Low serum apolipoprotein A1/B ratio is associated with proliferative diabetic retinopathy in type 2 diabetes

Background

The association between lipids and diabetic retinopathy (DR) remains unclear. Only a few studies have reported the association between proliferative diabetic retinopathy (PDR) and the serum concentrations of apolipoprotein A1 (apoA1), apolipoprotein B (apoB) and apolipoprotein E (apoE). So we investigated the lipid profile in type 2 diabetic patients of long duration with very mild nonproliferative diabetic retinopathy (NPDR) or PDR.

Methods

Serum samples were obtained from 25 type 2 diabetic patients with very mild NPDR and 25 type 2 diabetic patients with PDR, and the two groups were matched by diabetes duration and glycosylated hemoglobin (HbA_1c) levels. The levels of total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, apoA1, apoB, and apoE were measured by enzymatic colorimetric, surfactant, and immunotubidimetric method.

Results

Compared with PDR subjects, very mild NPDR subjects were characterized by increased HDL cholesterol (P?=?0.0433) and apoA1 (P?=?0.0290) levels, higher HDL cholesterol/LDL cholesterol (P?=?0.0377) and apoA1/apoB (P?=?0.0061) ratio in serum. There were significant associations between the decreased apoA1 and low apoA1/apoB ratio in serum and PDR. Even after adjustment for age, decreased apoA1 level (P?=?0.0304) and low apoA1/apoB ratio (P?=?0.0218) in serum were significantly associated with PDR in type 2 diabetic patients of over 15?years’ duration.

Conclusions

Low apolipoprotein A1/apolipoprotein B ratio in serum was associated with PDR in type 2 diabetic patients of long duration.     

Proliferative and inflammatory factors in the vitreous of patients with proliferative diabetic retinopathy

Purpose:

The purpose was to measure the concentrations of various cytokines and growth factors (including vascular endothelial growth factor [VEGF] and pigment epithelium-derived factor [PEDF]) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate interaction between inflammatory and proliferative factors in the genesis of PDR.

Materials and Methods:

Vitreous samples from 32 eyes with PDR and 25 eyes without diabetes mellitus and signs of DR (control) were collected. Vitreous concentrations of VEGF, PEDF, monocyte chemotactic protein-1 (MCP-1), interleukin-4 (IL-4), IL-6, IL-8, IL-10, IL-17A, and secretory immunoglobulin A (sIgA) were simultaneously measured using enzyme-linked immunoassay.

Results:

Vitreous levels of VEGF, PEDF, IL-17A, IL-6, IL-8, IL-4, and sIgA were significantly (Π < 0.05) higher in eyes with PDR compared to control. The concentration of VEGF was more than 17-times higher than in control, and the concentration of PEDF was not changed oppositely and was also higher (1.45-times) compared to control, that may indicate disturbances of compensatory mechanisms in angiogenesis regulation in PDR. Significant (P < 0.05) positive correlations were observed between vitreous concentrations of VEGF and IL-17A (r = 0.45), VEGF and IL-8 (r = 0.48), VEGF and IL-4 (r = 0.51), PEDF and IL-17A (r = 0.48), PEDF and IL-8 (r = 0.59), MCP-1 and PEDF (r = 0.72), MCP-1 and IL-8 (r = 0.45), IL-4 and IL-17A (r = 0.65), IL-4 and IL-8 (r = 0.71), IL-8 and IL-17A (r = 0.59).

Conclusions:

Significantly raised levels of inflammatory and proliferative factors and numerous positive correlations between them may demonstrate a significant role of activation of vascular proliferation and local inflammation in the pathogenesis of PDR.     

Long-term anatomical and functional outcomes of idiopathic macular hole surgery. The yield of spectral-domain OCT combined with microperimetry

Background

To evaluate the correlations between anatomical and functional changes studied with microperimetry (MPM) and spectral-domain OCT (SD-OCT) in patients after successful repair of idiopathic macular hole (MH).

Methods

Monocentric, retrospective, interventional study in 23 eyes of 23 patients who underwent successful surgery for MH defined as closure of the hole, at least 1 year before. Reported data were pre- and postoperative best-corrected visual acuity (BCVA), retinal sensitivity values on MPM, macular and foveal thicknesses, and retinal anatomic lesions on SD-OCT.

