Form Of Retinopathy Research Articles

P052 Hydroxychloroquine retinopathy incidence in a UK specialist centre: a machine learning/natural language processing pilot study

Abstract Background/Aims Hydroxychloroquine (HCQ) is an antimalarial drug commonly used in autoimmune conditions such as systemic lupus erythematous (SLE) and rheumatoid arthritis (RA). In SLE, it has been shown to significantly improve survival and morbidity, but is known to be rarely associated with sight-threatening retinopathy. Data from the US suggested HCQ retinopathy was significantly more common than previously thought (up to 7%), causing the Royal College of Ophthalmology to recommend increased screening in 2018. Natural language processing (NLP) is a machine learning technique which purports to be able to identify patients with a specific diagnosis or taking specific mediations from unstructured data such as clinic letters. This study aimed to understand whether NLP could be used to (i) identify patients taking HCQ and (ii) determine rates of HCQ retinopathy from clinic letters in a UK tertiary Rheumatology centre. Methods The study was set across the Kellgren Centre for Rheumatology (regional tertiary lupus centre) and the Manchester Eye Hospital. Analysis was performed using CogStack/MedCat, an open source self-supervised NLP framework which extracts SNOMED coded items from unstructured electronic health data such as clinic letters. All clinical documents 2012-2022 were identified for patients attending clinics coded as HCQ retinopathy screening. These were processed through Cogstack/MedCat in two stages. Firstly, it identified all patients exposed to HCQ according to their clinic letters. Subsequently, MedCat searched all clinical documents for those patients for references to HCQ retinopathy, HCQ retinopathy screening or retinopathy. Diabetic retinopathy was used to sense-check for other forms of retinopathy. Finally, manual validation of the HCQ retinopathy positive cases was performed. Results From an original 202,704 documents, HCQ exposure was identified in 3904 unique patients. These patients had 74,377 associated clinical documents, from which the NLP process indicated 2815 referenced HCQ retinopathy or retinopathy alone (including screening). From clinic codes 1299 individual patients (33.3% of the HCQ exposed population) were confirmed to have undergone screening; 1094 (84.2%) were female, mean age 54.8 years at the time of screening. Of those screened, NLP highlighted 568 references to HCQ retinopathy from 507 patients, within which 10 (0.77%) were confirmed to have HCQ retinopathy by manual validation. Conclusion The study has demonstrated that NLP is a promising technique to quickly identify subsets of patients (e.g. those taking HCQ) from large numbers of outpatient clinic letters. Further training of the algorithm may improve its ability to identify rare but important clinical outcomes. In a tertiary SLE centre, roughly one third of patients on HCQ were screened for HCQ retinopathy and 0.77% confirmed HCQ retinopathy. This is much lower than data from the previous studies in the US, but is in keeping with more recent publications in UK data, reflected in recent amendments to screening guidelines. Disclosure Y. Mushtaq: None. G. Tilston: None. K.L. Hyrich: None. A. Barton: None. N. Peek: None. B. Parker: None. D. Griffiths: None. J.H. Humphreys: None.

Predictability of Nailfold Capillaroscopic Score in Diagnosing Retinopathy in Patients with Type 2 Diabetes Mellitus and its Utility as a Non-Invasive Tool for Differentiating from those Not Having Retinopathy: A Pilot Observational Cross-Sectional Analytical Study.

