CHANGES IN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PATIENTS WITH CHRONIC RENAL FAILURE UNDERGOING DIALYSIS FOR THE FIRST TIME

The effects of hemodialysis on the eye

The purpose of this study was to examine the effects of hemodialysis on the eye and its long-term consequences. Hemodialysis is a process that purifies the blood and maintains the balance of water, solutes, acid-base, and electrolytes. The eye, being primarily composed of fluid, has been speculated to be affected by this technique. To analyze these effects, a literature review was conducted, focusing on the anatomical structures, functions, and changes in the eye following hemodialysis. The search for relevant articles was carried out on PubMed, including studies published in English between 2000 and 2023. The results of the review showed that certain observations such as visual acuity, refraction, intraocular pressure, biometric parameters, and retinal nerve fiber layer did not show significant timing-related impacts, or there were conflicting findings. However, a connection was established between hemodialysis sessions and visual fields, parameters of visual-evoked potential, intraocular pressure in glaucoma, tear break-up time, Schirmer's test values, choroidal thickness, flow velocities of vessels, and ocular perfusion pressure values. In conclusion, it was determined that hemodialysis sessions can cause fluctuations that may complicate the assessment of eye health. To obtain a more accurate baseline evaluation, it is recommended to schedule ophthalmological examinations, a few hours after the hemodialysis session. Additionally, it is important to provide appropriate management for dry eyes and ocular hypertension, particularly during hemodialysis sessions. Coordination of these examinations with the timing of renal replacement therapy is advised to ensure optimal patient care.

Longitudinal renal function changes during real-world anti-vascular endothelial growth factor therapy for diabetic macular edema in Japan

PURPOSE

This retrospective observational study aimed to investigate the longitudinal changes in renal function and central macular thickness (CMT) and their impact on visual outcomes during anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME).

STUDY DESIGN

This study employed a retrospective observational design and analyzed data from treatment-naive patients with DME (62 cases, 100 eyes) receiving anti-VEGF therapy for 36 months. Baseline and follow-up assessments were conducted at 12, 24, and 36 months.

METHODS

Best corrected visual acuity (BCVA), CMT, number of anti-VEGF injections, HbA1c, serum creatinine (Cre), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urinary protein levels, and chronic kidney disease (CKD) stage were measured at each time point.

RESULTS

The study population had a mean age of 60.7 ± 12.2 years, with 41 men and 21 women. Over the 36-month period, the mean number of anti-VEGF injections per eye was 5.3 ± 3.3. Maximum CMT significantly decreased at each time point, and final BCVA showed significant improvement (logMAR: - 0.07). HbA1c levels remained stable, BUN and Cre levels increased, and eGFR decreased significantly over time. CKD stage 3+ at 36 months significantly resulted in worse CMT.

CONCLUSION

This retrospective observational study provides valuable insights into the longitudinal changes in renal function and CMT during anti-VEGF therapy for DME. Our findings emphasize the importance of monitoring renal function. This study contributes to our understanding of the complex relationship between renal function, DME, and anti-VEGF therapy, thereby facilitating improved management and outcomes in patients with DME.

The effect of long-term hemodialysis on diabetic retinopathy observed by swept-source optical coherence tomography angiography

BACKGROUND

Diabetes can cause chronic microvascular complications such as diabetic retinopathy (DR) and diabetic nephropathy (DN). DR and DN can lead to or exacerbate diabetic macular edema (DME). Hemodialysis (HD) is the main treatment method for patients with end-stage kidney disease (ESKD) secondary to DN.

PURPOSE

The aim of this prospective cohort study was to determine the immediate effect of single HD session on retinal and choroidal thickness in DR patients with ESKD and the features of DR and the prevalence of DME in these patients who have received long-term HD.

METHODS

Eighty-five eyes of 44 DR patients with ESKD who underwent long-term HD were examined by swept-source optical coherence tomography angiography (SS-OCTA). Based on OCTA images, the characteristics of DR and the prevalence of DME in these patients were analyzed. Changes in central retinal thickness (CRT), central retinal volume (CRV), subfoveal choroidal thickness (SFCT) and subfoveal choroidal volume (SFCV) within 30 min before and after single HD session were compared. CRT, CRV, SFCT and SFCV were compared before single HD session and before the next single HD session.

