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La rétinopathie diabétique est une cause majeure de cécité et de malvoyance qui affecte jusqu'à 90% des patients atteints de diabète. Le Maroc n’échappe pas à cette pathologie, qui est connue pour altérer le fonctionnement du système visuel et pourrait conduire également à des désordres chronobiologiques, aussi bien chez l’Homme que chez des modèles animaux. Ces altérations pourraient être liées aux dégénérescences neuronales des systèmes de photoréception classique (cône et bâtonnet) et des cellules ganglionnaires à mélanopsine, impliqués dans la régulation et l’entraînement par la lumière du système circadien. Cependant, à l’heure actuelle, peu d’études ont analysé précisément l’impact de la rétinopathie diabétique sur le système circadien. L’objectif de notre travail est d’analyser au cours de la rétinopathie diabétique (1) l’atteinte des cônes, des bâtonnets et des cellules ganglionnaires à mélanopsine, (2) le fonctionnement endogène moléculaire et la réponse à la lumière des horloges centrale et rétinienne et (3) la réponse comportementale du système circadien à la lumière. Notre stratégie est basée sur l’utilisation d’un modèle murin, chez lequel le diabète est induit expérimentalement par l’administration d’un agent chimique la streptozotocine (STZ), toxique pour les cellules β pancréatiques. Des approches morphométriques, moléculaires et comportementales ont été utilisées. Nos résultats montrent que le diabète induit des changements morphologiques des cellules ganglionnaires à mélanopsine tels que des gonflements des somas et des varicosités au niveau des dendrites avec une préservation du nombre total de ces cellules. Ceci est associé à une diminution de l’induction par la lumière du gène c-fos et des gènes de l’horloge Per1 et Per2 au niveau du SCN et à l’absence de cette induction au niveau rétinien au stade 12 semaines après l’induction du diabète. La machinerie moléculaire des horloges rétinienne et centrale évaluée par l’analyse de l’expression circadienne des gènes de l’horloge et des gènes contrôlés par les gènes de l’horloge montre que certains gènes de l’horloge clés pour chaque tissu sont altérés. A l’échelle comportementale, les souris STZ (souris diabétiques) montrent une réduction de l’amplitude du rythme de leur activité locomotrice totale et une diminution de la sensibilité à la lumière aux faibles intensités. Après une avance de phase du cycle 12L/12D, ces animaux présentent également une diminution de la vitesse de resynchronisation au nouveau cycle lumineux imposé par rapport aux animaux témoins. Ces nouvelles données montrent que le diabète de type 1 altère les réponses du système circadien à la lumière d’un point de vue moléculaire et comportemental et suggèrent que les patients diabétiques peuvent présenter des troubles circadiens particulièrement lorsqu’ils sont soumis aux challenges chronobiologiques / Diabetic retinopathy is a major cause of blindness and is commonly viewed as a vascular complication of type 1 diabetes. However, this kind of diabetes causes visual dysfunction before the onset of clinically visible microvascular changes, associated with diabetic retinopathy. Several histopathological studies in diabetic patients and in chemically-induced or genetic rodent models of diabetes indicate that photoreceptors and retinal ganglion cells (RGCs) are affected by diabetes with apoptotic degeneration. There is increasing evidence that melanopsin-expressing ganglion cells that are crucial for the regulation of a range of non-visual functions including the photic synchronization of circadian rhythms are altered in retinal pathologies. The link between diabetes and circadian rhythms has only been addressed in a relatively limited number of studies. Using a streptozotocin-induced (STZ) model of diabetes, we investigated the impact of diabetic retinopathy on non-visual functions by analyzing the morphology of melanopsin ganglion cells and light-induced c-fos and Period 1-2 clock genes in the central (SCN) and the retina clocks. The effect of this pathology on the endogenous circadian function of clock and controlled clock genes was assessed in the SCN and the retina at 12 weeks post-diabetes. Behaviorally, the ability of STZdiabetic mice to entrain to light was challenged by the exposure of animals to 1) successive light/dark (LD) cycle of decreasing or increasing light intensities during the light phase and 2) 6-hr advance of the LD cycle. Our results show that diabetes induces morphological changes of melanopsin-expressing ganglion cells including soma swelling and dendritic varicosities with no reduction in their total number, associated with decreased c-fos and clock genes induction by light in the SCN and also in the retina at 12 weeks post-onset of diabetes. In addition, the circadian expression of major clock genes was altered in the central and retinal clocks, suggesting that RD affects the endogenous molecular machinery and the light response of these two clocks. Moreover, STZ-diabetic mice exhibited a reduction of overall locomotor activity, a decrease of circadian sensitivity to light at low intensities, and a delay in the time to re-entrain after a phase advance of the LD cycle. These novel findings demonstrate that diabetes alters clock genes and behavioral responses of the circadian timing system to light and suggest that diabetic patients may show an increased propensity for circadian disturbances, in particular when they are exposed to chronobiological challenges

