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BACKGROUND: Diabetic retinopathy (DR) stands as the foremost cause of preventable blindness in adults. Despite efforts to expand DR screening coverage in the Brazilian public healthcare system, challenges persist due to various factors including social, medical, and financial constraints. Our objective was to evaluate the quality of images obtained with the AirDoc, a novel device, compared to Eyer portable camera which has already been clinically validated. METHODS: Images were captured by two portable retinal devices: AirDoc and Eyer. The included patients had their fundus images obtained in a screening program conducted in Blumenau, Santa Catarina. Two retina specialists independently assessed image's quality. A comparison was performed between both devices regarding image quality and the presence of artifacts. RESULTS: The analysis included 129 patients (mean age of 61 years), with 29 (43.28%) male and an average disease duration of 11.1 ± 8 years. In Ardoc, 21 (16.28%) images were classified as poor quality, with 88 (68%) presenting artifacts; in Eyer, 4 (3.1%) images were classified as poor quality, with 94 (72.87%) presenting artifacts. CONCLUSIONS: Although both Eyer and AirDoc devices show potential as screening tools, the AirDoc images displayed higher rates of ungradable and low-quality images, that may directly affect the DR and DME grading. We must acknowledge the limitations of our study, including the relatively small sample size. Therefore, the interpretations of our analyses should be approached with caution, and further investigations with larger patient cohorts are warranted to validate our findings.

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Purpose: To investigate the potential relation between methylation of miR-9-3 and stages of diabetic retinopathy (DR). Additionally, we explored whether miR-9-3 methylation impacts the serum levels of Vascular Endothelial Growth Factor (VEGF). Methods: A cross-sectional study was conducted with 170 participants with type 2 diabetes, including a control group (n = 64) and a diabetes retinopathy group (n = 106), which was further divided into NPDR (n = 58) and PDR (n = 48) subgroups. Epidemiological, clinical, anthropometric, biochemical ELISA assay were analysed. DNA extracted from leukocytes was used to profile miR-9-3 methylation using PCR-MSP. Results: MiR-9-3 hypermethylated profile was higher in the DR group (p < 0.001) and PDR subgroup compared to DM2 control group (p < 0.001). The hypermethylated profile in the PDR subgroup was also higher compared to NPDR subgroup (p < 0.001). There was no difference between DM2 control and NPDR group (p = 0.234). Logistic regression showed that miR-9-3 hypermethylation increases the odds of presenting DR (OR: 2.826; p = 0.002) and PDR (OR: 5.472; p < 0.001). In addition, hypermethylation of miR-9-3 in the DR and NPDR subgroup was associated with higher serum VEGF-A levels (p = 0.012 and p = 0.025, respectively). Conclusion: The methylation profile of the miR-9-3 promoter increases the risk of developing PDR. Higher levels of VEGF-A are associated with miR-9-3 hypermethylated profile in patients in the DR and NPDR stages. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01411-9.

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BACKGROUND: Diabetic retinopathy (DR) and limb amputation are frequent complications of diabetes that cannot always be explained by blood glucose control. Metabolomics is a science that is currently being explored in the search for biomarkers or profiles that identify clinical conditions of interest. OBJECTIVE: This study aimed to analyze, using a metabolomic approach, peripheral blood samples from type 2 diabetes mellitus (DM2) individuals, compared with those with diabetic retinopathy and limb amputation. METHODS: The sample consisted of 128 participants, divided into groups: control, DM2 without DR (DM2), non-proliferative DR (DRNP), proliferative DR (DRP), and DM2 amputated (AMP). Metabolites from blood plasma were classified by spectra using nuclear magnetic resonance (NMR), and the metabolic routes of each group using metaboanalyst. RESULTS: We identified that the metabolism of phenylalanine, tyrosine, and tryptophan was discriminant for the DRP group. Histidine biosynthesis, on the other hand, was statistically associated with the AMP group. The results of this work consolidate metabolites such as glutamine and citrulline as discriminating for DRP, and the branched-chain amino acids as important for DR. CONCLUSIONS: The results demonstrate the relationship between the metabolism of ketone bodies, with acetoacetate metabolite being discriminating for the DRP group and histidine being a significant metabolite in the AMP group, when compared to the DM2 group.