Diabetes mellitus (DM) is a chronic hyperglycaemic state associated with microvascular structural alterations. Nailfold capillaroscopy (NFC) is an in vivo study of microvascular circulation. This study aimed to investigate the diameters of capillary loops and morpho-structural changes using a handheld dermatoscope in patients with type 2 DM (T2DM) with and without diabetic retinopathy (DR) and to establish nailfold capillary changes and NFC score as a non-invasive method to identify microvascular complication in T2DM patients. A cross-sectional observational study was conducted in AIIMS Rishikesh for 6 months from August 2022 to February 2023. Our study participants were 100 adults more than 18 years of age diagnosed with T2DM, based on the American Diabetes Association (ADA) criteria. All patients were evaluated thoroughly for the presence of microvascular complications in the form of retinopathy. Based on this, they were divided into two groups-group 1 (T2DM with retinopathy) and group 2 (T2DM without retinopathy). Both groups were further subdivided into three subgroups based on haemoglobin A1c (HbA1c): the first group with HbA1c <7%, the second group with HbA1c 7-8.9% and the third group with HbA1c >=9%. For all the study participants, a detailed NFC was done for all 8 fingernails (excluding the thumb), using a handheld dermatoscope. Abnormal capillary shapes (ACS) were recorded by semi-quantitative score (NFC score). A significant association was seen in capillary density (loops/mm) (5.83 ± 0.72 in the DR group and 6.3 ± 0.89 in the no-DR group) (P value = 0.005), capillary density (loops/3 mm) (P value = 0.005), total number of microhaemorrhages/3 mm (P value < .0001), total number of giant capillaries/3 mm (P value = 0.0004), total number of avascular areas/3 mm (P value = 0.0005), enlarged capillaries/3 mm (P value = 0.002), tortuous capillaries/3 mm (P value < .0001), abrogated/bushy capillaries/3 mm (P value = 0.004), number of fingers involved excluding the thumb (P value < .0001) and total nailfold capillaroscopic score (P value < .0001) between the two groups, one with DR and another without DR. Furthermore, the proportion of patients with abnormal nailfold capillaroscopic findings, abnormal NFC score, was significantly higher in patients with DR as compared to patients without DR (51.85% vs 4.35%, respectively) (P value < 0.0001). Our results suggest that NFC could possibly be used as an adjunctive tool in diabetics for diagnosing or monitoring microvascular complications with total NFC score being the significant predictor of DR at a cut-off point of >0 with the area under the curve (AUC) of 0.745 for correctly predicting DR.

Correlation between HbA1c Levels and Severity of Diabetic Retinopathy

Background: In recent years, Diabetes Mellitus (DM) has emerged as the world's leading cause of death with the potential to develop micro vascular complications in the form of retinopathy. HbA1c is an indicator to identify hyperglycemia and plays an important role in monitoring the development of complications due to DM. This study is undertaken determine the relationship between HbA1C levels and the severity of diabetic retinopathy in DM patients.&#x0D; Aim: To identify the relationship between HbA1c levels and different stages of diabetic retinopathy.&#x0D; Method: An analytic observational, cross sectional design, using patients’ medical record. Patient data consisted of gender, age, DM duration, HbA1c levels, and stages of diabetic retinopathy. Non parametric correlation Spearman’s rho was chosen for statistical analysis. &#x0D; Result: A total of 72 DM patients consisted of 29 men and 43 women with a mean DM duration 10.4 years. A total of 37 patients were diagnosed with diabetic retinopathy with 30 NPDR respondents (41.7%) and 7 PDR respondents (9.7%). The average HbA1C levels based on the patient's diabetic retinopathy stages, as follows; normal attained 6.49% (SD ± 0.95), NPDR 8.17% (SD ± 1.77), and PDR 8.47% (SD ± 1, 10). Spearman's non-parametric test showed a strong and significant relationship (p

Study of Characteristic Retinal Findings among Hypertensive Population Attending a Tertiary Care Hospital in Nepal

