Long-term real-world outcomes of retinal microvasculature changes in proliferative diabetic retinopathy treated with panretinal photocoagulation vs. intravitreal conbercept

Macular Microvasculature Asymmetry Analysis for Evaluating Open-Angle Glaucoma in Diabetic Retinopathy Patients Treated with Pan-Retinal Photocoagulation

PURPOSE

To evaluate the usefulness of vertical asymmetry analysis of macular microvasculature for diagnosis of open-angle glaucoma (OAG) in diabetic retinopathy (DR) patients who have undergone pan-retinal photocoagulation (PRP).

DESIGN

Retrospective, cross-sectional diagnostic evaluation.

METHODS

DR patients with PRP were categorized into those without OAG (Group 1) and those with OAG (Group 2). Peripapillary retinal nerve fiber layer (pRNFL) thickness and macular vessel density (VD) were measured, and the vertical difference in pRNFL (vdRNFL) and VD (vdVD) was determined as the absolute difference between the superior and inferior sectors. Diagnostic performance was analyzed by calculating the area under the curve (AUC).

RESULTS

Analyses included 128 eyes (Group 1: 68 and Group 2: 60). The mean pRNFL thickness was 93.9 ± 14.8 μm in Group 1 and 85.5 ± 14.4 μm in Group 2 (P = 0.009). The mean vdRNFL was 13.1 ± 10.9 μm in Group 1 and 14.4 ± 12.6 μm in Group 2 (P = 0.607). The mean VD was 15.9 ± 3.3 mm-1 in Group 1 and 15.3 ± 2.6 mm-1 in Group 2 (P = 0.380), whereas the vdVD was 0.6 ± 0.6 mm-1 in Group 1 and 1.6 ± 1.4 mm-1 in Group 2 (P < 0.001). The AUC for diagnostic accuracy was 0.812 for vdVD, significantly higher than that for other factors (all P < 0.001).

CONCLUSIONS

Relying on pRNFL thickness for OAG evaluation in PRP-treated patients is not recommended. Analysis of vertical microvasculature asymmetry can serve as a useful factor for diagnosing OAG.

Oridonin attenuates diabetic retinopathy progression by suppressing NLRP3 inflammasome pathway

Oridonin (Ori) possesses anti-inflammatory properties. However, its potential to treat diabetic retinopathy (DR) remains unclear. This study aimed to investigate the retinal protective function of Ori and the underlying mechanism. In streptozotocin-induced mice, Ori alleviated visual impairment, reduced retinal and vascular lesions, protected the neuroretinal structure, reversed retinal nerve layer thickening. Addtionnally, Ori reduced TNF-α and IL-1β levels in the peripheral blood, and suppressed retinal NLRP3 inflammasome-related inflammatory factor. In vitro, human retinal endothelial cells (hRECs) were stimulated by high glucose (HG). HG-stimulated hRECs activated the NLRP3 inflammasome, whereas Ori significantly alleviated pyroptosis by enhancing cell viability and reducing IL-1β levels in the supernatant. Ori also inhibited NF-κB/NLRP3 inflammasome pathway. NEK7 depletion alleviated NLRP3 inflammasome activation and, to some extent, mimicked the role of Ori. Indeed, Ori reversed NLRP3 inflammasome activation by suppressing NEK7-NLRP3 interaction. Therefore, Ori may serve as a potential therapeutic agent for attenuating DR progression.

OCT angiography 2023 update: focus on diabetic retinopathy

Optical coherence tomography angiography (OCTA) has become part of the clinical practice and its growing applications are in continuous development. Coherently with the growing concern about the human and economic cost of diabetes, diabetic retinopathy (DR) was the most popular topic for OCTA studies in the past year. The analysis of the literature reveals that applications of OCTA in DR are in continuous growth. In particular, ultrawide field (UWF) OCTA and artificial intelligence (AI) based on OCTA images are affirming as the new frontiers of scientific research in the field. Diagnostic accuracy of AI methods based on OCTA is equal or superior to the one based on OCT methods and also bears potential to detect systemic associations. UWF OCTA is noninvasive method that is reaching similar accuracy of FA in detection of neovascularization and intraretinal microvascular abnormalities (IRMAs) and has allowed better characterization of microvascular peripherical changes in DR. Lastly, deep capillary plexus (DCP) characteristics seem to play a pivotal role in the development of diabetic macular edema (DME) and refinement of biomarkers for different phenotypes of DME and diabetic macular ischemia (DMI) is currently on its way.