RESULTS

There was no significant difference in the average CRT (251.69 ± 39.21 μm vs. 251.46 ± 39.38 μm, P = 0.286) or CRV (0.15 ± 0.62 μm vs. 0.15 ± 0.63 μm, P = 0.324) between before and after single HD session. After single HD session, SFCT (243.11 ± 77.15 μm vs. 219.20 ± 72.84 μm, P < 0.001) and SFCV (0.15 ± 0.10 μm vs. 0.13 ± 0.90 μm, P < 0.001) significantly decreased. There was no statistically significant difference in CRT (251.69 ± 39.21 μm vs. 251.11 ± 38.47 μm, P = 0.206), CRV (0.15 ± 0.62 μm vs. 0.15 ± 0.61 μm, P = 0.154), SFCT (243.11 ± 77.15 μm vs. 245.41 ± 76.23 μm, P = 0.108), or SFCV (0.15 ± 0.10 μm vs. 0.16 ± 0.10 μm, P = 0.174) before HD and before the next single HD session. On en face OCTA images, eighty-five eyes (100%) had retinal nonperfusion areas, foveal avascular zone (FAZ) enlargement, and abnormal retinal microvasculature. Based on cross-sectional OCTA images, retinal neovascularization (RNV) was confirmed in 42 eyes (49.41%), and intraretinal microvascular abnormalities (IRMAs) were detected in 85 eyes (100%). Seventeen eyes (20%) still had DME, all of which were cystoid macular edema (CME). Among eyes with DME, the epiretinal membrane (ERM) was present in 7 eyes (8.24%).

CONCLUSIONS

For DR patients with ESKD who have undergone long-term HD, the choroidal thickness still changes significantly before and after single HD session, which may be related to short-term effects such as reduced blood volume and plasma osmotic pressure caused by single HD session. Although macular features seem to have stabilized in DR patients undergoing long-term dialysis, the DR of patients with ESKD should still be given attention.

Nonlinear Relationship Between Low Density Lipoprotein and the Probability of Diabetic Macular Edema

Purpose

Previous studies simply linearized the relationship between low density lipoprotein (LDL) and diabetic macular edema's (DME) probability, ignoring the possibility of a nonlinear relationship between them. We aimed to investigate the nonlinear relationship between LDL and DME probability in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

The study recruited 431 T2DM patients who attended Guangdong Provincial People's Hospital from December 2017 to November 2018. A multivariate logistic regression model was conducted to evaluate the association between LDL and DME probability. The nonlinear relationship was identified by generalized additive model. Subgroup analyses were performed to assess the consistency of the association in different subgroups.

Results

LDL was positively associated with DME probability (OR=1.60, 95% CI: 1.10~2.34, P=0.0145) after adjusting for covariates. A nonlinear relationship between LDL and DME probability was discovered, with an inflection point for LDL around 4.85 mmol/L (95% CI: 4.18~4.93, P=0.037). The effect sizes and the confidence intervals on the left and right sides of inflection point were 2.17 (1.31 to 3.58) and 0.26 (0.04 to 1.77), respectively. Subgroup analyses revealed other variables had no effect on the association between them.

Conclusion

Our finding suggested LDL was positively correlated with DME probability in T2DM patients. And the relationship between LDL and DME probability was nonlinear. Our findings need to be confirmed by further causal researches.

Association between the response of intravitreal antivascular endothelial growth factor injection and systemic factors of diabetic macular edema

BACKGROUND

This study investigated the effects of systemic factors in response to intravitreal injections in patients with macular edema due to non-proliferative diabetic retinopathy (NPDR).

METHODS

We retrospectively reviewed the medical records of patients treated with intravitreal injections for macular edema secondary to NPDR between January 2018 and January 2021. The patients were divided into three groups according to the injection response. When patients with diabetic macular edema showed 20µ or more reduction in central retinal thickness compared to baseline, they were classified as responsive group, and if not, they were classified as refractory group. The responsive group was further divided into the complete and incomplete response groups. Patients with complete disappearance of edema at seven months were classified as the complete response group, whereas those in which edema did not disappear were classified as the incomplete response group. The clinical characteristics of each group, including medical history, ophthalmic examination results, and laboratory examination results at the time of diagnosis, were analyzed.