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Complications from diabetic retinopathy such as diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) constitute leading causes of preventable vision loss in working-age patients. Since vascular endothelial growth factor (VEGF) plays a major role in the pathogenesis of these complications, VEGF inhibitors have been the cornerstone of their treatment. Anti-VEGF monotherapy is an effective but burdensome treatment for DME. However, due to the intensive and burdensome treatment, most patients in routine clinical practice are undertreated, and therefore, their outcomes are compromised. Even in adequately treated patients, persistent DME is reported anywhere from 30% to 60% depending on the drug used. PDR is currently treated by anti-VEGF, panretinal photocoagulation (PRP) or a combination of both. Similarly, a number of eyes, despite these treatments, continue to progress to tractional retinal detachment and vitreous hemorrhage. Clearly there are other molecular pathways other than VEGF involved in the pathogenesis of DME and PDR. One of these pathways is the angiopoietin-Tie signaling pathway. Angiopoietin 1 (Ang1) plays a major role in maintaining vascular quiescence and stability. It acts as a molecular brake against vascular destabilization and inflammation that is usually promoted by angiopoietin 2 (Ang2). Several pathological conditions including chronic hyperglycemia lead to Ang2 upregulation. Recent regulatory approval of the bi-specific antibody, faricimab, may improve long term outcomes in DME. It targets both the Ang/Tie and VEGF pathways. The YOSEMITE and RHINE were multicenter, double-masked, randomized non-inferiority phase 3 clinical trials that compared faricimab to aflibercept in eyes with center-involved DME. At 12 months of follow-up, faricimab demonstrated non-inferior vision gains, improved anatomic outcomes and a potential for extended dosing when compared to aflibercept. The 2-year results of the YOSEMITE and RHINE trials demonstrated that the anatomic and functional results obtained at the 1 year follow-up were maintained. Short term outcomes of previously treated and treatment-naive eyes with DME that were treated with faricimab during routine clinical practice suggest a beneficial effect of faricimab over other agents. Targeting of Ang2 has been reported by several other means including VE-PTP inhibitors, integrin binding peptide and surrobodies.

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Diabetes mellitus (DM) is a chronic systemic disease characterized by a multifactorial nature, which may lead to several macro and microvascular complications. Diabetic retinopathy (DR) is one of the most severe microvascular complications of DM, which can result in permanent blindness. The mechanisms involved in the pathogenesis of DR are multiple and still poorly understood. Factors such as dysregulation of vascular regeneration, oxidative and hyperosmolar stress in addition to inflammatory processes have been associated with the pathogenesis of DR. Furthermore, compelling evidence shows that components of the immune system, including the complement system, play a relevant role in the development of the disease. Studies suggest that high concentrations of mannose-binding lectin (MBL), an essential component of the complement lectin pathway, may contribute to the development of DR in patients with DM. This review provides an update on the possible role of the complement system, specifically the lectin pathway, in the pathogenesis of DR and discusses the potential of MBL as a non-invasive biomarker for both, the presence and severity of DR, in addition to its potential as a therapeutic target for intervention strategies.

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This is a systematic review of 25 publications on the topics of the prevalence and cost of diabetic retinopathy (DR) in Trinidad and Tobago, the cost of traditional methods of screening for DR, and the use and cost of artificial intelligence (AI) in screening for DR. Analysis of these publications was used to identify and make estimates for how resources allocated to ophthalmology in public health systems in Trinidad and Tobago can be more efficiently utilized by employing AI in diagnosing treatable DR. DR screening was found to be an effective method of detecting the disease. Screening was found to be a universally cost-effective method of disease prevention and for altering the natural history of the disease in the spectrum of low-middle to high-income economies, such as Rwanda, Thailand, China, South Korea, and Singapore. AI and deep learning systems were found to be clinically superior to, or as effective as, human graders in areas where they were deployed, indicating that the systems are clinically safe. They have been shown to improve access to diabetic retinal screening, improve compliance with screening appointments, and prove to be cost-effective, especially in rural areas. Trinidad and Tobago, which is estimated to be disproportionately more affected by the burden of DR when projected out to the mid-21st century, stands to save as much as US$60 million annually from the implementation of an AI-based system to screen for DR versus conventional manual grading.

