Evaluación de la monitorización ambulatoria de la presión arterial en pacientes con obstrucción venosa retiniana / Evaluation of the ambulatory blood pressure monitoring in patients with retinal vein occlusion

Fundamentos La hipertensión arterial (HTA) es el principal factor de riesgo para el desarrollo de la obstrucción venosa retiniana (OVR). Objetivos Analizar el perfil hipertensivo con monitorización ambulatoria de la presión arterial (MAPA) en pacientes con una OVR. Pacientes y métodos Estudio con MAPA en 66 pacientes, 33 con OVR pertenecientes a una cohorte con esta enfermedad y 33 controles sin OVR ajustados por edad y sexo. Resultados Los pacientes con OVR tuvieron, respecto a los controles, cifras nocturnas elevadas de PAS 130mmHg (21) vs.119mmHg (11); p=0,01 y PAD 73mmHg (11) vs. 65mmHg (9); p=0,002. Además, presentaron menor descenso del porcentaje de Dipping ratio 6,0% (10,4) vs. 12,3% (6,3); p=0,005. Conclusiones Los pacientes con OVR tienen un perfil hipertensivo nocturno desfavorable. El reconocimiento de este hecho puede ayudar a optimizar el tratamiento (AU)

Background Arterial hypertension (AHT) is the main risk factor for the development of retinal vein occlusion (RVO). Aims To analyze the hypertensive profile with ambulatory blood pressure monitoring (ABPM) in patients with RVO. Patients and methods Retrospective and observational study of 66 patients with ABPM, 33 with retinal vein occlusion from a cohort of these disease and 33 controls without RVO, adjusted for age and sex. Results Compared to controls, patients with RVO had elevated nocturnal values of SBP 130mmHg (21) vs. 119mmHg (11); P=.01 and DBP 73mmHg (11) vs. 65mmHg (9); P=.002. In addition, they presented a lower decrease in the Dipping ratio percentage 6.0% (10.4) vs. 12.3% (6.3); P=.005. Conclusions Patients with RVO have an unfavorable nocturnal hypertensive profile. Recognition of this fact can help optimize their treatment (AU)

Evaluation of the ambulatory blood pressure monitoring in patients with retinal vein occlusion. / Evaluación de la monitorización ambulatoria de la presión arterial en pacientes con obstrucción venosa retiniana.

BACKGROUND: Arterial hypertension (AHT) is the main risk factor for the development of retinal vein occlusion (RVO). AIMS: To analyze the hypertensive profile with ambulatory blood pressure monitoring (ABPM) in patients with RVO. PATIENTS AND METHODS: Retrospective and observational study of 66 patients with ABPM, 33 with retinal vein occlusion from a cohort of these disease and 33 controls without RVO, adjusted for age and sex. RESULTS: Compared to controls, patients with RVO had elevated nocturnal values of SBP 130mmHg (21) vs. 119mmHg (11); P=.01 and DBP 73mmHg (11) vs. 65mmHg (9); P=.002. In addition, they presented a lower decrease in the Dipping ratio percentage 6.0% (10.4) vs. 12.3% (6.3); P=.005. CONCLUSIONS: Patients with RVO have an unfavorable nocturnal hypertensive profile. Recognition of this fact can help optimize their treatment.

Analysis of retinal nerve layers in idiopathic, LRRK2-associated Parkinson's disease and unaffected carriers of G2019S mutation.

