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Çoban F, Kaplan FB, Akkaya S, Okuroğlu N, Açıkalın B. Evaluation of optical coherence tomography parameters before and after parenteral iron treatment of patients with iron deficiency anemia. Photodiagnosis Photodyn Ther 2023; 43:103713. [PMID: 37494876 DOI: 10.1016/j.pdpdt.2023.103713] [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: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The aim of our study is to evaluate the relationship between iron deficiency anemia (IDA), which is a common and often chronic condition in young women, and the optical coherence tomography (OCT) findings, which have become an indispensable part of ophthalmology practice. We aim to identify a new biomarker for anemia evaluation by demonstrating the morphological changes in the eye before and after iron replacement treatment through OCT findings. METHODS 70 eyes of 35 patients diagnosed with IDA and planned to have parenteral iron replacement were included in the study. Patients were evaluated before treatment and between 4-6 weeks and 12-16 weeks after treatment. During visits, peripapillary and macular choroidal thicknesses and retinal nerve fiber layer (RNFL) thicknesses were evaluated with OCT along with serum hemoglobin(Hb) values. RESULTS The mean age of the patients was 36.80 ± 7.25. All 35 patients (100%) were female. The mean baseline Hb values of the patients increased statistically significantly both after 4-6 weeks and after 12-16 weeks (p < 0.05). A statistically significant difference was found between baseline and third visit in OCT findings in subfoveal, temporal, nasal, peripapillary temporal and peripapillary nasal choroidal thicknesses and total, inferior, nasal and temporal RNFL thicknes (p < 0.05). There was no statistically significant difference between the baseline and the third visit in the central macular thickness and superior RNFL thickness. CONCLUSION Significant increases in choroidal and RNFL thickness were detected after parenteral iron replacement in patients diagnosed with IDA. Our results demonstrate that the changes induced by IDA on the retina can be reversed with treatment.
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Affiliation(s)
- Fatih Çoban
- Department of Ophthalmology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8 Ataşehir, Istanbul 34752, Turkey.
| | - Fatih Bilgehan Kaplan
- Department of Ophthalmology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8 Ataşehir, Istanbul 34752, Turkey
| | - Sezen Akkaya
- Dunyagoz Hospital, Altunizade, Mahir İz Cd. No:7, Istanbul, Üsküdar 34662, Turkey
| | - Nalan Okuroğlu
- Department of Internal Medicine, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Açıkalın
- Department of Ophthalmology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8 Ataşehir, Istanbul 34752, Turkey
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Haghpanah S, Zekavat OR, Safaei S, Ashraf MA, Parand S, Ashraf H. Optical coherence tomography findings in patients with transfusion-dependent β-thalassemia. BMC Ophthalmol 2022; 22:279. [PMID: 35751049 PMCID: PMC9233398 DOI: 10.1186/s12886-022-02490-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Structural ophthalmologic findings have been reported in patients with β-thalassemia due to chronic anemia, iron overload, and iron chelation therapy toxicity in few previous studies. We aimed to investigate structural ocular findings and their relationship with hematological parameters in patients with transfusion-dependent β-thalassemia (TDT). METHODS In this cross-sectional study, from January 2018 to January 2019, 39 patients with TDT over the age of 18 participated. Multicolor fundus imaging, optical coherence tomography (OCT), and blue light fundus autofluorescence imaging were performed for all patients and 27 age- and sex-matched controls. RESULTS The mean age of patients was 28.6 ± 6.2 years. The central macular thickness and macular thicknesses in all quadrants were significantly thinner in patients than controls (P<0.05). None of the retinal nerve fiber layer (RNFL) measurements were significantly different between TDT patients and controls. There was a significantly negative correlation between hemoglobin with central macula thickness (r=-0.439, P=0.005). All measurements of macular subfield thickness were insignificantly thinner in patients with diabetes mellitus (DM) compared to the non-DM subgroup. CONCLUSIONS Macular thickness was significantly thinner in central macula and entire quadrants in TDT patients compared to healthy individuals; however, all RNFL measurement thicknesses were comparable between the two groups. Close monitoring of TDT patients by periodic ophthalmologic examinations with more focus on diabetic patients, patients with severe anemia and iron overload should be warranted.
