RESUMO
GLP-1 receptor agonist treatment revolutionised the management of type 2 diabetes mellitus with significant enhancement of cardiovascular risk reduction. They have been instrumental in effectively managing the glycaemic control of this at-risk patient group. This class of drugs are associated with rapid improvement in glucose levels and consequently, transient early worsening of pre-existing diabetic retinopathy (DR) which is well-recognised, but this paradox is less commonly perceived in routine clinical practice. The recent shortage of supply has resulted in an enforced hiatus to prescribing all existing GLP-1 receptor agonists, which is expected to last all through 2024. This becomes even more pertinent as their DR could have progressed due to worsening HbA1c as a result of the unforeseen interruption to GLP-1 receptor agonist treatment. Therefore, when these medications are recommenced in a few months' time, all prescribers need to be aware of these patients' most up-to-date DR status and liaise with their affiliated screening service.
Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Receptor do Peptídeo Semelhante ao Glucagon 1 , Hipoglicemiantes , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/diagnóstico , Humanos , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Hipoglicemiantes/uso terapêutico , Programas de Rastreamento/métodos , Hemoglobinas Glicadas/análise , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Exenatida/uso terapêutico , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Liraglutida/uso terapêutico , Proteínas Recombinantes de FusãoRESUMO
Diabetic retinopathy and nephropathy share pathophysiological mechanisms and there is a defined correlation between the severity of both these microvascular complications from suboptimal glycaemic control. The reno-protective properties offered by sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists should be applicable to diabetic retinopathy as well. However, in patients with pre-existing diabetic retinopathy, sudden improvement in glycaemic control is well documented to cause early worsening of the changes in the retina that is usually transient. This paradoxical phenomenon tends to occur with longer duration of diabetes, higher HbA1c at the outset, rapid improvement of glucose levels and the magnitude of HbA1c reduction with addition of more agents to tighten metabolic control. Interestingly, this progression of pre-existing diabetic retinopathy is not quite observed with newer sodium-glucose co-transporter-2 inhibitors. This article discusses potential further areas of future research where mechanisms of renal protection can be translated to the retina.
Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Retinopatia Diabética , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/prevenção & controle , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêuticoAssuntos
Cirurgia Bariátrica , Retinopatia Diabética , Obesidade Mórbida , Humanos , Retinopatia Diabética/etiologia , Retinopatia Diabética/diagnóstico , Cirurgia Bariátrica/efeitos adversos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Diabetes Mellitus Tipo 2/complicações , FemininoAssuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Inibidores do Transportador 2 de Sódio-Glicose , Simportadores , Humanos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucose , Peptídeo 1 Semelhante ao Glucagon , SódioRESUMO
OBJECTIVE: To assess the incidence of referable diabetic retinopathy (DR) in patients aged 80 and 85 years to determine whether screening interval can be extended safely in this age group. METHODS: Patients who were aged 80 and 85 years when they attended digital screening during April 2014-March 2015 were included. Screening results at baseline and over the next four years were analysed. RESULTS: 1880 patients aged 80 and 1105 patients aged 85 were included. Patients referred to hospital eye service (HES) for DR ranged from 0.7% to 1.4% in the 80-year-old cohort over 5 years. In this cohort a total of 76 (4%) were referred to HES for DR, of which 11 (0.6%) received treatment. Over the course of the follow up (FU), 403 (21%) died. In the 85-year-old cohort, referral to HES for DR each year ranged from 0.1% to 1.3%. In this cohort a total of 27 (2.4%) were referred to HES for DR, of which 4 (0.4%) received treatment. Over the course of follow-up 541(49%) died. All treated cases were for maculopathy in both cohorts and there were no cases of proliferative diabetic retinopathy requiring treatment. CONCLUSION: This study showed that the risk of progression of retinopathy is quite low in this age group and only a small proportion of patients developed referable retinopathy requiring treatment. This suggests relooking at the need for screening and ideal screening intervals in patients aged 80 years and over with no referable DR as they can be potentially classed as a group with low risk of sight loss.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Degeneração Macular , Doenças Retinianas , Humanos , Idoso de 80 Anos ou mais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Programas de Rastreamento/métodos , IncidênciaRESUMO
Aim: We aimed to create a collaborative data sharing project between two NHS trusts to improve attendance and access to diabetic retinopathy screening in individuals with severe mental illness (SMI). Methods: The eligible patient lists were analysed before and after interventions to assess their effectiveness over two data runs. Results: Screening attendance rates increased by 31% and 25% in the data runs; a significant number of patients (15%) who were screened required onward referral to hospital eye services. Patient registrations increased from 35% to 86% for previously not registered individuals. Inpatients were around 50% more likely to get screened and registered than community patients. Conclusion: Information sharing and collaborative working between services can improve patient health outcomes, increasing the number of eligible individuals with SMI registered and improving attendance. The project shows the potential for future data sharing collaborations, highlighting the need for further improvement, development and investment.