INTRODUCTION: In both prodromal and early symptomatic stages of idiopathic PD (iPD) peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell layer (mGCL) thinning have been identified. Here we assessed whether these alterations can also be detected in symptomatic and presymptomatic stages of LRRK2-PD. METHODS: 218 eyes belonging to 20 iPD, 19 LRRK2-PD (L2PD), 24 LRRK2 non-manifesting carriers (L2NMC), and 46 controls (HCs). pRNFL, mGCL thickness (squares), and Bruch's membrane opening minimum rim width were evaluated by SD-OCT. In L2NMC, 123I-ioflupane SPECT (DaT-SPECT) with semi-quantitative analysis was carried out. RESULTS: Compared to HCs, iPD patients showed significant thinning of the temporal (BMO-MRW and pRNFL), superior-temporal (BMO-MRW), inferior-temporal (BMO-MRW), superior-nasal (BMO-MRW) and central sectors (BMO-MRW) (p < 0.05), as well as in five mGCL sectors (p < 0.05). No significant differences were found between the L2PD or L2NMC and HCs. BMO-MRW thickness in its temporal-superior, superior-nasal and middle sectors was influenced by disease duration (p < 0.05) and mGCL thickness in sectors TS1, TS2, TS3, NS1 and NS3 was influenced by UPDRSIII and age (p < 0.05). CONCLUSION: LRRK2-PD is distinguished from iPD by absent or less retinal nerve involvement, both in clinical and preclinical stages.

Risk factors in developing retinal vein occlusion in subject with obstructive sleep apnea.

BACKGROUND: Patients with obstructive sleep apnoea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop Retinal Vein Occlusion (RVO) compared with a population of OSA patients without RVO. METHODS: We analysed patients with OSA diagnosed with RVO (21 cases; mean of age 61 (12) yrs. range 44-87 yrs. 67% men), belonging to a large cohort of people with long-term follow-up for RVO (up to 12 years). We compared them with 21 patients with OSA, without RVO, matched by age and gender, selected from the Sleep Unit Registry (control group). RESULTS: There were no differences in the prevalence of arterial hypertension (AHT) or Diabetes mellitus (DM), but the RVO patients presented a higher diastolic blood pressure compared to controls (87.6±12.6 mmHg vs. 77.9±10.1 mm Hg respectively). The polygraphic parameters were similar in both groups. The Apnoea-Hypopnoea Index (IHA) similar in both groups (30.4 ±20.9 RVO vs. 33.7 ± 22.1 controls). In addition, RVO patients had a less favourable lipid profile, with higher total cholesterol (218±52 mg/dL vs. 179±41 mg/dL), higher LDL cholesterol (139±47 mg/dL vs. 107±32 mg/dL) and higher atherogenic indices: LDL/HDL (2.78 ± 0.95 RVO vs. 2.03±0.67 controls) and total cholesterol / HDL (4.37± 1.08 vs. 3.45 ± 0.84). Among the cases, 81% had peripheral RVO (superior temporal branch in 20 out of 21 cases) and 19% had central RVO. 62% of the cases received intravitreal antiangiogenic therapy and dexamethasone implants and 33% received argon laser photocoagulation. CONCLUSIONS: Poor control of cardiovascular risk factors, particularly dyslipidaemias, in patients with OSA may lead to the development of this ocular complication.

Retinal changes in amyotrophic lateral sclerosis: looking at the disease through a new window.

Amyotrophic lateral sclerosis (ALS) is the most frequent degenerative disease affecting motor neurons (MN). ALS has been traditionally considered as a pure motor system disease; however, there are currently sufficient evidences supporting the involvement of other non-motor systems. Recently, the development and the implementation of the optical coherence tomography (OCT) have provided new data regarding the ocular involvement in the disease. In this sense, alterations in retinal nerve fiber layer thickness (RNFL), other retinal layers thicknesses such as outer nuclear layer (ONL) and inner nuclear layer (INL) and changes in the retinal blood vessels have been described in ALS patients. Interestingly, the study of ocular alterations in ALS appears not only as new biomarker tool, but also as a new opportunity to deep into the pathogenesis of the disease. In this article we will review and standardize published studies regarding OCT and ALS, emphasizing both their strengths and weaknesses.

Ganglion Cell Layer Thinning in Alzheimer's Disease.

