Search Results (135)

Background/Objectives: The hemoglobin–albumin–lymphocyte–platelet (HALP) score combines routine laboratory measures into an index of systemic immune–nutritional status. Its relationship with graded diabetic retinopathy (DR) severity is not fully established. We compared HALP between patients with DR and ophthalmology controls without documented diabetes and examined its association with retinopathy stage and proliferative disease. Methods: This prospective single-center case–control study enrolled 209 consecutive adults: 105 patients with DR and 104 controls. DR was recorded across eight ordered stages and additionally classified as non-proliferative DR (NPDR) or proliferative DR (PDR). Between-group tests, Spearman correlation, logistic regression, and receiver operating characteristic analysis were used. Results: HALP was lower in the DR group than in controls (47.47 [26.44] vs. 52.67 [31.83], p = 0.048) and in PDR than in NPDR (45.98 [17.62] vs. 52.90 [42.49], p = 0.008). HALP declined modestly with increasing stage (rho = −0.260, p = 0.007). In an exploratory age- and sex-adjusted model, each 10-unit increase in HALP was associated with lower odds of case-group membership (OR = 0.850, 95% CI: 0.750–0.963; p = 0.011). Within the DR cohort, HALP was not significantly associated with PDR after adjustment for age, sex, and HbA1c (OR = 0.809, 95% CI: 0.640–1.023; p = 0.077). Discrimination between cases and controls was limited (AUC = 0.579); a threshold of ≤52.09 provided 62.9% sensitivity and 53.8% specificity. Conclusions: Lower HALP values accompanied DR case status and greater retinopathy severity, but the adjusted association with PDR was not significant. Because diabetes status differed between groups, the case–control finding may reflect systemic effects of diabetes as well as retinal involvement. Full article

Background/Objectives: The clinical profile of serum Maresin-1 (MaR1) in relation to diabetic retinopathy phenotypes and proteinuria in type 2 diabetes mellitus (T2DM) remains unclear. We evaluated serum MaR1 across healthy controls and patients with T2DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), or proliferative DR (PDR), and examined the relationship between MaR1 and the urine protein-to-creatinine ratio (UPCR). Methods: This single-center cross-sectional study included 93 participants. Serum MaR1 was measured by ELISA. Group differences were assessed with the Kruskal–Wallis test and Holm-adjusted post hoc tests. DR phenotypes were analyzed among patients with T2DM. The MaR1-UPCR relationship was examined using correlation and adjusted regression models. Results: MaR1 differed across groups (H = 49.36, p < 0.001, epsilon² = 0.521). The median MaR1 was 89.8 (82.8–97.2) pg/mL in controls and 34.3 (33.0–36.0), 35.8 (34.4–36.7), and 34.0 (33.1–35.7) pg/mL in T2DM without DR, NPDR, and PDR, respectively. MaR1 was higher in controls than in all T2DM groups, whereas T2DM groups did not differ. Within T2DM, MaR1 was not associated with DR stage (H = 4.44, p = 0.109; rho = −0.001, p = 0.996). MaR1 was inversely related to the UPCR overall (rho = −0.272, p = 0.008), but not within T2DM (rho = −0.057, p = 0.634) or in adjusted models. Conclusions: MaR1 was markedly lower in T2DM than in controls. This reduction was not explained by DR stage or proteinuria. These findings indicate that MaR1 should be interpreted as a T2DM-associated systemic alteration rather than as a marker of retinopathy stage or proteinuria. Full article