This report contains a summation of a variety of articles that have been read and analysed. Each article describes different methods that can be used to detect lesions, optic disks, drusen and exudates in retinal images. I.e. diagnose e.g. Diabetic Retinopathy and Age-Related Macular Degeneration. A general approach is presented, which all methods more or less is based on. Methods to locate the optic disk The PCA  kNN Regression Hough Transform Fuzzy Convergence Vessel Direction Matched Filter Etc. The best method based on result, reliability, number of images and publisher is kNN regression. The result of this method is remarkably good and that brings some doubt about its reliability. Though the method was published at IEEE and that gives the method a more trustful look. A next best method which also is very useful is Vessel Direction Matched Filter. Methods to detect drusen – diagnose Age-Related Macular Degeneration PNN classifier Histogram approach Etc. The best method based on result, reliability, number of images and publisher is the PNN classifier. The method had a sensitivity of 94 % and a specificity of 95 %. 300 images were used in the experiment which was published by the IEEE in 2011. Methods to detect exudates – diagnose Diabetic Retinopathy Morphological techniques Luv colour space, Wiener filter an Canny edge detector. The best method based on result, reliability, number of images and publisher is an experiment called “Feature Extraction”. The method includes the Luv colour space, Wiener filter (remove noise) and the Canny edge detector. / Den här rapporten innehåller en sammanfattning av ett flertal artiklar som har blivit studerade. Varje artikel har beskrivit en metod som kan användas för att upptäcka sjuka förändringar i ögonbottenbilder, det vill säga, åldersförändringar i gula fläcken och diabetisk retinopati. Metoder för att lokalisera blinda fläcken PCA kNN regression Hough omvandling Suddig konvergens Filtrering beroende på kärlens riktning Mm. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är kNN regression. De förvånansvärt goda resultaten kan inbringa lite tvivel på huruvida resultaten stämmer. Artikeln publicerades dock av IEEE och det gör artikeln mer trovärdig. Den näst bästa metoden är filtrering beroende på kärlens riktning. Metoder för att diagnosticera åldersförändringar i gula fläcken PNN klassificeraren Histogram Mm. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är PNN klassificeraren. Metoden hade en sensitivitet på 94 % och en specificitet på 95 %. 300 bilder användes i experimentet som publicerades av IEEE år 2011. Metoder att diagnosticera diabetisk retinopati Morfologiska tekniker Luv colour space, Wiener filter and Canny edge detector. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är ett experimentet som heter ”Feature Extraction”. Experimentet inkluderar Luv colour space, Wiener filter (brus borttagning) och Canny edge detector

Ischemic retinopathies (IR) are vision-threatening diseases that affect a substantial amount of people across all age groups worldwide. The current treatment options of photocoagulation and anti-VEGF therapy have side effects and are occasionally unable to prevent disease progression. It is therefore worthwhile to consider other molecular targets for the development of novel treatment strategies that could be safer and more efficient. During the manifestation of IR, the retina, normally an immune privileged tissue, encounters enhanced levels of cellular stress and inflammation that attract mononuclear phagocytes (MPs) from the blood stream and activate resident MPs (microglia). Activated MPs have a multitude of effects within the retinal tissue and have the potential to both counter and exacerbate the harmful tissue microenvironment. The present review discusses the current knowledge about the role of inflammation and activated retinal MPs in the major IRs: retinopathy of prematurity and diabetic retinopathy. We focus particularly on MPs and their secreted factors and cell–cell-based interactions between MPs and endothelial cells. We conclude that activated MPs play a major role in the manifestation and progression of IRs and could therefore become a promising new target for novel pharmacological intervention strategies in these diseases.