Background Systemic hypertension is one of the most common chronic, debilitating diseases prevalent in the modern era, with many complications in terms of stroke, chronic kidney disease, coronary artery disease and retinopathy. When it comes to the eye, as a target organ damage, it leads to one of the many vision threatening conditions, hence degrading the quality of life. Early detection and subsequent management of patients at risk of hypertensive retinopathy serves to be a crucial panacea in the treatment course.&#x0D; Objective To investigate the characteristics retinal findings among hypertensive population and analyze the associated risk factors.&#x0D; Method A hospital based prospective study was conducted, among 250 patients presenting to ophthalmology outpatient department in Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH), over a time span of 6 months, to analyze hypertensive retinopathy and its implications. Fundus examination under mydriasis was done on all subjects and hypertensive retinopathy was graded according to the modified Scheie classification.&#x0D; Result Most patients belonged to age group of 56-65 years (30%). Nearly half (48%, N=120) of the hypertensive population had some forms of retinopathy. Grade II hypertensive retinopathy (24.8%) was the most common hypertensive change observed. Majority (55%) of the patients with retinopathy were smokers. About two-third of the subjects (67.5%) had been diagnosed to have hypertension and under treatment for over 5 years.&#x0D; Conclusion The occurrence of retinopathy among hypertensive patients attending ophthalmology department is higher. Awareness regarding systemic hypertension and its effect on ocular health is very important to be disseminated among public. Timely referral among medical specialities could diagnose and prevent curable blindness among hypertensive patients.

Acute Response and Neuroprotective Role of Myo/Nog Cells Assessed in a Rat Model of Focal Brain Injury.

Focal brain injury in the form of a needlestick (NS) results in cell death and induces a self-protective response flanking the lesion. Myo/Nog cells are identified by their expression of bone morphogenetic protein inhibitor Noggin, brain-specific angiogenesis inhibitor 1 (BAI1) and the skeletal muscle specific transcription factor MyoD. Myo/Nog cells limit cell death in two forms of retinopathy. In this study, we examined the acute response of Myo/Nog cells to a NS lesion that extended from the rat posterior parietal cortex to the hippocampus. Myo/Nog cells were identified with antibodies to Noggin and BAI1. These cells were the primary source of both molecules in the uninjured and injured brain. One day after the NS, the normally small population of Myo/Nog cells expanded approximately eightfold within a 1 mm area surrounding the lesion. Myo/Nog cells were reduced by approximately 50% along the lesion with an injection of the BAI1 monoclonal antibody and complement. The number of dying cells, identified by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL), was unchanged at this early time point in response to the decrease in Myo/Nog cells. However, increasing the number of Myo/Nog cells within the lesion by injecting BAI1-positive (+) cells isolated from the brains of other animals, significantly reduced cell death and increased the number of NeuN+ neurons compared to brains injected with phosphate buffered saline or exogenous BAI1-negative cells. These findings demonstrate that Myo/Nog cells rapidly react to injury within the brain and increasing their number within the lesion is neuroprotective.

Honey Dressing Intervention with Diabetic Foot Ulcer: Systematic Review

Diabetic foot ulcers are one of the complications of diabetes mellitus that are often suffered by patients with a history of diabetes mellitus in addition to complications in the form of retinopathy. The purpose of this study was to collect appropriate types of therapy for wound care in diabetic foot ulcer patients. This study uses a systematic review approach. Article search was limited to inclusion criteria and exclusion criteria. The inclusion criteria in this study were diabetic patients with diabetic foot ulcers. The conclusion in this study is that honey is very effective for wound healing in diabetic foot ulcer patients, although there are several methods that are quite effective besides honey, namely the Vacuum Closing package (negative pressure wound care). Honey has been shown to reduce wound size and heal wounds

Genetic investigation of 211 Chinese families expands the mutational and phenotypical spectra of hereditary retinopathy genes through targeted sequencing technology