Diabetic retinopathy (DR) reflects retinal microvascular injury and systemic immune-metabolic stress, and most public DR transcriptomic datasets lack paired microbiome/metabolomic profiles. We used gutMGene v2.0 as a curated microbe/metabolite–host gene prior and integrated it with peripheral blood transcriptomics from GSE221521. Candidate genes were refined by weighted gene co-expression network analysis (WGCNA), repeated resampling, cross-dataset assessment, mechanism scoring, peripheral blood mononuclear cell (PBMC) single-cell localization and filamin A (FLNA)-centered single-cell gene regulatory network (GRN) virtual knockout. The gutMGene prior contained 238 host genes; 15 DR-associated genes overlapped this prior, and WGCNA retained ten candidate gut microbe and microbial metabolite-related genes (GMMRGs): FLNA, AKT1, IRAK1, BCL10, CDK6, CTSD, JUP, CXCL1, CXCR2 and IL4R. Resampling prioritized FLNA as the most consistent candidate. Cross-dataset assessment localized the strongest signal to type 2 diabetes (T2D) PBMCs, retinal endothelial cells and advanced proliferative diabetic retinopathy with diabetic macular edema (PDR + DME) retinal tissue, with weaker separation in whole blood, broad retinal tissue and six-donor type 1 diabetes (T1D) PBMCs. FLNA virtual knockout predicted cell-context-dependent perturbation of immune-related transcriptional programs, including IL4R in DR B cells and CTSD in DR monocytes/NK cells. This prior-guided study identifies FLNA within a ten-gene GMMRG set as a circulating host-response signal that links curated microbe/metabolite–host records to immune-vascular and cytoskeletal remodeling in DR. Full article

Background/Objectives: Faricimab is a novel bispecific antibody simultaneously inhibiting vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2). Its efficacy in vitrectomized eyes with diabetic macular edema (DME), a setting with altered intravitreal pharmacokinetics, remains poorly characterized. We evaluated the 12-month outcomes of intravitreal faricimab (IVF) for DME in eyes vitrectomized for proliferative diabetic retinopathy (PDR). Methods: We retrospectively reviewed 12 consecutive eyes of 11 patients (mean age 59.4 ± 10.5 years) with DME after pars plana vitrectomy (PPV) for PDR who received IVF (6 mg/0.05 mL) between September 2022 and August 2024 with at least 12 months of follow-up. Best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT) were assessed at baseline (BL), 6 months (M6), and 12 months (M12). Results: Eight eyes were treatment-naïve and 4 had been switched from prior anti-VEGF therapy. Two eyes (16.7%) required a change in therapy: one for intraocular inflammation and one for inadequate anatomical response. In the 10 eyes that continued IVF, the mean number of injections was 4.1 ± 1.9. CRT decreased significantly from 489.5 ± 95.9 µm at BL to 328.5 ± 74.7 µm at M6 (p = 0.0065) and 307.0 ± 64.3 µm at M12 (p = 0.0023; repeated-measures ANOVA with Dunnett’s post hoc test). Mean BCVA improved from 0.33 ± 0.26 to 0.23 ± 0.21 logMAR at M12 (p = 0.0894). Conclusions: In this small retrospective study of vitrectomized eyes with DME after PPV for PDR, IVF was associated with significant anatomical improvement, while visual acuity remained stable over 12 months, with a relatively low injection burden. Faricimab may be a useful therapeutic option in this challenging population, although larger prospective studies are warranted to confirm these findings. Full article

Background/Objectives: Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes (T2D) and a leading cause of visual impairment. The relationships among Mediterranean diet adherence, dietary components, DR, and vision-related quality of life remain incompletely defined. This cross-sectional study evaluated Mediterranean Diet Score (MDS) as the primary dietary endpoint, individual MDS components as secondary endpoints, and micronutrient intakes as exploratory endpoints. Methods: In this single-centre study, 129 subjects with long-standing T2D were classified as no DR (NDR; n = 85), non-proliferative DR (NPDR; n = 36), or proliferative DR (PDR; n = 8). Dietary intake was assessed using a food frequency questionnaire and vision-related quality of life using the NEI-VFQ-25. Results: Subjects with DR had longer diabetes duration than those without DR (18 vs. 16 years, p < 0.01). Overall MDS did not differ by DR status, indicating a null finding for the primary dietary endpoint. In secondary analyses, lower legume consumption was observed among participants with DR and was associated with higher odds of DR in multivariable models. Participants with PDR showed poorer vision-related quality of life, although this finding was limited by the small PDR subgroup and high NEI-VFQ-25 scores in other groups. Exploratory analyses suggested associations between selected micronutrient intakes and NEI-VFQ-25 domains. Conclusions: Overall Mediterranean diet adherence was not associated with DR status. Secondary and exploratory findings should be considered hypothesis-generating and require confirmation in prospective studies. Full article

