Progression of Retinopathy Secondary to Maternally Inherited Diabetes and Deafness – Evaluation of Predicting Parameters

PURPOSE: To investigate the prognostic value of demographic, functional, and imaging parameters on retinal pigment epithelium (RPE) atrophy progression secondary to Maternally Inherited Diabetes and Deafness (MIDD) and to evaluate the application of these factors in clinical trial design. DESIGN: Retrospective observational case series. METHODS: Thirty-five eyes of 20 patients (age range, 24.9-75.9 years) with genetically proven MIDD and demarcated RPE atrophy on serial fundus autofluorescence (AF) images were included. Lesion size and shape-descriptive parameters were longitudinally determined by two independent readers. A linear mixed effect model was used to predict the lesion enlargement rate based on baseline variables. Sample size calculations were performed to model the power in a simulated interventional study. RESULTS: The mean follow-up time was 4.27 years. The mean progression rate of RPE atrophy was 2.33 mm2/year revealing a dependence on baseline lesion size (+0.04 [0.02-0.07] mm2/year/mm2, p<0.001), which was absent after square root transformation. The fovea was preserved in the majority of patients during the observation time. In the case of foveal involvement, the loss of visual acuity lagged behind central RPE atrophy in AF images. Sex, age, and number of atrophic foci predicted future progression rates with a cross-validated mean absolute error of 0.13 mm/year and to reduce the required sample size for simulated interventional trials. CONCLUSIONS: Progressive RPE atrophy could be traced in all eyes using AF imaging. Shape-descriptive factors and patients' baseline characteristics had significant prognostic value, guiding appropriate subject selection and sample size in future interventional trial design

New diagnostic and therapeutic strategies in acute and chronic central serous corioretinopathy

Purpose Central serous chorioretinopathy (CSCR) is a disease in which a serous detachment of the neurosensory retina occurs over an area of leakage from the choriocapillaris through the retinal pigment epithelium (RPE). CSCR can be acute or chronic. Classic image studies for CSCR are Fluorescine Angiography (FA) and Optical Coherence Tomography (OCT).No medical therapy is currently indicated for CSCR despite a range of potential medical treatments evaluated in many case reports. Argon laser photocoagulation can be considered only with a single leak located more than 300 µm from the center of the fovea. Autofluorescence (AF) with ultra-widefield scanning laser and Subthreshold Micropulse (SDM) photostimulation with true yellow 577nm diode laser are the newer diagnostic and therapeutic options. Methods AF with ultra-widefield scanning laser (Daytona™, Optos plc UK) was performed in fifteen patients affected by acute and chronic CSCR. All the areas of serous retinal detachment visible at AF as hyperfluorescence were treated with SDM photostimulation (IQ 577™ true yellow laser, Iridex CA). Controls were made at 15 days, 1 and three months after the treatment. Results Ultra-widefield AF allowed to identify several zones of serous detachment not detected with FA and out of range of OCT scans. In most of cases we obtained the complete resolution of serous detachment and visual acuity improvement. Gain in visual acuity was better in acute cases of CSCR. Conclusion Ultra-widefield AF followed by SDM photostimulation can be an effective diagnostic and therapeutic option for patients with acute and chronic CSCR

New diagnostic and therapeutic strategies in acute and chronic central serous corioretinopathy

Purpose Central serous chorioretinopathy (CSCR) is a disease in which a serous detachment of the neurosensory retina occurs over an area of leakage from the choriocapillaris through the retinal pigment epithelium (RPE). CSCR can be acute or chronic. Classic image studies for CSCR are Fluorescine Angiography (FA) and Optical Coherence Tomography (OCT).No medical therapy is currently indicated for CSCR despite a range of potential medical treatments evaluated in many case reports. Argon laser photocoagulation can be considered only with a single leak located more than 300 µm from the center of the fovea. Autofluorescence (AF) with ultra-widefield scanning laser and Subthreshold Micropulse (SDM) photostimulation with true yellow 577nm diode laser are the newer diagnostic and therapeutic options. Methods AF with ultra-widefield scanning laser (Daytona™, Optos plc UK) was performed in fifteen patients affected by acute and chronic CSCR. All the areas of serous retinal detachment visible at AF as hyperfluorescence were treated with SDM photostimulation (IQ 577™ true yellow laser, Iridex CA). Controls were made at 15 days, 1 and three months after the treatment. Results Ultra-widefield AF allowed to identify several zones of serous detachment not detected with FA and out of range of OCT scans. In most of cases we obtained the complete resolution of serous detachment and visual acuity improvement. Gain in visual acuity was better in acute cases of CSCR. Conclusion Ultra-widefield AF followed by SDM photostimulation can be an effective diagnostic and therapeutic option for patients with acute and chronic CSCR

Subthreshold micropulse photocoagulation with true yellow 577nm diode laser for macular oedema

Purpose Subthreshold, or tissue sparing, Diode Micropulse Photocoagualtion (SDM) is a treatment used to produce a therapeutic effect without inducing detectable intraretinal damage. Actually treatment options are available for diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), central serous chorioretinopathy (CSR), macular edema secondary to branch retinal vein occlusion (BRVO), and even glaucoma. Methods We used micropulse technology with 577nm yellow diode laser to produce a therapeutic effect without inducing intraretinal damage detectable on clinical examination during or after the treatment. All patients were affected by clinically significative macular edema (CSME) due to diabetic retinopathy, venous branch retinal occlusion and central serous retinopathy. Results Controls prefomed at 1, 3 and 6 months showed no detectable retinal scars in any case. Foveal thickness decreased in all patients, visual acuity remained stable (<10 ETDRS letters) or improved (≥10 ETDRS letters). Conclusion The results of our study indicate that, in the treatment of CSME due to PDR, BRVO and CSR,SDM photocoagulation is at least as effective as conventional photocoagulation without any clinically discernible evidence of laser-induced iatrogenic damage

Hypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study

Background: This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting. Methods: A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020, followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate (eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG levels (vHTG) (respectively &lt;150 mg/dL, 150-500 mg/dL and &gt;500 mg/dL) were comparatively evaluated. Results: Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ± 66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 person-years, in normal-TG, HTG and vHTG subjects, respectively (P&lt;0.01). The incidence of ESKD was 0.7 and 0.9 per 1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P&lt;0.01). Univariate and multivariate analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint) increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300-1.696; P&lt;0.001). Moreover, each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%CI 1.039-1.086 P&lt;0.001) and ESKD (OR:1.174, 95%CI 1.070-1.289, P = 0.001). Conclusions: This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of long-term kidney function deterioration