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Affiliation(s)
- Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Safaei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Ashraf
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Parand
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ashraf
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Düzgün E, Demir N, Alkan AA, Uslu Doğan C, Çakır A. Retinochoroidal vascular plexuses in patients with iron deficiency anaemia. Clin Exp Optom 2021; 105:326-332. [PMID: 33938383 DOI: 10.1080/08164622.2021.1916387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Clinical relevance: Optical coherence tomography angiography (OCT-A) may enable the identification of alteration in the retinochoroidal microvasculature in patients with iron deficiency anaemia.Background: To investigate the presence of macular microvascular alterations in females with IDA by using OCT-A.Methods: This is a cross-sectional comparative study. Forty patients with IDA and 35 age-matched healthy women underwent a complete ophthalmologic examination and OCT-A imaging. Foveal avascular zone parameters and the vessel density in the superficial (SCP) and deep capillary plexus (DCP) were calculated using automated software. All measurements were compared between groups. Correlations between the OCT-A metrics and haematological laboratory parameters were evaluated.Results: Compared to healthy subjects, IDA patients revealed significantly decreased vessel density of the SCP in all parafoveal quadrants (p < 0.05). In contrast, vessel density analysis in DCP has shown no statistically significant difference in all parafoveal quadrants (p > 0.05). Although foveal vessel density in both SCP and DCP were higher in the IDA group, only the foveal vessel density in DCP was significantly higher than controls (p = 0.001). The mean values of the foveal avascular zone area and perimeter and choriocapillaris flow area were significantly lower in the IDA group (p < 0.05). The parafoveal vessel density in SCP, foveal avascular zone area, and choriocapillaris flow area were positively correlated with haematological parameters including haemoglobin, haematocrit, mean corpuscular haemoglobin, and mean corpuscular volume (p < 0.01).Conclusion: Patients with IDA had decreased parafoveal vessel density in the SCP, but not the DCP. Foveal avascular zone metrics and choriocapillaris flow area measurements were significantly lower in IDA.
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Affiliation(s)
- Eyüp Düzgün
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nazan Demir
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdurrahman Alpaslan Alkan
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ceylan Uslu Doğan
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akın Çakır
- Department of Ophthalmology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Cennamo G, Montorio D, Mazzella G, Ricchi P, Costantini S, Spasiano A, Filosa A, Storino MR, Aquila F, Tranfa F, Grosso M. Retinal and Choriocapillaris Vascular Changes in Patients Affected by Different Clinical Phenotypes of β-Thalassemia: An Optical Coherence Tomography Angiography Study. BIOLOGY 2021; 10:biology10040276. [PMID: 33800572 PMCID: PMC8065569 DOI: 10.3390/biology10040276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/02/2022]
Abstract
Simple Summary β-thalassemia represents a hematological disorder that determines anomalous hemolysis and ineffective erythropoiesis. The patients, undergoing regular lifelong blood transfusion, show an iron overload in the tissues that requires an iron chelation therapy. Both iron accumulation and iron-chelating agents cause ocular manifestations, such as retinal pigment epithelial (RPE) degeneration, RPE mottling, cataract, optic neuropathy and retinal venous tortuosity. In this cross-sectional study, we described the retinal and choriocapillaris microvascular changes in different clinical phenotypes of β-thalassemia that may reflect a tissue hypoxia status and oxidative damages. Abstract In this cross-sectional study we assessed the vascular alterations in retinal and choriocapillaris perfusion in patients affected by β-thalassemia, by means of optical coherence tomography angiography (OCTA). A total of 124 eyes of 62 patients (mean age 44.74 ± 5.79 years old) affected by β-thalassemia (transfusion dependent thalassemia (TDT), non-transfusion dependent thalassemia (NTDT) and minor) were compared to 40 eyes of twenty healthy subjects. We evaluated the vessel density (VD) in superficial capillary plexus, deep capillary plexus, radial peripapillary capillary, choriocapillaris and the foveal avascular zone area. The TDT group showed a statistically significant reduction in retinal and choriocapillaris VD respect to controls and the other groups (p < 0.05). No statistically significant difference was found in OCTA parameters between β-thalassemia minor and controls. The NTDT group showed a significant reduction in VD in deep capillary plexus respect to controls and β-thalassemia minor. Significant negative correlations were shown in TDT group between foveal avascular zone and hemoglobin (r = −0.437, p = 0.044) and between ferritin levels and VD of choriocapillaris (r = −0.431, p = 0.038). The OCTA parameters provided a deeper understanding on retinal and choriocapillaris vascular impairment affected by tissue hypoxia levels and the oxidative stress in different clinical phenotypes of the β-thalassemia.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (G.M.)
| | - Giuliano Mazzella
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (G.M.)