RESULTS

Of the 112 eyes (91 patients) that satisfied the inclusion criteria, 89 (77 patients) in the responsive group and 23 (14 patients) in the refractory group were included in the analysis. The responsive group was further divided into the complete (51 eyes) and incomplete (38 eyes) response groups. The refractory group had significantly higher glycated hemoglobin levels and significantly lower estimated glomerular filtration rates than the responsive group (p = 0.026 and p = 0.012, respectively). In the multivariate logistic regression analysis, both factors were found to be significant in predicting the degree of response (all p < 0.05). No factor showed a significant difference between the incomplete and complete response groups(all p > 0.05).

CONCLUSIONS

In macular edema caused by NPDR, low glomerular filtration rates and high glycated hemoglobin levels may be used as predictors of poor response to intravitreal injection therapy. In addition to blood glucose control, education should be provided regarding the need for the continuous monitoring of renal function.

Phenome- and genome-wide analyses of retinal optical coherence tomography images identify links between ocular and systemic health

The human retina is a multilayered tissue that offers a unique window into systemic health. Optical coherence tomography (OCT) is widely used in eye care and allows the noninvasive, rapid capture of retinal anatomy in exquisite detail. We conducted genotypic and phenotypic analyses of retinal layer thicknesses using macular OCT images from 44,823 UK Biobank participants. We performed OCT layer cross-phenotype association analyses (OCT-XWAS), associating retinal thicknesses with 1866 incident conditions (median 10-year follow-up) and 88 quantitative traits and blood biomarkers. We performed genome-wide association studies (GWASs), identifying inherited genetic markers that influence retinal layer thicknesses and replicated our associations among the LIFE-Adult Study (N = 6313). Last, we performed a comparative analysis of phenome- and genome-wide associations to identify putative causal links between retinal layer thicknesses and both ocular and systemic conditions. Independent associations with incident mortality were detected for thinner photoreceptor segments (PSs) and, separately, ganglion cell complex layers. Phenotypic associations were detected between thinner retinal layers and ocular, neuropsychiatric, cardiometabolic, and pulmonary conditions. A GWAS of retinal layer thicknesses yielded 259 unique loci. Consistency between epidemiologic and genetic associations suggested links between a thinner retinal nerve fiber layer with glaucoma, thinner PS with age-related macular degeneration, and poor cardiometabolic and pulmonary function with a thinner PS. In conclusion, we identified multiple inherited genetic loci and acquired systemic cardio-metabolic-pulmonary conditions associated with thinner retinal layers and identify retinal layers wherein thinning is predictive of future ocular and systemic conditions.

The Haemodialysis Session Effect on the Choroidal Thickness and Retinal and Choroidal Microcirculation-A Literature Review

Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation.

Impact of Hemodialysis on Subfoveal Choroidal Thickness Measured by Optical Coherence Tomography: A Systematic Review and a Pooled Analysis of Self-Controlled Case Series

INTRODUCTION

Hemodialysis (HD) has various effects on the body, including optimizing body fluid composition and volume, which may have an impact on subfoveal choroidal thickness (SCT) in individuals with end-stage kidney disease (ESKD). However, previous studies have produced conflicting results regarding the effect of HD on SCT in patients with ESKD. Therefore, we conducted a meta-analysis to investigate the influence of HD on SCT.

METHODS

A comprehensive search of relevant studies and bibliographies was conducted using Embase, PubMed, and Web of Science databases up to September 2022. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to summarize the SCT change. Heterogeneity and publication bias were assessed, and a random-effects model was employed for the meta-analysis. Subgroup analyses were also performed to evaluate the influence of factors such as diabetes mellitus (DM), the severity of diabetic retinopathy (DR), diurnal variation adjustment, optical coherence tomography (OCT) types, and OCT scan modes.

RESULTS

A total of 15 studies involving 1010 eyes were eligible for this meta-analysis, including 552 diabetic eyes, 230 non-diabetic eyes, and the remaining 228 eyes were uncategorized. The meta-analysis revealed a significant reduction in SCT after HD (WMD = -13.66 μm; 95% CI -24.29 to -3.03 μm; z = -5.115, P < 0.0001). Subgroup analysis indicated a significant difference between the DM and non-DM groups (WMD = -24.10 μm vs. -15.37 μm, 95% CI -27.39 to -20.80 μm vs. -19.07 to -11.66 μm; P = 0.001). Additionally, the group with proliferative diabetic retinopathy (PDR) exhibited a more pronounced reduction in SCT (WMD =  -28.66 μm; 95% CI -37.10 to -20.23; z = -6.660, P < 0.0001). Adjusting for diurnal variation, different types or scan modes of OCT did not significantly affect the results.

