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Diabetic Retinopathy: Current Concepts and Future Directions
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Diabetic Retinopathy: Current Concepts and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 25 September 2024 | Viewed by 3607

Special Issue Editor

Dr. Lihteh Wu

E-Mail Website
Guest Editor
1. Associados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica
2. Illinois Eye and Ear Infirmary, Department of Ophthalmology, School of Medicine, University of Illinois Chicago, Chicago, IL, USA
Interests: macula; retina; vitreous; diabetic retinopathy; age-related macular degeneration; retinal detachment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Currently the world faces a challenge of epidemic proportions called diabetes mellitus (DM). According to several estimates, in 2021 10.5% (537 million) of the adult population suffered from DM. Approximately half of these do not even know that they have DM. The number of people worldwide with DM will rise to 643 million by the year 2030. DM is no longer a disease of rich developed countries. Changes in dietary habits, obesity and physical inactivity are responsible for spreading this epidemic into the developing countries. All of these individuals will be at risk of developing diabetic retinopathy (DR).

Over the past decade, new pharmacological treatments for diabetic macular edema, proliferative diabetic retinopathy and nonproliferative diabetic retinopathy have been approved. Novel biomarkers have been identified in different imaging modalities, particularly in OCTA and SD-OCT. Artificial intelligence algorithms have aided the identification of these biomarkers.

Dr. Lihteh Wu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetic retinopathy
  • diabetes mellitus
  • diabetic macular edema
  • biomarkers
  • imaging modalities
  • OCTA
  • SD-OCT
  • vitrectomy
  • anti-VEGF
  • steroids

Published Papers (4 papers)