Results

Macular sensitivity (MS) and foveal sensitivity (FS) were lower and the number of lesions of the outer retinal layers was higher in patients with a poorer postoperative VA (P?=?0.029, P?=?0.011 and P?=?0.003 respectively). Preoperative MH size was lower and MS and FS were better in patients with a preserved junction line between the inner and outer segments of photoreceptors (IS/OS) (P?=?0.045, P?=?0.001, and P?=?0.001 respectively). Better postoperative VA was correlated with better preoperative VA (P?=?0.012, r?=?0.513). Postoperative VA was correlated with MS and FS (P?=?0.032, r?=?0.449, and P?=?0.019, r?=?0.483 respectively). Greater foveal thickness was associated with better postoperative VA (P?=?0.020, r?=?0.482).

Conclusion

Postoperative outer retinal layer integrity is associated with better final retinal sensitivity. Further studies are warranted to assess the role of SD-OCT and microperimetry in the pre- and postoperative evaluation of idiopathic macular holes.     

Relationship between mean platelet volume and retinopathy in patients with type 2 diabetes mellitus

Objectives

To evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus.

Materials and methods

In this study, ocular findings and MPV values were retrospectively reviewed in 192 patients with type 2 diabetes mellitus. The patients were classified into four groups according to ocular findings, as follows: group 1, diabetic patients without diabetic retinopathy (n?=?70); group 2, diabetic patients with non-proliferative diabetic retinopathy (n?=?64); group 3, diabetic patients with proliferative diabetic retinopathy (n?=?58); and group 4, healthy controls (n?=?100).

Results

A significant difference was found in MPV values between groups 2 and 4 (P?=?0.001), between groups 3 and 4 (P?=?0.001), and between groups 1 and 4 (P?=?0.004). No significant difference was found in MPV values between groups 1 and 2 (P?=?0.241) and between groups 2 and 3 (P?=?0.460); whereas there was a statistically significant difference between groups 1 and 3 (P?=?0.015). The three diabetic groups (groups 1, 2, and 3) were compared with each other. While there was a statistically significant difference between groups 1 and 3 (P?=?0.015), there was no significance between groups 2 and 3 (P?=?0.46), and between group 1 and 2 (P?=?0.241). Logistic regression analysis found a 1.40-fold increase in the risk of retinopathy development (OR: 1.404; P?=?0.002) and a 1.46-fold increase in the risk of proliferative diabetic retinopathy (OR: 1.466; P?=?0.002) as the MPV value increased.

Conclusions

In diabetic patients, the risk of retinopathy development increases with higher MPV values.     

Fluorescein angiography, optical coherence tomography, and histopathologic findings in a VEGF165 animal model of retinal angiogenesis

Background

To establish an animal model of retinal neovascularization using vascular endothelial growth factor (VEGF165) and analyze the model using optical coherence tomography (OCT), fluorescein angiography (FA), and histopathologic evaluation.

Methods

Twelve rabbits were divided into groups as follows: group 1 (n?=?3), sham intravitreous injections of 0.1?ml of balanced saline; group 2 (n?=?6), one 10-μg intravitreal injection of VEGF165 on day 0; and group 3 (n?=?3), two 10-μg intravitreal injections of VEGF165, one on day 0 and one on day 7. Follow-up evaluations (days 0, 3, 7, 14, 21, 28) included obtaining fundus color photographs and FA, OCT, and histopathologic examinations. Eyes were enucleated and stained with hematoxylin and eosin (H&;E).

Results

One injection of VEGF (group 2) was associated with dilatation and tortuosity of the retinal blood vessels that developed within 72?h. Retinal neovascularization was present by day 7 and regressed by day 14. However, even on day 28, the capillaries were still tortuous. Two VEGF injections (group 3) caused increased leakage and neovascularization up to day 14; severe capillary nonperfusion was seen during week 4. At the end of the follow-up period, OCT and histopathologic examination of group 3 showed peripapillary tractional retinal detachments. By day 7, the differences between the retinal thickness seen on OCT in groups 2 and 3 and the group 1 control group were significant (p?Conclusions FA, OCT, and histopathologic findings showed that this retinal neovascularization model is efficient, sustainable, and reliable. One injection of VEGF165 created neovascularization that peaked after 1?week; two injections created more intense neovascularization that evolved to retinal detachments after 4?weeks.     