BackgroundHereditary retinopathy is a significant cause of blindness worldwide. Despite the discovery of many mutations in various retinopathies, a large number of patients remain genetically undiagnosed. Targeted next-generation sequencing of the human genome is a suitable approach for the molecular diagnosis of retinopathy.MethodsWe describe a cohort of 211 families from central China with various forms of retinopathy; 95 patients were investigated using multigene panel sequencing, and the other 116 with suspected Leber hereditary optic neuropathy (LHON) were tested by Sanger sequencing. The detected variation of targeted sequencing was verified by PCR-based Sanger sequencing. We performed a comprehensive analysis of the cases using sequencing data and ophthalmologic examination information.ResultsPotential causal mutations were identified in the majority of families with retinopathy (57.9% of 95 families) and suspected LHON (21.6% of 116 families). There were 68 variants of a certain significance distributed in 31 known disease-causing genes in the 95 families; 37 of the variants are novel and have not been reported to be related to hereditary retinopathy. The NGS panel solution provided a 45.3% potential diagnostic rate for retinopathy families, with candidate gene mutations of undefined pathogenicity revealed in another 12.6%of the families.ConclusionOur study uncovered novel mutations and phenotypic aspects of retinopathy and demonstrated the genetic and clinical heterogeneity of related conditions. The findings show the detection rate of pathogenic variants in patients with hereditary retinopathy in central China as well as the diversity and gene distribution of these variants. The significance of molecular genetic testing for patients with hereditary retinopathy is also highlighted.

Cone dystrophy with supernormal rod responses: A rare KCNV2 gene variant.

To describe the clinical, electrophysiological, and genetic findings of three Portuguese families with a rare variant in the KCNV2 gene resulting in "cone dystrophy with supernormal rod responses" (CDSRR). Retrospective clinical revision of five individuals from three unrelated families with CDSRR. Ophthalmological examination was described in all patients and included color vision testing, fundus photography, fundus autofluorescence (FAF) imaging, spectral domain-optical coherence tomography (SD-OCT), pattern electroretinogram (ERG), and full-field ERG. The mutational screening of the KCNV2 gene was performed with Sanger and Next Generation Sequencing. All patients showed childhood-onset photophobia and progressive visual acuity loss with varying degrees of severity. In multimodal imaging, various degrees of retinal pigment epithelium disturbances and outer retinal atrophy, which tend to be worst with advancing age, were observed. Molecular screening identified a rare presumed truncating variant (p.Glu209Ter) in homozygosity in two families and in compound heterozygosity in a third family. Three patients showed ERG changes characteristic of CDSRR, however, two patients presented with incomplete electrophysiological features of the disease. A rare variant in the KCNV2 gene was identified in five patients from three Portuguese families. This variant often leads to a severe and progressive form of retinopathy. Considerable variability in the ERG responses among patients with this KCNV2 variant was observed.

Serum Fluorescence of Advanced Glycation End Products: A Potential Screening Tool to Distinguish Between Diabetic Patients with and without Microvascular Complications

Introduction: Enhanced formation and accumulation of Fluorescent Advanced Glycation End products (F-AGEs) in diabetes mellitus have been linked to increased risk of developing the associated vascular complications. Aim: To evaluate the potential of serum fluorescence levels of F-AGEs as screening tools to distinguish between type 2 diabetic patients with and without microvascular complications such as retinopathy, neuropathy. Materials and Methods: This cross-sectional study was conducted between June 2016 and June 2017, included 95 type 2 diabetic patients with more than 1 year of diabetes duration. Fasting blood glucose, glycated haemoglobin and total protein levels were estimated by automated methods. Serum F-AGEs were estimated by using a simple spectrofluorometric method. Microvascular complications due to diabetes mellitus were studied in each patient from medical records data on fundus examination for retinopathy and touch, vibration sensation detection for neuropathy. Diabetic patients were categorised into two groups as those without microvascular complications and those with microvascular complications-retinopathy and neuropathy. Statistical tests used for comparisons between groups were chi-square test for gender distribution, independent t-test for other parameters and Pearson’s correlations. The p-value &lt;0.05 indicated significant difference between variables. Results: Mean age of the population was 55.1±5.3 years. Diabetic patients with microvascular complications (n=26) in the form of retinopathy, neuropathy had significantly higher levels of serum F-AGEs with mean 7.4±1.8 AU/g protein compared with diabetic patients without complications with mean value 1.5±0.7 AU/g protein (p&lt;0.01). Conclusion: Two categories of serum fluorescent AGE values, without overlap, could be distinguished between diabetic patients with and without complications. Measurement of serum F-AGEs products has the potential to emerge as a simple, valuable screening tool to distinguish between diabetic patients with and without microvascular complications.