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Diabetic retinopathy (DR) is a complication of diabetes with a complex pathophysiology and multiple factors involved. Recently, it has been found that the upregulation of the renin-angiotensin-aldosterone system (RAAS) leads to overexpression of angiotensin II (Ang II), which induces oxidative stress, inflammation, and angiogenesis in the retina. Therefore, RAAS may be a promising therapeutic target in DR. Notably, RAAS inhibitors are often used in the treatment of hypertension. Still, the potential role and mechanism of DR must be further studied. In this review, we discuss and summarize the pathology and potential therapeutic goals of RAAS in DR.

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Diabetic retinopathy (RD) is a microvascular disease that can cause the formation of fragile neovessels, increasing the risk of hemorrhages and leading to vision loss. Current therapies are based on the intravitreal injection of anti-VEGF (vascular endothelial growth factor), which is invasive and can cause secondary effects. The development of new treatments that complement the current therapies is necessary to improve the patient's outcomes. Nanostructured formulations offer several advantages regarding drug delivery and penetration. In this research, a resveratrol nanosuspension (RSV-NS) was prepared and characterized using dynamic light scattering, field emission scanning electron microscopy, and infrared spectroscopy. The RSV-NS had an average particle size of 304.0 ± 81.21 nm with a PDI of 0.225 ± 0.036, and a spherical-like morphology and uniform particle distribution. Cell viability, proliferation, and migration were tested on endothelial cells (HMRECs). RSV-NS in a concentration of less than 18.75 µM did not have a cytotoxic effect on HMRECs. Likewise, proliferation and migration were significantly reduced compared to the unstimulated control at 37.5 µM. The RSV-NS did not present cytotoxic effects but decreased cell proliferation and migration, indicating that it could provide an important contribution to future medical implementations and could have a high potential to treat this disease.

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Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

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BACKGROUND: To evaluate structural changes in retina and choroid in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD). METHODS: T2D patients with mild or no diabetic retinopathy (DR) were followed for 3 years using structural SS-OCT and OCT angiography (OCT-A) taken every 6 months. Parameters were compared longitudinally and according to the DKD status on baseline. RESULTS: One hundred and sixty eyes from 80 patients were followed for 3 years, 72 with no DKD (nDKD) at baseline and 88 with DKD. Trend analysis of T2D showed significant thinning in GCL + and circumpapillary retinal fiber neural layer (cRFNL), choroid, and decreased vascular density (VD) in superficial plexus and central choriocapillaris with foveal avascular zone (FAZ) enlargement. Patients with no DKD on baseline presented more significant declines in retinal center and choroidal thickness, increased FAZ and loss of nasal and temporal choriocapillaris volume. In addition, the nDKD group had worse glycemic control and renal parameters at the end of the study. CONCLUSION: Our data suggests the potential existence of early and progressive neurovascular damage in the retina and choroid of patients with Type 2 Diabetes (T2D) who have either no or mild Diabetic Retinopathy (DR). The progression of neurovascular damage appears to be correlated with parameters related to glycemic control and renal damage.

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During an artificial intelligence (AI)-assisted diabetic retinopathy screening event, we performed a survey on patients´ perceptions on AI. Respondents were individuals with diabetes, mostly followed in primary healthcare with a low education level. While 49.6% of participants said they knew what AI was, only 14% reported good or expert knowledge of AI. The vast majority reported positive feelings towards AI in healthcare. We highlight the importance of understanding patients´ views regarding AI in health in a real-life situation and emphasize the importance of digital education.

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Objective: the present study aimed to evaluate the prevalence of diabetic nephropathy and diabetic retinopathy, in addition to the associations that can be established between these microvascular complications of diabetes mellitus. Methods: this was a retrospective study, a systematic review without metaanalysis. The authors used the Pubmed and SciELO databases to search the terms "diabetic nephropathy", "diabetic retinopathy" and "type 2 diabetes", including publications dated 2011 to 2021. Results/Discussion: the results presented were a synthesis of patients with both pathologies and their correlations, in addition to associated laboratory changes and agreement between the stages or severity of both conditions. Conclusions: DN and DR are pathologies that are directly interconnected and cause repercussions for patients.

