Conjunctival Marginal Zone Lymphoma in a Patient With Neurofibromatosis Type 1: A Case Report

We present a case of painless bulbar conjunctival mass due to B-cell non-Hodgkin lymphoma (NHL), without systemic involvement, in a 76-year-old man. Following an excision biopsy, histopathologic examination and immunohistochemistry confirmed the diagnosis, prompting a referral for hemato-oncological assessment. The patient underwent comprehensive laboratory and imaging scans, subsequently receiving combined chemo-immunotherapy that resulted in complete remission to date. This case is reported as it is crucial to recognize that a conjunctival insult might emerge in neurofibromatosis type 1 (NF1) patients.

Alterations in Retinal Vessel Diameters in Patients with Retinal Vein Occlusion before and after Treatment with Intravitreal Ranibizumab

Purpose: To investigate the alterations of retinal vessel diameters in patients with macular edema secondary to retinal vein occlusion (RVO), before and after treatment with intravitreal ranibizumab. Methods: Digital retinal images were obtained from 16 patients and retinal vessel diameters were measured before and three months after treatment with intravitreal ranibizumab with validated software to determine central retinal arteriolar and venular equivalents, as well as arteriolar to venular ratio. Results: In 17 eyes of 16 patients with macular edema secondary to RVO (10 with branch RVO and 6 with central RVO) aged 67 ± 10.2 years, we found that diameters of both retinal arterioles and venules were significantly decreased after intravitreal ranibizumab treatment. Specifically, the central retinal arteriolar equivalent was 215.2 ± 11.2 μm at baseline and 201.2 ± 11.1 μm at month 3 after treatment (p < 0.001), while the central retinal venular equivalent was 233.8 ± 29.6 μm before treatment versus 207.6 ± 21.7 μm at month 3 after treatment (p < 0.001). Conclusions: A significant vasoconstriction in both retinal arterioles and venules in patients with RVO was found at month 3 after intravitreal ranibizumab treatment compared to baseline. This could be of clinical importance, since the degree of vasoconstriction might be an early marker of treatment efficacy, compatible with the idea that hypoxia is the major trigger of VEGF in RVO. Further studies should be conducted to confirm our findings.

Efficacy and safety of vitamin supplements with resveratrol in diabetic macular edema: Long-term results of a comparative study

PURPOSE

To investigate the adjunct efficacy and safety of vitamin supplements, including resveratrol, in patients with diabetic macular edema (DME) treated with intravitreal anti-vascular endothelial factor (anti-VEGF) agents.

METHODS

Participants in this prospective study were 45 patients with DME, who were treated with either intravitreal anti-VEGF injections (n = 23, Group I) or with combination of intravitreal anti-VEGF injections and vitamin supplements, including resveratrol (n = 22, Group II). All patients underwent visual acuity measurement, slit-lamp examination and spectral domain-optical coherence tomography (SD-OCT) at baseline and monthly after the loading phase of three-monthly anti-VEGF injections, following a PRN protocol.

RESULTS

There was a statistically significant improvement in visual acuity in both groups at month 12 compared to baseline, although the mean change in visual acuity did not differ between the two groups (p = 0.183). Accordingly, there was a statistically significant decrease in central retinal thickness in both groups at month 12 compared to baseline, while the mean difference in central retinal thickness was significantly greater in the "combination" group. The mean number of intravitreal anti-VEGF injection was less in Group II (6.45 ± 1.12 in Group II vs. 7.39 ± 1.31 in Group I, p = 0.018).

CONCLUSIONS

Vitamin supplements with resveratrol was found to be an effective adjunct to intravitreal anti-VEGF injections in patients with DME, offering better anatomic restoration with less injections at the 12-month follow-up.

