Retinal Abnormalities In Patients Research Articles

Retinal arterial blood flow and retinal changes in patients with sepsis: preliminary study using fluorescein angiography

BackgroundAlthough tissue perfusion is often decreased in patients with sepsis, the relationship between macrohemodynamics and microcirculatory blood flow is poorly understood. We hypothesized that alterations in retinal blood flow visualized by angiography may be related to macrohemodynamics, inflammatory mediators, and retinal microcirculatory changes.MethodsRetinal fluorescein angiography was performed twice during the first 5 days in the intensive care unit to observe retinal abnormalities in patients with sepsis. Retinal changes were documented by hyperfluorescence angiography; retinal blood flow was measured as retinal arterial filling time (RAFT); and intraocular pressure was determined. In the analyses, we used the RAFT measured from the eye with worse microvascular retinal changes. Blood samples for inflammation and cerebral biomarkers were collected, and macrohemodynamics were monitored. RAFT was categorized as prolonged if it was more than 8.3 seconds.ResultsOf 31 patients, 29 (93%) were in septic shock, 30 (97%) required mechanical ventilation, 22 (71%) developed delirium, and 16 (51.6%) had retinal angiopathies, 75% of which were bilateral. Patients with prolonged RAFT had a lower cardiac index before (2.1 L/kg/m2 vs. 3.1 L/kg/m2, P = 0.042) and during angiography (2.1 L/kg/m2 vs. 2.6 L/kg/m2, P = 0.039). They more frequently had retinal changes (81% vs. 20%, P = 0.001) and higher intraocular pressure (18 mmHg vs. 14 mmHg, P = 0.031). Patients with prolonged RAFT had lower C-reactive protein (139 mg/L vs. 254 mg/L, P = 0.011) and interleukin-6 (39 pg/ml vs. 101 pg/ml, P < 0.001) than those with shorter RAFT.ConclusionsRetinal angiopathic changes were more frequent and cardiac index was lower in patients with prolonged RAFT, whereas patients with shorter filling times had higher levels of inflammatory markers.

Joint Effect of Early Microvascular Damage in the Eye &Kidney on Risk of Cardiovascular Events.

Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30–300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD.

Genetic analysis and clinical phenotype of two Indian families with X-linked choroideremia.

Purpose:This study aims to describe the phenotype and genotype of two Indian families affected with X-linked choroideremia (CHM).Materials and Methods:In these two families, the affected individuals and unaffected family members underwent a comprehensive ophthalmic examination including an optical coherence tomography (OCT) and electroretinogram. Blood samples were collected from the families for genetic analysis. Next generation sequencing (NGS) was done using a panel of 184 genes, which covered previously associated genes with retinal dystrophies. Sequencing data were analyzed for the CHM, RPGR, and RP2 genes that have been implicated in CHM and X-linked retinitis pigmentosa (XLRP), respectively. The identified variants were confirmed by Sanger sequencing in available individuals and unrelated controls.Results:In two unrelated male patients, NGS analysis revealed a previously reported 3’-splice site change c.820-1G>C in the CHM gene in the first family and hemizygous mutation c.653G>C (p.Ser218X) in the second family. The asymptomatic family members were carriers for these mutations. Spectral domain-OCT showed loss of outer retina, preservation of the inner retina, and choroidal thinning in the affected males and retinal pigment epithelial changes in the asymptomatic carriers. The identified mutations were not present in 100 controls of Indian origin. There were no potential mutations found in XLRP-associated (RPGR and RP2) genes.Conclusion:This report describes the genotype and phenotype findings in patients with CHM from India. The identified genetic mutation leads to lack of Rab escort protein-1 (REP-1) or affects the production of a REP-1 protein that is likely to cause retinal abnormalities in patients.

Optomap ultrawide field imaging identifies additional retinal abnormalities in patients with diabetic retinopathy.