The main advantages of optical retinal imaging may allow researchers to achieve deeper analysis of retinal ganglion cells (GC) in vivo using optical coherence tomography (OCT). Using this device to elucidate the impact of Alzheimer's disease (AD) on retinal health with the aim to identify a new AD biomarker, a large amount of studies has analyzed GC in different stages of the disease. Our review highlights recent knowledge into measuring retinal morphology in AD making distinctive between whether those studies included patients with clinical dementia stage or also mild cognitive impairment (MCI), which selection criteria were applied to diagnosed patients included, and which device of OCT was employed. Despite several differences, previous works found a significant thinning of GC layer in patients with AD and MCI. In the long term, an important future direction is to achieve a specific ocular biomarker with enough sensitivity to reveal preclinical AD disorder and to monitor progression.

Evaluation of choroidal thickness in prodromal Alzheimer's disease defined by amyloid PET.

OBJECTIVE: To assess and compare the involvement of choroidal thickness (CT) in patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) defined by amyloid PET and healthy controls (HC). METHODS: Sixty-three eyes from 34 AD patients [12 eyes (19.0%) with dementia and 51 eyes (80.9%) with MCI], positive to 11C-labelled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired HC were recruited. All participants underwent enhanced depth imaging optical coherence tomography (EDI-OCT) assessing CT at 14 measurements from 2 B-scans. Paired Student t-test was used to compare CT measurements between MCI, dementia and sex- and age-paired HC. A univariate generalized estimating equations model (GEE) test was performed to compare MCI and dementia individually with all HC included. RESULTS: Compared with HC, eyes from patients with positive 11C-PiB PET/CT showed a significant CT thinning in 5 selected locations (in foveal thickness in vertical scan, in temporal scan at 1500µm, in superior scan at 500µm and in inferior scan at 1000µm and 1500µm, p = 0.020-0.045) whilst few significant CT reduction data was reported in MCI or dementia individually versus HC. However, the GEE test identified significant CT thinning in AD compared with all HC included (p = 0.015-0.046). CONCLUSIONS: To our knowledge, the present study is the first measuring CT in eyes from MCI and dementia eyes positive to 11C-PiB PET/CT reporting a significant trend towards CT thinning in MCI patients which became more pronounced in dementia stage. We support further investigation involving larger and prospective OCT studies in AD population characterized with available biomarkers to describe whether choroidal vascular damage occurs specifically in prodromal stages of AD.

Retinal Artery Contraction After Phenylephrine as a Cardiovascular Risk Biomarker.

BACKGROUND AND AIM: We investigated the in vivo changes of artery diameter (AD) and vein diameter (VD) after topical phenylephrine 2.5% instillation, and its relationship with the Systematic Coronary Risk Evaluation (SCORE). METHODS: This is a cross-sectional study. Healthy control patients were included. All of the participants underwent enhanced depth imaging by spectral-domain optical coherence tomography before and 30 minutes after phenylephrine instillation, using eye-tracking and follow-up software. Changes in AD and VD were assessed. RESULTS: The study included 45 eyes of 45 patients (14 males and 31 females). The mean age was 58.6 ± 15.1 years (26-88 years). Mean SCORE risk estimation value was 2.0 (0-14). No significant correlation was found between pre-phenylephrine AD or VD with age (p=0.237 and p=0.821, respectively), SCORE (p=0.545 and p=0.723, respectively). AD significant thinned after phenylephrine (p<0.001), whereas no significant changes could be depicted in VD (p=0.474). Changes in AD after phenylephrine were significantly related with SCORE risk estimation (p=0.035). Discordantly, changes in VD after phenylephrine were not significantly related with SCORE (p=0.505). CONCLUSION: As a significant thinning of AD occurred following phenylephrine instillation, and as the magnitude of this thinning is related with SCORE, it is useful to test the retinal artery contraction to infer the cardiovascular health status.

Outer Nuclear Layer Damage for Detection of Early Retinal Toxicity of Hydroxychloroquine.