POS0807 RETINAL VESSEL CALIBERS AS A NON-INVASIVE BIOMARKER OF INFLAMMATORY BURDEN IN PRIMARY SYSTEMIC VASCULITIS

Background:

Primary Systemic Vasculitides (PSV) constitute a heterogeneous group of rare and potentially life-threatening autoimmune diseases, characterized by a varying degree of inflammatory response, leading to local or generalized vascular disease. Vessel involvement accounts for the micro- and macrovascular complications of the disease, along with the classic risk factors including, among others age and chronic use of steroids (1). Early identification of high-risk patients for cardiovascular disease (CVD) development and the contribution of inflammation towards this adverse outcome are still unmet needs. Alterations of retinal microcirculation have been independently associated with increased CVD risk in the general population (2). The potential changes of retinal vasculature and their association with disease activity and the magnitude of inflammation have not been studied in PSV so far.

Objectives:

To explore the effect of disease activity and inflammation on retinal microcirculation in PSV, classified according to vessel size as large, medium or small vessel vasculitides (LVV, MVV or SVV respectively), and polymyalgia rheumatica (PMR) without vasculitis.

Methods:

Fifty-nine patients, 43 with active disease [30 active vasculitis (12 LVV, 4 MVV, 14 SVV) and 13 PMR] and 16 with chronic inactive disease (13 vasculitis, 3 PMR) were studied. All patients were matched at 1:1 ratio with 59 controls, without underlying autoimmune/autoinflammatory disorder, neoplasia or infection, according to age, gender, CVD history, BMI, smoking, arterial hypertension, dyslipidemia, diabetes mellitus and treatment related to comorbidities. A total of 32 rheumatoid arthritis (RA) patients with mild to moderate inflammatory component as defined by standard of care acute phase reactants (ESR and CRP) and 16 chronic RA patients with normal ESR and CRP levels, matched 1:1 according to all the above parameters with 32 active and 16 inactive vasculitis/PMR patients respectively, served as disease controls. Digital retinal images were obtained and retinal vessel calibers were measured with a validated software to determine central retinal arteriolar and venular equivalents ratio (CRAE and CRVE respectively). For 16 patients with active vasculitis/PMR, retinal examination was performed in two time points (baseline and ≤ 6 months later).

Results:

In the overall population, patients with active Vasculitis/PMR had increased CRVE (213.8±21.7 vs 201.3±17.1, p<0.001) and CRAE (180.0±19.2 vs 164.1±17.5 p<0.001) compared to healthy controls. Separating patients according to disease type, we found that in LVV, MVV and PMR, CRAE (p≤0.05) and CRVE (p<0.05) were increased compared to control group, while in SVV only CRAE was increased (p<0.001). Interestingly, chronic patients with disease in remission displayed higher CRAE compared to matched controls (179.8±17.2 vs 169.1±11.1, p=0.006). After immunosuppressive treatment for ≤ 6 months CRVE and to a lesser extent CRAE were reduced (p=0.048 and 0.149 respectively) with a stronger statistical significance found in the Vasculitis group (p=0.026 and 0.069 respectively). Pearson’s linear correlation coefficient in active disease state (at baseline examination) revealed positive bivariate correlation only between CRVE with ESR and CRP. Patients with Vasculitis/PMR had also increased CRAE when compared to RA patients in both active and inactive disease status (182.8±19.4 vs 170.1±18.4, p<0.001 and 179.8±17.2 vs 166.3±17.9, p=0.005 respectively).

Conclusion:

Systemic inflammation alters retinal microcirculation in both a reversible (venules) and irreversible (arterioles) way, independently of PSV form. Thus, common disease specific pathogenetic mechanisms related to inflammation may be implicated in vascular remodeling. Sequential follow-up of PSV patients will address whether retinal vessel calibers may serve as a biomarker of disease activity and CVD development.

References:

[1]Argyropoulou OD et al. Curr Opin Rheumatol 2017.

[2]Shaohua G et al. Current Atherosclerosis reports 2020.

Disclosure of Interests:

None declared

Corneal endothelial cells and central corneal thickness in patients with neurofibromatosis type 1

Purpose:

The aim of this study was to evaluate the morphological properties of corneal endothelial cells and central corneal thickness (CCT) in patients with neurofibromatosis type 1 (NF1) and to compare them with age-matched healthy controls.