PurposeTo compare diabetic retinopathy (DR) severity grading between Optomap ultrawide field scanning laser ophthalmoscope (UWFSLO) 200° images and an Early Treatment Diabetic Retinopathy Study (ETDRS) seven-standard field view.MethodsOptomap UWFSLO images (total: 266) were retrospectively selected for evidence of DR from a database of eye clinic attendees. The Optomap UWFSLO images were graded for DR severity by two masked assessors. An ETDRS seven-field mask was overlaid on the Optomap UWFSLO images, and the DR grade was assessed for the region inside the mask. Any interassessor discrepancies were adjudicated by a senior retinal specialist. Kappa agreement levels were used for statistical analysis.ResultsFifty images (19%) (P<0.001) were assigned a higher DR level in the Optomap UWFSLO view compared to the ETDRS seven-field view, which resulted in 40 images (15%) (P<0.001) receiving a higher DR severity grade. DR severity grades in the ETDRS seven-field view compared with the Optomap UWFSLO view were identical in 85% (226) of the images and within one severity level in 100% (266) of the images. Agreement between the two views was substantial: unweighted κ was 0.74±0.04 (95% confidence interval: 0.67–0.81) and weighted κ was 0.80±0.03 (95% confidence interval: 0.74–0.86).ConclusionCompared to the ETDRS seven-field view, a significant minority of patients are diagnosed with more severe DR when using the Optomap UWFSLO view. The clinical significance of additional peripheral lesions requires evaluation in future prospective studies using large cohorts.

Retinal abnormalities in patients with cerebrovascular accident

Background: Cerebrovascular accident (CVA) or stroke is a leading cause of morbidity and mortality worldwide. The aim of the study is to document the retinal abnormalities in patients with CVA seen in a tertiary hospital. Materials and Methods: The retina of patients aged ≥18 years with CVA occurring within 1 year managed in a tertiary hospital were examined from October to December 2013 and the findings recorded. Patients with prior history of ocular trauma and unconscious stroke patients were excluded. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20 and P < 0.05 was taken as significant. Results: A total of 85 patients comprising 61 (71.8%) males and 24 (28.2%) females were seen. The mean age was 66.1 ± 11.0 years (range: 43-88 years), out of which 57 (67.1%) were ≥60 years. There were 67 (78.8%) and 18 (21.2%) cases of ischemic and hemorrhagic stroke, respectively. Hypertension was the most common predisposing factor of stroke in 95.3% of the patients. Abnormalities in the retina background included hemorrhages in 18 (10.6%) eyes, hard exudates and cotton wool spots in 13 (7.8%) and 4 (2.4%) eyes respectively. Retinal vascular abnormalities were documented in 55 (32.4%) eyes. There were more abnormalities in the retina vasculature of patients with hypertension, diabetes mellitus (DM), and hyperlipidemia than in patients without these conditions (P < 0.50). There were also more abnormalities in the background retina of the diabetics when compared to the nondiabetics (P = 0.02). Conclusion: Regular ophthalmic evaluation of patients with predisposing risk factors for CVA with early detection of ocular manifestations/complications of the disease could help modify treatment to prevent or limit more untoward and debilitating effects such as stroke.

Routine retinal examination in patients with acute stroke in Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria

Background: There is high prevalence of hypertension and diabetes in patients with stroke, and these are also major risk factors for potentially blinding retinal diseases. This study was conducted to determine the prevalence and types of retinal abnormalities in patients with acute stroke in Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria. Materials and Methods: A prospective study of 297 consecutive patients with acute stroke was carried out. All the patients recruited had dilated fundoscopy and those who had retinal abnormalities were referred to the eye clinic for follow-up on discharge. Data analysis was by use of statistical package for social sciences (SPSS version 17), with statistical significance set at a P -value of 0.05. Results: Out of the 275 patients examined, 57.4% ( n = 158) had retinal abnormalities. Age-related Macular Degeneration (AMD) predominated (36.7%), followed by cotton wool spots (22.2%) and retinal hemorrhage (16.5%). Hard exudates constituted 12.7%. Neovascularization and microaneurysms formed 5% each, while branch retinal vein occlusion constituted only 1.9%. Sixty-four percent were hypertensive and 24% were diabetic. Conclusion: The prevalence of retinal abnormalities among stroke patients is quite remarkable (57.4%). Routine retinal examination in such patients cannot be overemphasized because it may help to detect potentially vision-threatening retinal disorders.

Bilateral central retinal vein occlusion in a young person with storm syndrome.

To report the presence of previously undescribed retinal abnormalities in patients with Storm and other progeric syndromes. Review of the clinical and photographic records of a patient with Storm syndrome who developed bilateral central retinal vein occlusion. A 43-year-old woman with a diagnosis of Storm (Werner-like) syndrome, a connective tissue disease characterized by premature aging, presented with bilateral nonsimultaneous central retinal vein occlusion. The patient was also observed to have bilateral peripheral retinal pigment epithelial alterations. Retinal abnormalities can be observed in patients with premature aging syndromes. These abnormalities include the development of venous occlusive disease and peripheral retinal pigment epithelial alterations at a relatively young age and may be related to the underlying genetic mutation.

Retinal abnormalities in patients treated with interferon

Retinal abnormalities in patients treated with interferon