Increased levels of N(ε)- Carboxy methyl lysine (N(ε)-CML) are associated with topographic alterations in retinal pigment epithelium: A preliminary study

PURPOSE

To evaluate the association of serum levels of N(ε)- Carboxy methyl lysine (N(ε)-CML), an advanced glycation end product with topographic alterations in retinal pigment epithelium (RPE) in diabetic retinopathy on spectral domain optical coherence tomography (SD-OCT).

METHOD

Consecutive cases of type 2 diabetes mellitus with no retinopathy (n=20); non-proliferative diabetic retinopathy (n=20); proliferative diabetic retinopathy (n=20) and healthy controls (n=20) between the ages of 40 and 65years were included. RPE alterations were graded on segmentation map of SD-OCT: grade 0, No RPE alterations; grade 1, RPE alterations in up to two quadrants and grade 2, RPE alterations in more than two quadrants. Serum level of N(ε)-CML and glycated hemoglobin (HbA1c) was analyzed using the standard protocol. Statistical analysis was done.

RESULTS

Significant increase in N(ε)-CML was observed with increased severity of diabetic retinopathy (F=34.1; p<0.0001). Fisher exact test revealed significant increase in grades of RPE alterations with increased severity of diabetic retinopathy (p<0.001). Univariate ordinal regression analysis was done to calculate the risk of progression in grades of RPE alteration with individual changes in variables like duration of diabetes (odds ratio=1.37; p=0.001), HbA1c (odds ratio=1.37; p=0.002) and Nε-CML (odds ratio=1.37; p<0.0001). Multivariate ordinal regression analysis for predicting progression in grades of RPE alteration revealed Nε-CML to be an independent predictor of increase in grades of RPE alteration (adjusted odds ratio=1.07; p<0.01) when duration of diabetes and HbA1c were held constant.

CONCLUSION

Increase in serum levels of N(ε)- Carboxy methyl lysine is significantly associated with topographic alterations in RPE. Grades of RPE alteration increase significantly with increased severity of diabetic retinopathy.

Ultrasonographic findings in eyes with retinal detachments secondary to retinopathy of prematurity

PURPOSE

To describe ultrasonographic findings of stages 4 and 5 retinopathy of prematurity.

PATIENTS AND METHODS

Ocular ultrasonography was performed using a 10-MHz transducer. Forty-four patients (88 eyes) with stages 4 and 5 retinopathy of prematurity were evaluated. Twenty-five patients were female. The mean age was 8.4 months (standard deviation, +/- 4.9).

RESULTS

Retinal detachment configurations were as follows: 31% closed posterior and open anterior, 19% closed posterior and anterior, 14% open posterior and anterior, and 14% open posterior and closed anterior. Additional findings included vitreous opacities (14%), proliferative vitreoretinopathy (22%), subretinal opacities (24%), choroidal thickening (18%), and reduced axial diameter (75%).

CONCLUSIONS

Ultrasonographic evaluation in eyes with advanced retinopathy of prematurity guides surgical indication, management, and visual prognosis.

Scleral Buckling Procedures for Longstanding or Chronic Rhegmatogenous Retinal Detachment with Subretinal Proliferation

OBJECTIVE

To investigate longstanding or chronic retinal detachments (RDs) with subretinal strands and their clinical features and therapeutic effects using conventional retinal surgery.

DESIGN

Retrospective, consecutive, noncomparative case series.

PARTICIPANTS

Cases of 36 patients (40 eyes) with longstanding RD and subretinal proliferation who had undergone scleral buckling or encircling procedures between January 1, 1995 and October 31, 2003 at one institution were reviewed.

METHODS

A retrospective analysis of the patient data was conducted from the medical records.

MAIN OUTCOME MEASURES

Visual acuity (VA) and postoperative anatomic retinal reattachment at the final follow-up visit between 3 and 24 months (mean, 6.9).

RESULTS

Forty eyes with an RD (mean duration, 13.8 months) treated with scleral encircling and buckling had a 90% cure rate after one surgery. The VA levels increased in 77.5% of eyes to over 5/100 at the final follow-up visit. Longstanding or chronic RD with subretinal proliferation had subretinal proliferative strands (i.e., a shallow RD) and a smooth atrophic detached retina, not a thickened retina.

CONCLUSIONS

Our results suggest that scleral encircling and buckling can be used in most patients with a longstanding RD. The chronic pathologic course of longstanding rhegmatogenous RD should be considered before treatment.

[The use of ultrasonographic techniques for the diagnosis of retinopathy of prematurity]

INTRODUCTION

Ultrasonographic techniques are commonly used for the imaging of various tissue structures and organs, including the eyeball and orbit. The non-invasive ultrasound imaging is safe for the patient and may be repeated after a short time unlike in the case of other radiological techniques. In pediatric ophthalmology, ultrasonography plays a major role as an auxiliary examination for the diagnosis of various intraocular diseases, pathologies of the retina and choroid, and retrobulbar conditions. Ultrasonography is of major importance in diagnosing eye disorders associated with opacity preventing visual inspection of the posterior eye segment.