Methods:

Nineteen NF1 patients and 38 healthy individuals were recruited. All participants underwent complete ophthalmological examination as well as noncontact specular microscopy to measure endothelial cell density (ECD), average cell area (AVG), coefficient of variation of cell area (CV), the percentage of hexagonal cells, and CCT. Eyes with previous ocular trauma, inflammation or surgery, and preexisting corneal and ocular surface diseases were excluded.

Results:

NF1 patients had higher ECD compared to healthy controls of the same age (2764.2 ± 270.4 versus 2570.4 ± 449.2 cells/mm, respectively), although at a borderline level (P = 0.051). Patients with NF1 presented significantly lower CV and AVG when compared to controls (32.9 ± 4.6 versus 37.8 ± 9.5%, P = 0.011 and 364.9 ± 34.4 versus 406.0 ± 107.4 µm, P = 0.038, respectively). The NF1 group had significantly higher hexagonality in comparison with controls (55.7 ± 6.5 versus 50.5 ± 9.9%, P = 0.025). CCT was similar between the two groups (P = 0.955).

Conclusion:

Our results show that corneal endothelium has more favorable morphological characteristics in NF1 patients compared to healthy individuals of the same age.

A Multifactorial Approach in Type 2 Diabetes Over 3 Years Decelerates Progression of Subclinical Arterial Disease in Routine Clinical Practice

The beneficial effect of multifactorial treatment of cardiovascular (CV) risk factors (RFs) in type 2 diabetes (T2D) is well established from randomized clinical trials. We prospectively evaluated the impact of such treatment in a real-world setting, on the development of subclinical arterial damage (SAD), as determined by structural/functional noninvasive biomarkers of vascular pathology (atheromatosis, carotid hypertrophy, arteriosclerosis). We prospectively studied 116 persons with T2D, treated with a multifactorial approach for CV RFs at a tertiary medical center, and 324 individuals without diabetes, for 3.2 years. The primary outcome was changes in vascular biomarkers related to SAD. At baseline, participants in the diabetes group had higher prevalence of SAD. At study end, the changes in clinical, biochemical, and lifestyle characteristics, as well as antihypertensive and lipid-lowering treatments, were comparable between the 2 groups. During follow-up, classical CV RFs (smoking, blood pressure, low-density lipoprotein-cholesterol, triglycerides) and behavioral features were significantly improved in both groups. Multivariate analysis, after adjusting for all classic CV RFs and use of antihypertensive/lipid-lowering therapies, demonstrated that all evaluated SAD biomarkers were similarly changed in the 2 groups. In conclusion, implementation of a multimodality approach of T2D treatment is feasible and efficacious in decelerating progression of SAD in routine clinical practice.

Mean arterial pressure values calculated using seven different methods and their associations with target organ deterioration in a single-center study of 1878 individuals

To assess the differences among seven different methods for the calculation of mean arterial pressure (MAP) and to identify the formula that provides MAP values that are more closely associated with target organ deterioration as expressed by the carotid cross-sectional area (CSA), carotid-to-femoral pulse-wave velocity (cf-PWV) and left ventricular mass (LVM). The study population consisted of 1878 subjects who underwent noninvasive cardiovascular risk assessment. Blood pressure (BP) was assessed in all subjects, and MAP was calculated by direct oscillometry and six different formulas. Carotid artery ultrasound imaging was performed in 1628 subjects. The CSA of the right and left common carotid artery (CCA) were calculated and used as surrogates of arterial wall mass and hypertrophy. Aortic stiffness was evaluated in 1763 subjects by measuring the cf-PWV. Finally, 218 subjects underwent echocardiographic examination for the assessment of LVM. Among the examined methods of MAP calculation, the formula MAP1=[diastolic BP]+0.412 × [pulse pressure] yielded the strongest correlations with the LVM, cf-PWV and CSA of the right and left CCA, even after adjusting for age and gender. The MAP calculation using the 0.412 was superior compared with the traditional formula that uses the 0.33 for the discrimination of subjects with left ventricular and carotid wall hypertrophy, as well as subjects with increased aortic stiffness. MAP estimated with the 0.412 is better correlated with target organ deterioration compared with other formulas. Future studies are needed to explore the accuracy of these formulas for MAP estimation compared with direct intra-arterial BP measurement.