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CURRENT ISSUE

№1' 2022

OPHTHALMOLOGY

International Medical Journal, Vol. 28., Iss. 1, 2022, P. 65−70.

DOI (https://doi.org/10.37436/2308-5274-2022-1-14)

DIABETIC MACULAR EDEMA: VISUAL EVOKED POTENTIALS IN ASSESSING THE ACTIVITY OF SUBCORTICAL STRUCTURES AND PRIMARY VISUAL AREAS OF PATIENTS

Dnipro State Medical University, Ukraine

To determine the role of visual evoked potentials in assessing the activity of subcortical structures and primary visual zones in the patients with diabetic macular edema, 91 patients with type 2 Diabetes mellitus with nonproliferative diabetic retinopathy were examined. The study used methods of visiometry, refractokeratometry, measurement of intraocular pressure, biomicroscopy and ophthalmoscopy, computed perimetry, optical coherence tomography, electroencephalography to determine the visual evoked potentials. In all examined patients the visual acuity was 0.19±0.001. The ophthalmoscopic picture was characterized by the presence of microhemorrhages, hard and single soft exudates, distinct veins, vascular venous loops along the veins, tortuosity of the arteries. In patients with diabetic macular edema, diffuse retinal thickening in the macular area, significant changes in the thickness and volume of the central, para− and periphoveal areas were observed on optical coherence tomography. The analysis of visual evoked potentials showed that in patients the most deformed were components P2 − P3, N2 − N3, which participate in information processing at the level of primary and integrative cortical modal−specific processing. The high sensitivity of the initial parts of visual analyzer to the unfavorable state of intracerebral homeostasis in diabetic macular edema, which respond to its disorder in the first place, has been suggested. The results of the study of induced brain activity confirm the development of neurodynamic disorders of a complex nature in this category of patients. Investigation of induced activity in diabetic macular edema is a highly informative method that should be used to optimize diagnosis, pathogenetic therapy, control treatment, and prevent the progression of diabetic retinopathy.

Key words: diabetic macular edema, visual evoked potentials, diagnosis.

REFERENCES

1. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta−analysis / J. Li et al. Eur. J. Epidemiol. 2020. № 35 (1). R. 11−23. URL: https://pubmed.ncbi.nlm.nih.gov/31515657/

2. Visual Acuity and Foveal Structure in Eyes with Fragmented Foveal Avascular Zones / R. Linderman et al. Ophthalmol. Retina. 2020. № 4 (5). R. 535−544. URL: https://pubmed.ncbi.nlm.nih.gov/31956075/. doi: https://doi.org/10.1016/j.oret.2019.11.014

3. K., Santhanamahalingam S., Duraisamy M. Algorithms for Diagnosis of Diabetic Retinopathy and Diabetic Macula Edema. A Review Adv. Exp. Med. Biol. 2021. № 1307. R. 357−373. doi: 10.1007/5584_2020_499. URL: https://pubmed.ncbi.nlm.nih.gov/32166636/

4. Oftal'mologiya. Natsional'noe rukovodstvo. Kratkoe izdanie / Pod red. S. E. Avetisova, E. A. Egorova, L. K. Moshetovoi, V. V. Neroeva, Kh. P. Takhchidi. M.: GEOTAR−Media, 2014. 740 s.

5. Retinal images benchmark for the detection of diabetic retinopathy and clinically significant macular edema (CSME) / M. Noor−Ul−Huda et al. Biomed. Tech. (Berl.). 2019. № 64 (3). R. 297−307. doi: 10.1515/bmt−2018−0098. URL: https://pubmed.ncbi.nlm.nih.gov/30055096/

6. Diabetic macular edema / G. Tan et al. Lancet Diabetes Endocrinol. 2017. № 5 (2). R. 143−155. doi: 10.1016/S2213−8587(16)30052−3. URL: https://pubmed.ncbi.nlm.nih.gov/27496796/

7. Khits' A. R. Dіabetichnii makulyarnii nabryak: menedzhment patsієntіv u svіtlі suchasnikh rekomendatsіi. Ukr. med. chasopis. 2021. URL: https://www.umj.com.ua/article/212799/diabetichnij−makulyarnij−nabryak−menedzhment−patsiyentiv−u−svitli−suchasnih−rekomendatsij