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Research

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13 pages, 1373 KiB  
Article
The Natural History of Retinal Sensitivity Loss in Diabetic Macular Ischemia over One Year Evaluated by Microperimetry
by Wei-Shan Tsai, Sridevi Thottarath, Sarega Gurudas, Jinzhi Zhao, Chui Ming Gemmy Cheung, Taffeta Ching Ning Yamaguchi, Andrea Giani, Elizabeth Pearce and Sobha Sivaprasad
J. Clin. Med. 2024, 13(8), 2219; https://doi.org/10.3390/jcm13082219 - 11 Apr 2024
Viewed by 273
Abstract
Background/Objectives: This one-year prospective observational study, conducted at two centers, aimed to report the natural history of retinal sensitivity (RS) loss in diabetic macular ischemia (DMI). Methods: Patients with stable-treated proliferative diabetic retinopathy (PDR) were recruited if there was evidence of [...] Read more.
Background/Objectives: This one-year prospective observational study, conducted at two centers, aimed to report the natural history of retinal sensitivity (RS) loss in diabetic macular ischemia (DMI). Methods: Patients with stable-treated proliferative diabetic retinopathy (PDR) were recruited if there was evidence of DMI on optical coherence tomography angiography, defined as a foveal avascular zone ≥ 0.5 mm2 or parafoveal capillary dropout ≥ 1 quadrant. The minimal visual acuity required for performing microperimetry (MP) was ≥54 Early Treatment Diabetic Retinopathy Study letters (Snellen equivalent 20/80). The overall RS (oRS) and pointwise sensitivity (PWS) within the 3 × 3 mm macula were assessed at baseline and twelve months. A value <25 decibels (dB) was defined as impaired RS, and a decrease of 2 and 7 dB was regarded as mild and severe loss, respectively. Results: A total of 88 patients (97 eyes) were included. No statistically significant MP changes were detected at one year. However, 10% of the cohort lost oRS ≥ 2 dB, and 73% lost ≥2 dB PWS in ≥5 loci, whereas 1% lost oRS ≥ 7 dB, and 4% lost ≥7 dB PWS in ≥5 loci. The foveola and temporal parafovea were the most vulnerable to severe RS loss. Compared to their counterpart, eyes with baseline oRS ≥ 25 dB had significantly more RS loss in the macula and superior parafovea (55% versus 32% and 53% versus 28%, both p = 0.01). Conclusions: Rather than oRS loss, ≥2 dB loss in PWS in ≥5 loci is a more feasible outcome measure for clinical trials in DMI. Full article
(This article belongs to the Special Issue Diabetic Retinopathy: Current Concepts and Future Directions)
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25 pages, 2668 KiB  
Article
Oxidative Stress Mediates Epigenetic Modifications and the Expression of miRNAs and Genes Related to Apoptosis in Diabetic Retinopathy Patients
by Sarah Karam-Palos, Irene Andrés-Blasco, Cristina Campos-Borges, Vicente Zanón-Moreno, Alex Gallego-Martínez, Victor Alegre-Ituarte, Jose J. García-Medina, Salvador Pastor-Idoate, Inmaculada Sellés-Navarro, Jorge Vila-Arteaga, Antonio V. Lleó-Perez and Maria D. Pinazo-Durán
J. Clin. Med. 2024, 13(1), 74; https://doi.org/10.3390/jcm13010074 - 22 Dec 2023
Viewed by 905
Abstract
Knowledge on the underlying mechanisms and molecular targets for managing the ocular complications of type 2 diabetes mellitus (T2DM) remains incomplete. Diabetic retinopathy (DR) is a major cause of irreversible visual disability worldwide. By using ophthalmological and molecular-genetic approaches, we gathered specific information [...] Read more.
Knowledge on the underlying mechanisms and molecular targets for managing the ocular complications of type 2 diabetes mellitus (T2DM) remains incomplete. Diabetic retinopathy (DR) is a major cause of irreversible visual disability worldwide. By using ophthalmological and molecular-genetic approaches, we gathered specific information to build a data network for deciphering the crosslink of oxidative stress (OS) and apoptosis (AP) processes, as well as to identify potential epigenetic modifications related to noncoding RNAs in the eyes of patients with T2DM. A total of 120 participants were recruited, being classified into two groups: individuals with T2MD (T2MDG, n = 67), divided into a group of individuals with (+DR, n = 49) and without (−DR, n = 18) DR, and a control group (CG, n = 53). Analyses of compiled data reflected significantly higher plasma levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) and significantly lower total antioxidant capacity (TAC) in the +DR patients compared with the −DR and the CG groups. Furthermore, the plasma caspase-3 (CAS3), highly involved in apoptosis (AP), showed significantly higher values in the +DR group than in the −DR patients. The microRNAs (miR) hsa-miR 10a-5p and hsa-miR 15b-5p, as well as the genes BCL2L2 and TP53 involved in these pathways, were identified in relation to DR clinical changes. Our data suggest an interaction between OS and the above players in DR pathogenesis. Furthermore, potential miRNA-regulated target genes were identified in relation to DR. In this concern, we may raise new diagnostic and therapeutic challenges that hold the potential to significantly improve managing the diabetic eye. Full article
(This article belongs to the Special Issue Diabetic Retinopathy: Current Concepts and Future Directions)
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10 pages, 1213 KiB  
Article
Association of a Bioimpedance Profile with Optical Coherence Tomography Features in Diabetic Macular Edema
by Sunjin Hwang, Mincheol Seong, Min Ho Kang, Zheng Xian Thng, Heeyoon Cho and Yong Un Shin
J. Clin. Med. 2023, 12(20), 6676; https://doi.org/10.3390/jcm12206676 - 22 Oct 2023
Viewed by 1016
Abstract
We examined the association between bioimpedance profiles and optical coherence tomography (OCT) features in patients with diabetic macular edema (DME). This cross-sectional study included 100 eyes of 100 patients with type 2 diabetes mellitus. The systemic fluid status was assessed using extracellular water-to-total [...] Read more.
We examined the association between bioimpedance profiles and optical coherence tomography (OCT) features in patients with diabetic macular edema (DME). This cross-sectional study included 100 eyes of 100 patients with type 2 diabetes mellitus. The systemic fluid status was assessed using extracellular water-to-total body water ratio (ECW/TBW) and phase angle (PhA), which was measured using bioimpedance equipment. ECW/TBW was higher in the DR (diabetic retinopathy) with DME group than in the no DR and DR without DME groups (p = 0.007 and p = 0.047, respectively); however, no significant difference was observed between the no DR and DR without DME groups. The PhA values were significantly lower in the DR with DME group (5.45 ± 0.84) than in the no DR (6.69 ± 0.69) and DR without DME groups (6.05 ± 1.15) (p < 0.001, p = 0.032, respectively). The presence of multiple HRF (hyper-reflective foci) was associated with a significantly higher ECW/TBW (p = 0.001). In the group with the most significant HRF, PhA was lower than in those with none or moderate amounts of HRF (p < 0.05). Bioimpedance fluid profiles of patients with OCT features of DME suggest a connection between the overall systemic state, including fluid status and DME development. Further research is required to fully understand and utilize this information for effective clinical assessment and treatment planning. Full article
(This article belongs to the Special Issue Diabetic Retinopathy: Current Concepts and Future Directions)
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Review

