Diagnostic efficacy of total homocysteine and C-reactive protein for ocular ischemic syndrome

Retinal Manifestations in High Altitude

Dangi, Meenu, Arnab Sadhukhan, Poninder Kumar, S. Bandopadhayay, Vijay K. Sharma, V.K. Patra, Manu Chaudhary, and Vipin Rana. Retinal manifestations in high altitude. High Alt Med Biol. 24:296-301, 2023. Aim: To study the high altitude (HA)-related retinal manifestations among security personnel and thus to provide new insights into the characteristics and mechanisms of retinopathy. Materials and Methods: This was a multicentric, nonrandomized prospective observational and descriptive study. We studied 54 security personnel over 1 year, who were referred from HA areas of northern India and north-eastern India for ocular problems. Complete coagulation profile was performed among patients with vascular occlusion. Results: There were total of 54 patients with ages ranging from 22 to 55 years. HA retinopathy was noticed in 28 patients: central retinal vein occlusion (6 patients), branch retinal vein occlusion (4 patients), branch retinal artery occlusion (1 patient), central retinal artery occlusion (4 patients), ocular ischemic syndrome (1 patient), central serous chorioretinopathy (7 patients), acetazolamide-induced maculopathy (1 patient), and solar retinopathy (2 patients). Along with an increased hematocrit, serum homocysteine was raised in the majority of vascular occlusions. The mean age was 38.16 years, the mean altitude was 14,716 ft, and the mean duration of stay was 11.2 weeks. Conclusion: Hypobaric hypoxia due to HA is a potential risk for HA retinopathy and associated vascular occlusions. Aside from increased hematocrit, hyperhomocysteinemia is a potential cause of vascular occlusions.

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.

Bilateral Ocular Ischemic Syndrome in the Setting of Chronic Angle Closure Glaucoma

We report novel case of a 57-year-old woman who developed bilateral ocular ischemic syndrome in the setting of chronic angle closure glaucoma without associated angle neovascularization. Detailed is a course in which markedly prolonged, elevated intraocular pressure led to significantly reduced arterial perfusion at the level of the central retinal artery, leading to the clinical picture of ocular ischemic syndrome.

Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome

Ocular ischemic syndrome (OIS) is a severe ocular disease caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. OIS is easily misdiagnosed or undiagnosed given its asymptomatic onset and complicated ocular manifestations. The present study reviewed 42 patients with OIS, including 30 males (71.43%), 29 older patients (69.05%, >61 yrs), and 35 patients (83.33%) with two or more systemic diseases. Only 6 patients had ocular symptoms as the initial signs upon visiting the Department of Ophthalmology of three hospitals (the First Affiliated Hospital, Sun Yat-sen University; Zhongshan Ophthalmic Center, Sun Yat-sen University; and the Second Affiliated Hospital, Guangzhou Medical University). The ocular symptoms varied from visual deterioration to periorbital pain. Thirty-seven patients (88.10%) complained of constitutional symptoms. Ocular manifestations were diverse and involved both anterior and posterior segments. We reported a case of corneal edema and corneal epithelium erosion in the ipsilateral eye due to internal carotid artery stenosis. As the clinical manifestations of OIS are complex, ophthalmologists must carefully examine patients to avoid a misdiagnosis or a failure to diagnose. The management of OIS requires cooperation with cardiologists and neurologists.