Increased levels of vascular endothelial growth factor in the aqueous humor of patients with diabetic retinopathy

Purpose:

This study aims to investigate the levels of aqueous vascular endothelial growth factor (VEGF) in diabetic patient groups in comparison to normal subjects, and to correlate elevated VEGF with the severity of diabetic retinopathy (DR).

Materials and Methods:

Aqueous samples were obtained from 78 eyes of 74 patients undergoing intraocular surgery and they were examined by the enzyme-linked immunosorbent assay. Color photographs, optical coherence tomography scans, and fluorescein angiography were used to evaluate patients preoperatively.

Results:

A strong statistical correlation was found to exist between the level of aqueous VEGF and the severity of DR (P < 0.001), whereas, the VEGF levels in a control group and a diabetic group without DR were not significantly different (P = 0.985). Aqueous VEGF levels were significantly elevated in patients with proliferative DR (PDR) as compared to the control group (P < 0.001), to diabetic patients without retinopathy (NDR) (P < 0.001), and to diabetic patients with nonproliferative DR (NPDR) (P < 0.001). The aqueous VEGF levels were significantly higher in patients with active PDR than in those with quiescent PDR (P = 0.001). On the other hand, a statistically insignificant (P = 0.065) correlation was found between elevated aqueous VEGF and the presence of macular edema in the NPDR group.

Conclusions:

VEGF was elevated in the aqueous humor of patients with DR compared to that in normal eyes. The aqueous VEGF level had a strong correlation with the severity of retinopathy along with a statistically insignificant difference in macular edema.     

Decreased retinal sensitivity and loss of retinal nerve fibers in multiple system atrophy

Background and aim

In a previous study, retinal nerve fiber layer thickness (RNFLT) loss was shown as part of the neurodegenerative process in multiple system atrophy (MSA). Here, we investigate in a larger cohort of MSA patients whether the RNFLT loss translates into respective visual field defects.

Methods

Spectral domain optical coherence tomography was performed in 20 MSA patients (parkinsonian subtype?=?12, cerebellar subtype?=?8) to quantify peripapillary RNFLT. Visual field (90°) was analyzed by automated static perimetry to investigate retinal structure/function relationship. Eight data sets did not meet stringent quality criteria, and only 12 data sets were further analyzed.

Results

Compared to healthy controls, MSA patients demonstrated a significant reduction of RNFLT in the nasal sectors (p _{nasal-superior} ?=?0.02, p _nasal ?=?0.03, p _{nasal-inferior} ?<?0.01), while changes in temporal RNFLT measures (p _{temporal-superior} ?=?0.42, p _temporal ?=?0.34, p _{temporal-inferior} ?=?0.25) were not statistically significant compared to healthy controls (ANOVA). MSA patients featured a significant global mean deviation (2.74 dB; p?<?0.01) without predominant peripheral visual field defects. Statistical analysis of mean defect in the central (0–30°), peripheral (30–90°) or global (0–90°) visual field revealed no significant correlation (r ² _central?=?0.11, r ² _peripheral?=?0.04, r ² _global?=?0.07) with nasal RNFLT in MSA patients.

Conclusion

MSA patients feature significant reduction in nasal RNFLT and global mean deviation when compared to healthy controls, consistent with the multi-systemic nature of this neurodegenerative disorder. This finding provides first evidence for two independent deteriorations of the visual system in MSA.     

Long-term progression of retinal vasculitis in Behçet patients using a fluorescein angiography scoring system

Background

To evaluate the long-time progression of retinal vasculitis in Behçet patients using the fluorescein angiography (FA) scoring system.

Methods

Retrospective study was conducted for 71 eyes of 43 patients who met the study criteria. All patients completed at least 2 years of follow-up. FA was taken during the periods of active retinal vasculitis and the quiescent phase, and analyzed using a FA scoring system. Among nine categories, the four most prevalent FA signs were evaluated: optic disc hyperfluorescence (score 0–3), macular edema (score 0–4), retinal vascular staining and/or leakage (score 0–7), and capillary leakage (score 0–10).