Objetivo: o presente estudo teve como objetivo avaliar a prevalência de nefropatia diabética e retinopatia diabética, além das associações que podem ser estabelecidas entre essas complicações microvasculares do diabetes mellitus. Métodos: estudo retrospectivo, revisão sistemática sem metanálise, os autores utilizaram as bases de dados Pubmed e SciELO para busca dos termos "nefropatia diabética", "retinopatia diabética" e "diabetes tipo 2", incluindo publicações datadas de 2011 a 2021. Resultados/Discussão: os resultados apresentados foram uma síntese dos pacientes com ambas as patologias e suas correlações, além de alterações laboratoriais associadas e concordância entre os estágios ou gravidade de ambas as condições. Conclusões: ND e RD são patologias que estão diretamente interligadas e causam repercussões aos pacientes.

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BACKGROUND: The most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. OBJECTIVE: To carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. METHOD: Retrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. RESULTS: 1227 files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. 65% presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36) ml/min/1.73 m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6 to 15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy. (p = 0.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. CONCLUSION: The results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.

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ABSTRACT Diabetic retinopathy (DR) is a complication of diabetes with a complex pathophysiology and multiple factors involved. Recently, it has been found that the upregulation of the renin-angiotensin-aldosterone system (RAAS) leads to overexpression of angiotensin II (Ang II), which induces oxidative stress, inflammation, and angiogenesis in the retina. Therefore, RAAS may be a promising therapeutic target in DR. Notably, RAAS inhibitors are often used in the treatment of hypertension. Still, the potential role and mechanism of DR must be further studied. In this review, we discuss and summarize the pathology and potential therapeutic goals of RAAS in DR.

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ABSTRACT Purpose: This study measured serum hypoxia--inducible factor-1 (HIF-1α) and survivin levels in patients with diabetes and investigated their association with the severity of retinopathy. Methods: This study included 88 patients with type 2 diabetes mellitus who underwent routine eye examinations. Three groups were created. Group 1 consisted of patients without diabetic retinopathy. Group 2 included patients with non-proliferative diabetic retinopathy. Group 3 included patients with proliferative diabetic retinopathy. To measure serum HIF-1α and survivin levels, venous blood samples were collected from patients. Results: The mean HIF-1α levels in groups 1, 2, and 3 were 17.30 ± 2.19, 17.79 ± 2.34, and 14.19 ± 2.94 pg/ml, respectively. Significant differences were detected between groups 1 and 3 (p=0.01) and between groups 2 and 3 (p=0.01). The mean survivin levels in groups 1, 2, and 3 were 42.65 ± 5.37, 54.92 ± 5.55, and 37.46 ± 8.09 pg/ml, respectively. A significant difference was only detected between groups 2 and 3 (p=0.002). Conclusion: The present study revealed that serum HIF-1α and survivin levels are increased in patients with non-proliferative diabetic retinopathy compared to those in patients without diabetic retinopathy.

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ABSTRACT Purpose: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. Methods: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. Results: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). Conclusion: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings.

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ABSTRACT Purpose: This study investigates the protective effect of cilostazol on the development and evolution of diabetic retinopathy in rats. Methods: Sixty male rats were divided into four groups: untreated nondiabetic rats, untreated diabetic rats, cilostazol-treated nondiabetic rats, and cilostazol-treated diabetic rats. The thickness of the internal limiting membrane to the outer limiting membrane, inner plexiform layer, inner nuclear layer, and outer nuclear layer were measured. The number of cell nuclei per 50-μm length in retinal sections was counted to quantify the degree of retinal cell loss. Results: The number of nuclei in the ganglion cell layer was significantly higher in untreated nondiabetic rats (p<0.05). The mean number of nuclei in the cilostazol-treated nondiabetic rats was significantly higher than that in the cilostazol-treated diabetic rats (p<0.05). The cilostazol-treated nondiabetic rats had a significantly higher mean nuclei count in the inner nuclear layer and inner plexiform layer as compared with the other groups (p<0.05). The total mean retinal thickness of the cilostazol-treated nondiabetic rats was significantly higher than that of cilostazol-treated diabetic rats and untreated diabetic rats (p<0.05). Conclusion: By decreasing the loss of ganglion cells and reducing the sensorineural atrophy in the internal retinal layers, cilostazol had a protective effect against changes caused by diabetic retinopathy in diabetic rats.