CONCLUSION

HD leads to a significant decrease in SCT among patients with ESKD, especially in patients with DM with PDR.

Insights into human health from phenome- and genome-wide analyses of UK Biobank retinal optical coherence tomography phenotypes

The human retina is a complex multi-layered tissue which offers a unique window into systemic health and disease. Optical coherence tomography (OCT) is widely used in eye care and allows the non-invasive, rapid capture of retinal measurements in exquisite detail. We conducted genome- and phenome-wide analyses of retinal layer thicknesses using macular OCT images from 44,823 UK Biobank participants. We performed phenome-wide association analyses, associating retinal thicknesses with 1,866 incident ICD-based conditions (median 10-year follow-up) and 88 quantitative traits and blood biomarkers. We performed genome-wide association analyses, identifying inherited genetic markers which influence the retina, and replicated our associations among 6,313 individuals from the LIFE-Adult Study. And lastly, we performed comparative association of phenome- and genome- wide associations to identify putative causal links between systemic conditions, retinal layer thicknesses, and ocular disease. Independent associations with incident mortality were detected for photoreceptor thinning and ganglion cell complex thinning. Significant phenotypic associations were detected between retinal layer thinning and ocular, neuropsychiatric, cardiometabolic and pulmonary conditions. Genome-wide association of retinal layer thicknesses yielded 259 loci. Consistency between epidemiologic and genetic associations suggested putative causal links between thinning of the retinal nerve fiber layer with glaucoma, photoreceptor segment with AMD, as well as poor cardiometabolic and pulmonary function with PS thinning, among other findings. In conclusion, retinal layer thinning predicts risk of future ocular and systemic disease. Furthermore, systemic cardio-metabolic-pulmonary conditions promote retinal thinning. Retinal imaging biomarkers, integrated into electronic health records, may inform risk prediction and potential therapeutic strategies.

Correlation Between Imaging Morphological Findings and Laboratory Biomarkers in Patients with Retinal Vein Occlusion

INTRODUCTION

The aim of this study was to investigate the possible correlation between peripheral blood biomarkers and morphological characteristics of retinal imaging in patients with retinal vein occlusion (RVO).

METHODS

Participants in this cross-sectional observational study were 65 consecutive patients (65 eyes) with treatment-naïve RVO, who underwent spectral-domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA). In addition, peripheral blood samples were taken to evaluate full blood count and biochemical parameters. The association between imaging characteristics and laboratory parameters was examined.

RESULTS

Eyes with subretinal fluid presented significantly higher neutrophil-to-lymphocyte ratios (p = 0.028). Hyperreflective foci on SD-OCT were found to be associated with higher triglyceride levels (p = 0.024). The presence of cysts on SD-OCT was associated with significantly higher triglycerides (p = 0.010). Central subfield thickness (CST) higher than 464 μm was associated with higher lymphocyte count (p = 0.016) and higher urea (p = 0.015). No significant associations were found between laboratory parameters and intraretinal fluid, ellipsoid zone and external limiting membrane condition, or epiretinal membrane and macular ischemia.

CONCLUSIONS

Specific imaging morphological characteristics were found to be associated with laboratory parameters in patients with RVO. These findings may help reveal the pathophysiology of RVO and its correlation with the development of specific clinical signs, while they could guide individualized treatment.

Preliminary Study of Different Treatment Responses between Bevacizumab, Aflibercept and Dexamethasone Implant According to Renal Function in Diabetic Macular Edema Patients