Results

Mean number of total active inflammations was 2.6?±?1.5 times during mean 55.0?±?20.0 months. Mean scores at the first active inflammation were 1.8?±?1.0 for optic disc hyperfluorescence, 2.4?±?1.0 for macular edema, 5.3?±?2.1 for retinal vascular staining and/or leakage, and 5.8?±?3.2 for capillary leakage. Mean total FA score was 17.4?±?6.8. Mean scores at the first quiescent phase were 0.6?±?0.4 for optic disc hyperfluorescence, 1.1?±?1.2 for macular edema, 3.8?±?1.9 for retinal vascular staining and/or leakage, and 3.5?±?3.5 for capillary leakage. Mean total FA score was 9.1?±?5.0. Mean scores for each active inflammation and quiescent phase were not significantly changed, and mean FA scores were significantly reduced in quiescent phase (P?=?0.003 for optic disc hyperfluorescence, P?=?0.005 for macular leakage, P?=?0.010 for retinal vascular staining and/or leakage, P?=?0.008 for capillary leakage, and P?=?0.018 for total FA score; paired t-test).

Conclusions

Retinal vasculitis of Behçet patients did not significantly progress during long-term follow-up.     

Better performance of RTVue than Cirrus spectral-domain optical coherence tomography in detecting band atrophy of the optic nerve

Background

To assess the agreement and diagnostic performance between retinal nerve fiber layer (RNFL) thickness measurements obtained using the Cirrus (Carl Zeiss Meditec) and RTVue (Optovue Inc.) devices for detection of band atrophy (BA) in patients with permanent temporal hemianopia.

Methods

In this retrospective study, 26 eyes with BA and 64 control eyes were enrolled. The Cirrus optic disc cube protocol and the RTVue optic nerve head map protocol were used. The Cirrus measurements were extracted and regrouped to be topographically matched with the RTVue measurements. Concordance correlation and 95?% limits of agreement were assessed. Areas under the receiver operating characteristic curves (AUC) and the Spearman’s correlation coefficient between average Humphrey total deviation in the temporal hemifield and average RNFL thickness were calculated.

Results

RTVue measured consistently thicker values than Cirrus in controls, whereas in eyes with BA, nasal segment measurements from the RTVue were thinner than those obtained using the Cirrus. Each quadrant showed moderate to close agreement in controls, whereas in eyes with BA, the nasal and temporal quadrants exhibited poor agreement. The RTVue measurements demonstrated significantly higher AUCs for nasal segments just above (0.95) and below (0.96) the horizontal meridian than Cirrus measurements (0.80 and 0.66, respectively) and a significant correlation with visual field loss (r_s?=?0.46, P?=?0.02 for RTVue vs. r_s?=?0.26, P?=?0.22 for Cirrus).

Conclusions

The RTVue RNFL thickness measurements in nasal sectors showed better diagnostic performance in detecting BA and higher correlations with temporal hemianopia than the Cirrus measurements.     

Clinical features of IgG4-related dacryoadenitis

Background

To elucidate the clinical characteristics of IgG4-related dacryoadenitis.

Methods

Clinical features, laboratory findings, radiological findings, associated diseases, treatment, and prognosis were prospectively examined in 12 patients (seven men, five women; mean age, 60.9?±?15.1 years) with IgG4-related dacryoadenitis.

Results

In addition to eyelid swelling, other ophthalmologic symptoms were observed in seven patients, including diplopia (n?=?4), ptosis (n?=?2), visual field disturbance (n?=?2), eye pain (n?=?2), decrease of visual acuity (n?=?2), eye-movement disturbance (n?=?1), dry eye (n?=?1), corneal ulcer (n?=?1), and epiphora (n?=?1). Swelling of the lacrimal glands was bilateral in half of the patients. Other IgG4-related diseases were present in nine patients, including sialadenitis (n?=?5), autoimmune pancreatitis (n?=?4), retroperitoneal fibrosis (n?=?2), and lymphadenopathy (n?=?8). Serum IgG4 levels were significantly higher in patients with other IgG4-related disease (1070?±?813 mg/dl) than in those without (197?±?59 mg/dl, p?=?0.017). Allergic histories and elevated serum IgE levels were each detected in six patients. Eight patients showed inflammatory extension beyond the lacrimal gland, such as thickened rectus muscle (n?=?6), inflammation of the optic nerve (n?=?2), and retrobulbar inflammation (n?=?3). Steroid therapy was effective in seven patients, but dacryoadenitis relapsed in two patients with markedly higher serum IgG4 levels and autoimmune pancreatitis.