RESUMO Objetivo: O objetivo deste estudo foi investigar o efeito protetor do cilostazol no desenvolvimento e na evolução da retinopatia diabética em ratos. Métodos: Sessenta ratos machos foram divididos em 4 grupos: ratos não-diabéticos não-tratados, ratos diabéticos não-tratados, ratos não-diabéticos tratados com cilostazol e ratos diabéticos tratados com cilostazol. A espessura da membrana limitante interna à membrana limitante externa, a camada plexiforme interna, a camada nuclear interna e a camada nuclear externa foram medidas. Para quantificar o grau de perda de células da retina, foi contado o número de núcleos de células por 50 μm de comprimento em secções retinianas. Resultados: O número de núcleos no GCL foi significativamente maior em Ratos não-diabéticos não-tratados com cilostazol (p<0,05). O número médio de núcleos em Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol (p<0,05). A contagem média de núcleos em camada nuclear interna e camada plexiforme interna de ratos não-diabéticos tratados com cilostazol foi significativamente maior do que nos outros grupos (p<0,05). A espessura retiniana média total de Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol e Ratos diabéticos não-tratados (p<0,05). Conclusão: Os resultados demonstraram que o cilostazol teve um efeito protetor contra as alterações causadas pela retinopatia diabética em ratos diabéticos, diminuindo a perda de células ganglionares e reduzindo a atrofia neurossensorial nas camadas retinianas internas.

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ABSTRACT Purpose: This study aimed to determine the effect of serum G receptor-mediated protein-1 levels on the development of retinopathy in patients with diabetes in comparison with healthy individuals. Methods: The study enrolled patients with diabetic retinopathy (Group 1), patients without diabetic retinopathy (Group 2), and healthy individuals (Group 3). Levels of serum progesterone, serum G receptor-mediated protein-1, estradiol, oxidant/antioxidants, and thyroid-releasing hormones were analyzed and compared among the groups. Post-hoc analysis was performed to compare the subgroups in which significant differences were found. Results: Groups 1, 2, and 3 each included 40 patients. A significant difference was found among all groups in terms of serum G receptor-mediated protein-1, oxidant/antioxidant, and estradiol levels (p<0.01), but no significant difference was found in terms of thyroid-releasing hormone or progesterone (p=0.496, p=0.220, respectively). In the post-hoc analysis of the groups with significant differences, another significant difference was found among all groups for serum G receptor-mediated protein-1 and oxidant/antioxidant levels (p<0.05). Serum G receptor-mediated protein-1 and oxidant levels were positively correlated, whereas serum G receptor-mediated protein-1 and antioxidant levels were negatively correlated (r=0.622/p<0.01, r=0.453/p<0.01, r=0.460/p<0.01, respectively). The multiple regression analysis showed that increased levels of serum G receptor-mediated protein-1 may help prevent diabetic retinopathy. Conclusions: Serum G receptor-mediated protein-1 levels, which were the highest in the diabetic retinopathy Group, increased as the oxidant/antioxidant balance changed in favor of oxidative stress. This appears to be a defense mechanism for preventing neuronal damage.

