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1.
Automatic Parallel Detection of Neovascularization from Retinal Images Using Ensemble of Extreme Learning Machine.
Huang, H, Ma, H, Qian, W
Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference. 2019;:4712-4716
Abstract
Retinopathy screening is a non-invasive method to collect retinal images and neovascularization detection from retinal images plays a significant role on the identification and classification of diabetes retinopathy. In this paper, an automatic parallel detection framework for neovascularization with color retinal images using ensemble of extreme learning machine is proposed. The framework employs two Map-Reduce Jobs to extract features and trains Extreme Learning Machine models. Ensemble methods such as bagging, subspace partitioning and cross validating are used to increase the accuracy. The framework is evaluated with retinal images from MESSIDOR database. Experimental results show the framework can improve the detection accuracy, as well as speedup the processing time to 22 times on average.
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2.
First-in-human study of the safety, effectiveness and ease of use of the intra-ocular diathermy forceps during vitrectomy.
van Overdam, K, Pawiroredjo, J, Jiawan, D, Manning, S
Acta ophthalmologica. 2019;(8):e1150-e1151
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3.
Elevated serum OxLDL is associated with progression of type 2 Diabetes Mellitus to diabetic retinopathy.
Kuppan, K, Mohanlal, J, Mohammad, AM, Babu, KA, Sen, P, Undurti, ND, Natarajan, V, Narayanasamy, A
Experimental eye research. 2019;:107668
Abstract
Hyperlipidemia is associated with the progression of diabetic retinopathy (DR). Paraoxonase 1 (PON1), an esterase is known to prevent systemic LDL oxidation. This study assessed if serum oxLDL is associated with the progression of Type 2 DM to DR. This study is part of a three-year hospital based prospective study where 87 subjects were recruited. This included T2DM without DR (n = 22); Non-Proliferative (NPDR) (n = 21) and Proliferative DR (PDR) (n = 22) along with age/sex matched controls (n = 22). Serum oxLDL-Ab was estimated by ELISA. Serum PON esterase activity and plasma Malondialdehyde (MDA) level were estimated by spectrophotometry and the serum Advanced Glycation End products (AGE) level by spectroflourimetry. The systemic levels of oxLDL, AGE and MDA were increased with the progression of T2DM without DR to DR as seen by ANOVA (P < 0.05). Serum oxLDL-Ab levels showed a positive correlation to total cholesterol (P = 0.04) as evaluated in the DR group. Statin intake was found to lower PON esterase activity (P < 0.05). Based on this pilot study, it is proposed that elevated serum oxLDL should be validated in larger cohort studies to ensure it could be potential risk factor for the progression of T2DM to DR.
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4.
Diagnostic accuracy of non-mydriatic fundus camera for screening of diabetic retinopathy: A hospital based observational study in Pakistan.
Fahadullah, M, Memon, NA, Salim, S, Ahsan, S, Fahim, MF, Mumtaz, SN, Shaikh, SA, Memon, MS
JPMA. The Journal of the Pakistan Medical Association. 2019;(3):378-382
Abstract
OBJECTIVE To determine the diagnostic accuracy of non-mydriatic fundus camera for the detection of diabetic retinopathy. METHODS The cross-sectional study was conducted at Al Ibrahim Eye Hospital, Karachi, from January to May 2015, and comprised patients with type 2 diabetes who were screened for diabetic retinopathy. Single 45° fundus image focussed at macula was obtained and labelled using non-mydriatic fundus camera by a trained optometrist. Photos were labelled as positive (diabetic retinopathy present), negative (no diabetic retinopathy) or unreadable. The pupil was then dilated and fundi were examined by ophthalmologist with slit-lamp and fundus lens. Results of fundus examination were labelled as positive, negative or invisible/indecisive. Results of ophthalmologist were taken as the standard reference to evaluate sensitivity and speci?city for detecting diabetic retinopathy with non-mydriatic fundus camera. SPSS 20 was used for data analysis. RESULTS Total eyes screened numbered 2970 related to 1485 patients. Diabetic retinopathy was found in 646(21.8%) eyes, 485(20.9%) photographs were unreadable and 1839(57.3%) were normal. Ophthalmologist on slit lamp bio-microscopy labelled 736(25%) eyes as positive for diabetes retinopathy, 335(15%) as indecisive and 1899(60%) as normal. The sensitivity of non-mydriatic fundus camera was 400/556 (72%) while specificity was 1548/1794 (86.3%). Positive predictive value and negative predictive value were 400/646 (62%) and 1548/1704 (90%) respectively. The level of agreement was moderate (k=0.0551) for optometrist compared to ophthalmologist. False positive diagnosis by optometrist numbered 78/1839 (4.24%) and false negative was 123/646(19%). CONCLUSIONS Non-mydriatic fundus camera was found to be a reliable screening tool for detecting and referral diabetic retinopathy cases to ophthalmologist for further evaluation and management.
