Paradoxical enhancement of the ERG c-wave by a small dose of sodium iodate

The relationship of central foveal thickness to urinary iodine concentration in retinitis pigmentosa with or without cystoid macular edema

IMPORTANCE

Current treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) are not always effective, may lead to adverse effects, and may not restore visual acuity. The present research lays the rationale for evaluating whether an iodine supplement could reduce CME in RP.

OBJECTIVE

To determine whether central foveal thickness (CFT) in the presence of CME is related to dietary iodine intake inferred from urinary iodine concentration (UIC) in nonsmoking adults with RP.

DESIGN, SETTING, AND PARTICIPANTS

We performed a cross-sectional observational study of 212 nonsmoking patients aged 18 to 69 years referred to our institution for RP with visual acuity of no worse than 20/200 in at least 1 eye.

EXPOSURE

Retinitis pigmentosa with or without CME.

MAIN OUTCOMES AND MEASURES

With the eye as the unit of analysis, the relationship of log CFT measured by optical coherence tomography to UIC measured from multiple spot samples and represented as a 3-level classification variable (<100, 100-199, and ≥200 µg/L), assigning greater weight to patients with more reliable UIC estimates.

RESULTS

Analyses were limited to 199 patients after excluding 11 who failed to return urine samples for measuring UIC and 2 outliers for UIC. Of the 199 patients, 36.2% had CME in 1 or both eyes. Although log CFT was inversely related to UIC based on findings from all eyes (P = .02), regression of log CFT on UIC separately for eyes with and without CME showed a strong inverse significant relationship for the former group (P < .001) and no significant relationship for the latter group (P = .66) as tested. For the eyes with CME, CFT ranged from a geometric mean of 267 µm for a median UIC of less than 100 µg/L to a geometric mean of 172 µm for a median UIC of 200 µg/L or greater. In contrast, we found no significant association between CME prevalence and UIC based on the entire sample as tested (odds ratio, 1.01 [95% CI, 0.38-2.67]; P = .99).

CONCLUSIONS AND RELEVANCE

A higher UIC in nonsmoking adults with RP was significantly associated with less central foveal swelling in eyes with CME. Additional study is required to determine whether an iodine supplement can limit or reduce the extent of CME in patients with RP.

Functional recovery of retina after sodium iodate injection in mice

ERGs and the azide responses were recorded from mice before and periodically up to 6 weeks after retinal pigment epithelium (RPE) damage by iodate injection to follow the recovery of retinal pigment epithelium and retinal function. At 14 days postinjection, there was a partial recovery of the maximal b-wave amplitude and the azide response but no further recovery was found after 14 days. The retinal sensitivity showed a slow recovery, and at 6 weeks postinjection did not differ from the pre-iodate sensitivity. These findings correlated with histological observations. We concluded that the recovery in ERGs resulted from RPE recovery and the large patchy area of recovered retina functioned normally.

Potassium iodate retinopathy

A case of potassium iodate toxicity in a 22-year-old man was reported. After taking a solution of highly concentrated potassium iodate, the patient developed nausea, vomiting, diarrhea and blurred vision. The visual acuity was hand motion in both eyes. The funduscopic examination showed retinal edema with subsequent pigmentary change at the macula and retinal pigment clumping resembling retinitis pigmentosa. The fundus fluorescein angiography and electrophysiologic studies showed degenerative changes of the retinal pigment epithelium and photoreceptor cells.

Effects of sodium iodate on the electroretinogram c-wave in the cat

The c-wave of the vitreal electroretinogram decreased in amplitude and was replaced by a slow, polarity reversed potential following an i.v. infusion of sodium iodate, as first described by Noell. Intraretinal recordings showed that the negative-going c-wave, induced by iodate (30 mg/kg), was composed of reduced slow pIII and trans-epithelial c-wave. The effects of iodate on these components may originate from direct effects on the retinal pigment epithelial cells, namely, a large decrease in the trans-epithelial resistance. Other factors could have contributed to the change in the c-wave amplitude.

L-cystein protects the pigment epithelium from acute sodium iodate toxicity

Intravenous sodium iodate damages the retinal pigment epithelium, causing immediate loss of the electroretinogram c-wave and eventual pigmentary retinopathy. L-cystein, an agent that enhances the c-wave, has been reported to prevent the late development of pigmentary degeneration. We found in rabbits that L-cystein given 30 min before, or simultaneously with (but not 30 min after) sodium iodate also blocks the loss of the c-wave. This result occurred at doses of L-cystein lower than those needed to produce enhancement of the c-wave, suggesting that these two actions of L-cystein may be independent. The iodate-blocking action of L-cystein may depend on chemical interaction.