A Cross-Sectional Study of Various Imaging and Biochemical Biomarkers in Patients with Diabetic Macular Edema in Different Stages of Diabetic Retinopathy

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2022 Sep 30

PMID 36176978

Authors

Prithvi Naveen

Vijaya Sahu

Madhumallika Pathak

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare which imaging and biochemical biomarkers are associated with different stages of diabetic retinopathy (DR) in type 2 diabetes mellitus patients with diabetic macular edema (DME).

Patients And Methods: It was a cross-sectional, observational study that included 100 patients of DME with different stages of DR. Patients were divided into two groups: Group A - DME with non-proliferative diabetic retinopathy (NPDR) and Group B - DME with proliferative diabetic retinopathy (PDR). Group A was further subdivided into three subgroups: A (1) - DME with mild NPDR, A (2) - DME with moderate NPDR, and A (3) - DME with severe NPDR. The primary outcome measure was the association of imaging and biochemical biomarkers with different stages of DR in patients with DME.

Results: Out of 100 patients, Group A (1) had 1, Group A (2) 44, Group A (3) 29, and group: B had 29 patients. As Group A (1) had only one patient, we did not include it in the calculation. The overall mean age of the study population was 54.84+9.87 years, with a male preponderance (76%). The HbA1c levels, serum triglyceride level, serum cholesterol level, and microalbuminuria level showed no significant association with different stages of DR (P>0.05). Still, we found high serum urea levels (p=0.027) in Group B patients. The optical coherence tomography (OCT)-based imaging biomarkers - central subfield thickness (CST), cystoid macular edema (CME), subretinal fluid (SRF), and hyperreflective foci (HRF) - showed no significant association with various stages of DR. The presence of diffuse retinal thickness (DRT) (p=0.04) and the epiretinal membrane (ERM) (p=0.04) showed significant association with Group B patients.

Conclusion: The essential biochemical biomarkers such as serum urea levels and DRT and ERM may be considered an important imaging biomarker for the advanced stage of DR.

Citing Articles

Molecular-Genetic Biomarkers of Diabetic Macular Edema.

Andres-Blasco I, Gallego-Martinez A, Casaroli-Marano R, Di Lauro S, Arevalo J, Pinazo-Duran M J Clin Med. 2024; 13(23).

PMID: 39685883 PMC: 11642322. DOI: 10.3390/jcm13237426.

References

Knyazer B, Schachter O, Plakht Y, Serlin Y, Smolar J, Belfair N . Epiretinal membrane in diabetes mellitus patients screened by nonmydriatic fundus camera. Can J Ophthalmol. 2016; 51(1):41-6. DOI: 10.1016/j.jcjo.2015.09.016. View

. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985; 103(12):1796-806. View

Ng C, Cheung N, Wang J, Islam A, Kawasaki R, Meuer S . Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population. Ophthalmology. 2010; 118(4):694-9. PMC: 3070851. DOI: 10.1016/j.ophtha.2010.08.009. View

Nathan D . The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care. 2013; 37(1):9-16. PMC: 3867999. DOI: 10.2337/dc13-2112. View

King P, Peacock I, Donnelly R . The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999; 48(5):643-8. PMC: 2014359. DOI: 10.1046/j.1365-2125.1999.00092.x. View

Vitale S, Maguire M, Murphy R, Hiner C, Rourke L, Sackett C . Clinically significant macular edema in type I diabetes. Incidence and risk factors. Ophthalmology. 1995; 102(8):1170-6. DOI: 10.1016/s0161-6420(95)30894-9. View

Fong D, Aiello L, Gardner T, King G, Blankenship G, Cavallerano J . Retinopathy in diabetes. Diabetes Care. 2003; 27 Suppl 1:S84-7. DOI: 10.2337/diacare.27.2007.s84. View

Zander E, Herfurth S, Bohl B, Heinke P, Herrmann U, Kohnert K . Maculopathy in patients with diabetes mellitus type 1 and type 2: associations with risk factors. Br J Ophthalmol. 2000; 84(8):871-6. PMC: 1723591. DOI: 10.1136/bjo.84.8.871. View

Mukhtar A, Khan M, Junejo M, Ishaq M, Akbar B . Effect of pan retinal photocoagulation on central macular thickness and visual acuity in proliferative diabetic retinopathy. Pak J Med Sci. 2016; 32(1):221-4. PMC: 4795873. DOI: 10.12669/pjms.321.8758. View

10.

Yassin S, Aljohani S, Alromaih A, Alrushood A . Optical coherence tomography patterns of diabetic macular edema in a Saudi population. Clin Ophthalmol. 2019; 13:707-714. PMC: 6497898. DOI: 10.2147/OPTH.S199713. View

11.

Koo N, Jin H, Kim K, Kim Y . Relationship between the morphology of diabetic macular edema and renal dysfunction in diabetes. Korean J Ophthalmol. 2013; 27(2):98-102. PMC: 3596626. DOI: 10.3341/kjo.2013.27.2.98. View

12.

Acan D, Karahan E, Kocak N, Kaynak S . Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema. Int J Ophthalmol. 2018; 11(7):1204-1209. PMC: 6048320. DOI: 10.18240/ijo.2018.07.21. View

13.

Ferris 3rd F, Patz A . Macular edema. A complication of diabetic retinopathy. Surv Ophthalmol. 1984; 28 Suppl:452-61. DOI: 10.1016/0039-6257(84)90227-3. View

14.

Wilkinson C, Ferris 3rd F, Klein R, Lee P, Agardh C, Davis M . Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003; 110(9):1677-82. DOI: 10.1016/S0161-6420(03)00475-5. View

15.

Asensio-Sanchez V, Gomez-Ramirez V, Morales-Gomez I, Rodriguez-Vaca I . [Clinically significant diabetic macular edema: systemic risk factors]. Arch Soc Esp Oftalmol. 2008; 83(3):173-6. View

16.

Klein R, Klein B, Moss S . Epidemiology of proliferative diabetic retinopathy. Diabetes Care. 1992; 15(12):1875-91. DOI: 10.2337/diacare.15.12.1875. View

17.

Ghosh S, Bansal P, Shejao H, Hegde R, Roy D, Biswas S . Correlation of morphological pattern of optical coherence tomography in diabetic macular edema with systemic risk factors in middle aged males. Int Ophthalmol. 2014; 35(1):3-10. DOI: 10.1007/s10792-014-9922-z. View

18.

Raman R, Rani P, Kulothungan V, Rachepalle S, Kumaramanickavel G, Sharma T . Influence of serum lipids on clinically significant versus nonclinically significant macular edema: SN-DREAMS Report number 13. Ophthalmology. 2010; 117(4):766-72. DOI: 10.1016/j.ophtha.2009.09.005. View

19.

Benarous R, Sasongko M, Qureshi S, Fenwick E, Dirani M, Wong T . Differential association of serum lipids with diabetic retinopathy and diabetic macular edema. Invest Ophthalmol Vis Sci. 2011; 52(10):7464-9. DOI: 10.1167/iovs.11-7598. View

20.

Jenkins A, Joglekar M, Hardikar A, Keech A, ONeal D, Januszewski A . Biomarkers in Diabetic Retinopathy. Rev Diabet Stud. 2015; 12(1-2):159-95. PMC: 5397989. DOI: 10.1900/RDS.2015.12.159. View