RESUMO
BACKGROUND: To report a case of metastatic hepatocholangiocarcinoma to the vitreous and retina. CASE PRESENTATION: A 70-year-old male, who was recently diagnosed with hepatocholangiocarcinoma, was complaining of floaters in his right eye over the past 5 months and was referred to the Liverpool Ocular Oncology Centre. On presentation, his visual acuity in the right eye was 6/24. Fundus exam revealed a whitish, unilateral, full-thickness retinal lesion at the inferotemporal arcade of his right eye, with vitreous infiltration and subretinal fluid. The patient underwent 25G pars plana vitrectomy with biopsy, resection of the lesion and intravitreal bevacizumab injection. Histopathology testing of the surgical specimens confirmed the diagnosis of metastatic carcinoma to the eye. Two months postoperatively his visual acuity had improved to 6/7.5 and there was no sign of active disease in his right eye, while 9 months postoperatively his visual acuity decreased to 6/9.5 due to developing nuclear sclerotic cataract in his right eye. CONCLUSION: The current report presents the first case of a hepatocholangiocarcinoma metastasis to the vitreous and retina.
Assuntos
Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/secundário , Corpo Vítreo/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/metabolismo , Biópsia , Colangiocarcinoma/metabolismo , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Neoplasias da Retina/terapia , Tomografia Computadorizada por Raios X , VitrectomiaAssuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Dexametasona/efeitos adversos , Implantes de Medicamento , Substituição de Medicamentos , Glucocorticoides/efeitos adversos , Humanos , Injeções Intravítreas , Edema Macular/etiologia , Edema Macular/fisiopatologia , Ranibizumab/uso terapêutico , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To investigate the coexistence of ocular microvascular and systemic macrovascular abnormalities in early stage, newly diagnosed and previously untreated normal tension glaucoma patients (NTG). METHODS: Retinal vascular reactivity to flickering light was assessed in 19 NTG and 28 age-matched controls by means of dynamic retinal vessel analysis (IMEDOS GmbH, Jena, Germany). Using a newly developed computational model, the entire dynamic vascular response profile to flicker light was imaged and used for analysis. In addition, assessments of carotid intima-media thickness (IMT) and pulse wave analysis (PWA) were conducted on all participants, along with blood pressure (BP) measurements and blood analyses for lipid metabolism markers. RESULTS: Patients with NTG demonstrated an increased right and left carotid IMT (p = 0.015, p = 0.045) and an elevated PWA augmentation index (p = 0.017) in comparison with healthy controls, along with an enhanced retinal arterial constriction response (p = 0.028), a steeper retinal arterial constriction slope (p = 0.031) and a reduced retinal venous dilation response (p = 0.026) following flicker light stimulation. CONCLUSIONS: Early stage, newly diagnosed, NTG patients showed signs of subclinical vascular abnormalities at both macro- and micro-vascular levels, highlighting the need to consider multi-level circulation-related pathologies in the development and progression of this type of glaucoma.