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La rétinopathie induite par l’oxygène (RIO) est un modèle animal semblable aux rétinopathies vue chez l’homme. Dans ce modèle, une destruction des microvaisseaux rétiniens est suivie d’une néovascularisation pathologique qui chez l’homme peut mener à un détachement de la rétine et subséquemment une perte de vision. Afin de remédier à cette revascularisation anarchique, un traitement de cellules souches (hématopoïétiques et mésenchymateuses) a été effectué chez des souris soumises à ce modèle. Les cellules injectées ont pu migrer à la rétine et induire une revascularisation saine (surtout les cellules souches mésenchymateuses). L’injection du milieu de culture de ces cellules induit aussi une revascularisation semblable à celle vue chez les souris traitées avec les cellules indiquant que l’effet thérapeutique des cellules semble être accompli par l’entremise de facteurs paracrines. Ces résultats suggèrent que ces cellules peuvent jouer un rôle au niveau de l’angiogénèse et indiquent un potentiel thérapeutique pour les rétinopathies. / Oxygen induced retinopathy (OIR) is an animal model that mimics the developing phases of retinopathies seen in humans such as diabetic retinopathy and retinopathy of prematurity. An initial destruction of retinal microvasculature is followed by pathological neovascularization that can lead to retinal detachment in humans and therefore blindness. Utilizing bone marrow derived stem cells (mesenchymal and hematopoietic), we aimed to repopulate the retina with normal vessels which are affected in the OIR model. Cells injected into the vitreous migrated to the retina and reduced both the area of vasoobliteration and neovascularization. Injection of conditioned cell medium also induced proper vascular repair similar to that seen in mice injected with cells indicating that the cells therapeutic effect is achieved through paracrine action. These results suggest that bone marrow stem cells play a role in angiogenesis and could be a potential therapeutic aid in treating retinopathies.

Objetivo: Comparar o efeito da terapia da fotocoagulação panretiniana (PFC) associada à injeção intravítrea de Ranibizumabe (RBZ) versus terapia isolada com PFC em pacientes com retinopatia diabética proliferativa (RDP) precoce, virgens de tratamento, com ou sem edema macular diabético (DME) durante 6 meses de acompanhamento. Projeto: Estudo prospectivo intervencionista, randomizado e controlado. Métodos: Sessenta olhos de 30 pacientes com RDP bilateral precoce foram randomizados para o grupo de estudo (GE) que foram tratados com PFC associado a duas injeções de RBZ intravítreo (0.5mg/0.05ml) ou para o grupo controle (GC) tratados apenas com PFC. Mudanças na acuidade visual (AV) corrigida, na sensibilidade ao contraste (SC) e na espessura foveal (EF) foram comparados no início, e nos 1, 3 e 6 meses após o tratamento. Resultados: No GE, a diferença na média da AV do baseline para o mês 6 teve um aumento significativo de + 3,4 letras (p = 0,006) e uma diminuição significativa na EF de - 47.6um (p < 0,001). No GC, a diferença na média da AV teve uma diminuição de - 3,4 letras (p = 0,04) e uma mudança na EF de -3.8 um (p = 0,96). Com relação ao teste de SC dentre os 28 olhos do GE, houve uma melhora no mês 6 em relação ao baseline nos ciclos: 1,5 (p < 0.001) e 3,0 ciclo (p=0.023). Dentre os 30 olhos do GC, não houve uma diferença estatística nos momentos estudados. Conclusão: A injeção intravítrea de RBZ associado com PFC pode ser um tratamento eficaz em olhos de pacientes com RDP precoce e EMD / Purpose: To compare the efficacy of therapy with panretinal photocoagulation (PRP) and intravitreal