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, “Cardarelli” Hospital, 80131 Naples, Italy; (P.R.); (S.C.); (A.S.); (A.F.)
| | - Silvia Costantini
- Rare Blood Cell Disease Unit, “Cardarelli” Hospital, 80131 Naples, Italy; (P.R.); (S.C.); (A.S.); (A.F.)
| | - Anna Spasiano
- Rare Blood Cell Disease Unit, “Cardarelli” Hospital, 80131 Naples, Italy; (P.R.); (S.C.); (A.S.); (A.F.)
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, “Cardarelli” Hospital, 80131 Naples, Italy; (P.R.); (S.C.); (A.S.); (A.F.)
| | | | - Francesca Aquila
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Fausto Tranfa
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (G.M.)
- Correspondence:
| | - Michela Grosso
- CEINGE-Biotecnologie Avanzate, 80131 Naples, Italy; (M.R.S.); (M.G.)
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
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Haghpanah S, Zekavat OR, Bordbar M, Karimi M, Zareifar S, Safaei S, Ramzi M, Ashraf H. Ocular findings in patients with transfusion-dependent β-thalassemia in southern Iran. BMC Ophthalmol 2020; 20:376. [PMID: 32962679 PMCID: PMC7510146 DOI: 10.1186/s12886-020-01647-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ocular involvement may occur via several mechanisms in patients with transfusion-dependent β-thalassemia (TDT) mainly chronic anemia, iron overload and iron chelator toxicity. We aimed to evaluate the frequency of abnormal ocular findings and their relationship with hematologic parameters in TDT patients. Methods In this cross-sectional study from January 2018 to January 2019, a total of 79 patients with TDT over the age of 18 who were on iron-chelation therapy (ICT) were consecutively investigated. All patients were registered at the Thalassemia Comprehensive Center affiliated with Shiraz University of Medical Sciences, Shiraz, Southern Iran. Complete ophthalmic examination was performed by an expert ophthalmologist. Clinical and hematologic parameters were collected from the patients´ medical records. Results The mean age ± standard deviation (SD) of the patients was 28.4 ± 5.6 years (range: 18–43). Twenty-four patients (30.4%) were male and 29 (36.7%) were splenectomized. The mean ± SD of the best-corrected visual acuity (VA) was 0.960 ± 0.086 decimal, (range: 0.6–1), 0.016 ± 0.046 logMar, (range: 0–0.2). The frequency of patients with VA > 0.1 logMar was 3 (3.8%). The mean intraocular pressure (IOP) was 14.88 ± 3.34 (6–25) mmHg. Fundus abnormalities were observed in 8 patients (10.1%), consisting of increased cup-disk ratio (3.8%), vessel tortuosity (2.5%), retinal pigment epithelium degeneration (2.5%), myelinated nerve fiber layer (1.3%), and internal limiting membrane wrinkling (1.3%). No significant association was observed between fundus abnormalities, VA, or IOP with hematologic parameters (P > 0.05). TDT patients with diabetes mellitus had significantly higher IOP (P = 0.010) but similar frequency of fundus abnormalities with non-diabetic patients (P > 0.05). Conclusions The frequency of ocular abnormalities in our patients was lower than the previous reports. The frequency of fundus abnormalities were similar in diabetic and non-diabetic thalassemia patients indicating close monitoring and proper management of the disease and comorbidities in these patients.
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Affiliation(s)
- Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheila Zareifar
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Safaei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ashraf
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Korkmaz MF, Can ME, Kazancı EG. Effects of iron deficiency anemia on peripapillary and macular vessel density determined using optical coherence tomography angiography on children. Graefes Arch Clin Exp Ophthalmol 2020; 258:2059-2068. [PMID: 32125506 DOI: 10.1007/s00417-020-04633-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate retinal vascular parameters by optical coherence tomography angiography (OCT-A) in iron deficiency anemia (IDA). METHODS Thirty-two patients with IDA (study group) and 30 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. OCT-A scans were performed in a 6 × 6 mm area centered on the macula. Foveal avascular zone (FAZ), non-flow area (NFA), FAZ perimeter (PERIM), acircularity index (AI) of FAZ, and foveal density (FD) were measured in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). SCP and DCP were also scanned centered on the optic disk. Hemoglobin (Hb), mean corpuscular volume (MCV), serum iron, total iron-binding capacity (TIBC), and ferritin were also studied and compared for both groups. RESULTS The mean age was 12.22 ± 4.48 years (ranged 5-18 years) in the study group and 12.37 ± 3.76 years (ranged 6-18 years) in the control group. The mean FAZ value was 0.290 ± 0.09 mm2 in the study group and 0.298 ± 0.11 mm2 in the control group. The mean NFA value was 0.477 ± 0.10 mm2 in the study group and 0.486 ± 0.13 mm2 in the control group (p > 0.05). FD and AI were not statistically significant between the study group and control group (p > 0.05). The mean value for SCP was statistically significant between the study group and control group (p < 0.05). The mean value for DCP was not significantly different between the study and control groups (p > 0.05). The mean values for capillary density on optic disk were also statistically significant between the study group and control group (p < 0.05). A negative correlation was found between serum iron, TIBC, and capillary plexus density (p < 0.05). A positive correlation was found between MCV and ferritin values and capillary plexus density (p < 0.05). CONCLUSION IDA had significantly lower capillary plexus density. We detected retinal microvascular changes in young IDA patients before significant ocular anomalies, especially ischemic changes, developed.
