ABSTRACT
PURPOSE: The prognosis of visual acuity (VA) after branch retinal vein occlusion (BRVO) in patients with diabetes mellitus is unknown compared to the VA in non-diabetic patients with BRVO. The aim of this study was to evaluate the visual outcome of BRVO in diabetic and non-diabetic patients. METHODS: A retrospective case-control study of diabetic and non-diabetic patients with BRVO was performed. VA and commonly known risk factors and complications of BRVO were compared in a follow-up period of at least 1 year. RESULTS: A total of 28 eyes of patients with diabetes and 49 eyes of non-diabetic patients with BRVO were included. One year after BRVO, the VA in the patients with diabetes decreased significantly more than that of the non-diabetic patients. During the second year after BRVO, the VA did not change significantly in either group. BRVO in patients with diabetes occurs at an earlier age. Diabetic patients needed more outpatient visits. CONCLUSIONS: The VA 1 year after BRVO in patients with diabetes is worse compared to the VA in patients without diabetes. The VA stabilizes 1 year after onset in both groups. Diabetic patients tend to need more frequent follow-up in order to treat the sequelae of BRVO.
Subject(s)
Diabetes Mellitus/physiopathology , Retinal Vein Occlusion/physiopathology , Visual Acuity/physiology , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
AIMS/HYPOTHESIS: Vascular endothelial growth factor (VEGF) is thought to be instrumental in the progression of diabetic retinopathy. Indications exist that the renin-angiotensin system is involved in VEGF overexpression. We assessed the vitreous VEGF concentrations in patients and related them to anti-hypertensive treatment, with special interest in the use of ACE-inhibitors. METHODS: Samples of vitreous fluid (10-80 microl) were obtained from 39 patients both with Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus and 11 non-diabetic patients undergoing intra-ocular surgery. The VEGF-A concentrations were assessed by immunoassay. RESULTS: Control patients and patients without proliferative diabetic retinopathy ( n = 8) had low and comparable VEGF concentrations (medians < 50 pg/ml). In contrast, patients with proliferative diabetic retinopathy ( n = 31) had high vitreous VEGF concentrations (median 1134 pg/ml), which showed a negative correlation with the use of ACE inhibiting medication (Spearman rank-R = - 0.54; p = 0.002, n = 13). Diastolic and systolic blood pressure did not differ significantly between the two subgroups with proliferative diabetic retinopathy, i. e. those patients receiving ACE-inhibition (medians 88/160 mm Hg, respectively) and the others (90/160). For the mostly used ACE-inhibitor in the proliferative diabetic retinopathy group, i. e. enalapril ( n = 8), a linear dose-effect relation was observed (-20 +/- 4 pg x ml(-1) x mg(-1) x day(-1); p = 0.024; coefficient +/- SEM). CONCLUSION/INTERPRETATION: Treatment with ACE-inhibitors attenuates retinal overexpression of VEGF-A in patients with proliferative diabetic retinopathy, probably by interference with a local effect of angiotensin II.
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Diabetic Retinopathy/physiopathology , Enalapril/therapeutic use , Endothelial Growth Factors/metabolism , Lymphokines/metabolism , Vitreous Body/blood supply , Adult , Age of Onset , Aged , Aged, 80 and over , Blood Pressure/drug effects , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 2/physiopathology , Female , Humans , Intraocular Pressure/drug effects , Male , Middle Aged , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth Factors , Vitreous Body/drug effects , Vitreous Body/physiologyABSTRACT
PURPOSE: To report a case of Alcaligenes xylosoxidans endophthalmitis and to increase awareness of its potential as an intraocular pathogen. METHODS: An 80-year-old woman in good general health developed A. xylosoxidans endophthalmitis 8 months after an uncomplicated cataract extraction performed at another institution. Eventually, vitrectomy with removal of the intraocular lens and capsule was performed because of recurrent disease after intravitreal antibiotic injections. RESULTS: Microbiologic examination of the vitreous biopsies and capsule disclosed A. xylosoxidans, a motile, gram-negative rod resistant to many antibiotics. CONCLUSION: A. xylosoxidans should be considered as a cause of low-grade endophthalmitis after cataract surgery.
