿病视网膜病变(Nonproliferative Diabetic Retinopathy,NPDR),随机分为观察组和对照组,其中对照组予以全视网膜光凝治疗,观察组在对照组的基础上加用中药治疗。结果:观察组患者25例,视力提高者15例,有效率为60%(15/25);对照组25例,视力提高者3例,有效率为12%(3/25);两组间比较,差异有统计学意义(P<0.05)。观察组视力提高值为(0.13±0.07),对照组视力提高值为(0.05±0.04);两组间比较,差异有统计学意义(P<0.05)。结论:中药治疗对阴虚燥热型重度NPDR患者视力的提高有较好疗效,对改善患者视力、延缓糖尿病视网膜病变的进程有一定疗效,值得临床推广应用。

二甲双胍联合养肝清目汤治疗气阴两虚型非增殖期糖尿病性视网膜病变的临床效果

目的观察中西医结合治疗非增殖期糖尿病性视网膜病变(NPDR)的疗效。方法将57例中医辨证属于气阴两虚型NPDR患者按治疗方法不同分为对照组(28例,在常规治疗的基础上,采用给予短期强化胰岛素方案降糖治疗)与观察组(29例,在对照组基础上加用二甲双胍并联合养肝清目汤治疗)。50 d后,对两组患者的治疗效果进行比较分析。结果与对照组相比较,观察组的治疗总有效率明显更高(P<0.05);治疗后,观察组BMI优于对照组(P<0.05)。治疗后,观察组眼压、生活质量评分及中医症状积分改善情况明显优于对照组(P<0.05)。两组不良反应总发生率比较,差异不显著(P>0.05)。结论短期强化胰岛素方案基础上,加用二甲双胍联合养肝清目汤治疗NPDR气阴两虚型患者,有助于提高患者生存质量,疗效显著,值得临床推荐应用。

非增殖期糖尿病视网膜病变患者血清microRNA表达谱的分析

目的分析非增殖期糖尿病视网膜病变(NPDR)患者血清microRNA(miRNA)表达谱的特征。方法选取T2DM患者60例,根据荧光素眼底血管造影结果分为糖尿病无视网膜病变(NDR)组和非增殖期糖尿病视网膜病变(NPDR)组,各30例。采用miRNA微流体芯片技术检测并筛选出两组血清中差异表达的miRNAs,RT-qPCR对部分差异表达基因进行验证。结果芯片检测发现,与NDR组比较,NPDR组4个血清miRNAs表达上调,5个血清miRNAs表达下调(P<0.05)。RT-qPCR验证,4个上调的miRNAs,其中,miR-19a、miR-29c、miR-4659b的差异表达有统计学意义(Z=-4.184、-4.450、-2.794,P<0.05),且受试者工作特征(ROC)曲线下面积(AUC)分别为0.814、0.834、0.710。结论 NPDR患者血清miRNA表达谱中有9个miRNAs差异表达明显,其中,表达上调的miR-19a、miR-29c、miR-4659b可作为潜在的NPDR候选生物标志物。