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Gouliopoulos N, Siasos G, Oikonomou E, Sapounas S, Rouvas A, Ziogas AC, Moschos MM, Tousoulis D. The Association of Systemic Endothelial Dysfunction With Diffuse Diabetic Macular Edema. Angiology 2024:33197241263384. [PMID: 38889729 DOI: 10.1177/00033197241263384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Our aim was to assess whether systemic endothelial dysfunction, evaluated non-invasively by flow mediated dilation (FMD), is associated with diabetic macular edema (DME) and to determine if it is further impaired in patients with diffuse-DME. Consecutive patients (n = 84) with type-2 diabetes mellitus (T2DM) and diabetic retinopathy were enrolled. DME was not present in 38 (non-DME) and present in 46 patients; 25 with focal and 21 with diffuse-DME. No differences were detected between DME and non-DME groups regarding the clinical and demographic characteristics, except for the age of T2DM initiation (lower in non-DME). FMD values were significantly impaired in DME compared with non-DME patients, even after adjustment for multiple covariates (3.56 ± 1.03 vs 4.57 ± 1.25%, P = .003). Among DME patients, no differences were found concerning the clinical and demographic data, while FMD levels were significantly lower in diffuse-DME patients, compared with the focal-DME ones, regardless of the impact several confounders (2.88 ± 0.65 vs 4.08 ± 0.95%, P = .002). It is noteworthy that FMD values of non-DME and focal-DME patients did not differ significantly (4.52 ± 1.24 vs 4.21 ± 1.06%, P = .307). Moreover, among DME patients, impaired FMD was an independent predictor of diffuse-DME (odds ratio: 0.06, 95% CI 0.01-0.47, P = .007).
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Affiliation(s)
- Nikolaos Gouliopoulos
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Gerasimos Siasos
- Department of Cardiology, Medical School of National and Kapodistrian University of Athens, Sotiria Thoracic Diseases General Hospital, Athens, Greece
| | - Evangelos Oikonomou
- Department of Cardiology, Medical School of National and Kapodistrian University of Athens, Sotiria Thoracic Diseases General Hospital, Athens, Greece
| | - Spyros Sapounas
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, 'Alexandra' Hospital, Athens, Greece
| | - Alexandros Rouvas
- 2nd Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'Attikon' University General Hospital, Athens, Greece
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynecology, Medical School of University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Marilita M Moschos
- 1st Department of Ophthalmology, Medical School of National and Kapodistrian University of Athens, 'G. Gennimatas' General Hospital, Athens, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, Medical School of National and Kapodistrian University of Athens, 'Hippokration' General Hospital, Athens, Greece
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Beros AL, Sluyter JD, Hughes AD, Hametner B, Wassertheurer S, Scragg RKR. Arterial Stiffness and Incident Glaucoma: A Large Population-Based Cohort Study. Am J Ophthalmol 2024; 266:68-76. [PMID: 38754800 DOI: 10.1016/j.ajo.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To investigate whether arterial stiffness, assessed oscillometrically, is associated with incident glaucoma in the Vitamin D Assessment (ViDA) Study cohort, aged 50 to 84 years. DESIGN Prospective, population-based cohort study. METHODS Arterial stiffness was assessed in 4,713 participants without known glaucoma (mean ± SD age = 66 ± 8 years) from 5 April 2011 to 6 November 2012 by way of aortic PWV (aPWV), estimated carotid-femoral PWV (ePWV) and aortic PP (aPP). Incident glaucoma was identified through linkage to national prescription and hospital discharge registers. Relative risks of glaucoma for each arterial stiffness measure were estimated by Cox proportional hazards regression, over the continuum of values and by quartiles. RESULTS During a mean ± SD follow-up of 10.5±0.4 years, 301 participants developed glaucoma. Arterial stiffness, as measured by aPWV (Hazard ratio (HR) per SD increase, 1.36, 95% CI 1.14-1.62) and ePWV (HR per SD increase, 1.40, 95% CI 1.14-1.71) but not aPP (HR per SD increase, 1.06, 95% CI 0.92-1.23) was associated with incident glaucoma. When arterial stiffness was analyzed as a categorical variable, the highest quartiles of aPWV (HR, 2.62, 95% CI 1.52-4.52; Ptrend = .007), ePWV (HR, 2.42, 95%CI 1.37-4.27; Ptrend = .03), and aPP (HR, 1.68, 95%CI 1.10-2.5; Ptrend = .02) were associated with the development of glaucoma. CONCLUSIONS Arterial stiffness measured with a simple oscillometric device predicted the development of glaucoma and could potentially be used in clinical practice to help identify people at risk of this condition. It may also present a new therapeutic research avenue, including in respect of systemic antihypertensives.