Background/Objectives: Diabetic retinopathy (DR) is one of the most common microvascular complications in type 2 diabetes mellitus (T2DM), in which oxidative stress, inflammation and angiogenic pathways are associated with the development and progression beyond glycemic control. Serum trace element levels (Cu, Zn, Fe, Mg, Cr, Mn, Cd, and Se), antioxidant enzyme activities (superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)) were measured in patients with T2DM, with and without DR, as well as in healthy controls, and their associations with the presence and severity of DR were evaluated. Methods: 61 T2DM patients, 27 healthy controls. Patients with T2DM were classified into T2DM without DR (n = 30) and T2DM with DR (n = 31). Non-proliferative DR (NPDR, n = 19) and proliferative DR (PDR, n = 12) were classified as the T2DM with DR group. Inductively coupled plasma–mass spectrometry (ICP-MS) was used to quantify serum trace elements. SOD and GSH-Px activities were measured using colorimetric assays. Results: Significant differences were observed in trace element levels and antioxidant enzyme activities among the study groups (p < 0.001 to 0.05). The DR subgroup had lower levels of Cr, Cu and Se compared to the T2DM without DR group; Cd, Zn and Mn were also higher in the T2DM with DR than in the T2DM without DR group. Fe levels were significantly higher in the PDR subgroup than in the T2DM without DR group (p < 0.001). The PDR group showed greater declines of Cr, Cu and GSH-Px compared to NPDR while higher values for Mn, Fe, and Zn were obtained (p < 0.001). Several biomarkers remained significantly associated with DR after adjustment for metabolic variables. Correlation analysis between trace elements, and antioxidant enzymes showed significant associations. Conclusions: Trace element imbalance, and reduced antioxidant enzyme activities may contribute to the development and progression of DR in T2DM. These findings suggest that oxidative stress and micronutrient imbalance may be linked to DR-related biochemical alterations. Full article

Background/Objectives: Observational studies have reported comorbidity between diabetic retinopathy (DR) and physical frailty, but their genetic interplay remains incompletely understood. This study evaluated shared genetic architecture and potential causal relationships between DR severity and frailty-related phenotypes (FRPs). Methods: GWAS summary statistics were analyzed for four DR phenotypes (broad DR, background DR [BDR], severe non-proliferative DR, and proliferative DR [PDR]) and six FRPs, including frailty index (FI), appendicular lean mass, handgrip strength (HGS), and walking pace (UWP). Global and local genetic correlations were estimated using LDSC, HDL, and LAVA. Causality was assessed using bidirectional Mendelian randomization (MR) and latent causal variable (LCV) analyses. Biological mechanisms were investigated using partitioned heritability, cross-trait meta-analysis, Bayesian colocalization, tissue and cell enrichment, prioritization (MAGMA/TWAS), and 3D chromatin annotation. Results: BDR and PDR showed positive genetic correlations with FI and negative correlations with UWP. Local genetic correlation analyses identified 82 significant regions, including signals on chromosome 6. MR supported a directional effect in which genetic liability to DR was associated with higher FI and lower HGS, with no evidence of reverse causation. LCV indicated partial genetic causality within a shared polygenic architecture. Cross-trait meta-analysis and colocalization highlighted the MHC region, prioritizing C2, AIF1, NOTCH4, and EHMT2. Additional non-MHC loci included the BCL2L15 gene cluster and TERF1. Conclusions: DR and frailty share genetic determinants involving neurovascular, metabolic, and immune-inflammatory pathways, supporting an association between DR liability and frailty-related decline. Future longitudinal and functional studies are needed to validate these findings and assess candidate pleiotropic genes. Full article

