Abstract
Rheohaemapheresis treatment influences rheological markers and most likely improves metabolism in affected retinal areas, resulting not only in absorption of soft drusen but also reduction or complete disappearance of drusenoid retinal pigment epithelium detachments. However, the character of the treatment process has raised suspicion that there is a decrease not only in cholesterol but also in antioxidants, such as vitamin E and vitamin A. Twenty-three patients with the progressive dry form of age-related macular degeneration were each treated with 8 procedures of rheohaemapheresis. We measured levels of vitamin E (α-tocopherol), the vitamin E/cholesterol ratio in serum and lipoproteins (VLDL, LDL, HDL). Vitamin E in erythrocyte membrane and serum vitamin A (retinol) were also measured. These parameters were determined before and after rheohaemapheresis. Erythrocyte superoxide dismutase, erythrocyte glutathione peroxidase and serum malondialdehyde were analysed as markers of antioxidant activity and lipid peroxidation, respectively. In serum, the VLDL and LDL fraction ratios of vitamin E/cholesterol increased significantly. Additionally, the HDL fraction ratio showed an increase but this was not statistically significant. The patients showed no clinical signs of vitamin E deficiency, and their serum concentrations of vitamin E did not differ from normal values. The results show that rheohaemapheresis in addition to causing a significant reduction in atherogenic LDL cholesterol, may have favourable additive anti-atherogenic effects due to a relative increase in the content of vitamin E in the lipoprotein fractions.
Highlights
Age-related macular degeneration (AMD) is a highly complex disease, with demographic, environmental and genetic risk factors[1]
Cholesterol and TAG were measured in serum and different lipoprotein fractions, including VLDL, LDL and HDL fractions
The results of 3 trials, enrolling primarily persons at usual risk, found little evidence that supplementation with vitamin E for 4 to 6 years or with β-carotene for 10 years could materially reduce the risk of AMD; with a treatment duration of 10 years, the current findings extended these earlier findings by showing that very longterm supplementation with vitamin E alone was unlikely to have an important effect on AMD occurrence[29]
Summary
Age-related macular degeneration (AMD) is a highly complex disease, with demographic, environmental and genetic risk factors[1]. It affects the central region of the retina and choroid, which can result in loss of central vision[2]. AMD is the leading cause of vision loss in the developed world, such as in Europe, the USA and Australia, among people older than 55/ 65 years old, accounting for up to 50% of all cases. The prevalence in adults is approximately 3% (ref.[2]). It is estimated that approximately 30% of adults older than the age of 75 years old have some signs of AMD and that approximately 10% of these patients demonstrate advanced or late stages of the disease[7]. A comparison of statistical data from the Czech Republic with those from other countries provided difficulties because in the Czech Republic, the limit for legal blindness is 1/60, while in other countries, it is 6/60 (ref.[5])
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