Background: The purpose of this study was to investigate the association between responses to intravitreal bevacizumab injection and renal function in diabetic macular edema (DME) patients. Methods: A retrospective study of the medical records of 104 treatment-naïve DME patients who received intravitreal bevacizumab injection (IVBI) was conducted. Based on the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2), the participants were classified into three groups. Intergroup comparisons of the best-corrected visual acuity (BCVA) and central subfield retinal thickness (CST) changes were performed after three-monthly consecutive IVBIs. In the groups with decreased renal function, the response to further treatment with a different drug was investigated. Results: A total of 104 participants were included in the study: 60 participants in the preserved renal function group (eGFR ≥ 60), 25 participants in the moderate chronic kidney disease (CKD) group (30 ≤ eGFR < 60), and 19 participants in the severe CKD group (eGFR < 30). After three-monthly consecutive IVBIs, BCVA (p < 0.001) and CST (p < 0.001) were significantly improved only in the preserved renal function group. Following further treatment of patients with decreased renal function, the treatment results were significantly better in those who were switched to aflibercept or dexamethasone implant than in those who were maintained on IVBI. Conclusions: From this preliminary study, we observed that renal function might affect the response to IVBI treatment in patients with DME. In the case of a poor response to initial IVBI treatment for DME in patients with moderate to severe CKD, our study supports switching to the aflibercept or dexamethasone implant.

The effect of hemodialysis on macular thickness

Introduction/Objective. During hemodialysis (HD) treatment great fluctuations were recorded in the systemic hemodynamic parameters and in the volume and composition of ocular fluid. There are only a few studies that analyzed the effect of HD on retinal and macular thickness with conflicting results. Objective of this study was to determine macular thickness, marked as central foveal thickness, average macular thickness and macular volume, shortly before and after HD. Methods. Prospective study of 30 chronic renal failure (CRF) patients on HD treatment. Thorough ophthalmologic examinations were performed including evaluation of best corrected visual acuity, intraocular pressure and slit-lamp examination of all eye segments. Macular thickness was determined by optical coherence tomography shortly before and after HD. The next parameters were evaluated: central foveal thickness, average macular thickness and macular volume. The correlation between systemic parameters and macular thickness changes during HD was tested. Results. There were significant changes in body weight and blood pressure pre- and post-HD. Results showed macular thickness (central foveal thickness, average macular thickness and macular volume) decreased, but the change was not significant. There was no significant correlation between systemic hemodynamic parameters and macular thickness changes. Conclusion. Results of this study showed there was no statistically significant changes in macular thickness CRF patient undergoing HD. Further research on a larger group of patients and a longer follow-up time are required to confirm these findings.

Visual/anatomical outcome of diabetic macular edema patients lost to follow-up for more than 1 year

To investigate the visual/anatomical outcome of diabetic macular edema (DME) patients lost to follow-up (LTFU) for more than 1 year during intravitreal anti-VEGF treatment. A retrospective review of 182 treatment-naïve DME patients was performed. Among them, we identified patients LTFU for more than 1 year during anti-VEGF treatment. Visual acuity and anatomic outcomes at the first visit, last visit before being LTFU, return visit, and after re-treatment were analyzed and compared with those of DME patients with regular follow-up. Patients who had continuous follow-up visits were assigned to the control group. Sixty patients (33%) with DME were LTFU for more than 1 year during anti-VEGF treatment. Multivariate analysis revealed that the ratio of male (p = 0.004), diabetes mellitus (DM) duration less than 5 years (p = 0.015), and poor early anatomic response (p = 0.012) were higher compared to the control group. Eighteen patients returned to the clinic and received re-treatment. After re-treatment with anti-VEGF, central subfield thickness (CST) was significantly improved to the CST of before LTFU. However, visual acuity did not recover to the level before LTFU (0.63 ± 0.26 vs. 0.45 ± 0.28, p = 0.003). About thirty percent of DME patients were LTFU for more than 1 year. Permanent visual loss was observed in these LTFU patients. Patients with a high risk of LTFU such as male, early DM, and poor response after initial injections should be treated more aggressively to improve the visual outcomes.

SYSTEMIC FACTORS AND EARLY TREATMENT RESPONSE TO INTRAVITREAL INJECTION FOR DIABETIC MACULAR EDEMA: The Role of Renal Function

PURPOSE

To investigate the effect of systemic factors on early treatment response to intravitreal bevacizumab injection (IVBI) and intravitreal dexamethasone implant (IVDI) in patients with diabetic macular edema (DME).

METHODS

We reviewed the medical records of 117 treatment naïve DME patients who underwent IVBI. We divided the patients according to their IVBI response. An IVDI was performed in patients with poor response to IVBIs. We investigated the various systemic factors of diabetic patients and examined the relationship between systemic factors and the treatment response to IVBI and IVDI.