Background: Intraocular surgery on patients with an irreversibly blind fellow eye carries high risks, often causing treatment delays due to patient and surgeon hesitation. Existing data beyond cataracts are scarce. This study aims to evaluate the clinical profiles, prognosis, and economic value of diverse surgeries in this monocular population to guide clinical decision-making and optimize blindness prevention strategies. Methods: This retrospective study included 308 patients with a pre-existing blind fellow eye who underwent primary inpatient intraocular surgery under a standardized clinical protocol between June 2021 and June 2025. Baseline demographics, bilateral etiologies, visual outcomes, postoperative complications, and average cost-effectiveness ratios (ACERs) were analyzed. Postoperative outcomes were evaluated for patients with at least 6 months of follow-up. Results: The primary surgical indications were cataract (51.3%), proliferative diabetic retinopathy (PDR, 19.5%), glaucoma (15.9%), and rhegmatogenous retinal detachment (RRD, 7.5%). Notably, 49.4% of patients exhibited identical blinding etiologies bilaterally. Among patients completing the 6-month follow-up (n = 109), overall mean BCVA significantly improved from 1.36 ± 0.77 to 0.73 ± 0.65 logMAR (p < 0.001). The cataract group achieved the greatest visual improvement and the lowest ACER. Despite surgical complexity and higher complication rates, PDR and RRD interventions achieved visual improvement in over 60% of cases. Conclusions: Despite high clinical stakes, timely surgery in monocular patients yields substantial visual and economic benefits. The notable disease symmetry highlights a critical window for early intervention, emphasizing the need for public health strategies that prioritize screening progressive bilateral diseases. Full article

Background/Objectives: This retrospective cohort study compared hospitalization and follow-up rates in patients with newly diagnosed proliferative diabetic retinopathy (PDR) versus those without prior diabetic retinopathy (DR) screening. Methods: Using TriNetX, a global electronic health record database, 57,964 patients aged ≥ 40 years with type 2 diabetes and newly diagnosed PDR without diabetic macular edema (DME) requiring panretinal photocoagulation or intravitreal injection were included. Patients were stratified based on the presence or absence of prior DR screening in the last 5 years and balanced using propensity score matching (PSM). Primary outcomes included 30-, 60-, and 90-day hospitalization rates and repeat ophthalmic follow-up as estimated using repeat PDR diagnosis codes and repeat retinal imaging codes, including OCT, fundus photography, and fluorescein angiography. Results: Of 57,964 patients, 25,003 had no prior DR screening and 32,961 had prior DR screening. After matching, 19,316 patients were included per cohort. Patients without known DR screening had significantly higher hospitalization rates at 30 days (RR = 1.78, 95% CI 1.67–1.89), 60 days (RR = 1.59, 95% CI 1.51–1.67), and 90 days (RR = 1.51, 95% CI 1.44–1.58), and lower repeat ophthalmic visits by PDR codes at 30 days (RR = 0.458, 95% CI 0.440–0.476), 60 days (RR = 0.450, 95% CI 0.437–0.463) and 90 days (RR = 0.420, 95% CI 0.408–0.432) or by repeat retinal imaging codes at 30 days (RR = 0.450, 95% CI 0.423–0.478), 60 days (RR = 0.394, 95% CI 0.377–0.411), and 90 days (RR = 0.381, 95% CI 0.366–0.396) (all p < 0.0001). Conclusions: Absence of known prior DR screening in PDR patients is associated with higher hospitalization risk and reduced ophthalmic follow-up, suggesting that a lack of screening indicates broader gaps in healthcare engagement and disease control. Tailored strategies are needed to prevent vision loss as well as systemic complications. Full article

Purpose: The aim of this study is to describe a slit-modified 23-gauge infusion trocar designed to enable early postoperative hypotony-free sclerotomy closure by allowing scleral suturing prior to complete trocar removal, and to report initial clinical outcomes in eyes with proliferative diabetic retinopathy with or without vitreous hemorrhage (PDR + H and PDR). Methods: A standard 23-gauge metallic (titanium) trocar was modified by creating a longitudinal slit that permitted passage of a suture needle while the trocar remained partially engaged within the scleral tunnel. At the end of pars plana vitrectomy, a transscleral suture was placed through the slit with the knot prepared prior to trocar removal, followed by simultaneous trocar extraction and suture tightening. Eighteen consecutive patients undergoing vitrectomy for PDR (fourteen with vitreous hemorrhage [PDR + H]; four without) were included. Intraocular pressure (IOP) was recorded preoperatively, immediately after sclerotomy closure (postoperative baseline), and at 8 and 24 h postoperatively. The study was designed as an exploratory pilot feasibility and safety evaluation of a slit-modified infusion trocar in 23-gauge vitrectomy. The primary outcomes were postoperative IOP stability and wound leakage. Secondary outcomes included early hypotony, postoperative hemorrhage, choroidal effusion, and the need for additional suturing. Results: All procedures were completed without intraoperative complications. The mean IOP was 14.83 ± 2.50 mmHg preoperatively, 13.33 ± 1.53 mmHg immediately after closure, 14.17 ± 3.01 mmHg at 8 h, and 15.17 ± 1.79 mmHg at 24 h. No cases of wound leakage or early postoperative hypotony were observed in either subgroup. One eye exhibited a transient IOP increase at 8 h; no choroidal effusion, postoperative hemorrhage, or need for secondary suturing occurred. Endotamponade consisted of balanced salt solution (BSS) in eight eyes, SF6 in seven eyes, silicone oil in two eyes, and air in one eye. Conclusions: The slit-modified infusion trocar enables secure, hypotony-free closure of the infusion sclerotomy by eliminating the open-wound interval during trocar removal. This simple biomedical device modification provides stable early postoperative IOP across different tamponade agents and appears safe and feasible in high-risk eyes with PDR. Full article

