Osteoprotegerin and soluble receptor activator of nuclear factor-kappa B ligand in exudative age-related macular degeneration

Calcification and inflammation are among the important cases of exudative age-related macular degeneration [E-ARMD]. The aim of the present study was to elucidate if there is any relationship between serum Osteoprotegerin [OPG], soluble receptor activator of nuclear factor-kappa B ligand [RANK-ligand] and E-ARMD. In a cross-sectional study, we compared 45 E-ARMD patients with 45 matched controls. Diagnosis was confirmed by fluorescein angiography. Serum samples were analyzed for OPG, RANK-ligand, low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglyceride [TG]. The levels of OPG and RANK-ligand were measured by ELISA methods. The mean age was 72.0 +/- 11.5 years in the E-ARMD group and 68.2 +/- 8.9 years in the control group [p=0.09]. The level of serum OPG was 132.10 +/- 75.49 pg/ml in the E-ARMD group and 94.88 +/- 61.65 pg/ml in the control subjects. E-ARMD patients had significantly high levels of OPG [p=0.012], as well as significantly high levels of LDL-C and TC [p=0.001 and p=0.005, respectively]. We could not find any significant difference in RANK-ligand, HDL-C, or TG between two study groups [p>0.05]. To the best of our knowledge, this is the first study investigating the levels of OPG in E-ARMD patients. The present study showed that E-ARMD patients had high levels of serum OPG. It may act as a protective factor for E-ARMD or only as a secondary phenomenon of different processes of E-ARMD. Further prospective studies would be necessary for prognostic and predictive significance of OPG in patients affected by E-ARMD

High-sensitivity C-reactive protein and tumor necrosis factor alpha in pseudoexfoliation syndrome

The purpose of the present study was to determine the alterations in high-sensitivity C-reactive protein and Tumor Necrosis factor alpha levels in the blood serum of pseudoexfoliation syndrome cases [a disease with similar risk factors as systemic endothelial dysfunction diseases] and to compare the results with healthy individuals. High-sensitivity C-reactive protein and Tumor Necrosis factor alpha levels were determined in 30 cases with pseudoexfoliation syndrome and in 30 control patients of the same age and sex, by enzyme-linked immunosorbent assay. The levels of high- sensitivity C-reactive protein and Tumor Necrosis factor alpha in the blood serum of patients with pseudoexfoliation syndrome [3.95 +/- 0.88 mg/1, 332 +/- 0.99 pg/ml, respectively] were significantly higher than in the control group [2.51 +/- 0.79mg/l 0.43 +/- 0.15 pg/ml, respectively] p=0.001, p=0.002. The results suggest that increased levels of high-sensitivity C-reactive protein and Tumor Necrosis factor alpha, as markers of inflammation and peripheral endothelial dysfunction in pseudoexfoliation syndrome, may be risk factors for systemic and ocular manifestations of pseudoexfoliation syndrome

Topiramate induced bilateral angle-closure glaucoma

To describe a case of acute angle-closure glaucoma associated with oral topiramate [Topamax, Aria Daroo] therapy Two weeks after initiation of oral topiramate therapy for epilepsy, a 35-year-old woman presented with blurred vision and headache. Intraocular pressure in both eyes was significantly elevated and her visual acuity was 20/30 Ocular Uterque [OU]. Bilateral conjunctival chemosis, shallow anterior chamber and mild corneal edema were observed. Topiramate therapy was discontinued. Topical therapy was initiated in both eyes with betamethasone, atropine and timolol. Symptoms and signs including vision accuracy, refraction and intraocular pressure resolved over the next 2 weeks. Topiramate therapy may be associated with ciliochoroidal effusion resulting in angle-closure glaucoma; therefore, patients on such therapy should be carefully monitored