METHODS

Among ultrasonographic techniques in pediatric ophthalmology the most frequently used are B-scan, A-scan, and Doppler ultrasonography. Because of the resolution of ultrasonographic methods in comparison to radiological techniques, they play an important role in monitoring the dynamics of pathological processes in retinopathy of prematurity (ROP). Other radiological methods such as CT, MRI or subtractive angiography do not offer a detailed view of retinal attachment or vitreo-retinal proliferation.

CONCLUSION

Ultrasonography as an auxiliary examination at subsequent stages of ROP helps to document the changes and in case of corneal opacity connected with progression of vitreo-retinal abnormalities is the basis for the diagnosis.

Ultrasound biomicroscopy in silicone oil-filled eyes

PURPOSE

To establish reproducible ultrasound biomicroscopy (UBM) imaging patterns characteristic of the presence and behavior of silicone oil and of peripheral vitreoretinal proliferation in eyes that have undergone vitreoretinal surgery with silicone oil injection.

METHODS

The study design was a case series. Ultrasound biomicroscopy was performed on 34 eyes of 34 patients (age range, 20-68 years). For an image to be considered a UBM pattern, it was required to be consistently reproducible in the same eye and to be observed in more than one eye.

RESULTS

Four patterns are described: silicone oil particles, ghost images, "painting" or surface impregnation of iris and anterior chamber angle, and peripheral proliferative vitreoretinopathy. One type of ghost image, the secondary reflection of the cornea, paired with disappearance of the aqueous-silicone oil interface corresponded to massive silicone oil displacement into the anterior chamber. Gross proliferation produced funnel and tentlike images, whereas minute, networklike images seemed to represent early changes. There was a close correspondence between these UBM patterns and previous ophthalmologic clinical findings.

CONCLUSION

Easily recognizable, distinct UBM patterns are characteristic of conditions found in silicone oil-filled eyes. Ultrasound biomicroscopy seems to be a useful tool for assessing changes in silicone oil-filled eyes.

Ultrasound biomicroscopic features of anterior proliferative vitreoretinopathy

PURPOSE

To evaluate the utility of ultrasound biomicroscopy (UBM) in the diagnosis of anterior proliferative vitreoretinopathy (APVR).

METHODS

Ultrasound biomicroscopy (frequency, 50 MHz; depth of penetration, 5 mm; resolution, 40 microm) was used to examine 53 eyes of 52 subjects with rhegmatogenous or traumatic retinal detachment (RD). The results were compared with findings during vitrectomy.

RESULTS

In 43 eyes (42 patients), RD was detected using UBM, attaining 81% consistency with observations during operation. Among 36 eyes with surgically proved APVR, 33 (92%) had APVR detected by UBM. The UBM images showed shallow RD, circumferential contraction, or anterior displacement around the ora serrata. The anterior displacement could be classified into C-shaped anterior displacement, ciliary body adhesion, and pupil adhesion. Ultrasound biomicroscopy showed that a retinal step was formed on the surface of the ora serrata and the ciliary body. Failure to detect APVR by UBM may be due to severe choroidal detachment or a narrow palpebral fissure that hampers exposure of the ora serrata and the part of the eyeball posterior to it.

CONCLUSION

Ultrasound biomicroscopy is a useful tool for the evaluation of APVR, which is difficult by ordinary methods. Ultrasound biomicroscopic images of APVR have typical features that may be used to help guide surgery and estimate prognosis.

[Enzymatically induced posterior vitreous detachment in proliferative diabetic vitreoretinopathy]

BACKGROUND

Complete detachment of the posterior vitreous cortex is an important aim in the treatment of proliferative diabetic vitreoretinopathy (PDVR). Today a posterior vitreous detachment (PVD) can only be achieved during vitrectomy. A randomized pilot study was started to evaluate wether intravitreally injected TPA is sufficient to induce a PVD in diabetic eyes.

PATIENTS AND METHODS

Eight weeks prior to vitrectomy because of proliferative diabetic vitreoretinopathy (non-clearing haemorrhage, fibrovascular proliferations) 20 eyes which had an attached vitreous received a cryopexy of the peripheral retina. In 11 eyes that had been selected at random 10 micrograms of recombinant tissue plasminogen activator were injected midvitreally 24 hrs later. A newly formed PVD was assessed by means of biomicroscopy or ultrasound.

RESULTS

A newly formed partial (n = 3) or complete (n = 7) PVD was found in 10 of 11 TPA-treated eyes versus one partial detached vitreous in the control group. In 3 younger patients PVD developed exclusively after TPA-injection. We did not observe severe changes of the ERG, decrease of visual acuity, severe new vitreous haemorrhages or opacities of the lens. In 3 eyes (2 eyes of the control group) a circumscribed retinal detachment developed during the follow-up period.