8. Optical coherence tomography for age−related macular degeneration and diabetic macular edema: an evidence−based analysis. Medical Advisory Secretariat. Ont. Health Technol. Assess Ser. 2009. № 9 (13). R. 1−22. URL: https://pubmed.ncbi.nlm.nih.gov/23074517/

9. Browning D., Stewart M., Lee Ch. Evidence−based management. Diabetic macular edema. Indian J. of Ophthalmology. 2018. Vol. 66 (12). R. 1736−1750. doi: 10.4103/ijo.IJO_1240_18. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256891/

10. Nakaz MOZ Ukraїni vіd 21 grudnya 2012 roku № 1118 "Unіfіkovanii klіnіchnii protokol pervinnoї ta vtorinnoї (spetsіalіzovanoї) medichnoї dopomogi. Tsukrovii dіabet 2 tipu". URL: http://mtd.dec.gov.ua

11. Dodatok do nakazu MOZ Ukraїni vіd 22 travnya 2009 roku № 356 "Protokol nadannya medichnoї dopomogi khvorim z dіabetichnoyu retinopatієyu". URL: http:// medstandart.net

12. Postanova Kabіnetu Mіnіstrіv Ukraїni vіd 31 travnya 2012 roku № 485 "Pro vnesennya zmіn do Postanovi Kabіnetu Mіnіstrіv Ukraїni vіd 3 grudnya 2009 roku № 1317". URL: http://zakon2.rada.gov.ua/laws/show/1317−2009−%DO%BF%/print

13. Khel'sinskaya deklaratsiya Vsemirnoi meditsinskoi assotsiatsii. Eticheskie printsipy meditsinskikh issledovanii s uchastiem cheloveka v kachestve ob"ekta issledovaniya. Peresmotr, oktyabr' 2008. URL: http: //www.mniip.org/science/library/Helsinki_declaration.php.

14. Pogorelov V. O. Klіnіko−neirofіzіologіchnі osoblivostі perebіgu gostrikh іshemіchnikh porushen' mozkovogo krovoobіgu (dіagnostika, prognoz): dis. d−ra med. nauk: 14.01.15, 2012. 429 s. URL: https://docs.google.com/document/d/1MqLaTCTEfRXor7Tgl0koaP8Ik2p7ZKZj/edit?rtpof=true&sd=true

15. Statistichna obrobka danikh / V. P. Babak, A. Ya. Bіlets'kii, O. P. Pristavka, P. O. Pristavka. K.: MІVVTs, 2001. 387 s.

16. Delay in seeking medical care after the onset of symptoms in patients with sight−threatening diabetic retinopathy / Y. Wei et al. J. Int. Med. Res. 2021. Vol. 49 (5). doi: 10.1177/03000605211013224. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150428/

17. Maksimchuk O. Yu. Optichna kogerentna tomografіya v dіagnostitsі gostrikh porushen' venoznogo krovoobіgu v sіtkіvtsі і їkh uskladnen'. Aktual'nі problemi suchasnoї meditsini. 2020. T. 20, № 4 (72). S. 70−77. doi: 10.31718/2077−1096.20.4.72. URL: https://visnyk−umsa.com.ua/index.php/journal/issue/view/9

18. Spaide R. F. Retinal vascular cystoid macular edema: Review and new theory. Retina. 2016. № 36 (10). R. 1823−1842. URL: https://pubmed.ncbi.nlm.nih.gov/27328171/. doi: https://doi.org/10.1097/iae.0000000000001158

19. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040 / K. Ogurtsova et al. Diabetes Res. Clin. Pract. 2017. Vol. 128. P. 40−50. doi: 10.1016/j.diabres.2017.03.024. URL: http://www.ncbi.nlm.nih.gov/pubmed/28437734

20. Ding J., Wong T. Current epidemiology of diabetic retinopathy and diabetic macular edema. Curr. Diab. Rep. 2012. Vol. 12 (4). R. 346−354. doi: 10.1007/s11892−012−0283−6. URL: https://pubmed.ncbi.nlm.nih.gov/22585044/

21. Diabetic Macular Edema / C. Duphare et al. StatPearls. 2021. URL: https://pubmed.ncbi.nlm.nih.gov/32119271/