[Contribution of selected cellular adhesion molecules and proinflammatory cytokines in the pathogenesis of proliferative diabetic retinopathy]

Proliferative diabetic retinopathy (PDR) is caused by structural and functional disorders of the retinal vessels. Complex pathobiological mechanisms of this process have not been clearly explained so far.

PURPOSE

To prove the role of immunological-inflammatory process in the development of the proliferative diabetic retinopathy.

MATERIAL AND METHODS

Forty six patients, aged 63.97+/-9 were enrolled in the study, treated for diabetes type 2 for 12.56+/-6,87 years. In 19 patients (12 women and 7 men aged 64.63+/-8.38, treated for diabetes for 12.47+/-6.75 years) a parallel analysis of given parameters was performed in both serum and vitreous body samples. Vitrectomy, in course of which the vitreous body samples were obtained, was performed in these patients because of vitreous haemorrhage, causing traction retinal detachment in some patients. The control group consisted of 15 patients (9 women and 6 men), aged 63.00+/-14.58, who underwent the vitrectomy procedure because of reasons other than diabetic retinopathy. The concentration values of the soluble forms of ICAM-1, VCAM-1, IL-6 and TNF-alpha were estimated both in the serum and vitreous body samples on the basis of the ELISA method. The biochemical tests were performed routinely in the clinical laboratory.

RESULTS

Mean concentrations of the investigated parameters were significantly higher in the group of patients suffering from PDR, both in the serum and in the vitreous body samples, in comparison with the values observed in the control group. In the presence of HbAlc at the level of 9.21+/-2.17% a directly proportional correlation between the TNF-alpha either in serum or in the vitreous body samples and VCAM-1 in the vitroeus body samples was found. It is worth mentioning that the increase of the TNF-alpha concentration in the vitreous body was significantly related to the rise of the VCAM-1.

CONCLUSIONS

The above mention of findings prove the remarkable role of the immunological and inflammatory response in the pathogenesis of this specific vascular complication of diabetes. The research was a source of evidence which highlighted the necessity of optimal metabolic control of the disease in the prevention of vascular complications of diabetes.

HLA typing in patients of Eales disease

OBJECTIVE

To determine any predisposition of haplotypes with Eales disease.

DESIGN

A case control study.

PLACE AND DURATION OF STUDY

This study was started in February 2002 and data collected till April 2003 at Eye Department of Military Hospital, Rawalpindi.

PATIENTS AND METHODS

The frequency of HLA antigens both class-I and II by complement dependent standard lymphocytotoxicity test was studied in 32 patients of Eales disease (group-I) and 32 age and gender matched normal persons as controls (group-II). Both patients and controls underwent complete ocular and clinical examination and were followed up for one year.

RESULTS

Mean age was 30.8 years. HLA DR3 was found in 20 patients of group-I and none in group-II. HLA types A1, B8, B5 (51) and DR 15 (2) were found in 12 out of 32 patients of eales disease and none in controls. HLA DQ2 and DR52 was found in 28 cases of group-I as compared to 18 cases of group-II (p = .005).

CONCLUSION

HLA phenotypes HLA DR3, A1, B8, B5 (51) and DR 15 (2) occurred in majority of cases of Eales disease, whereas these were not found in controls which was statistically significant. Similarly, HLA DQ2, DR52 and Bw6 was found in higher frequency in Eales patients and thus strongly associated with it. We conclude that certain HLA haplotypes have a possible predilection for Eales disease.

Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage

PURPOSE

To investigate the hemostatic effects of SF6 gas in preventing postoperative vitreous hemorrhage in diabetic vitrectomy.

METHODS

A prospective, randomized study of 33 diabetic eyes with vitreous hemorrhage, treated by vitrectomy. In 17 of our cases SF6 20% was injected into the eye at the end of the operation, while in 16 cases BSS remained in the vitreous cavity.

RESULTS

The incidence of vitreous hemorrhage recurrence was 17.6% for the SF6 group and 12.5% for the BSS group (statistically not significant). Progression of lens opacities was observed in 23.5% of the SF6 group, and in 18.8% of the BSS group (statistically not significant, with a higher incidence in the SF6 group).

CONCLUSIONS

SF6 gas did not show hemostatic effects in the cases studied. Furthermore, it may have contributed to cataract progression. Therefore we suggest that the use of SF6 is not recommended as a treatment modality in preventing new vitreous hemorrhage after diabetic vitrectomy.

[Parameters of blood proteinase inhibitor balance and hyperlipoproteinemia in patients with proliferative diabetic retinopathy with vitreous hemorrhage]

The parameters of proteinase-inhibitor balance and lipid metabolism were studied in the blood of patients with proliferative diabetic retinopathy. Metabolic disorders in patients with proliferative diabetic retinopathy with hemophthalmia are characterized by a notable increase in the activities of trypsin-like enzymes and alpha 2-macroglobulin level and normal activity of alpha 1-antitrypsin and shifted lipid metabolism parameters characteristic of types IIb and IV hyperlipoproteinemia. These data indicate a necessity of monitoring lipid metabolism and proteinase-inhibitor balance in patients with diabetic retinopathy in order to detect subjects at a high risk of hemophthalmia and timely start drug correction for preventing this complication.

Bilateral vitreous hemorrhages in an infant with low fibrinogen levels

The finding of retinal or vitreous hemorrhage in a child under age 3 years may cause significant controversy with regard to the etiology, because it raises the suspicion of nonaccidental injury. Blood dyscrasias have been documented to cause retinal and vitreous hemorrhages in adults and children, but they have rarely been reported to be the cause of retinal hemorrhages in neonates. We report on a patient with a low plasma fibrinogen level who had bilateral retinal hemorrhage that proceeded to vitreous hemorrhage. This subtle abnormality of the blood clotting cascade caused significant retinal and vitreous hemorrhage in a child without risk factors for abuse.

Serum alpha-1 acid glycoprotein levels in patients with idiopathic peripheral retinal vasculitis (Eales' disease)

Serum alpha-1 acid glycoprotein levels were measured in 27 patients with idiopathic peripheral retinal vasculitis (Eales' disease) and 31 healthy subjects by single radial immunodiffusion technique. The levels were found to be significantly increased in both moderate and severe types of the disease. The serum levels of this protein paralleled the severity of the disease. The increased alpha-1 acid glycoprotein in serum showed a significant fall to near normal levels during the quiescent stage. Our observations support the hypothesis that idiopathic peripheral retinal vasculitis is an immune mediated disease. It is proposed that serum alpha-1 acid glycoprotein may be considered as a reliable parameter of the activity and the degree of severity of the disease, as well as an useful tool for monitoring the efficacy of treatment.