Background/Objectives: Optical coherence tomography angiography (OCTA) enables noninvasive quantitative assessment of the retinal microvasculature and is widely used in diabetic retinopathy (DR). However, OCTA-derived metrics are highly dependent on post-processing techniques, particularly vessel binarization. This study aimed to compare local and global binarization methods applied after Frangi filtering for vessel enhancement in parafoveal vessel density analysis. Methods: This cross-sectional study included 69 participants: 17 healthy controls and 52 diabetic patients, classified as the following: no DR (n = 14), non-proliferative DR (NPDR, n = 18), or proliferative DR (PDR, n = 20). All subjects underwent comprehensive ophthalmological examination and OCTA imaging of the superficial capillary plexus using a Topcon OCTA system. Images were processed using a custom MATLAB protocol. Following Frangi filtering, five binarization methods were applied: three local (Phansalkar, local Otsu, adaptive mean) and two global (global mean and global Otsu). Parafoveal vessel density was quantified within the four inner quadrants of the ETDRS grid. Results: Statistically significant differences in vessel density were consistently observed between PDR group and both the control and no DR groups across all local binarization methods. Among global methods, only global Otsu thresholding detected a significant difference between PDR and control. The most robust differences were predominantly identified in the nasal and inferior quadrants. Conclusions: Local adaptive binarization methods demonstrated superior sensitivity and structural preservation for parafoveal vessel density analysis in DR. Global methods showed limited discriminative capability. These findings support the preferential use of local adaptive techniques for reliable OCTA-based vascular assessment in diabetic retinopathy. Full article

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes and can lead to severe visual impairment. Based on disease severity, DR is classified into no clinically apparent diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Although nearly all retinal cell types are involved in DR progression, the dominant cell populations and their pathophysiological changes at each stage remain unclear. By integrating bulk and single-cell transcriptomic data from human and mouse retinas, this study revealed the following: (1) In the NDR stage, photoreceptors exhibit significant changes in ribosomal pathways. (2) In the NPDR stage, endothelial cells and pericytes show marked transcriptional alterations, accompanied by enhanced LAMININ signaling in cell-cell communication. (3) At the PDR stage, neural and glial cells are extensively involved in disease progression, with notable changes in ANGPTL signaling. Additionally, this study observed DR-specific subtypes of endothelial cells and pericytes and potentially identifies gene signatures in macroglia cells that correlate with disease duration. The altered expression of several key genes in early diabetic retina was confirmed by qPCR. These findings may offer a comprehensive view of the cellular and molecular landscape underlying DR and may suggest potential targets. Full article