Diseases associated with mutations in CNGA3: Genotype-phenotype correlation and diagnostic guideline.

Along with the molecular and functional characterization of CNGA3, knowledge about diseases associated with CNGA3 mutations has made great progress. So far, CNGA3 mutations are not only one of the most common causes of achromatopsia and cone dystrophy or cone-rod dystrophy but also one of the most commonly mutated genes among various forms of retinopathy. Understanding the clinical characteristics of CNGA3-associated retinal diseases may help clinical practice of infants or children with related diseases. Recognizing the importance of CNGA3 in inherited retinal diseases may enhance related research in searching for functional restoration or repair of CNGA3 defects.

FREQUENCY AND OUTCOME OF RETINOPATHY IN PROFOUNDLY PRETERM NEWBORNS RECEIVING SPECIALIZED MEDICAL CARE

Objective. To determine frequency of retinopathy cases in profoundly preterm newborns treated at Gorodkov Ivanovo Scientific Research Institute of Maternity and Childhood in 2016-2017, as well as to evaluate impact of the risk factors on disease severity in the conditions of specialized medical care. We examined 344 profoundly preterm newborns with gestational age of less than 32 weeks. 83 children (24.1%) were diagnosed with retinopathy of preterm newborns. A high quality of medical care was proved by a low percentage of children with severe forms of retinopathy in preterm newborns and absence of blindness in the children. A low gestational age, low Apgar score at the end of the first minute of life and traditional artificial lung ventilation are the most significant factors of severe retinopathy of preterm newborns.

Swept source optical coherence tomography and optical coherence tomography angiography in pediatric enhanced S-cone syndrome: a case report

BackgroundEnhanced S-cone syndrome is an autosomal recessive retinal dystrophy related to a defect in a nuclear receptor gene (NR2E3) that leads to alteration in cells development from rod to S-cone. This retinal dystrophy may be associated with retinal schisis. The aim of this report is to describe structural optical coherence tomography and optical coherence tomography angiography features in a case of enhanced S-cone syndrome associated with macular schisis.Case presentationA Caucasian 13-year-old girl underwent measurement of best corrected visual acuity, ophthalmoscopic evaluation, and fundus autofluorescence examination. Photopic and scotopic electroretinography were carried out as well. Enhanced S-cone syndrome was suspected on the basis of clinical and electrophysiological findings. Structural optical coherence tomography and optical coherence tomography angiography allowed the further characterization of the associated macular schisis.Genetic analysis not only confirmed the diagnosis but increased the clinical novelty of this case report by showing two variations in the NR2E3 gene probably related to the phenotype: a missense variation c.1118T>C which leads to the substitution of leucine with proline in amino acid position 373, and c.349+5G>C, which involves a gene sequence near a splicing site.ConclusionsSwept source structural optical coherence tomography (B scans and “en face” images) and optical coherence tomography angiography allowed the observation of retinal structural details and the involvement of each retinal layer and capillary plexus in enhanced S-cone syndrome. Of interest, neither of the two NR2E3 gene variants found in this case report have been linked to any form of retinopathy.

Association of Retinopathy with Chronic Kidney Disease in Diabetes Mellitus

Background: Diabetic retinopathy (DR) and nephropathy are two major complications of diabetes mellitus carrying significant morbidity and mortality. In this study DR was investigated in different stages of chronic kidney disease (CKD) to find out possible association of these two devastating complications.Methods: This cross-sectional study was conducted in 150 diabetic patients having CKD in BIRDEM. CKD was defined as estimated glomerular filtration rate (eGFR) of &lt;60ml/min/1.73m2and/or urinary albumin excretion rate (UAER) &gt;30 mg/day in at least two occasions in 3 months apart. Retinopathy was assessed by direct fundoscopic examination and confirmed by color fundus photography. Severe DR (SDR) included proliferative diabetic retinopathy, severe non-proliferative DR and maculopathy; whereas microaneurysm regarded as non-severe retinopathy.Results: Majority (68%) of the respondents had some form of retinopathy (38.35% SDR and 29.65% nonsevere). There was strong association between different levels of albuminuria (UAER) and DR (p&lt;0.0001). On the contrary DR did not correspond with stages of CKD (P=0.349). Hypertension (79.5%) and dyslipidaemia (59%) were common co-morbidities.Conclusion: This study concluded that DR prevalence was more in nephropathy along with significant association with UAER. Whereas different stages of CKD was not associated with stages of DR . This finding focused the necessity of regular retinal examination irrespective of the stage of renal involvement.Birdem Med J 2018; 8(3): 210-214