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Affiliation(s)
- Angela L Beros
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand
| | - John D Sluyter
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand
| | - Alun D Hughes
- Institute of Cardiovascular Sciences (A.D.H.), University College London, London, United Kingdom
| | - Bernhard Hametner
- Center for Health & Bioresources (B.H., S.W.), AIT Austrian Institute of Technology, Vienna, Austria
| | - Siegfried Wassertheurer
- Center for Health & Bioresources (B.H., S.W.), AIT Austrian Institute of Technology, Vienna, Austria
| | - Robert K R Scragg
- School of Population Health (A.L.B., J.D.S., R.K.R.S.), University of Auckland, Auckland, New Zealand.
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Gregory CD, Rimmer MP. Extracellular vesicles arising from apoptosis: forms, functions, and applications. J Pathol 2023; 260:592-608. [PMID: 37294158 PMCID: PMC10952477 DOI: 10.1002/path.6138] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/10/2023]
Abstract
Extracellular vesicles (EVs) are lipid bilayer-enclosed subcellular bodies produced by most, if not all cells. Research over the last two decades has recognised the importance of EVs in intercellular communication and horizontal transfer of biological material. EVs range in diameter from tens of nanometres up to several micrometres and are able to transfer a spectrum of biologically active cargoes - from whole organelles, through macromolecules including nucleic acids and proteins, to metabolites and small molecules - from their cells of origin to recipient cells, which may consequently become physiologically or pathologically altered. Based on their modes of biogenesis, the most renowned EV classes are (1) microvesicles, (2) exosomes (both produced by healthy cells), and (3) EVs from cells undergoing regulated death by apoptosis (ApoEVs). Microvesicles bud directly from the plasma membrane, while exosomes are derived from endosomal compartments. Current knowledge of the formation and functional properties of ApoEVs lags behind that of microvesicles and exosomes, but burgeoning evidence indicates that ApoEVs carry manifold cargoes, including mitochondria, ribosomes, DNA, RNAs, and proteins, and perform diverse functions in health and disease. Here we review this evidence, which demonstrates substantial diversity in the luminal and surface membrane cargoes of ApoEVs, permitted by their very broad size range (from around 50 nm to >5 μm; the larger often termed apoptotic bodies), strongly suggests their origins through both microvesicle- and exosome-like biogenesis pathways, and indicates routes through which they interact with recipient cells. We discuss the capacity of ApoEVs to recycle cargoes and modulate inflammatory, immunological, and cell fate programmes in normal physiology and in pathological scenarios such as cancer and atherosclerosis. Finally, we provide a perspective on clinical applications of ApoEVs in diagnostics and therapeutics. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Christopher D Gregory
- Centre for Inflammation ResearchInstitute for Regeneration and Repair, University of EdinburghEdinburghUK
| | - Michael P Rimmer
- Centre for Reproductive HealthInstitute for Regeneration and Repair, University of EdinburghEdinburghUK
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Maddala R, Ho LTY, Karnam S, Navarro I, Osterwald A, Stinnett SS, Ullmer C, Vann RR, Challa P, Rao PV. Elevated Levels of Growth/Differentiation Factor-15 in the Aqueous Humor and Serum of Glaucoma Patients. J Clin Med 2022; 11:jcm11030744. [PMID: 35160195 PMCID: PMC8837086 DOI: 10.3390/jcm11030744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 01/11/2023] Open
Abstract
Dysregulated levels of growth/differentiation factor-15 (GDF15), a divergent member of the transforming growth factor-beta super family, have been found to be associated with the pathology of various diseases. In this study, we evaluated the levels of GDF15 in aqueous humor (AH) and serum samples derived from primary open-angle glaucoma (POAG) and age- and gender-matched non-glaucoma (cataract) patients to assess the plausible association between GDF15 and POAG. GDF15 levels were determined using an enzyme-linked immunosorbent assay, and data analysis was performed using the Wilcoxon rank sum test, or the Kruskal–Wallis test and linear regression. GDF15 levels in the AH (n = 105) of POAG patients were significantly elevated (by 7.4-fold) compared to cataract patients (n = 117). Serum samples obtained from a subgroup of POAG patients (n = 41) also showed a significant increase in GDF15 levels (by 50%) compared to cataract patients. GDF15 levels were elevated in male, female, African American, and Caucasian POAG patients. This study reveals a significant and marked elevation of GDF15 levels in the AH of POAG patients compared to non-glaucoma cataract control patients. Although serum GDF15 levels were also elevated in POAG patients, the magnitude of difference was much smaller relative to that found in the AH.
