Retinal Photoreceptors and Microvascular Changes in Prediabetes Measured with Adaptive Optics (rtx1™): A Case-Control Study.

BACKGROUND: Patients with prediabetes are at risk for diabetes, cardiovascular events, and microvascular complications. The rtx1 (Imagine Eyes, France) permits early detection of changes in the retinal photoreceptors and vessels. OBJECTIVE: Cone parameters and retinal microvasculature were analyzed with the rtx1 in 12 prediabetic patients and 22 healthy subjects. The analysis was based on cone density (DM), interphotoreceptor distance (SM), cone packing regularity, and retinal vessel parameters: wall thickness, lumen diameter (LD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall. RESULTS: DM in the prediabetic group was not significantly lower than that in the control group (18,935 ± 1713 cells/mm2 and 19,900 ± 2375 cells/mm2, respectively; p = 0.0928). The LD and WLR means differed significantly between the prediabetic and the control groups (LD 94.3 ± 10.9 versus 101.2 ± 15, p = 0.022; WLR 0.29 ± 0.05 versus 0.22 ± 0.03, p < 0.05). A multivariate regression analysis showed that the WLR was significantly correlated with BMI and total cholesterol. CONCLUSIONS: Abnormalities found in rtx1 examinations indicated early signs of arteriolar dysfunction, prior to impaired glucose tolerance progressing to diabetes. The rtx1 retinal image analysis offers noninvasive measurement of early changes in the vasculature that routine clinical examination cannot detect.

Prevalence of ocular abnormalities in prediabetic patients.

AIM: The aim of our study was to evaluate the prevalence of ocular abnormalities in prediabetic individuals. MATERIAL AND METHODS: 61 subjects aged 37-78 (41 women, 20 men), with impaired fasting glucose and/or impaired glucose tolerance, were enrolled in the study and compared to 30 healthy volunteers, aged 39-75 (20 women, 10 men), without prediabetes and history of previous ocular diseases. Both groups of patients underwent a complete physical examination, biochemical tests and ophthalmic examination: visual acuity testing, intraocular pressure measurement, anterior and posterior segment evaluation, fundus photographs, optical coherence tomography, colour vision and letter contrast sensitivity tests. RESULTS: The prevalence rates of various ocular abnormalities in prediabetic subjects as compared to healthy controls were as follows: acquired colour vision impairment 8.2% vs. 0% (p<0.05), signs of retinopathy: 9.8% vs. 0% (p<0.05), cataract: 32.8%/ vs. 6.7% (p<0.05), and corneal surface disorders: 19.7% vs. 3.3% (p<0.05). Optical coherence tomography revealed increased prevalence of posterior vitreous detachments and epiretinal membranes in prediabetic individuals as compared to healthy controls. There were no statistically significant differences in central retinal thickness, mean visual acuity and mean intraocular pressure between the two groups. CONCLUSION: Patients with prediabetes present with numerous ocular abnormalities. The prevalence of ocular disorders in prediabetic subjects is significantly higher as compared to healthy population. Regular ophthalmic monitoring seems to be essential at this stage of hyperglycemic disorders. A dedicated prevention and screening programs should be implemented in prediabetic population in order to early detect ocular abnormalities and identify individuals at risk of other diabetic complications.

[Ocular abnormalities in patients with prediabetes]. / Zmiany w narzadzie wzroku u osób, u których rozpoznano stan przedcukrzycowy.

Prediabetes is recognized as the major risk factor for type 2 diabetes. Nearly 7% of adults worldwide are estimated to have prediabetes and the prevalence is increasing. There is evidence of microvascular and macrovascular complications in patients with prediabetes. Early detection of prediabetes and lifestyle modification could therefore contribute to the prevention of type 2 diabetes and its complications. Many reports indicate the possibility of ocular abnormalities in prediabetes. A number of studies show associations between prediabetes and early forms of retinopathy. There is also evidence that colour vision and contrast sensitivity are impaired in these patients. Our study analyses data regarding ocular abnormalities in prediabetes.

[Variability of clinical manifestations in the family with Axenfeld-Rieger syndrome]. / Zmiennosc obrazu klinicznego w rodzinie z zespolem Axenfelda-Riegera.

PURPOSE: Axenfeld-Rieger syndrome is an ocular anterior segment dysgenesis, autosomal dominantly inherited, commonly associated with glaucoma and systemic anomalies. This study presents various clinical manifestations of Axenfeld-Rieger syndrome within one family. MATERIAL AND METHODS: Three members of the family: patient 1--father (54 years old), patient 2--son (31 years old), and patient 3--daughter (30 years old), underwent complete ophthalmic examination, including standard glaucoma diagnostics. Additional investigations, such as: ultrasound biomicroscopy (UBM, Opticon 2000), corneal topography Orbscan II (Bausch & Lomb, Inc., Rochester, N.Y., USA), corneal confocal microscopy ConfoScan 3 (Nidek Technologies), central corneal thickness measurements with optical low-coherence reflectometer (OLCR, pachymeter Haag-Streit), were carried out. It was impossible to perform complete eye examination in one case (patient 1) because of severity of ocular changes. RESULTS: All family members described had iris abnormalities (hypoplastic iris stroma) and early-onset glaucoma, however severity of symptoms were different in each case. The most advanced disease was recognized in patient 1. Other findings included: posterior embryotoxon (patients 2 and 3), iridocorneal angle abnormalities (patients 2 and 3), microcornea (patient 2) and extraocular features (patients 1 and 2): dental anomalies (microdontia and hypodontia), maxillary hypoplasia and periumbilical skin fold. All of these symptoms supported the diagnosis of Axenfeld-Rieger syndrome. In addition, we also diagnosed keratoconus in patient 2 and hypermetropia, strabismus and corneal scar in patient 3. CONCLUSIONS: Reported cases of Axenfeld-Rieger syndrome demonstrate phenotypic variability of the disease among family members, which is characteristic for this disorder and can cause diagnostic problems.

[Prevalence of Kayser-Fleischer ring in patients with Wilson's disease]. / Ocena czestosci wystepowania pierscienia Kaysera-Fleischera u pacjentów z choroba Wilsona.

The aim of the study was to assess prevalence of Kayser-Fleischer ring in children with Wilson's disease. 36 patients aged 7-17 years were enrolled into the study. All of them underwent ophthalmic examination by slit-lamp biomicroscopy. Kayser-Fleischer ring was found in 2 children (5.6%)--16 years old boy and girl with liver insufficiency. In addition, the girl had neurological symptoms. After 2 years of treatment K-F ring was not detected in the girl's eyes. Our data indicate that Kayser-Fleischer ring is rare in children and its absence does not exclude diagnosis of Wilson's disease.