Background/Objectives: This study aimed to evaluate the autoregulatory capacity of optic nerve head (ONH) tissue blood flow in response to intraocular pressure (IOP) fluctuations during vitrectomy in patients with proliferative diabetic retinopathy (PDR). We hypothesized that impaired autoregulation of ONH tissue blood flow in response to intraoperative IOP fluctuations could contribute to subsequent ONH atrophy and the development of visual field defects in PDR patients following vitrectomy. Methods: We included five eyes from five patients with PDR (mean age 70.6 ± 9.0 years) undergoing 25-gauge pars plana vitrectomy. ONH tissue blood flow was quantitatively assessed using intraoperative laser speckle flowgraphy. Mean blur rate in the tissue area (MT), an indicator of ONH tissue blood flow, was measured at baseline (infusion pressure 0 mmHg), during sustained elevation to 25 mmHg (at 5 and 10 min), and 1 min after return to baseline (11 min). IOP was modulated using the IOP Control system of the Constellation platform. Results: Elevation of IOP to 25 mmHg significantly reduced ONH tissue blood flow, with MT decreasing by 29% at 10 min compared with baseline (p < 0.05, Dunn’s multiple comparisons test). After IOP returned to baseline, MT significantly recovered compared with the 10 min measurement (p < 0.05) and returned to levels not significantly different from baseline (p > 0.05). Conclusions: MT decreases during intraoperative IOP elevation in PDR undergoing vitrectomy, but recovers after the return to baseline pressure, suggesting preserved short-term autoregulatory capacity. Careful IOP management during vitrectomy remains important in eyes with PDR. Full article

Diabetic retinopathy (DR) is a major complication of both Type 1 and Type 2 diabetes mellitus (T1DM and T2DM). Disease progression can result in visual impairment, primarily due to diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). Although several ocular treatments are available for DME, a subset of patients fails to respond, reflecting the multifactorial, complex, and systemic nature of DR. Inflammatory biomarkers can be classified according to different characteristics, including imaging biomarkers—most commonly assessed using optical coherence tomography (OCT)—and molecular biomarkers, which are defined by their biochemical and biophysical properties. Pro- and anti-inflammatory cytokines, chemokines, adipokines, and inflammation-related enzymes are recognized as key inflammatory biomarkers and can be detected in the vitreous humour, aqueous humour, tears, serum, and other biological tissues. The identification and characterization of reliable biomarkers may help determine disease severity, monitor disease progression, and predict the risk of specific outcomes, thereby aiding in the prevention of end-stage disease (prognostic biomarkers). In addition, biomarkers may serve as predictive tools for therapeutic response, guiding personalized treatment strategies and enabling ongoing monitoring. This review provides a comprehensive overview of the role of inflammatory biomarkers in the diagnosis and management of DR and DME. Full article

Background: The aim of this study was to comprehensively investigate the potential degenerative effects of periodontitis severity on retinal and choroidal structures in patients with different types of diabetic retinopathy (DR). Materials and Methods: The study’s Clinical Trials Registration Number is NCT07137013. A total of 100 participants (56 females and 44 males), each group consisting of 20 individuals, were allocated into five groups: systemically healthy controls (G1), diabetic patients without DR (G2: DM+ DR−), non-proliferative DR without diabetic macular edema (G3: NPDR DME−), non-proliferative DR with diabetic macular edema (G4: NPDR DME+), and proliferative DR (G5: PDR). Ocular examinations were performed using optical coherence tomography (OCT) and OCT angiography (OCTA). Retinal layer thicknesses, choroid-sclera interface (CSI), ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), and peripapillary CSI were assessed by OCT, whereas superficial and deep retinal vessel densities and the foveal avascular zone (FAZ) were evaluated by OCTA. Clinical periodontal status was assessed using plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL). Results: In the G3 and G5 groups, the presence of stage III–IV periodontitis was associated with a marked increase in retinal layer thickness. GCL + Inner Plexiform Layer (GCL+) thickness was significantly reduced in individuals with stage III–IV periodontitis in almost all regions of the G5 group, except for the 3 mm nasal and inferior areas. Peripapillary CSI values showed a significant decrease with increasing periodontitis severity. RNFL thickness was significantly reduced in individuals with stage III–IV periodontitis, particularly in the G5 group. OCTA analyses demonstrated significant reductions in superficial and deep retinal vessel densities in several regions in the presence of stage III–IV periodontitis. Moreover, FAZ areas were significantly enlarged in individuals with stage III–IV periodontitis in the G2 and G5 groups. Conclusions: Periodontal inflammation, particularly in advanced periodontitis (stage III–IV), induces degenerative changes in the retinal microvasculature and neural tissues. Increasing periodontitis severity may represent a potential provoking factor in the pathogenesis of DR. Full article