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Affiliation(s)
- Rupalatha Maddala
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Leona T. Y. Ho
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Shruthi Karnam
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Iris Navarro
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Anja Osterwald
- Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (A.O.); (C.U.)
| | - Sandra S. Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Christoph Ullmer
- Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (A.O.); (C.U.)
| | - Robin R. Vann
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
| | - Pratap Challa
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
- Duke Eye Center, Duke University, Durham, NC 27710, USA
- Correspondence: (P.C.); (P.V.R.); Tel.: +919-684-3282 (P.C.); +919-681-5883 (P.V.R.); Fax: +919-681-8267 (P.C.); +919-684-8983 (P.V.R.)
| | - Ponugoti V. Rao
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA; (R.M.); (L.T.Y.H.); (S.K.); (I.N.); (S.S.S.); (R.R.V.)
- Duke Eye Center, Duke University, Durham, NC 27710, USA
- Correspondence: (P.C.); (P.V.R.); Tel.: +919-684-3282 (P.C.); +919-681-5883 (P.V.R.); Fax: +919-681-8267 (P.C.); +919-684-8983 (P.V.R.)
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Lee T, Bae HW, Seong GJ, Kim CY, Lee SY. High Pulse Wave Velocity Is Associated With Decreased Macular Vessel Density in Normal-Tension Glaucoma. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 34398200 PMCID: PMC8374976 DOI: 10.1167/iovs.62.10.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To investigate the relationship between pulse wave velocity (PWV) and retinal vessel density (VD) measured by optical coherence tomography angiography (OCTA) in patients with normal-tension glaucoma (NTG). Methods This retrospective study included 103 patients with NTG and 109 healthy controls who underwent glaucoma examination and PWV measurements. Each group was classified into two subgroups according to a brachial-ankle PWV of 1400 cm/s. NTG was diagnosed when the maximum untreated intraocular pressure was < 21 mmHg on three repeated measurements obtained at different times in the presence of glaucomatous optic discs (neuroretinal rim thinning and excavation), peripapillary retinal nerve fiber layer defects, and glaucomatous visual field defects. Healthy controls did not have glaucomatous optic discs or visual field defects and exhibited normal retinal nerve fiber layer thickness. The interval between glaucoma examination and PWV measurements did not exceed six months. Univariate and multivariate logistic regression analyses were performed to identify factors associated with high PWV. Results PWV was higher in the NTG group than in the control group, while peripapillary VD and macular VD (mVD) were lower (all P < 0.05). Stepwise logistic regression analysis revealed that high PWV was significantly associated with age, mean arterial pressure (MAP), and mVD in the NTG group. Meanwhile, high PWV was significantly associated with age, MAP, and low-density lipoprotein cholesterol levels in healthy controls. Conclusions High PWV is associated with decreased mVD in NTG patients, suggesting that systemic arterial stiffness might be involved in the pathogenesis of NTG.
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Affiliation(s)
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Yeop Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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6
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Hubens WHG, Kievit MT, Berendschot TTJM, de Coo IFM, Smeets HJM, Webers CAB, Gorgels TGMF. Plasma GDF-15 concentration is not elevated in open-angle glaucoma. PLoS One 2021; 16:e0252630. [PMID: 34048486 PMCID: PMC8162581 DOI: 10.1371/journal.pone.0252630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/10/2021] [Indexed: 12/26/2022] Open
Abstract
Aim Recently, the level of growth differentiation factor 15 (GDF-15) in blood, was proposed as biomarker to detect mitochondrial dysfunction. In the current study, we evaluate this biomarker in open-angle glaucoma (OAG), as there is increasing evidence that mitochondrial dysfunction plays a role in the pathophysiology of this disease. Methods Plasma GDF-15 concentrations were measured with ELISA in 200 OAG patients and 61 age-matched controls (cataract without glaucoma). The OAG patient group consisted of high tension glaucoma (HTG; n = 162) and normal tension glaucoma (NTG; n = 38). Groups were compared using the Kruskal-Wallis nonparametric test with Dunn’s multiple comparison post-hoc correction. GDF-15 concentration was corrected for confounders identified with forward linear regression models. Results Before correcting for confounders, median plasma GDF-15 levels was significantly lower in the combined OAG group (p = 0.04), but not when analysing HTG and NTG patients separately. Forward linear regression analysis showed that age, gender, smoking and systemic hypertension were significant confounders affecting GDF-15 levels. After correction for these confounders, GDF-15 levels in OAG patients were no longer significantly different from controls. Subgroup analysis of the glaucoma patients did not show a correlation between disease severity and plasma GDF-15, but did reveal that for NTG patients, intake of dietary supplements, which potentially improve mitochondrial function, correlated with lower plasma GDF-15. Conclusion The present study suggests that plasma GDF-15 is not suited as biomarker of mitochondrial dysfunction in OAG patients.
