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.

FLAT IRREGULAR PIGMENT EPITHELIUM DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY: A Form of Pachychoroid Neovasculopathy?

PURPOSE: To investigate the differences in natural course, intravitreal bevacizumab injection (IVB) responsiveness, and optical coherence tomography angiography findings according to the type of pigment epithelial detachment (PED) in patients with central serous chorioretinopathy (CSC). METHODS: A retrospective review of angiographically proven CSC patients was conducted. Pigment epithelium detachment was classified as flat irregular or focal. To identify the natural course of CSC, we had observed whether subretinal fluid was improved without any treatment until symptom duration was >3 months. When CSC symptom duration was >3 months, IVB injection was performed. Symptom duration, central subfield thickness, subfoveal choroidal thickness, presence of subretinal fluid, natural course, optical coherence tomography angiography findings, and IVB responsiveness were compared between the PED types. RESULTS: One hundred eyes were included (64 flat irregular PED vs. 34 focal PED). Flat irregular PED had a longer symptom duration than focal PED (7.20 ± 11.52 vs. 3.69 ± 3.98 months, P = 0.03). In untreated cases, the rate of complete resolution of subretinal fluid was significantly lower in flat irregular PED than in focal PED (34.78% vs. 65.22%, P = 0.017). In contrast to the natural course, responsiveness to IVB was significantly better in flat irregular PED (72.41% vs. 31.58%, P = 0.005). Optical coherence tomography angiography revealed more CNV in flat irregular PED (42.90% vs. 10.00%, P = 0.014). Subfoveal choroidal thickness in flat irregular PED was significantly thicker. CONCLUSION: In CSC patients with flat irregular PED, the natural course was poor, but treatment response to IVB was favorable. Flat irregular PED patients showed longer symptom duration and thicker subfoveal choroidal thickness than those with focal PED. Optical coherence tomography angiography revealed more choroidal neovascularization in flat irregular PED. These findings suggest that CSC with flat irregular PED could be considered a form of pachychoroid neovasculopathy.

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 (HbA1C), 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 HbA1C was a significant risk factor for the presence of DR at new T2DM diagnosis (odds ratio, 2.372; P < 0.001). HbA1C, 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 HbA1C, 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 HbA1C, FPG, UACR, and urine microalbumin levels.

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

PURPOSE: To investigate the spectral domain optical coherence tomography findings before and after dialysis in patients with diabetic end-stage renal disease undergoing dialysis for the first time. METHODS: A retrospective medical review of patients with diabetic end-stage renal disease who recently started dialysis was conducted. Spectral domain optical coherence tomography findings before and after initiation of dialysis were analyzed. Systemic blood pressure, body weight, estimated glomerular filtration rate, and serum levels of blood urea nitrogen, creatinine (Cr), albumin, hemoglobin (Hb), and total CO2 were measured before and 1 month after starting dialysis. The correlations between the changes in these variables and the degree of decrease of the central subfield thickness after initiation of dialysis were analyzed. RESULTS: A total 26 eyes from 15 patients were included. Among them, 14 started hemodialysis, and 1 started peritoneal dialysis. After initiation of dialysis, the incidence of any macular edema significantly decreased from 69.2% (18/26) to 26.9% (7/26) (P = 0.001). The central subfield thickness (317.92 ± 91.41 vs. 287.77 ± 57.55 µm, P = 0.006) and subfoveal choroidal thickness (313.31 ± 85.89 vs. 288.81 ± 92.02; P = 0.024) also significantly decreased. Improvement in blood urea nitrogen, Cr, Hb, and total CO2 levels in serum and estimated glomerular filtration rate was observed. A significant positive correlation between the amount of central subfield thickness decrease and the decrease in serum blood urea nitrogen was found (Pearson correlation coefficient: 0.481, P = 0.013). CONCLUSION: Macular edema and central subfield thickness significantly decreased after initiation of dialysis in patients with diabetic chronic renal failure without any ocular treatment. This may be related to the improvement in uremia and volume overload after the initiation of dialysis.

The Association between the Frequency of Rhegmatogenous Retinal Detachment and Atmospheric Temperature.

Rhegmatogenous retinal detachment (RRD) frequency was observed to be higher with an increase in the daily temperature range. This showed that a wide daily range of temperature, rather than the absolute value of the temperature, is associated with the occurrence of RRD. Purpose. To investigate the association between the frequency of rhegmatogenous retinal detachment (RRD) and the atmospheric temperature. Method. A retrospective review of consecutive eyes that had undergone primary RRD surgery from 1996 to 2016 at Chungbuk National University Hospital was conducted. Temperature data (highest, lowest, and mean daily temperatures and daily temperature range) in Chungbuk Province were obtained from the Korean Meteorological Administration database. We investigated the relationship between the daily temperature range and the frequency of RRD surgery. We also analyzed the association between various temperature data and the frequency of RRD surgery. Result. There were 1,394 RRD surgeries from 1996 to 2016. Among them, 974 eyes were included in this study. The monthly average number of RRD operations showed a bimodal peak (in April and October) throughout the year. With the same tendency as the frequency of RRD, the monthly average of the daily temperature range over 1 year also showed a bimodal peak in April and October. There was a significant positive correlation between the monthly average of the daily temperature range and the number of RRD surgeries (r = 0.297, P < 0.001). However, there were no associations between RRD frequency and the mean temperature, highest temperature, and lowest temperature. Conclusion. The higher the daily temperature range, the higher was the RRD frequency observed. We speculated that dynamic changes in temperature during the day may affect degrees in chorioretinal adhesion and liquefaction of the vitreous, which may eventually result in retinal detachment. Therefore, further experimental studies on the correlation between temperature changes and retinal detachment are needed.