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5.
Single-Field Non-Mydriatic Fundus Photography for Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis.
Hu, J, Chen, R, Lu, Y, Dou, X, Ye, B, Cai, Z, Pu, Z, Mou, L
Ophthalmic research. 2019;(2):61-67
Abstract
PURPOSE Single-field non-mydriatic fundus photography (NMFP) has been used to detect diabetic retinopathy (DR) in many studies; however, its value in a general clinical setting has not been established. Here we performed a meta-analysis to evaluate its diagnostic effectiveness. METHOD We systematically searched PubMed, EMBASE, and Cochrane databases for candidate studies published through May 19, 2018. A random-effect model was used to calculate the diagnostic indicators including the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence intervals. RESULTS Ten prospective studies were ultimately included. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.68, 0.94, 11.2, 0.34 and 33, respectively. The AUC was 0.88. Subgroup analysis showed that single-field NMFP had a respective sensitivity and specificity of 0.73 and 0.91 when compared to standard 7-field mydriatic stereoscopic photography (7SF), and 0.54 and 0.98 when compared to slit-lamp biomicroscopy as reference standard. CONCLUSIONS Single-field NMFP is inadequate to detect DR. Additionally, it showed higher sensitivity and lower specificity when 7SF was used as reference standard, as compared to slit-lamp biomicroscopy, suggesting that different reference standards used in DR screening might have affected the diagnostic results.
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6.
Posterior segment drug delivery for the treatment of exudative age-related macular degeneration and diabetic macular oedema.
Wong, CW, Wong, TT
The British journal of ophthalmology. 2019;(10):1356-1360
Abstract
Inhibitors of vascular endothelial growth factors are used to treat a myriad of retinal conditions, including exudative age-related macular degeneration (AMD), diabetic macular oedema (DME) and diabetic retinopathy. Although effective, long-term efficacy is limited by the need for frequent and invasive intravitreal injections. The quest for sustained action therapeutics that can be delivered to target tissue in the least invasive manner is an arduous endeavour that has ended in premature failure for several technologies in Phase II or III trials. Nevertheless, there have been promising preclinical studies, and more are on the horizon: port delivery systems for the treatment of exudative AMD have entered Phase III trials and a wide array of preclinical studies have demonstrated the potential for nanoparticles, such as liposomes, dendrimers and cell penetrating peptides to deliver therapeutics into the posterior segment via minimally invasive routes. In this review, we discuss the challenges posed by ocular barriers for drug penetration and present the recent advancements of the most pertinent drug delivery platforms with a focus on the treatment of exudative AMD and DME.
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7.
Sub-threshold micropulse laser treatment reduces inflammatory biomarkers in aqueous humour of diabetic patients with macular edema.
Midena, E, Micera, A, Frizziero, L, Pilotto, E, Esposito, G, Bini, S
Scientific reports. 2019;(1):10034
Abstract
Subthreshold micropulse laser (SMPL) is a tissue-sparing technique whose efficacy is demonstrated for diabetic macular edema (DME) treatment. However, its mechanism of action is poorly known. A prospective observational study was performed on naïve DME patients treated with SMPL, to evaluate the changes of aqueous humor (AH) inflammatory and vaso-active biomarkers after treatments. AH samples of eighteen DME eyes were collected before and after SMPL. Ten non-diabetic AH samples served as controls. Full ophthalmic evaluation, spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography were performed in DME group. Glass chip protein array was used to quantify 58 inflammatory molecules. Central retinal thickness (CRT) and visual acuity were also monitored. Several molecules showed different concentrations in DME eyes versus controls (p value < 0.05). Fas Ligand (FasL), Macrophage Inflammatory Proteins (MIP)-1α, Regulated on Activation Normal T Cell Expressed and Secreted (RANTES) and Vascular Endothelial Growth Factor (VEGF) were increased in DME at baseline versus controls and decreased after SMPL treatments (p < 0.05). CRT reduction and visual acuity improvement were also found. Inflammatory cytokines, mainly produced by the retinal microglia, were significantly reduced after treatments, suggesting that SMPL may act by de-activating microglial cells, and reducing local inflammatory diabetes-related response.