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Affiliation(s)
- Wouter H G Hubens
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Mariëlle T Kievit
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Irenaeus F M de Coo
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Hubert J M Smeets
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Theo G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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Çerik İB, Dindaş F, Yalınbaş Yeter D. Pseudoexfoliation syndrome: Are the eyes the mirror of the heart? Echocardiography 2021; 38:604-611. [PMID: 33738846 DOI: 10.1111/echo.15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Pseudoexfoliation syndrome (PEX) is a disease characterized by the accumulation of fibrillary material in the extracellular matrix in the eye and many tissues. Myocardial involvement occurs as in other storage diseases. Speckle tracking echocardiography is a quantitative echocardiography modality that enables the detection of subclinical changes that cannot be detected by standard echocardiographic evaluation. In this study, we aimed to evaluate potential subclinical myocardial dysfunction in PEX patients by speckle tracking echocardiography. METHODS AND RESULTS The study group consisting of 29 cardiac asymptomatic pseudoexfoliation syndromes and 30 healthy volunteers were included in this case-control cross-sectional study. Detailed echocardiographic evaluations and strain analyses of all participants were performed. Concerning standard echocardiographic parameters, there was only a marginally significant difference between the two groups in the e' mean wave, and it was lower in the PEX group than the control group (0.07 ± 0.03, 0.10 ± 0.08, respectively, P = .06). However, in strain echocardiography, the global longitudinal strain (GLS) value was observed to be significantly lower in the PEX group than the control group (-17.02 ± 2.02, -19.29 ± 2.26, respectively P < .001). GLS was observed to be an independent predictor in the multivariable logistic regression model made to determine independent predictors of PEX syndrome (OR = 0.59, CI = 0.418-0.832, P = .003). CONCLUSION Subclinical myocardial involvement in PEX syndrome, in which standard echocardiographic techniques are blinded, can be detected by the strain echocardiography. PEX causes deterioration in the deformation parameters of the left ventricle. Systemic involvement should not be forgotten in patients with PEX and cardiac functions should be monitored.
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Affiliation(s)
- İdris Buğra Çerik
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ferhat Dindaş
- Department of Cardiology, Training and Research Hospital, Uşak University, Uşak, Turkey
| | - Duygu Yalınbaş Yeter
- Department of Ophthalmology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Gouliopoulos N, Siasos G, Moschos MM, Oikonomou E, Rouvas A, Bletsa E, Stampouloglou P, Siasou G, Paraskevopoulos T, Vlasis K, Marinos G, Tousoulis D. Endothelial dysfunction and impaired arterial wall properties in patients with retinal vein occlusion. Vasc Med 2020; 25:302-308. [PMID: 32308146 DOI: 10.1177/1358863x20913609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Retinal vein occlusion (RVO) is a common retinal vascular lesion, and a leading cause of visual impairment. Patients with RVO have an increased risk for cardiovascular disease and share multiple common risk factors. In this study, we investigated the endothelial function and arterial stiffness of patients with RVO compared to healthy-control (CL) subjects. We enrolled 40 consecutive patients with RVO and 40 CL subjects. RVO was diagnosed by an ophthalmologist, endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, and carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) of the radial artery were measured to evaluate arterial stiffness and reflected waves, respectively. No significant differences were detected between the studied groups in sex, age, presence of hypertension or dyslipidemia, body mass index, systolic and diastolic blood pressure levels, total cholesterol levels, and smoking habits (p > 0.05 for all). However, patients with RVO had impaired FMD (p = 0.002) and increased PWV (p = 0.004), even after adjustment for several confounders. Both FMD and PWV were also significantly and independently associated with the development of RVO. Furthermore, a significant and positive correlation between PWV and systolic blood pressure existed only in the CL group. Therefore, we have shown that RVO is associated with significant endothelial dysfunction and increased arterial stiffness. Our results strengthen the vascular theory, according to which, systemic endothelial dysfunction and arteriosclerosis play a significant role in the pathogenesis of RVO.
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Affiliation(s)
- Nikolaos Gouliopoulos
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marilita M Moschos
- 1st Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Alexandros Rouvas
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evanthia Bletsa
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Panagiota Stampouloglou
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Georgia Siasou
- 1st Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Konstantinos Vlasis
- Department of Anatomy, Laiko General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Marinos
- Department of Anatomy, Laiko General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration Hospital, Athens, Greece
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