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23 pages, 1269 KiB  
Review
Relationship between Biochemical Pathways and Non-Coding RNAs Involved in the Progression of Diabetic Retinopathy
by Małgorzata Mrowicka, Jerzy Mrowicki and Ireneusz Majsterek
J. Clin. Med. 2024, 13(1), 292; https://doi.org/10.3390/jcm13010292 - 04 Jan 2024
Cited by 1 | Viewed by 1063
Abstract
Diabetic retinopathy (DR) is a progressive blinding disease, which affects the vision and quality of life of patients, and it severely impacts the society. This complication, caused by abnormal glucose metabolism, leads to structural, functional, molecular, and biochemical abnormalities in the retina. Oxidative [...] Read more.
Diabetic retinopathy (DR) is a progressive blinding disease, which affects the vision and quality of life of patients, and it severely impacts the society. This complication, caused by abnormal glucose metabolism, leads to structural, functional, molecular, and biochemical abnormalities in the retina. Oxidative stress and inflammation also play pivotal roles in the pathogenic process of DR, leading to mitochondrial damage and a decrease in mitochondrial function. DR causes retinal degeneration in glial and neural cells, while the disappearance of pericytes in retinal blood vessels leads to alterations in vascular regulation and stability. Clinical changes include dilatation and blood flow changes in response to the decrease in retinal perfusion in retinal blood vessels, leading to vascular leakage, neovascularization, and neurodegeneration. The loss of vascular cells in the retina results in capillary occlusion and ischemia. Thus, DR is a highly complex disease with various biological factors, which contribute to its pathogenesis. The interplay between biochemical pathways and non-coding RNAs (ncRNAs) is essential for understanding the development and progression of DR. Abnormal expression of ncRNAs has been confirmed to promote the development of DR, suggesting that ncRNAs such as miRNAs, lncRNAs, and circRNAs have potential as diagnostic biomarkers and theranostic targets in DR. This review provides an overview of the interactions between abnormal biochemical pathways and dysregulated expression of ncRNAs under the influence of hyperglycemic environment in DR. Full article
(This article belongs to the Special Issue Diabetic Retinopathy: Current Concepts and Future Directions)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Targeting Pericyte Retention in Diabetic Retinopathy: A Review
Author: Bohler
Highlights: Pericytes play a fundamental role in preserving the integrity of the blood-retina barrier. Pericyte dropout is a hallmark feature in the pathogenesis of diabetic retinopathy. Biochemical changes within the Angiopoietin-TIE2 system play a significant role in the loss of pericytes along retinal vasculature. Pericyte retention is a promising, yet under explored avenue for diabetic retinopathy treatment.

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