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Affiliation(s)
- Muhammet Furkan Korkmaz
- Department of Pediatrics, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey.
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital, Bursa, Turkey
| | - Elif Güler Kazancı
- Department of Pediatric Hematology, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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Güler Kazancı E, Korkmaz MF, Can ME. Optical coherence tomography angiography findings in young β-thalassemia patients. Eur J Ophthalmol 2020; 30:600-607. [PMID: 31902243 DOI: 10.1177/1120672119899375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose was to evaluate retinal vascular parameters by optical coherence tomography angiography in β-thalassemia major patients. METHODS Thirty-three patients with β-thalassemia major (study group) and 29 healthy children (control group) were enrolled in the study. All subjects underwent a complete ocular examination. The mean foveal avascular zone, non-flow area, foveal avascular zone perimeter, acircularity index of foveal avascular zone, foveal density, the superficial capillary plexus, and deep capillary plexus were scanned using 6 × 6 mm optical coherence tomography angiography scans centered on the macula. Superficial capillary plexus and deep capillary plexus were also scanned centered on the optic disk. We collected data on histories of patients, and hemoglobin and ferritin were also studied from both groups. RESULTS The mean age was 13.85 ± 4.69 years (range: 4-21 years) in β-thalassemia major group and 12.59 ± 3.66 years (range: 6-18 years) in the control group. The mean foveal avascular zone value was 0.265 ± 0.11 mm2 in the study group and 0.296 ± 0.12 mm2 in the control group. The mean non-flow area value was 0.468 ± 0.12 mm2 in the study group and 0.479 ± 0.14 mm2 in the control group (p > 0.05). Differences in the mean values for foveal density and acircularity index were statistically significant between the study group and control group (p < 0.05, p = 0.026, and p = 0.026, respectively). Superficial capillary plexus and deep capillary plexus were not a significant difference between the study and control groups in 6 × 6 mm scans on macula and 4.5 × 4.5 mm scans on optic disk area (p > 0.05). Acircularity index was negatively correlated (r = -0.292, p = 0.026), and foveal density was positively correlated with hemoglobin (r = 0.292, p = 0.026). CONCLUSION By using optical coherence tomography angiography, we detected foveal microvascular changes in young β-thalassemia patients before significant ocular anomalies development.
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Affiliation(s)
- Elif Güler Kazancı
- Department of Pediatric Hematology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Muhammet Furkan Korkmaz
- Department of Pediatrics, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital, Bursa, Turkey
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Heydarian S, Jafari R, Dailami KN, Hashemi H, Jafarzadehpour E, Heirani M, Yekta A, Mahjoob M, Khabazkhoob M. Ocular abnormalities in beta thalassemia patients: prevalence, impact, and management strategies. Int Ophthalmol 2019; 40:511-527. [PMID: 31602527 DOI: 10.1007/s10792-019-01189-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Beta thalassemia (β-thalassemia) is a hereditary disease caused by defective globin synthesis and can be classified into three categories of minor (β-TMi), intermedia (β-TI), and major (β-TM) thalassemia. The aim of our study is to investigate the effects of β-thalassemia and its treatment methods on different parts of the eye and how early-diagnostic methods of ocular complications in this disorder would prevent further ocular complications in these patients by immediate treatment and diet change. METHODS We developed a search strategy using a combination of the words Beta thalassemia, Ocular abnormalities, Iron overload, chelation therapy to identify all articles from PubMed, Web of Science, Scopus, and Google Scholar up to December 2018. To find more articles and to ensure that databases were thoroughly searched, the reference lists of selected articles were also reviewed. RESULTS Complications such as retinopathy, crystalline lens opacification, color vision deficiency, nyctalopia, depressed visual field, reduced visual acuity, reduced contrast sensitivity, amplitude reduction in a-wave and b-wave in Electroretinography (ERG), and decrease in the Arden ratio in Electrooculography (EOG) have all been reported in β-thalassemia patients undergoing chelation therapy. CONCLUSION Ocular problems due to β-thalassemia may be a result of anemia, iron overload in the body tissue, side effects of iron chelators, and the complications of orbital bone marrow expansion.