In hydroxychloroquine (HCQ) retinopathy, early detection of asymptomatic retinal changes and the interruption of the drug are essential to prevent permanent vision loss. Our purpose was to investigate the roles of ganglion cell layer (GCL) and outer nuclear layer (ONL) thicknesses measured by optical coherence tomography (OCT) in the early diagnosis of retinopathy. One hundred and fourteen eyes of 76 individuals with HCQ treatment were enrolled in the study (42 eyes with impaired visual field (VF) and 72 eyes with nondamaged VF). We found that ONL was significantly decreased in the HCQ retinopathy group compared with the control group in the nasal macula (p = 0.032) as well as in four sectors (p < 0.044), whereas no significant differences were found comparing GCL in both groups. If VF were altered superiorly or temporarily, ONL was significantly thinned inferiorly (p = 0.029) and nasally (p = 0.008), respectively. Duration of HCQ treatment was significantly related with ONL in seven sectors of ONL (p < 0.047). We suggest that ONL measured with OCT might be used to assess early HCQ retinal toxicity.

Ganglion cell layer thinning in prodromal Alzheimer's disease defined by amyloid PET.

INTRODUCTION: The objective of this study was to investigate and compare optic nerve and retinal layers in eyes of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) with paired control eyes using optical coherence tomography. METHODS: Sixty-three eyes of 34 subjects, 12 eyes with AD and 51 eyes with MCI, positive to 11C-labeled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired control eyes underwent optical coherence tomography scanning analyzing retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), Bruch's membrane opening-minimum rim width (BMO-MRW), inner plexiform layer (IPL), outer nuclear layer, and lamina cribrosa (LC). RESULTS: Compared with healthy controls, eyes of patients with positive 11C-PiB PET/CT showed a significant thinning of RNFL (P < .028) and GCL (P < .014). IPL and outer nuclear layer also showed significant thinning in two (P < .025) and one location (P < .010), respectively. No significant differences were found when optic nerve measurements BMO-MRW and LC were compared (P > .131 and P > .721, respectively). Temporal sector GCL, average RNFL, and temporal sector RNFL also exhibited significant thinning when MCI and control eyes were compared (P = .015, P = .005 and P = .050, respectively), and also the greatest area under the curve values (0.689, 0.647, and 0.659, respectively). GCL, IPL, and RNFL tend to be thinner in the AD group compared with healthy controls. DISCUSSION: Our study suggests that RNFL and GCL are useful for potential screening in the early diagnosis of AD. LC and BMO-MRW appear not to be affected by AD.

Topographic correlation and asymmetry analysis of ganglion cell layer thinning and the retinal nerve fiber layer with localized visual field defects.

PURPOSE: To evaluate the accuracy of the measurement of the ganglion cell layer (GCL) of the posterior pole analysis (PPA) software of the Spectralis spectral-domain (SD) optical coherence tomography (OCT) device (Heidelberg Engineering, Inc., Heidelberg, Germany), the asymmetry of paired GCL sectors, the total retinal thickness asymmetry (RTA), and the peripapillary retinal nerve fiber layer (pRNFL) test to discriminate between healthy, early and advanced glaucoma eyes. METHODS: Three hundred eighteen eyes of 161 individuals with reliable visual fields (VF) were enrolled in this study. All participants were examined using the standard posterior pole and the pRNFL protocols of the Spectralis OCT device. VF impairment was graded in hemifields, and the GCL sectors were correlated with this damage. Thicknesses of each GCL, the GCL map deviation asymmetry and the pRNFL were compared between control and glaucomatous eyes. The area under the receiver operating characteristic curve (AUC) of these analyses was assessed. RESULTS: Fourteen of the 16 sectors of the GCL and pRNFL were significantly thinner in eyes with glaucoma than in control eyes (p<0.006). Similarly, the GCL map deviation showed a significant difference between these eyes and both the control eyes as well as the eyes with early glaucoma (p = 0.001 and p = 0.039, respectively). The highest values of AUC to diagnose both early and advanced glaucoma corresponded to the average pRNFL analysis and the GCL map deviation (AUC>0.823, p<0.040 and AUC>0.708, p<0.188, respectively). CONCLUSIONS: Although 16 central sectors of the GCL observed with PPA showed good correlation with VF damage, the pRNFL and the GCL map deviation were more effective for discrimination of glaucomatous damage.