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      Factors Associated With the Presence of Foveal Bulge in Eyes With Resolved Diabetic Macular Edema

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          Abstract

          Purpose: To evaluate factors associated with the presence of foveal bulge (FB) in resolved diabetic macular edema (DME) eyes.

          Methods: A total of 165 eyes with complete integrity of ellipsoid zone (EZ) at the fovea and resolved DME were divided into two groups according to the presence of FB at 6 months after intravitreal injection of ranibizumab treatment. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), outer nuclear layer (ONL) thickness, height of serous retinal detachment (SRD) and non-SRD, and inner segment (IS) and outer segment (OS) lengths of the two groups were measured and compared at baseline and each follow-up. The correlations between the presence of FB and pre- and post-treatment factors were determined by logistic regression analysis.

          Results: At baseline, BCVA was significantly better, and CFT and incidence and height of SRD were significantly lower in the FB (+) group (all P < 0.05). At 6 months, FB was present in 65 (39.39%) eyes. Post-treatment BCVA was significantly better and OS length was significantly longer in the FB (+) group at 6 months (all P < 0.05). Multivariate analysis identified younger age, better BCVA, and lower CFT before treatment as significant predictors of the existence of FB at 6 months (all P < 0.05). At 6 months, better BCVA and longer OS length were significantly correlated with the existence of FB (all P < 0.05).

          Conclusions: Factors associated with the presence of FB after the resolution of DME include younger age, better baseline BCVA and lower baseline CFT, and better post-treatment BCVA and longer post-treatment OS length.

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          Most cited references30

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          Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

          Diabetic retinopathy (DR) is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes mellitus worldwide, approximately one third have signs of DR and of these, a further one third of DR is vision-threatening DR, including diabetic macular edema (DME). The identification of established modifiable risk factors for DR such as hyperglycemia and hypertension has provided the basis for risk factor control in preventing onset and progression of DR. Additional research investigating novel risk factors has improved our understanding of multiple biological pathways involved in the pathogenesis of DR and DME, especially those involved in inflammation and oxidative stress. Variations in DR prevalence between populations have also sparked interest in genetic studies to identify loci associated with disease susceptibility. In this review, major trends in the prevalence, incidence, progression and regression of DR and DME are explored, and gaps in literature identified. Established and novel risk factors are also extensively reviewed with a focus on landmark studies and updates from the recent literature.
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            Mechanisms of macular edema: Beyond the surface.

            Macular edema consists of intra- or subretinal fluid accumulation in the macular region. It occurs during the course of numerous retinal disorders and can cause severe impairment of central vision. Major causes of macular edema include diabetes, branch and central retinal vein occlusion, choroidal neovascularization, posterior uveitis, postoperative inflammation and central serous chorioretinopathy. The healthy retina is maintained in a relatively dehydrated, transparent state compatible with optimal light transmission by multiple active and passive systems. Fluid accumulation results from an imbalance between processes governing fluid entry and exit, and is driven by Starling equation when inner or outer blood-retinal barriers are disrupted. The multiple and intricate mechanisms involved in retinal hydro-ionic homeostasis, their molecular and cellular basis, and how their deregulation lead to retinal edema, are addressed in this review. Analyzing the distribution of junction proteins and water channels in the human macula, several hypotheses are raised to explain why edema forms specifically in the macular region. "Pure" clinical phenotypes of macular edema, that result presumably from a single causative mechanism, are detailed. Finally, diabetic macular edema is investigated, as a complex multifactorial pathogenic example. This comprehensive review on the current understanding of macular edema and its mechanisms opens perspectives to identify new preventive and therapeutic strategies for this sight-threatening condition.
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              Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema.

              To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).
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                Author and article information

                Contributors
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                07 January 2022
                2021
                : 8
                : 755609
                Affiliations
                [1] 1The First School of Clinical Medicine, Southern Medical University , Guangzhou, China
                [2] 2General Hospital of Central Theater Command , Wuhan, China
                [3] 3Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital , Guangzhou, China
                [4] 4Aier School of Ophthalmology, Central South University , Changsha, China
                [5] 5Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences , Guangzhou, China
                Author notes

                Edited by: Haotian Lin, Sun Yat-sen University, China

                Reviewed by: Carlo Gesualdo, Università della Campania Luigi Vanvitelli, Italy; Vishali Gupta, Post Graduate Institute of Medical Education and Research (PGIMER), India

                *Correspondence: Honghua Yu yuhonghua@ 123456gdph.org.cn

                This article was submitted to Ophthalmology, a section of the journal Frontiers in Medicine

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fmed.2021.755609
                8776985
                35071259
                d91375a6-64ee-45c6-b03d-f9013f5af26d
                Copyright © 2022 Wu, Hu, Liu, Lin, Xiao, Zeng, Fang, Yan, Ye, Yan, Huang, Yu, Song and Zang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 August 2021
                : 29 November 2021
                Page count
                Figures: 4, Tables: 3, Equations: 0, References: 30, Pages: 8, Words: 6128
                Funding
                Funded by: National Natural Science Foundation of China-China Academy of General Technology Joint Fund for Basic Research, doi 10.13039/501100019492;
                Award ID: 81870663
                Funded by: Guangdong Medical Research Foundation, doi 10.13039/501100003785;
                Award ID: A2021378
                Categories
                Medicine
                Original Research

                complication of diabetic retinopathy,diabetic macular edema (dme),foveal bulge,optical coherence tomography (oct),central foveal thickness (cft),visual acuity (va)

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