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Affiliation(s)
- Samira Heydarian
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Jafari
- Department of Ophthalmology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Ebrahim Jafarzadehpour
- Department of Optometry, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Heirani
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monireh Mahjoob
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ulusoy MO, Türk H, Kıvanç SA. Spectral domain optical coherence tomography findings in Turkish sickle-cell disease and beta thalassemia major patients. J Curr Ophthalmol 2019; 31:275-280. [PMID: 31528761 PMCID: PMC6742756 DOI: 10.1016/j.joco.2019.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 11/01/2022] Open
Abstract
Purpose To assess probable structural changes using spectral domain optical coherence tomography (SD-OCT) on sickle-cell disease (SCD) and beta thalassemia major (B-TM) patients, without any retinal abnormalities. Methods This cross-sectional study included 32 B-TM, 34 SCD patients, and 44 healthy controls. One of the eyes of all participants was evaluated for SD-OCT and choroidal thickness, retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), ganglion cell complex (GCC). Results Age, gender, and intraocular pressure (IOP) were not statistically different between the three groups. Hemoglobin (Hgb), hematocrite (Htc), and ferritin levels were not statistically different between the SCD and B-TM groups. Choroidal thickness at the subfoveal region was statistically higher in the control group (353.79 ± 71.93) than in the B-TM (317.41 ± 53.44) and SCD (283.21 ± 63.27) groups. In addition, it was statistically higher in the B-TM group than the SCD group (P = 0.05). CMT did not differ among the three groups, average RNFL was only significantly thinner in SCD than in controls, and GCC thickness was significantly thinner in SCD than in controls and B-TM. Conclusion In both diseases, we can show early structural changes even if proliferative or non-proliferative retinopathy or other ocular manifestations were not developed yet.
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Affiliation(s)
- Mahmut Oğuz Ulusoy
- Department of Ophthalmology, Başkent University, School of Medicine, Konya Research Hospital, Konya, Turkey
| | - Hakan Türk
- Department of Ophthalmology, Tarsus State Hospital, Mersin, Turkey
| | - Sertaç Argun Kıvanç
- Department of Ophthalmology, Uludağ University, School of Medicine, Bursa, Turkey
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Coskun M, Sevencan NO. The Evaluation of Ophthalmic Findings in Women Patients With Iron and Vitamin B12 Deficiency Anemia. Transl Vis Sci Technol 2018; 7:16. [PMID: 30159209 PMCID: PMC6108531 DOI: 10.1167/tvst.7.4.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine whether there are differences in the central corneal thickness (CCT), retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) in women with iron deficiency anemia (IDA) and vitamin B12 deficiency anemia (B12DA). Methods The patients were divided and evaluated in three groups as IDA (group 1), combined IDA-B12DA (group 2), and healthy females (group 3). Each group constituted 35 subjects. CCT, endothelial cell density (CD), the coefficient of variation (CV), and hexagonality (HEX) values were evaluated. Superior, nasal, inferior, and temporal retinal nerve fiber analysis were done, and mean thickness of GC-IPL complex was also evaluated. Results CCT was found to be less (thin CCT) in group 2 as compared to group 1 and group 3 (P = 0.016 and P = 0.013, respectively). While CD measurements did not vary significantly between the groups, CV value was found to be lower in the control group as compared to that in the other groups (P = 0.001 and P = 0.002, respectively). HEX and the thicknesses of all RNFL and GC-IPL were lower in both the anemic groups as compared to the control group (P = 0.012 and P = 0.013, respectively); however, no significant difference was determined between the anemia groups. Conclusions It should be noted that anemia is a common clinical picture particularly seen in women, and there may be a tendency toward corneal and retinal disorders in these patients. The present study found that presence in the patients with IDA and with combined IDA-B12DA may have influenced endothelial functions; also the patients with anemia had significantly thinner CCT than healthy controls. Translational Relevance Optical coherence tomography and specular microscopy measurements may provide important data for early diagnosis and treatment of both corneal and retinal diseases according to the type of anemia in anemic women.