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8.
Association of diabetic retinopathy stage with the severity of female urinary incontinence.
Cankurtaran, V, Ozates, S, Ozler, S, Dirican, E
Neurourology and urodynamics. 2019;(7):1883-1888
Abstract
PURPOSE To assess the relation between diabetic retinopathy (DR) severity and urinary incontinence (UI) in patients with diabetes mellitus (DM). MATERIALS AND METHODS This prospective and observational study included 153 subjects. Patients were divided into three subgroups, according to severity of DR, as: No-DR, nonproliferative DR (NPDR), and proliferative DR (PDR); 40 age-matched healthy subjects formed the control group. Turkish version of the Urogenital Stress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess the UI symptoms and their effect on quality of life. The UDI-6 and IIQ-7 scores were the primary outcomes of the study. RESULTS No significant difference was observed between groups regarding age, maternal parity, body mass index, type of delivery, menopausal status, and smoking. The mean UDI-6 urgency UI questions score was significantly higher in the PDR group and significantly higher in the NPDR group than in the control group. The mean UDI-6 stress UI questions score was similar between groups. The mean UDI-6 voiding difficulty questions score was significantly higher in the PDR group and no significant difference was observed between other groups. The mean IIQ-7 score was significantly lower in the PDR group. A moderate and positive correlation was found between glycated hemoglobin level and the UDI-6 urgency UI and voiding difficulty questions and total scores. A weak and positive correlation was found between the duration of DM and the all UDI-6 scores. CONCLUSION The present study showed that UI symptoms and their effect on QOL were more severe in patients with PDR.
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9.
Association of non-alcoholic fatty liver disease with microvascular complications of type 2 diabetes.
Afarideh, M, Aryan, Z, Ghajar, A, Ganji, M, Ghaemi, F, Saadat, M, Heidari, B, Mechanick, JI, Esteghamati, A
Primary care diabetes. 2019;(6):505-514
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) affects risks of type 2 diabetes (T2D), diabetes-related complications, and cardiovascular disease in a complex manner. This study is designed to clarify associations of sonographically-detected NAFLD and serum liver enzymes with diabetes-related microvascular complications. METHODS A matched case-contorl study was designed for 440 patients with T2D and at least one of the chronic diabetes-related microvascular complications and 495 age- and gender-matched control patients with T2D. RESULTS Considering pre-existing and newly developed chronic microvascular complications, diabetic peripheral neuropathy was found in 347 out of 935 (37.1%) study patients, diabetic retinopathy in 141/935 (15.1%), and diabetic nephropathy in 103/935 (11.0%). Diagnosis of diabetic retinopathy and diabetic nephropathy were inversely associated with the presence of NAFLD in the crude logistic regressions (OR [95% CI] = 0.18 [0.05-0.63], p value = 0.007; OR [95% CI] = 0.17 [0.04-0.59], p value = 0.011, respectively). The subgroup of NAFLD with elevated liver enzymes had lower odds of having diabetic peripheral neuropathy in the fully adjusted model (OR [95% CI] = 0.34 [0.12-0.98], p value = 0.048). CONCLUSION Diagnosis of NAFLD with or without elevated serum liver enzymes was inversely correlated with certain chronic diabetes microvascular complications. Possible explanations for this counter-intuitive and unexpected finding are discussed and center on reverse-causality, wherein sicker patients may develop beneficial compensatory physiological and behavioral adaptations. Diversity of studied patients, in particular with regards to the ethnic and racial differences among the Western and Asian populations may also partly account for contrasting findings of the relationship between NAFLD and microvascular complications of diabetes.
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10.
ETDRS Grading of Diabetic Retinopathy: Still the Gold Standard?
Solomon, SD, Goldberg, MF
Ophthalmic research. 2019;(4):190-195
Abstract
This article aims to provide a narrative history of the evolution, modification, and legacy of the Early Treatment Diabetic Retinopathy Study classification system.