CONCLUSIONS

The described technique can be used in diabetics without severe side effects. It facilitates the removal of the vitreous cortex and may be a valuable adjunct to the surgical management of PDVR. Unlike other proteases TPA is available for clinical use through recombinant DNA technology which allows standardized enzymatic activities, steril and non-infectious conditions.

Ultrasound biomicroscopic analysis of anterior proliferative vitreoretinopathy

PURPOSE

To report the use of ultrasound biomicroscopy for preoperative assessment of anterior proliferative vitreoretinopathy.

METHODS

Case report. In a 35-year-old man with tractional retinal detachment and anterior proliferative vitreoretinopathy, we used ultrasound biomicroscopy with UX-02 (Rion Co Ltd, Tokyo, Japan) to perform the preoperative analysis of the ciliary body, anterior vitreous, and detached peripheral retina.

RESULTS

In all meridians, the posterior insertion of the vitreous was drawn anteriorly, creating a retinal trough, and the meridian distance between the anterior and posterior vitreous base insertions was reduced. Retinochoroidal detachment was detected posterior to the anterior vitreous base insertion. Based on these imagings, sclerotomy locations were selected.

CONCLUSION

Ultrasound biomicroscopy may be useful to assess anterior proliferative vitreoretinopathy preoperatively and to decide on sclerotomy sites.

[Vitreo-retinal complications of hemoglobinopathy SC]

Sickle hemoglobinopathies are frequent in black population. Double heterozygous SC gives less general symptoms but ocular complications are very common. Fluorescein angiography of 20 cases are reported. All the patients had hemoglobin electrophoresis showing double heterozygous SC. Clinical investigations included fundus examination and fluorescein angiography. Laser treatment or cryotherapy were realised regarding lesions features. Vascular retinal complications were found in 75% of cases, including vitreous hemorrhage (10% of cases). There was no correlation between fundus examination and fluorescein angiography. Fluorescein angiography is useful for early diagnosis and allows preventive laser treatment.

[Examination of anterior proliferative vitreoretinopathy with ultrasound biomicroscopy]

OBJECTIVE

To diagnose anterior proliferative vitreoretinopathy (a-PVR) with ultrasound biomicroscopy (UBM).

METHODS

The UBM images of 27 cases (27 eyes) of suspicious a-PVR from cases with retinal detachment with PVR were analyzed and compared with the images of B scan ultrasound and the findings during vitrectomy.

RESULTS

UBM diagnosis of a-PVR was found in 20 eyes with retinal circumferential contraction, and in 15 eyes with retinal anterior displacement. A-PVR was not diagnosed by UBM in 7 eyes. UBM images of a-PVR included: the pattern of dots and cords in vitreous proliferation, the echo augmentation and obvious central displacement of the retina with circumferential contraction. Besides, the trough, "angle" and "Z" shaped overlap of the retina were the characteristics of the retinal anterior displacement.

CONCLUSION

UBM plays an important role in the clinical diagnosis of a-PVR.

Comparative study of incomplete posterior vitreous detachment as a risk factor for proliferative vitreoretinopathy

BACKGROUND

Abnormal vitreoretinal relationships have recently been implicated in many vitreoretinal disorders. Sites of abnormal vitreoretinal adherences are likely to exist in eyes predisposed to rhegmatogenous retinal detachment (RD), causing either retinal tears or incomplete posterior vitreous detachment (PVD). The present study was designed in two parts to identify the risk for preoperative and postoperative proliferative vitreoretinopathy (PVR) due to incomplete PVD.

METHODS

We prospectively evaluated the vitreoretinal relationships using high-resolution kinetic echography in 102 consecutive eyes of 100 patients with rhegmatogenous RD. In the first part, a case-control study was conducted to compare the vitreous status in patients with preoperative PVR (cases) with that in patients with non-PVR-complicated RD (controls). During the second part, patients with noncomplicated RD (65 eyes) who were operated on by a simple retinal attachment procedure were followed up for a mean period of 6.6 months to compare the recurrence of RD due to postoperative PVR according to their vitreous status.

RESULTS

Patients with PVR on study entry had a higher prevalence of partial PVD (28 of 32 eyes, 87%) than did controls (25 of 70 eyes, 35%). The statistical significance of this difference was independent of all other variables studied. After a mean follow-up period of 6.6 months, the incidence of recurrence of RD associated with postoperative PVR was 33% in the eyes with incomplete PVD, compared with 4.9% in the eyes without incomplete PVD.

CONCLUSIONS

Our results support the notion that the occurrence of incomplete PVD in RD is a significant risk factor for preoperative and postoperative PVR.