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Affiliation(s)
- Mehmet Coskun
- Medicine Faculty, Department of Ophthalmology, The University of Karabuk, Karabuk, Turkey
| | - Nurhayat O Sevencan
- Medicine Faculty, Department of Internal Medicine, The University of Karabuk, Karabuk, Turkey
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Healy K, Palmer AC, Barffour MA, Schulze KJ, Siamusantu W, Chileshe J, West KP, Labrique AB. Nutritional Status Measures Are Correlated with Pupillary Responsiveness in Zambian Children. J Nutr 2018; 148:1160-1166. [PMID: 29924320 DOI: 10.1093/jn/nxy069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Impairments in visual function have been well characterized in vitamin A deficiency. However, eye function may also be sensitive to other nutrient deficiencies. Objective We examined associations between visual function-characterized by pupillary threshold or pupillary responsiveness-and nutritional status in Zambian children. Methods We used digital pupillometry to measure visual responses to calibrated light stimuli (-2.9 to 0.1 log cd/m2) among dark-adapted children aged 4-8 y (n = 542). We defined pupillary threshold as the first light stimulus at which pupil diameter decreased by ≥10% and considered a pupillary threshold ≥-0.9 log cd/m2 as impaired. Pupillary responsiveness was defined by absolute percentage of change in pupil diameter from pre- to poststimulus. We tested associations between these measures and serum concentrations of retinol, β-carotene, ferritin, soluble transferrin receptor, and hemoglobin (Hb <11.0 or 11.5 g/dL were used to define anemia, depending on age), as well as anthropometric indexes, with the use multilevel mixed-effects models. Results Pupillary threshold was correlated only with serum retinol (r = 0.12, P < 0.05). The strongest correlates of pupillary responsiveness were Hb (r = -0.16, P < 0.01), height-for-age z score (r = 0.14, P < 0.05), weight-for-age z score (r = 0.14, P < 0.05), and soluble transferrin receptor (r = 0.12, P < 0.05). In multivariate models, anemia was positively associated with pupillary responsiveness (β = 2.99; 95% CI: 1.26, 4.72). Conclusions In this marginally nourished population, we found positive correlations between vitamin A status, iron status, or anthropometric indexes and visual function. Hb was negatively associated with visual function, with greater pupillary responsiveness among anemic children. We posit that this may signal altered parasympathetic activity, possibly driven by infection. Future studies should consider a broader range of indicators to better characterize the relation between nutrition and visual function. This trial was registered at clinicaltrials.gov as NCT01695148.
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Affiliation(s)
- Katherine Healy
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda C Palmer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maxwell A Barffour
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Retinal nerve fiber layer thickness in children with β-thalassemia major. Saudi J Ophthalmol 2017; 31:224-228. [PMID: 29234223 PMCID: PMC5717504 DOI: 10.1016/j.sjopt.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/28/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose To measure the retinal nerve fiber layer thickness (RNFLT) in children with β-thalassemia major and to compare with healthy controls. Methods A total of 47 patients with β-thalassemia major and 51 healthy controls were included. Each subject underwent a standard ophthalmological examination. RNFLT measurements were performed using optical coherence tomography. Results Mean age of the patient group and healthy controls were 13.7 ± 2.1 and 14.3 ± 2.2 years, respectively. Mean peripapillary RNFL thickness was 94 µm in the patient group, and 100 µm in the control group (p < 0.01). In patients with β-thalassemia major, RNFL was thinner in all quadrants than control subjects. Within the β-thalassemia major group neither average RNFLT nor each four quadrant RNFLT were correlated with the age, serum ferritin or serum hemoglobin levels (p > 0.05). Conclusion In this study, we observed RNFL was thinner in patients with β-thalassemia major. Thinning of RNFL did not correlate with hemoglobin or ferritin levels.