Rare retinal complications of bone marrow transplantation (BMT): a case report

BackgroundBone marrow transplantation retinopathy is a rare condition affecting the posterior pole. The purpose of this case report is to highlight the possible risk factors and clinical features.Case presentationA 19y old male with relapsed and refractory acute lymphoblastic leukaemia was admitted under haematology with pyrexia of unknown origin. At the time of his admission, he reported bilateral and sequential visual impairment for 2 days. On examination, there was bilateral profound retinopathy across the posterior poles. This was symmetrical and with associated macular oedema. Infective aetiology was excluded and cyclosporine was stopped. Although no definitive treatment was initiated the visual acuity improved whilst macular oedema fluctuated.ConclusionBMT and chemotherapy can cause ocular complications but these are usually confined to the anterior segment. Posterior segment complications in the form of retinopathy is very rare. We report this case to highlight some of the clinical features and course of disease.

Retinal de novo lipogenesis coordinates neurotrophic signaling to maintain vision.

Membrane lipid composition is central to the highly specialized functions of neurological tissues. In the retina, abnormal lipid metabolism causes severe forms of blindness, often through poorly understood neuronal cell death. Here, we demonstrate that deleting the de novo lipogenic enzyme fatty acid synthase (FAS) from the neural retina, but not the vascular retina, results in progressive neurodegeneration and blindness with a temporal pattern resembling rodent models of retinitis pigmentosa. Blindness was not rescued by protection from light-evoked activity; by eating a diet enriched in palmitate, the product of the FAS reaction; or by treatment with the PPARα agonist fenofibrate. Vision loss was due to aberrant synaptic structure, blunted responsiveness to glial-derived neurotrophic factor and ciliary neurotrophic factor, and eventual apoptotic cell loss. This progressive neurodegeneration was associated with decreased membrane cholesterol content, as well as loss of discrete n-3 polyunsaturated fatty acid– and saturated fatty acid–containing phospholipid species within specialized membrane microdomains. Neurotrophic signaling was restored by exogenous cholesterol delivery. These findings implicate de novo lipogenesis in neurotrophin-dependent cell survival by maintaining retinal membrane configuration and lipid composition, and they suggest that ongoing lipogenesis may be required to prevent cell death in many forms of retinopathy.

THE ROLE OF VARIOUS REGULATORY FACTORS IN PATHOLOGICAL VASOPROLIFERATION IN THE RETINOPATHY OF PREMATURITY

Retinopathy of prematurity continues to occupy one of the leading positions in the structure of vision disability among the children. The problem of optimizing the prognosis of this condition, its early diagnostics, and adequate treatment remains a serious challenge and is inextricably connected with the better understanding of the pathogenesis of this disease. It is known that the mechanism underlying the development of retinopathy of prematurity involves the imbalance between the angiogenic factors controlling the process of growth and development of blood vessels in the immature retinal tissue in the combination with the biochemical and immunological disturbances of homeostasis in the prematurely born infants as a result of systemic somatic pathology and the unfavourable multifactorial influence of the environmental conditions, in the first place the effect of elevated oxygen concentrations used for the nursing the preterm babies. A large number of papers have been devoted to the study of various factors contributing to the development of retinopathy in preterm patients at the molecular level. For the purpose of the present review, the search for the relevant literature was carried out using the Medline database. The role of the vascular endothelial growth factor (VEGF-A) and insulin-like growth factor-1 (IGF-1) in the development of pathological vasoproliferation associated with retinopathy of prematurity has been most thoroughly explored. Information about the role of VEGF-A in the pathogenesis of the disease provided the basis for the use of anti-VEGF therapy in the clinical practice for the treatment of certain forms of retinopathy. However, the complicated and multifactorial character of the pathogenesis of this disease as well as the need for the enhancement of the effectiveness of its treatment and optimization of the screening procedure dictates the necessity of looking for additional approaches to the solution of this problem and of studying the relationships between various factors involved in the disturbance of retinal angiogenesis in the children presenting with retinopathy of prematurity.