ranibizumab (RBZ) injection versus PRP alone in patients with treatment-naive bilateral non-high risk proliferative diabetic retinopathy (PDR) with and without diabetic macular edema (DME) with a 6-month follow-up. Design: Prospective, interventional, randomized controlled trial. Methods: Sixty eyes of 30 patients with bilateral non-high risk PDR were randomized either to the study group (SG) receiving PRP plus two intravitreal ranibizumab injections (0.5mg/0.05ml), the first one week before and the second four weeks after the PRP or to the control group (CG) receiving PRP alone. Mean change in best-corrected visual acuity (BCVA), contrast sensitivity (CS) and central macular thickness (CMT) were compared at baseline and 1, 3 and 6 months after treatment. Results: Changes from baseline to 6 months showed in the SG an increased in the BCVA by + 3.4 letters (p= 0.006) with a decrease in CMT by - 47.6um (p < 0.001). In the CG, a decrease by - 3.4 letters (p = 0.04) and an decrease by -3.8um (p= 0.96). Regarding the CS in the SG, there was an improvement compared to baseline for the sixth month in the 1.5 (p < 0.001) and 3.0 cycles (p = 0.023). The CG did not show significant results from baseline to month 6. Conclusion: Intravitreal RBZ associated with PRP can be an effective treatment in eyes with non-high risk PDR and DME

Introdução: Inúmeros estudos estabeleceram correlações entre o índice tornozelo-braço (ITB), um marcador de aterosclerose subclínica, e o prognóstico cardiovascular em diferentes populações. No entanto, poucos estudos avaliaram a correlação entre os valores do ITB e lesões cardiovasculares e renais, exclusivamente, em pacientes com hipertensão arterial e diabetes. Objetivo: Estudar a prevalência de alterações morfofuncionais cardíacas, carotídeas, retinianas e renais de acordo com a presença ou não de valores de ITB alterados (ITB <= 0,9 ou ITB > 1,4) em pacientes hipertensos com diabetes tipo 2. Métodos: Foram incluídos no estudo 99 pacientes hipertensos diabéticos com idade entre 50 e 80 anos. A aferição do ITB foi realizada em todos os pacientes por método validado e estes foram classificados em Grupo 1 (ITB normal, n = 49) ou Grupo 2 (ITB alterado, n =50). Todos os pacientes foram submetidos, em até 06 meses, à realização de ecodopplercardiograma, ultrassonografia de carótidas, retinografia colorida, aferição da taxa de filtração glomerular (TFG) e da albuminúria de 24h. Os pacientes foram analisados para a ocorrência ou não de um desfecho-composto ecocardiográfico que incluiu alterações morfológicas e funcionais cardíacas relevantes para a prática clínica. Os pacientes dos grupos 1 e 2 foram também comparados quanto à prevalência de placas carotídeas com ou sem repercussão hemodinâmica, TFG < 60 ml/mim/m2, albuminúria de 24h > 30mg e presença ou não de retinopatia. Por fim, foram comparadas as frequências médias das seguintes lesões de órgãos-alvo de ambos os grupos, considerando-se valor unitário para a presença de cada uma delas: hipertrofia do ventrículo esquerdo, retinopatia hipertensiva, TFG < 60 ml/min/m2 e estenose da artéria carótida interna > 50% do seu diâmetro. Resultados: A média de idade dos pacientes foi 65,4 ± 7 anos, sendo 61,6% deles do sexo feminino. A presença de níveis elevados de pressão arterial sistólica (153,4 ± 18 versus 170 ± 26 mmHg), de albuminúria de 24h > 30mg (55,3% versus 82,6%) e de TFG < 60 ml/min/m2 (12,8% versus 33,3%) foi significativamente maior (p < 0.05) entre os pacientes do Grupo 2. O desfecho-composto ecocardiográfico foi mais prevalente no grupo 2 (84,0% versus 59,2%; p = 0,006) e a frequência média de lesões de órgãos-alvo também foi maior nos pacientes do grupo 2 (0,36 ± 0,31 versus 0,19 ± 0,19; p = 0,001). Análise por regressão logística binária revelou que o ITB foi uma das variáveis preditoras independentes para o desfecho-composto ecocardiográfico (OR = 3,43; IC 95% = 1,07 - 11,0; p = 0,04). A partir da análise por regressão linear obteve-se um modelo final no qual o ITB foi uma das três variáveis preditoras independentes para a estimativa da frequência média de lesões de órgãos-alvo com coeficiente beta = 13,22 (1,81 - 24,63), ao lado da idade e do infarto prévio. Conclusão: Nossos dados mostram que valores de ITB alterados estão associados à maior prevalência de lesões em órgãos-alvo, principalmente alterações ecocardiográficas, em pacientes com hipertensão arterial e diabetes / Introduction: A lot of studies have established strong correlations between the ankle-brachial index (ABI), a marker of subclinical atherosclerosis and cardiovascular prognosis in different populations. However, few studies have assessed the correlation between the values of the ABI and cardiovascular and renal lesions in patients with hypertension and diabetes. Objective: To study the prevalence of cardiac, carotid, renal and retinal morphological and functional changes according to the presence or not of altered ABI values (ABI <= 0.9 or ABI > 1.4) in hypertensive patients with type 2 diabetes. Methods: It was included 99 diabetic hypertensive patients aged between 50 and 80 years. The measurement of the ABI was performed in all patients by validated method and they were classified in Group 1 (normal ABI, n = 49) or group 2 (altered ABI, n = 50). All patients were submitted, up to 6 months, to Doppler echocardiography, carotid ultrasound, color retinography, assessment of glomerular filtration rate (GFR) and 24h albuminuria. Patients were analyzed for the occurrence or not of a composite echocardiographic outcome which included morphological and functional cardiac alterations relevant to clinical practice. Patients in groups 1 and 2 were compared regarding the prevalence of carotid plaques with or without hemodynamic repercussion, TFG < 60 ml/min/m2, 24h albuminuria > 30 mg and the presence or not of retinopathy. Finally, we compared the prevalence of mean frequency of the following end-organ lesions of both groups, considering unit value for each one: left ventricular hypertrophy, hypertensive retinopathy, TFG < 60 ml/min/m2 and internal carotid artery stenosis > 50%. Results: The mean age of the patients was 65.4 ± 7 years, with 61.6% of them female. The presences of elevated levels of systolic blood pressure (153.4 ± 18 versus 170.0 ± 26 mmHg), of 24h albuminuria > 30 mg (55.3% versus 82.6%) and TFG < 60 ml/min/m2 (12.8% vs. 33.3%) were significantly greater (p < 0.05) among the patients of Group 2. The composite echocardiographic outcome was more prevalent in Group 2 (84.0% versus 59.2%, p = 0.006) and the average frequency of subclinical injury of target organs was also greater in patients of Group 2 (0.36 ± 0.31 versus 0.19 ± 0.19; p = 0.001). Binary logistic regression analysis revealed that the ABI was one of the independent predictors of composite echocardiographic outcome (OR = 3.43; IC 95% = 1.07 - 11.0; p = 0.04). From the linear regression analysis it was obtained a final model in which the ABI was one of three independent predictors for the estimation of the average frequency of end-organ damage with ? coefficient = 13.22 (1.81-24.63), besides age and previous myocardial infarction. Conclusion: Our data demonstrates that changed ABI values are associated with higher prevalence of subclinical end-organ lesions, principally changes in echocardiographic parameters, in patients with hypertension and diabetes