Conclusions

IgG4-related dacryoadenitis showed various ophthalmologic symptoms due to extensive inflammation beyond the lacrimal gland, frequent association with other IgG4-related disease or allergic phenomena, and steroid responsiveness.     

A prospective, randomised, multicenter trial for surgical treatment of central retinal vein occlusion: results of the Radial Optic Neurotomy for Central Vein Occlusion (ROVO) study group

Background

To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion (CRVO), radial optic neurotomy (RON) and intravitreal triamcinolone (IVT), in comparison to natural history.

Methods

A prospective, placebo-controlled, randomised and multi-center study. Patients with CRVO were treated in three groups — with either RON, a single intravitreal injection of 4 mg triamcinolone acetonide, or a placebo treatment. The main outcome measures were change of VA (visual acuity) and proportion of eyes with a significant improvement (defined as?>3 lines logMAR scale) of VA from baseline to month 12.

Results

Ninety patients were included. Due to insufficient data, seven were excluded. Forty-seven percent (n?=?18) of patients treated with RON showed an increase in VA, in comparison to 10 % (n?=?2) of placebo-treated patients, and 20 % (n?=?5) of patients treated with IVT. Significantly more patients showed an improvement in VA following RON than in the placebo group (p?=?0.009). Significantly more patients showed an improvement in VA following RON than in the IVT group (p?=?0.034). No significant difference was found when directly comparing improvement in VA following IVT and placebo (p?=?0.667) treatment.Significantly (p?=?0.007) more patients in the placebo group (35 %, n?=?7) showed a deterioration (defined as?>?3 lines LogMAR scale) in VA than patients in the RON group (8 %, n?=?3).

Conclusion

Our study showed that following treatment with RON, patients with CRVO display a significantly better long-term VA than untreated patients and patients treated with a single dose of IVT.     

Surgical outcome of Descemet’s stripping automated endothelial keratoplasty for bullous keratopathy secondary to argon laser iridotomy

Background

To report the 6-month clinical outcome of Descemet’s stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy (BK) secondary to argon laser iridotomy (ALI), and compare the results with those of DSAEK for pseudophakic bullous keratopathy (PBK) or Fuchs’ endothelial dystrophy (FED).

Methods

A total of 103 patients (54 with ALI, 28 with PBK, 21 with FED) undergoing DSAEK were retrospectively analyzed. Simultaneous cataract surgery was performed in 37 patients with ALI and 13 with FED. Preoperative ocular conditions, best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction (SE), induced astigmatism, keratometric value, endothelial cell density (ECD), and complications were determined over 6?months postoperatively.

Results

Mean axial length in the ALI group (21.8?±?0.8?mm) was significantly shorter than that in the FED (P?=?0.02) or PBK groups (P?=?0.003). Severe corneal stromal edema (n?=?6), advanced cataract (n?=?10), posterior synechia (n?=?3), poor mydriasis (n?=?5), and Zinn zonule weakness (n?=?1) were found only in the ALI group. A significant improvement was observed in postoperative BSCVA in all groups. No significant difference was observed in BSCVA, SE, induced astigmatism, keratometric value, ECD, or complications among the three groups.

Conclusions

Descemet’s stripping automated endothelial keratoplasty for BK secondary to ALI showed rapid postoperative visual improvement, with similar efficacy and safety to that observed in DSAEK for PBK or FED.     

Correlation of complement fragment C5a with inflammatory cytokines in the vitreous of patients with proliferative diabetic retinopathy

Purpose

To determine the vitreous concentration of complement fragment C5a in patients with proliferative diabetic retinopathy (PDR) and the relation between C5a and inflammatory cytokines including vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1).

Methods

Vitreous samples were obtained at the time of vitrectomy from 12 eyes of 11 PDR patients and from 11 eyes of 11 patients without diabetes with macular disease (controls). Vitreous and serum concentrations of human C5a, VEGF, and MCP-1 were quantified using FACS Caliber® flow cytometer.