RESUMO Objetivo: Esta pesquisa buscou determinar o im­pacto dos níveis de proteína G sérica no desenvolvimento da retinopatia em pacientes diabéticos, comparando-os a indivíduos saudáveis. Métodos: Foram incluídos, no estudo, 40 pacientes com retinopatia diabética (Grupo 1), 40 pacientes sem retinopatia diabética (Grupo 2) e 40 indivíduos saudáveis (Grupo 3). Os níveis hormonais de progesterona sérica, de proteína G sérica, estradiol, oxidante/antioxidante e hormônio liberado pela tireoide foram analisados e comparados. A análise post hoc foi realizada para comparar os subgrupos nos quais diferenças estatisticamente significativas foram encontradas. Resultados: Uma diferença significativa foi encontrada entre todos os grupos em termos de proteína G sérica, oxidante/antioxidante e níveis de estradiol (p<0.01), mas nenhuma diferença significativa foi encontrada em termos de hormônio liberado pela tireoide ou progesterona (p=0,496, p=0,220, respectivamente). Na análise post hoc dos grupos com diferenças estatisticamente significativas, outra diferença significativa foi encontrada entre todos os grupos para proteína G sérica e níveis oxidantes/antioxidantes (p<0,05). Os níveis de proteína G sérica e os níveis de oxidante foram positivamente correlacionados, enquanto os níveis de proteína G sérica e os níveis de antioxidantes foram negativamente correlacio­nados (r=0,622/p<0,01, r=0,453/p<0,01, r=0,460/p<0,01, respectivamente). A análise de regressão múltipla mos­trou que o aumento da proteína G sérica pode ajudar a prevenir a retinopatia diabética. Conclusões: Os níveis de proteína G sérica que eram mais altos no grupo de retinopatia diabética, aumentaram à medida que o equilíbrio oxidante/antioxidante mudou em favor do estresse oxidativo. Este parece ser um mecanismo de defesa para prevenir danos neuronais.

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ABSTRACT Purpose: Trimethylamine N-oxide serum levels have been associated with type 2 diabetes mellitus and its complications. The current study aimed to find out if plasma trimethylamine N-oxide level may be a novel marker in the diagnosis of diabetic retinopathy and if it can be used in the differential diagnosis of diabetic and nondiabetic retinopathy. Methods: The study included 30 patients with diabetic retinopathy, 30 patients with nondiabetic retinopathy, 30 patients with type 2 diabetes mellitus without retinopathy, and 30 healthy control participants. Biochemical parameters, serum IL-6, TNF-α, and trimethylamine N-oxide levels were measured in all participants. Results: Trimethylamine N-oxide level was significantly higher in diabetic retinopathy than in the other groups (p<0.001). There was no significant difference in trimethylamine N-oxide levels between nondiabetic retinopathy and control or type 2 diabetes mellitus Groups. There was a significant positive correlation between trimethylamine N-oxide level and elevated FPG, BMI, HOMA-IR score, BUN, IL-6, and TNF-α levels. Conclusion: The current study showed that the trimethylamine N-oxide level is elevated in diabetic retinopathy. These findings suggest that serum trimethylamine N-oxide level might be a novel marker for diabetic retinopathy, and it might be used in the differential diagnosis of diabetic and nondiabetic retinopathy.

RESUMO Objetivo: Os níveis séricos de N-óxido de trimetilamina têm sido associados ao diabetes mellitus tipo 2 e suas complicações. O presente estudo tem como objetivo responder a duas questões, entre elas: O nível plasmático de N-óxido de trimetilamina poderia ser um novo marcador no diagnóstico de retinopatia diabética? e Ele poderia ser utilizado no diagnóstico diferencial de retinopatia diabética e não diabética? Métodos: Trinta pacientes com retinopatia diabética, 30 pacientes com retinopatia não diabética, 30 pacientes com diabetes mellitus tipo 2 sem retinopatia e 30 participantes saudáveis do grupo controle foram incluídos no estudo. Parâmetros bioquímicos, níveis séricos de IL-6, de TNF-α e de N-óxido de trimetilamina foram medidos em todos os participantes. Resultados: O nível de N-óxido de trimetilamina foi significativamente maior na retinopatia diabética do que nos outros grupos (p<0,001). Não houve diferença significativa no nível de N-óxido de trimetilamina entre o grupo de retinopatia não diabética, do grupo controle ou do grupo de diabetes mellitus tipo 2. Houve uma correlação positiva significativa entre o nível de N-óxido de trimetilamina e os níveis elevados de FPG, IMC, HOMA-IR, BUN, IL-6 e TNF-α. Conclusão: O estudo atual mostrou que o nível de N-óxido de trimetilamina encontra-se elevado na retinopatia diabética. Esses achados sugerem que o nível sérico de N-óxido de trimetilamina pode ser um novo marcador na retinopatia diabética, podendo ser usado no diagnóstico diferencial de retinopatia diabética e não diabética.

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ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.