Simple and complex retinal dystrophies are associated with profoundly different disease networks

Retinopathies are a group of monogenetic or complex retinal diseases associated with high unmet medical need. Monogenic disorders are caused by rare genetic variation and usually arise early in life. Other diseases, such as age-related macular degeneration (AMD), develop late in life and are considered to be of complex origin as they develop from a combination of genetic, ageing, environmental and lifestyle risk factors. Here, we contrast the underlying disease networks and pathological mechanisms of monogenic as opposed to complex retinopathies, using AMD as an example of the latter. We show that, surprisingly, genes associated with the different forms of retinopathies in general do not overlap despite their overlapping retinal phenotypes. Further, AMD risk genes participate in multiple networks with interaction partners that link to different ubiquitous pathways affecting general tissue integrity and homeostasis. Thus AMD most likely represents an endophenotype with differing underlying pathogenesis in different subjects. Localising these pathomechanisms and processes within and across different retinal anatomical compartments provides a novel representation of AMD that may be extended to complex disease in general. This approach may generate improved treatment options that target multiple processes with the aim of restoring tissue homeostasis and maintaining vision.

Relationship between retinopathy and renal abnormalities in black hypertensive patients

BackgroundComplications of hypertension are particularly common in people of African descent but previous reports had suggested rarity of hypertensive retinopathy in black Africans. We evaluated retinal changes among Nigerian hypertensive patients and determined their relationship with renal function.MethodsConsecutive Hypertensive patients who were ≥18 years were selected for the study. Socio-demographic characteristics, anthropometric parameters and blood pressure were measured. All patients had ophthalmoscopic examination and retinal changes were graded according to Keith-Wegener’s classification. Blood samples were taken for blood urea nitrogen, lipids and C-reactive protein; and urine was collected for creatinine and microalbuminuria. Serum creatinine was determined using modified Jaffe method and estimated glomerular filtration (eGFR) was calculated using MDRD equation: 186 × (Creatinine/88.4)-1.154 × (Age)-0.203 × (0.742 if female) × (1.210 if black).ResultsOf the 240 patients studied, 187 (78 %) had one form of retinopathy or the other. While 85 (35.4 %) patients had grade 1 retinopathy, 87 (36.3 %) had grade 2, 13 (5.4 %) had grade 3 and 2 (0.83 %) had grade 4 respectively. Comparison of patients with and without retinopathy showed that, the former were older (p = 0.001) and had longer duration of hypertension (p = 0.001). Similarly, hypertensive patients with retinopathy had higher total cholesterol and low density lipoprotein cholesterol (p = 0.017, p = 0.041 respectively). However, eGFR was lower in individuals with retinopathy (46.2 ml/min/1.73) than those with normal retinal (55.9 ml/min/1.73) findings, p = 0.019. Multi-variable adjusted odds ratios showed increased probability of retinopathy with age (odds ratio-1.08, p = 0.001) and body mass index (odds ratio-1.20, p = 0.013).ConclusionsHypertensive retinopathy is a common clinical finding among hypertensive Nigerians and may occur pari passu with renal damage as consequences of long standing hypertension.