RESULTS

In a total of 117 treatment naïve DME eyes, 61 eyes (52.14%) were classified as IVBI responders. An IVDI was performed in 23 of 56 eyes with poor response to IVBI, and 17 eyes (73.91%) had a good response. Among various systemic factors of patients with diabetes, renal function (blood urea nitrogen, creatinine, and estimated glomerular filtration rate) showed a significant negative correlation with central subfield retinal thickness improvement after treatment (P < 0.05). However, there was no difference in HbA1C levels regarding the treatment response to IVBI and IVDI.

CONCLUSION

Renal function was significantly worse in patients with a poor response to IVBI and IVDI. Renal function could be used as a possible predictor for treatment response in certain patients with DME. Furthermore, for patients with DME with poor responses to anti-vascular endothelial growth factor or steroid treatments, assessment of renal function could help explain the poor treatment response.

Incidence of Paradoxical Neurosensory Detachment in Diabetic Eyes Undergoing Hemodialysis for End-Stage Renal Disease

Introduction

Ocular fluid dynamics are known to improve during hemodialysis, and the improvement of uremia after dialysis may lead to osmotic pressure changes in the retina, which eventually affect retinal edema. Recent studies using optical coherence tomography (OCT) to assess the effect of hemodialysis on macular thickness have shown variable results with a majority of them finding a decrease in retinal thickness. Paradoxical neurosensory retinal detachment (NSD) may be defined as the accumulation of subretinal fluid under the macula in patients who are on continuous HD. The purpose of the study was to find out the incidence of paradoxical neurosensory detachment in diabetic eyes undergoing hemodialysis (HD) and its management.

Methods

This was a cross-sectional, prospective study involving end-stage renal disease (ESRD) patients secondary to diabetes. This study evaluated the changes in macular thickness in diabetic retinopathy patients with and without diabetic macular edema (DME) by spectral-domain optical coherence tomography (SD-OCT) 60 minutes before and after HD for ESRD.

Results

Sixty-three eyes (36 patients) were included, with a mean age of 58.2±9.8 years. Seven eyes had paradoxical NSD at presentation with an incidence of 11.11%. Eyes with DME (Group A) showed a significant reduction in central macular thickness (CMT) by 28±2μm post HD, compared to eyes without DME (Group B) where CMT decreased by 15±2μm (p=0.003). Massive subretinal fluid accumulation (paradoxical NSD) with mean CMT 675.57±69.41μm recovered to 250.71±46.79μm at the final follow-up. Five eyes underwent an intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) to achieve the resolution of SRF, whereas two eyes improved spontaneously by nine months.

Conclusion

Hemodialysis results in a decrease of macular thickness in diabetic eyes with or without DME. Paradoxical neurosensory detachment can develop in eyes of patients undergoing HD chronically. Intravitreal dexamethasone implant (DEX-I, Ozurdex; Allergan, Dublin, Ireland) results in early amelioration of such a complication.

Evaluation of the reasons for the microvascular changes in patients with Fabry disease using optic coherence tomography angiography

PURPOSE

To investigate the blood flow changes in the choriocapillaris and the superficial and deep capillary plexus of the retina using optic coherence tomography angiography (OCTA) in patients with Fabry disease (FD) and reveal any possible association of these changes with the systemic findings.

METHODS

This cross-sectional study included 38 patients with FD and age- and gender-matched 40 healthy controls. OCTA images were obtained from all patients. Superficial (sCVD) and deep capillary vascular density (dCVD) in the foveal, parafoveal, and perifoveal zones and the whole image were recorded for each patient. Flow area in the choriocapillaris and central macular thickness (CMT) were also recorded.

RESULTS

Patients with FD showed a lower whole image (54.45 ± 5.99% vs 57.32 ± 6.71%, p = 0.004), foveal (34.94 ± 7.60% vs 39.65 ± 7.03%, p = 0.003), parafoveal (57.41 ± 4.85% vs 59.19 ± 4.67%, p = 0.043), and perifoveal (55.87 ± 6.43% vs 58.87 ± 7.02%, p = 0.003) dCVD compared to the healthy controls without a significant difference in the sCVD and choriocapillaris blood flow (p > 0.05). A significantly lower whole image and foveal dCVD in the FD patients with renal involvement was observed compared to the healthy controls (p = 0.027 and p = 0.024, respectively) without any significant difference between the FD patients without renal involvement and healthy controls (p = 0.17 and p = 0.13, respectively). CMT was significantly higher in FD patients with renal involvement compared to the ones without renal involvement (252.1 ± 18.5 µm vs 235.5 ± 17.6 µm, p = 0.016).