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Cikmazkara I, Ugurlu SK. Peripapillary retinal nerve fiber layer thickness in patients with iron deficiency anemia. Indian J Ophthalmol 2017; 64:201-5. [PMID: 27146929 PMCID: PMC4869457 DOI: 10.4103/0301-4738.181753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To evaluate the effect of iron deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness with optical coherence tomography (OCT). Materials and Methods: 102 female patients who had IDA (hemoglobin <12 g/dl, serum transferrin saturation <15%, serum iron <50 μg/dl, and serum ferritin <15 μg/dl) were enrolled in the study. Optic disc and RNFL parameters obtained by Cirrus high-definition OCT 4000 were compared with those of 49 age and sex-matched nonanemic individuals. The time between blood analysis and OCT measurements was 3.14 ± 5.6 (range, 0–28) days in the anemia group, and 3.5 ± 6.7 (range, 0–27) days in the control group (P = 0.76). Results: Average ages of 102 patients and 49 control subjects were 35.76 ± 10.112 (range, 18–66) years, and 36.08 ± 8.416 (range, 19–57) years (P = 0.850), respectively. The average RNFL thickness was 94.67 ± 9.380 in the anemia group, and 100.22 ± 9.12 in the control group (P = 0.001). Temporal, nasal, and lower quadrant average RNFL thicknesses of IDA group were thinner than the control group (P = 0.001, P = 0.013, P = 0.008). Upper quadrant RNFL thicknesses in IDA and control groups were similar. Correlation analysis revealed positive correlation between mean RNFL thickness and hemoglobin (r = 0.273), iron (r = 0.177), ferritin (r = 0.163), and transferrin saturations (r = 0.185), while a negative correlation was found between total iron binding capacity (r = −0.199) and mean RNFL thickness. Conclusions: Peripapillary RNFL thickness measured by OCT is thinner in adult female patients with IDA. It may have a significant influence on the management of many disorders such as glaucoma and neuro-ophthalmological diseases.
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Affiliation(s)
- Ipek Cikmazkara
- Department of Ophthalmology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Assessing posterior ocular structures in β-thalassemia minor. Int Ophthalmol 2017; 38:119-125. [PMID: 28054212 DOI: 10.1007/s10792-016-0431-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to investigate the effect of β-thalassemia minor on choroidal, macular, and peripapillary retinal nerve fiber layer thickness. METHODS To form the sample, we recruited 40 patients with β-thalassemia minor and 44 healthy participants. We used spectral-domain optical coherence tomography to take all measurements of ocular thickness, as well as measured intraocular pressure, axial length, and central corneal thickness. We later analyzed correlations of hemoglobin levels with ocular parameters. RESULTS A statistically significant difference emerged between patients with β-thalassemia minor and the healthy controls in terms of mean values of subfoveal, nasal, and temporal choroidal thickness (p = 0.001, p = 0.016, and p = 0.010, respectively). Except for central macular thickness, differences in paracentral macular thicknesses between the groups were also significant (superior: p < 0.001, inferior: p = 0.007, temporal: p = 0.001, and nasal: p = 0.005). Also, no statistically significant differences were noted for retinal nerve fiber layer thickness between two groups. CONCLUSION Mean values of subfoveal, nasal, temporal choroidal, and macular thickness for the four quadrants were significantly lower in patients with β-thalassemia minor than in healthy controls.
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Acer S, Balcı YI, Pekel G, Ongun TT, Polat A, Çetin EN, Yağcı R. Retinal nerve fiber layer thickness and retinal vessel calibers in children with thalassemia minor. SAGE Open Med 2016; 4:2050312116661683. [PMID: 27540484 PMCID: PMC4973478 DOI: 10.1177/2050312116661683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Evaluation of the peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements in children with thalassemia minor. METHODS In this cross-sectional and comparative study, 30 thalassemia minor patients and 36 controls were included. Heidelberg spectral domain optical coherence tomography was used for peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements. RESULTS There was no statistically significant difference in retinal nerve fiber layer thickness and subfoveal choroidal thickness between the two groups (p > 0.05). There was no correlation between retinal nerve fiber layer thickness and hemoglobin values. Both the arterioral and venular calibers were higher in thalassemia minor group (p < 0.05). CONCLUSION There is increased retinal arterioral and venular calibers in children with thalassemia minor compared with controls.