Results

Vitreous concentration of C5a increased significantly in patients with PDR [median (range): 928.7 (46.6 to 3,319.4) pg/ml] compared with controls [58.7 (22.2 to 1,432.4) pg/ml; p?<?0.01]. In PDR patients, vitreous concentration of C5a correlated significantly with those of VEGF (p?<?0.05) and MCP-1 (p?<?0.05).

Conclusions

Our results suggest that C5a may play an important role in the pathogenesis of PDR and work in concert with inflammatory cytokines such as VEGF and MCP-1 in pathological angiogenesis.     

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Purpose

1. Identify differences in optic nerve sheath diameter (ONSD) as an indirect measure of intracranial pressure (ICP) in glaucoma patients and a healthy population. 2. Identify variables that may correlate with ONSD in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) patients.

Methods

Patients with NTG (n?=?46) and POAG (n?=?61), and healthy controls (n?=?42) underwent B-scan ultrasound measurement of ONSD by an observer masked to the patient diagnosis. Intraocular pressure (IOP) was measured in all groups, with additional central corneal thickness (CCT) and visual field defect measurements in glaucomatous patients. Only one eye per patient was selected. Kruskal–Wallis or Mann–Whitney were used to compare the different variables between the diagnostic groups. Spearman correlations were used to explore relationships among these variables.

Results

ONSD was not significantly different between healthy, NTG and POAG patients (6.09?±?0.78, 6.03?±?0.69, and 5.71?±?0.83 respectively; p?=?0.08). Visual field damage and CCT were not correlated with ONSD in either of the glaucoma groups (POAG, p?=?0.31 and 0.44; NTG, p?=?0.48 and 0.90 respectively). However, ONSD did correlate with IOP in NTG patients (r?=?0.53, p?<?0.001), while it did not in POAG patients and healthy controls (p?=?0.86, p?=?0.46 respectively). Patient’s age did not relate to ONSD in any of the groups (p?>?0.25 in all groups).

Conclusions

Indirect measurements of ICP by ultrasound assessment of the ONSD may provide further insights into the retrolaminar pressure component in glaucoma. The correlation of ONSD with IOP solely in NTG patients suggests that the translaminar pressure gradient may be of particular importance in this type of glaucoma.     

Patients with early age-related macular degeneration exhibit signs of macro- and micro-vascular disease and abnormal blood glutathione levels

Background

This pilot study aimed to investigate systemic and retinal vascular function and their relationship to circulatory markers of cardiovascular risk in early age-related macular degeneration (AMD) patients without any already diagnosed systemic vascular pathologies.

Methods

Fourteen patients diagnosed with early AMD and 14 age- and gender-matched healthy controls underwent blood pressure, carotid intima-media thickness (C-IMT) and peripheral arterial stiffness measurements. Retinal vascular reactivity was assessed by means of dynamic retinal vessel analysis (DVA) using a modified protocol. Blood analyses were conducted for glutathione levels and plasma levels of total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG).

Results

The AMD patients showed significantly greater C-IMT (p?=?0.029) and augmentation index (AIx) (p?=?0.042) than the age-matched controls. In addition, they demonstrated a shallower retinal arterial dilation slope (Slope _AD) (p?=?0.005) and a longer retinal venous reaction time (RT) to flickering light (p?=?0.026). Blood analyses also revealed that AMD patients exhibited higher oxidized glutathione (GSSG) (p?=?0.024), lower redox index (p?=?0.043) and higher LDL-C (p?=?0.033) levels than the controls. Venous RT parameter correlated positively with blood GSSG levels (r?=?0.58, p?=?0.038) in AMD subjects, but not in the controls (p?>?0.05).

Conclusions

Patients diagnosed with early AMD exhibit signs of systemic and retinal vascular alterations that correlated with known risk markers for future cardiovascular morbidity.     

Retinal blood flow velocity in metabolic syndrome

Background

Metabolic syndrome (MetS) is characterized by obesity, insulin resistance, dyslipidemia, and hypertension. The Retinal Function Imager (RFI) is a new technique for measuring retinal blood-flow velocity. This study aims to compare retinal blood flow velocity between MetS and healthy subjects.