CONCLUSION

Patients with FD showed a lower dCVD without any change in sCVD and choriocapillaris compared to the healthy controls. This decrease was associated mostly with the renal involvement and duration of treatment.

Choroidal Thickness in Diabetes and Diabetic Retinopathy: A Swept Source OCT Study

Purpose

Previous studies on the association between choroidal thickness (CT) and severity of diabetic retinopathy (DR) gave conflicting results. The aim of this study was to evaluate the CT changes in diabetic patients and associated factors in a large sample of Chinese patients with diabetes.

Methods

Type 2 diabetes mellitus patients without history of ocular treatment were recruited from the community health system in Guangzhou, China. The swept source OCT instrument was used to obtain high-definition retina and choroid images. The diabetic retinopathy (DR) status was graded based on the guidelines of the United Kingdom National Diabetic Eye Screening Programme. Univariate and multivariate linear regression analyses was used to explore the association of CT with DR severity, diabetic macular edema (DME), hemoglobin A1c, and vision function.

Results

A total of 1347 patients were included in the final analysis. After adjusting for other factors, the patients with stage R3 DR had significantly thinner CT (β = –29.1 µm, 95% CI –53.8 to –4.4, P = 0.021) in comparison in those with R0. After adjusting for other factors, the CTs were thicker than those in R0 patients with difference of 15.6 µm (95% CI 4.3-26.9, P = 0.007) for outer nasal sector, 15.7 µm (95% CI 3.8-25.5, P = 0.008) for outer inferior, and 12.2 µm (95% CI 0.4-24.0, P = 0.042) for inner inferior sector. The presence of DME and hemoglobin A1c levels did not significantly affect average CT. Higher average CT was significantly associated with better best corrected visual acuity, with a –0.02 LogMAR unit per 100 µm increase in average CT (95% CI –0.03 to –0.01, P < 0.001).

Conclusions

CT increased in the early stage of DR, and further decreased with DR progression. DME was not significantly associated with CT. These findings provide more clues to suggest that choroid alterations play a role in the pathogenesis of DR.

Relationship between Clinical Features of Diabetic Retinopathy and Systemic Factors in Patients with Newly Diagnosed Type II Diabetes Mellitus

BACKGROUND

We investigated the relationship between clinical features of diabetic retinopathy (DR) and systemic factors in patients with newly diagnosed type II diabetes mellitus (T2DM).

METHODS

Retrospective review of newly diagnosed T2DM-patients who underwent complete ophthalmic examinations at the time of T2DM diagnosis were conducted. We reviewed DM related systemic factor data and investigated systemic factors related to the presence of DR at T2DM diagnosis. In DR patients, the relationship between DR severity and systemic factors was analyzed.

RESULTS

Of 380 patients, forty (10.53%) patients had DR at the initial ophthalmologic examination. Glycated hemoglobin (HbA_1C), fasting plasma glucose (FPG), urine albumin to creatinine ratio (UACR), and urine microalbumin level were significantly higher in DR patients than in patients without DR. In the multivariate logistic regression analysis, high HbA_1C was a significant risk factor for the presence of DR at new T2DM diagnosis (odds ratio, 2.372; P < 0.001). HbA_1C, FPG, UACR, and urine microalbumin level showed significantly positive correlations with DR severity .

CONCLUSION

In patients with newly diagnosed T2DM, 10.53% have DR at initial ophthalmologic examination and high HbA_1C, FPG, UACR and urine microalbumin levels. These factors are significantly positively correlated with DR severity. Therefore, more careful fundus examination is needed for newly diagnosed T2DM patients with high HbA_1C, FPG, UACR, and urine microalbumin levels.

Analysis of risk factors for progressive fibrovascular proliferation in proliferative diabetic retinopathy

PURPOSE

To investigate the risk factors associated with progressive fibrovascular proliferation (FVP) in proliferative diabetic retinopathy (PDR).

METHODS

We retrospectively reviewed the clinical data of patients who underwent pars plana vitrectomy for PDR between August 2017 and October 2019 at our department of ophthalmology. The FVP was divided into five grades based on the coverage area of proliferative membrane. Then we compared the patients with different severities of FVP to analyze the risk factors for higher grade of FVP in PDR.