Confiabilidad de la escala NEI VFQ-25 en una población colombiana con enfermedad ocular crónica

IntroductionThe Quality of life related of visual Functioning, is a measure that reflect the subject perception the patient has of his condition and the implications that carries of ocular disease, if consider: objective, expectations and interests. There are instruments designed to measure this construct, as the scale of National Eye Institute Visual Functioning Questionnaire -25 (NEI VFQ-25), that like any other questionnaire, before being used, it requires an analysis of reliability that supports the usefulness of the results. MethodsThe reliability of the Scale NEI VFQ-25 was evaluated in terms of internal consistency (Cronbach's Alpha coefficient) and reproducibility (Intraclass Correlation Coefficient–Limits of agreement of Bland and Altman). The questionnaire was applied in 206 people between 40 and 70 years old with diagnostics of bilateral chronic eye disease, who they were treated in the Fundación Oftalmológica de Santander FOSCAL. To assess reproducibility a subsample of 101 people were employed in whom it was applied twice the questionnaire. ResultsThe participants has an average age of 58.1 years and had glaucoma (21.71%), cataract (36.92%) or some form of retinopathy (35.46%). The Cronbach's Alpha coefficient ranged from α= 0.4761 (social Functioning) and α= 0.8430 (difficulties at work), while the Intraclass correlation coefficient was higher than 0.90. ConclusionThe findings demonstrate adequate reproducibility test fails, but shortcomings in the theoretical conceptualization of some domains of the scale.

Could Crocus sativus (saffron) be combined with conventional therapies for ocular diseases?

Dear Sir, Oxidative stress due the continuous contact of ocular tissues with radiation, atmospheric oxygen, environmental chemicals, and physical abrasion has been proposed to play a vital role in diseases such as glaucoma, cataract, uveitis, retrolental fibroplasias, age-related macular degeneration (AMD), and various forms of retinopathy. This offers a prospect for novel approach to their prevention and treatment. Unfortunately, there are no curative treatment options for AMD, and even palliative treatments are few. The utilized therapeutic modalities are associated with various adverse effects, are costly, and only manage the consequence without tackling the cause of the pathology. Hence, many novel options are being investigated. Conventional and newly promising management measures have not accomplished in reversing the outcome of ocular diseases to any radical extent. This has implied researchers to investigate alternative treatment options. Hence, the widespread collections of traditional medicinal knowledge systems from various parts of the world are re-investigated for their healing properties. Crocus sativus L., commonly known as saffron, is the raw material for one of the most expensive spices in the world, and it has been used in folk medicine for centuries. The major active constituents of saffron are crocin, crocetin, and safranal. There is increasing substantiation that the spice saffron, which contains powerful anti-oxidants, offers protection against neurodegenerative disorders, including AMD and Alzheimer's disease.[1] Ischemic retinopathy and AMD are the foremost ocular diseases that cause blindness. The etiology of these diseases is due in part to the reduction of blood flow in the retina and/or choroid. Crocin analogs isolated from C. sativus L. were found to significantly increase the blood flow in the retina and choroid and to facilitate retinal function recovery.[2] Experimental studies conducted by Ishizuka et al. have demonstrated that crocetin prevents ischemia-induced retinal damage through its inhibition of oxidative stress.[3] Results from the experiment by Yamauchi et al. suggest that crocetin has protective effects against retinal damage in vitro and in vivo, indicating that crocetin could suppress increase in caspase-3 and caspase-9 activities following retinal damage.[4] In a randomized clinical trial, it was demonstrated that short-term saffron supplementation improves retinal flicker sensitivity in early AMD.[5] Saffron extract prevented selenite-induced cataract formation in Wistar rats, probably due to the fortification of antioxidant status, diminution of the concentration of lipid peroxidation, shielding the sulfhydryl groups, and suppression of proteolysis of the lens water-soluble fraction. These findings highlight the anticataractogenic potential of saffron by virtue of its antioxidant property.[6] These attractive effects propose its presence as a therapeutic agent in future. Though saffron and its constituents have shown multiple useful effects, clinical evidence is still scarce in this regard, and more comprehensive studies with special focus on human clinical trials are required. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.