Methods

Twenty eyes of 20 MetS males and 21 eyes of 21 aged-matched healthy males underwent RFI and carotid–femoral pulse wave velocity (PWV) measurement as well as assessment of MetS parameters. The results in MetS and healthy subjects were compared.

Results

The average venular velocity in the MetS patients was significantly higher than in the healthy subjects (2.7?±?0.0 mm/sec versus 2.5?±?0.0 mm/sec respectively, P?=?0.013), following adjustment for age, heart rate and systolic blood pressure. Carotid–femoral PWV was higher in the MetS population than the healthy controls (10.3?±?1.2 mm/sec versus 9.3?±?1.5 mm/sec respectively, P?=?0.005). The diastolic blood pressure and MAP were correlated strongly with the arterial blood flow velocities in healthy subjects (r?=?0.503, P?=?0.020 and r?=?0.474, P?=?0.030 respectively) but not in MetS subjects.

Conclusions

The RFI was able to distinguish between the retinal blood flow of normal and MetS subjects. Higher venular blood flow velocity and the poor correlation between velocity and blood pressure of MetS subjects suggest that MetS causes microvascular damage.     

Ocular sarcoidosis: when should labial salivary gland biopsy be performed?

Purpose

To assess the usefulness of a labial salivary gland biopsy (LSGB) in subsets of patients with uveitis.

Methods

A retrospective study of 115 consecutive patients with uveitis for whom a LSGB had been done because of suspected ocular sarcoidosis (n?=?86) or unexplained uveitis (n?=?29). Eighty-six patients had a suspicion of ocular sarcoidosis because of ocular features (n?=?67), an elevated angiotensin converting enzyme (ACE) (n?=?29), or because of CT findings (n?=?32) suggestive of sarcoidosis. The biopsy results were analyzed together with their ophthalmological features and the results of other relevant examinations, such as the serum levels of ACE and a chest radiography or a CT scan.

Results

Six of the 115 patients (5.2 %) with uveitis had sarcoid granulomas on the LSGB. At the end of the study, 32 patients had proven sarcoidois while 22 patients were considered as having either indeterminate or presumed sarcoidosis, according to the criteria of Abad et al. A raised ACE (p?=?0.016) and a compatible radiology (p?=?0.033) were related to a positive LSGB test, but not to the features of uveitis. Granulomas were only found in the LSGB of the patients with an elevated ACE or compatible CT scans.

Conclusions

In this study, the LSGB sensitivity (18.75 %) in the patients with proven sarcoidosis appears to be lower than in other reports. Our results suggest that this investigation is a possible method of tissue diagnosis in patients with raised ACE and/or CT scan pattern compatible with sarcoidosis, and should not be performed in patients with unexplained uveitis or because of their ophthalmological features.     

Photoreceptor inner and outer segment layer thickness in multiple evanescent white dot syndrome

Purpose

To evaluate the photoreceptor inner and outer segment layer thickness in eyes with MEWDS.

Design

Prospective, non-comparative, observational case series. The follow-up duration was 4 months.

Methods

Four women were diagnosed with unilateral MEWDS. The ages of the patients were 25, 24, 35, and 40 years. The retinal microstructure was assessed by spectral-domain optical coherence tomography (SD-OCT). The thickness of the photoreceptor inner (IS) and outer (OS) segments and sum of them (IS + OS) at the fovea were analyzed.

Results

The visual acuity was reduced in three of four eyes at the acute phase. SD-OCT showed that the border of IS and OS (IS/OS) line and the cone outer segment tips (COST) line in the macula area were not detected in all four eyes. The IS + OS thickness was 50.3?±?5.6 μm and that of the healthy fellow eyes was 73.5?±?7.0 μm (n?=?4 eyes). The thickness of the IS was 27.8?±?2.6 μm and that of the OS was 45.8?±?7.3 μm. In all eyes, there was a spontaneous improvement of the visual acuity. SD-OCT showed a recovery of only the IS/OS line in the macular area, but the COST line was not visible in three cases. The mean IS + OS thickness increased to 56.0?±?7.9 μm (n?=?4), IS?=?26.0?±?2.0 μm (n?=?3), and OS?=?30.1?±?8.7 μm (n?=?3) in the early recovery phase, and to 64.8?±?9.3 μm (n?=?4), IS?=?28.5?±?1.7 μm (n?=?4), and OS?=?36.3?±?7.9 μm (n?=?4) in the late recovery phase. The mean inner and outer segment thickness remained unchanged in the fellow eyes.