RESULTS

Univariate analysis showed that positive urinary protein (p = 0.007), higher levels of serum blood urea nitrogen (BUN) (p < 0.001) and serum creatinine (p < 0.001), more severe stage of estimated glomerular filtration rate (p < 0.001), age < 45 years (p = 0.005), longer duration of diabetic retinopathy (p = 0.007), history of hypertension (p = 0.034) and smoking (p = 0.008) were related to FVP grade ≥ 3. Multivariate analysis showed that the level of BUN, age < 45 years and smoking were independent risk factors for FVP grade ≥ 3 in PDR patients.

CONCLUSION

This study demonstrated that BUN (odds ratio [OR] = 1.318, 95% confidence interval [CI] = 1.150-1.511, p < 0.001), age ≤ 45 years (OR = 3.774, 95% CI = 1.762-8.082, p = 0.001) and smoking (OR = 2.111, 95% CI = 1.040-4.288, p = 0.039) were independent risk factors for progressive FVP in PDR among northeastern Chinese patients.

Functional and anatomical changes in diabetic macular edema after hemodialysis initiation: One-year follow-up multicenter study

Diabetic nephropathy and retinopathy (DR) including diabetic macular edema (DME) are representative microvascular complications of diabetes. We conducted a retrospective multicenter study analyzing records from patients with DR (132 eyes in 70 patients) and end-stage renal diseases (ESRD) who underwent hemodialysis for the first time. We demonstrated that the central retinal thickness (CRT) values were significantly decreased (p < 0.0001), and the best-corrected visual acuity (BCVA) values were improved (p < 0.05) at 1, 3, 6, 9, and 12 months after hemodialysis initiation, in spite of a lack of specific ocular treatments for DME in 93.2% of eyes. We found a significant positive correlation in the rates of CRT changes between right and left eyes. The CRT reductions were greater in eyes with DME type subretinal detachment than in those with spongelike swelling and cystoid macular edema. The visual outcome gain was associated with the CRT reduction at 12 months in the eyes with good initial BCVA (≧20/50). Hemodialysis induction contributed to functional and anatomical improvements after 1 year, independently of initial laboratory values before the hemodialysis.

Relationship between diabetic macular edema and choroidal layer thickness

Purpose

To investigate the relationship between diabetic macular edema (DME) and the choroidal layer thickness in diabetic patients.

Methods

This is a retrospective observation study. Three hundred eighteen eyes of 159 diabetes mellitus (DM) patients and age-matched 100 eyes of 79 healthy controls were enrolled. DME was defined as over 300 μm in the central retinal subfield of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid sector. The central choroidal thickness (CCT), as well as inner and outer layers were determined based on enhanced depth imaging (EDI)–OCT. Diabetic patients with/without systemic diabetic treatments (DT) at the start of this study was defined as DT+ and DT–, respectively. The number of eyes examined was 62 and 256 eyes in DME+and DME–groups, respectively. DM patients were further subdivided into 4 groups with/without DME and DT; DME+DT+(35 eyes), DME–DT+(159 eyes), DME+DT–(27 eyes), and DME–DT–group (97 eyes). Multiple comparisons on CCT layers including control and each DM group were statistically examined.

Results

The total CCT layer was 254±83, 283±88, and 251±70 μm in the control, DME+, and DME–group, respectively. A total CCT layer in DME+was significantly thicker than the DME–group (P < 0.05). The outer CCT layer was 195±75, 222±83, and 193±63 μm in the control, DME+, and DME–group, respectively. The outer CCT layer in DME+ was significantly thicker than the DME–group (P < 0.05). In the subdivided groups, the total CCT layers in the control, DME+DT+, DME–DT+, DME+DT–and DME–DT–groups were 254±83, 274±88, 247±66, 290±84 and 258±75 μm, respectively. The outer CCT layers in each group were 195±75, 214±83, 189±58, 228±77, and 201±70 μm, respectively. Total CCT and the outer layer in DME+DT–was significantly thicker than the DME–DT+group (each P < 0.05). In contrast, there was no significant difference in inner layer between the groups.

Conclusions

The total and outer CCT layers of diabetic eyes were significantly thickened in the DME+DT–as compared with the DME–DT+group, suggesting that CCT may be related to the pathology of DME.