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Affiliation(s)
- Semra Acer
- Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Yasemin I Balcı
- Department of Pediatric Hematology and Thalassemia Center, Pamukkale University, Denizli, Turkey
| | - Gökhan Pekel
- Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Tuğba T Ongun
- Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Aziz Polat
- Department of Pediatric Hematology and Thalassemia Center, Pamukkale University, Denizli, Turkey
| | - Ebru N Çetin
- Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Ramazan Yağcı
- Department of Ophthalmology, Pamukkale University, Denizli, Turkey
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Liaska A, Petrou P, Georgakopoulos CD, Diamanti R, Papaconstantinou D, Kanakis MG, Georgalas I. β-Thalassemia and ocular implications: a systematic review. BMC Ophthalmol 2016; 16:102. [PMID: 27390837 PMCID: PMC4938965 DOI: 10.1186/s12886-016-0285-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Beta-thalassemia is a severe genetic blood disorder caused by a mutation in the gene encoding for the beta chains of hemoglobin. Individuals with beta-thalassemia major require regular lifelong Red Blood Cell transfusions to survive. Ocular involvement is quite common and may have serious implications. Methods Extensive review of observational studies on beta-thalassemia, to determine the prevalence and spectrum of ocular abnormalities, by clinical examination and multimodal imaging, and to investigate risk factors for their development. Results Frequency of ocular involvement differs among various studies (41.3–85 %, three studies). Ocular findings in beta-thalassemia may correlate to the disease itself, iron overload or the chelating agents used. Beta-thalassemia ocular manifestations include ocular surface disease, as demonstrated by tear function parameters (two studies). Lens opacities are present in 9.3–44 % (five studies). Lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively (two studies). Ocular fundus abnormalities characteristic of pseudoxanthoma elasticum (PXE), including peau d’orange, angioid streaks, pattern dystrophy-like changes, and optic disc drusen are a consistent finding in seven studies. Patients with PXE-like fundus changes were older than patients without these fundus changes (two studies). Age (two studies) and splenectomy (one study) had the strongest association with presence of PXE-like fundus changes. Increased retinal vascular tortuosity independently of the PXE-like fundus changes was found in 11–17.9 % (three studies), which was associated with aspartate amino transferase, hemoglobin and ferritin levels (two studies). Fundus autofluorescence and electrophysiological testing (ERG and EOG) may indicate initial stages or more widespread injury than is suggested by fundus examination (two studies). Conclusions Beta-thalassemia may present with various signs, both structural and functional. Pseudoxanthoma elasticum like fundus changes are a frequent finding in patients with b-thalassemia. These changes increase with duration or severity of the disease. Retinal vascular tortuosity may be an additional disease manifestation related to the severity and duration of anemia and independent of the PXE-like syndrome. Patients with long-standing disease need regular ophthalmic checkups because they are at risk of developing PXE-like fundus changes and potentially of subsequent choroidal neovascularization.
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Affiliation(s)
- Aliki Liaska
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Petros Petrou
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Ramza Diamanti
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Menelaos G Kanakis
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece.
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Bhoiwala DL, Dunaief JL. Retinal abnormalities in β-thalassemia major. Surv Ophthalmol 2015; 61:33-50. [PMID: 26325202 DOI: 10.1016/j.survophthal.2015.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/15/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
Patients with beta (β)-thalassemia (β-TM: β-thalassemia major, β-TI: β-thalassemia intermedia) have a variety of complications that may affect all organs, including the eye. Ocular abnormalities include retinal pigment epithelial degeneration, angioid streaks, venous tortuosity, night blindness, visual field defects, decreased visual acuity, color vision abnormalities, and acute visual loss. Patients with β-thalassemia major are transfusion dependent and require iron chelation therapy to survive. Retinal degeneration may result from either retinal iron accumulation from transfusion-induced iron overload or retinal toxicity induced by iron chelation therapy. Some who were never treated with iron chelation therapy exhibited retinopathy, and others receiving iron chelation therapy had chelator-induced retinopathy. We will focus on retinal abnormalities present in individuals with β-thalassemia major viewed in light of new findings on the mechanisms and manifestations of retinal iron toxicity.
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Affiliation(s)
- Devang L Bhoiwala
- Department of Ophthalmology, F. M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Joshua L Dunaief
- Department of Ophthalmology, F. M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA.
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Akdogan E, Turkyilmaz K, Ayaz T, Tufekci D. Peripapillary retinal nerve fibre layer thickness in women with iron deficiency anaemia. J Int Med Res 2014; 43:104-9. [PMID: 25476798 DOI: 10.1177/0300060514555562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To evaluate peripapillary retinal nerve fibre layer (RNFL) thickness in adult women with iron deficiency anaemia and healthy control subjects. METHODS Women with iron deficiency anaemia and age- and sex-matched healthy control subjects were sequentially recruited and underwent detailed ophthalmic examination, including spectral-domain optical coherence tomography (OCT). Serum haemoglobin (Hb), iron and ferritin concentrations, total iron-binding capacity (TIBC) and mean corpuscular volume were determined. RESULTS Peripapillary RNFL thicknesses in the nasal and inferior quadrants were significantly smaller in patients (n = 40) than in controls (n = 40). In the patient group, there were significant correlations between inferior quadrant RNFL thickness and Hb, and between nasal quadrant RNFL thickness and serum iron and ferritin concentrations, and TIBC. CONCLUSION Iron deficiency anaemia reduces RNFL thickness in adult women.
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Affiliation(s)
- Elif Akdogan
- Department of Haematology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Kemal Turkyilmaz
- Department of Ophthalmology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Teslime Ayaz
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Damla Tufekci
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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