Conclusion

Eyes with MEWDS have changes in the photoreceptor microstructures. The change in the IS + OS thickness during the natural recovery course might be due to an increase in the OS length.     

Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents

Background

We previously demonstrated that compliance with occlusion therapy for amblyopia was improved by the use of an educational programme, especially in children of parents of foreign origin and who spoke Dutch poorly. The programme consisted of: (i) a cartoon story for amblyopic children that explained without words why they should patch, (ii) a calendar with reward stickers, and (iii) an information leaflet for parents. In the current study, we assessed the individual effect of each component on compliance.

Methods

We recruited 120 3- to 6-year-old children who lived in a low socio-economic status (SES) area in The Hague and were starting occlusion therapy for the first time. They were randomised to receive one of the components (three intervention groups), or a picture to colour (control group). The randomisation was blinded for treating orthoptist and researcher. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). Primary outcome was percentage of compliance (actual/prescribed occlusion time). Secondary outcome was absolute occlusion hours per day. Parental fluency in Dutch was rated on a five-point scale.

Results

Compliance could be measured electronically in 88 of the 120 children; in 32 others, it failed for various reasons. Parental fluency in Dutch was moderate or worse in 36.4 % (p?=?0.327). Average compliance was 55 % standard deviation (SD) 40 (n?=?18) in the control group, 89 % SD 25 in the group receiving the educational cartoon (n?=?25, P?=?0.002 compared with control group), 67 % SD 33 (n?=?24, P?=?0.301) in the reward-calendar group and 73 % SD 40 (n?=?21, P?=?0.119) in the parent-information-leaflet group. On average, children in the control group occluded 1:46 SD1:19 hours/day, 2:33 SD 1:18 hours/day in the group receiving the educational cartoon, 1:59 SD 1:13 hours/day in the reward-calendar group and 2:18 SD 1:13 hours/day in the parent-information-leaflet group. No child who received the cartoon story occluded less than 1 hour per day, against seven in the reward-calendar group, five in the parent-information-leaflet group and five in the control group.

Conclusions

Although all three components of the programme improved compliance with occlusion therapy in children in low-SES areas, the educational cartoon had the strongest effect, as it explained without words to a 4- to 5-year-old child why it should wear the eye patch.     

Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure

Aims

To evaluate long-term efficacy of goniosynechialysis (GSL) combined with phacoemulsification and intraocular lens implantation (phaco-GSL) for primary angle closure or primary angle-closure glaucoma (PAC/PACG) and to analyze risk factors for surgical outcomes.

Methods

We reviewed medical records of 109 eyes of 109 patients (mean [± SD] age 70?±?9.4 years) who underwent phaco-GSL as primary treatment of PAC/PACG at five institutions. All eyes had a preoperative intraocular pressure (IOP) of ≥21 mmHg with or without medications. Surgical failure was defined as: (1) condition A: persistent IOP values of ≥21 mmHg, or (2) condition B: IOP values of ≥18 mmHg, with or without topical ocular medication, at two consecutive follow-up visits, or additional operations needed. Risk factors for surgical failure were analyzed via Cox proportional hazards model.

Results

Mean follow-up was 40.0 months (range, 1 to 139 months). Probabilities of treatment success at 1 and 3 years after phaco-GSL were 85.9 % and 85.9 % (condition A) and 66.2 % and 61.0 % (condition B) respectively. Via multivariable analysis, we identified risk factors for surgical failure to be younger age (relative risk [RR]?=?0.93/year, P?=?0.0333) and absence of postoperative laser peripheral iridoplasty (LPI) (P?=?0.0359) for condition A, and younger age (RR?=?0.94/year, P?=?0.0035), lower preoperative IOP (RR?=?0.93/mm Hg, P?=?0.0131), and absence of postoperative LPI (RR?=?2.34, P?=?0.0228) for condition B.

Conclusions

The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.