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1.
Cell Cycle ; 22(3): 331-346, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36200131

RESUMO

BACKGROUND: Hypertensive retinopathy (HR) is a retinal disease that may lead to vision loss and blindness. Sex-determining region Y (SRY)-box (SOX) family transcription factors have been reported to be involved in HR development. In this study, the role and upstream mechanism of SRY-box transcription factor 17 (SOX17) in HR pathogenesis were investigated. METHODS: SOX17 and miR-194-5p levels in Angiotensin II (Ang II)-stimulated human retinal microvascular endothelial cells (HRMECs) and retinas of mice were detected by RT-qPCR. SOX17 protein level as well as levels of tight junction proteins and vascular endothelial growth factor (VEGF) signaling-associated proteins were quantified by western blotting. Tube formation assays were performed to evaluate angiogenesis in HRMECs. The structure of mouse retinal tissues was observed by H&E staining. The interaction between miR-194-5p and SOX17 was confirmed by a luciferase reporter assay. RESULTS: SOX17 was upregulated in HRMECs treated with Ang II. SOX17 knockdown inhibited angiogenesis in Ang II-stimulated HRMECs and increased tight junction protein levels. Mechanically, SOX17 was targeted by miR-194-5p. Moreover, miR-194-5p upregulation restrained angiogenesis and increased tight junction protein levels in Ang II-treated HRMECs, and the effect was reversed by SOX17 overexpression. MiR-194-5p elevation inactivated VEGF signaling via targeting SOX17. miR-194-5p alleviated pathological symptoms of HR in Ang II-treated mice, and its expression was negatively correlated with SOX17 expression in the retinas of model mice. CONCLUSIONS: MiR-194-5p upregulation suppressed Ang II-stimulated HRMEC dysfunction and mitigates the symptoms of HR in mice by regulating the SOX17/VEGF signaling.


Assuntos
Retinopatia Hipertensiva , MicroRNAs , Humanos , Camundongos , Animais , Fator A de Crescimento do Endotélio Vascular/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Células Endoteliais/metabolismo , Proliferação de Células , Fatores de Crescimento do Endotélio Vascular/metabolismo , Fatores de Crescimento do Endotélio Vascular/farmacologia , Retinopatia Hipertensiva/metabolismo , Retinopatia Hipertensiva/patologia , Proteínas de Junções Íntimas/metabolismo , Fatores de Transcrição SOXF/genética , Fatores de Transcrição SOXF/metabolismo , Fatores de Transcrição SOXF/farmacologia , Proteínas HMGB/metabolismo , Proteínas HMGB/farmacologia
2.
Med Sci Monit ; 28: e935135, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35046380

RESUMO

The number of patients with arterial hypertension is continually increasing. Hypertension can cause organ complications, called hypertension-mediated organ damage (HMOD). One example is hypertensive retinopathy, in which high blood pressure (BP) damages both the retinal microcirculation and the retinal nerve fiber layer (RNFL). This can result in progressive and painless vision deterioration in some groups of patients. Unlike anywhere else in the human body, the microvasculature of the retina can be observed in vivo, and the progression of changes can be closely monitored. The harmful effect of increased BP on the eye is not only limited to hypertensive retinopathy, but can also lead to an exacerbation of diabetic retinopathy (DR) and to an increase in intraocular pressure (IOP), and it can also trigger the formation of thromboembolic lesions. This review presents an update on the pathogenesis of hypertensive retinopathy and the use of adaptive optics (AO) combined with optical coherence tomography (OCT) to evaluate the retinal microvasculature. The latest progress and directions of research in the field of hypertensive retinopathy are also discussed.


Assuntos
Retinopatia Hipertensiva/diagnóstico por imagem , Retinopatia Hipertensiva/patologia , Tomografia de Coerência Óptica/métodos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Retinopatia Hipertensiva/tratamento farmacológico
3.
Cells ; 10(12)2021 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-34943979

RESUMO

Diabetes and hypertension are complex pathologies with increasing prevalence nowadays. Their interconnected pathways are frequently manifested in retinopathies. Severe retinal consequences and their tight connections as well as their possible treatments are particularly important to retinal research. In the present, work we induced diabetes with streptozotocin in spontaneously hypertensive rats and treated them either with PACAP or olaparib and alternatively with both agents. Morphological and immunohistochemical analyses were carried out to describe cell-specific changes during pathologies and after different treatments. Diabetes and hypertension caused massive structural and cellular changes especially when they were elicited together. Hypertension was crucial in the formation of ONL and OPL damage while diabetes caused significant differences in retinal thickness, OPL thickness and in the cell number of the GCL. In diabetes, double neuroprotective treatment ameliorated changes of calbindin-positive cells, rod bipolar cells and dopaminergic amacrine cells. Double treatment was curative in hypertensive diabetic rat retinas, especially in the case of rod bipolar and parvalbumin-positive cells compared to untreated or single-treated retinas. Our results highlighted the promising therapeutic benefits of olaparib and PACAP in these severe metabolic retinal disorders.


Assuntos
Diabetes Mellitus Experimental/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Retinopatia Hipertensiva/tratamento farmacológico , Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/farmacologia , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Células Amácrinas/efeitos dos fármacos , Animais , Calbindinas/genética , Linhagem da Célula/efeitos dos fármacos , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/patologia , Retinopatia Diabética/genética , Retinopatia Diabética/patologia , Modelos Animais de Doenças , Humanos , Retinopatia Hipertensiva/genética , Retinopatia Hipertensiva/patologia , Ftalazinas/farmacologia , Piperazinas/farmacologia , Ratos , Ratos Endogâmicos SHR/genética , Células Bipolares da Retina/efeitos dos fármacos
5.
Aging (Albany NY) ; 13(9): 13166-13178, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972462

RESUMO

This study investigated functional alterations in the cerebral network of patients with hypertensive retinopathy (HR) by resting-state functional magnetic resonance imaging (rs-fMRI) and degree centrality (DC) methods. 31 patients with HR along with 31 healthy controls (HC) closely matched in gender and age were enrolled for the research. All participants were examined by rs-fMRI, and the DC method was applied to evaluate alterations in spontaneous cerebral activity between the 2 groups. We used the independent samples t test to evaluate demographic and general information differences between HR patients and HCs. The 2-sample t test was used to compare the DC values of different cerebral regions between the 2 groups. The accuracy of differential diagnostic HR was analyzed by receiver operating characteristic (ROC) curve method for rs-fMRI DC values changes. Pearson's correlation coefficient was applied to determine the correlation between differences in DC in specific cerebral areas and clinical manifestation. Results showed that DC values were higher in the left cerebellum posterior lobe (LCPL), left medial occipital gyrus (LMOG), and bilateral precuneus (BP) of HR patients compared to HCs. Mean DC values were lower in the right medial frontal gyrus/bilateral anterior cingulate cortex of HR patients. Anxiety and depression scores were positively correlated with DC values of LMOG and LCPL, respectively. Bilateral best-corrected visual acuity in HR patients was negatively correlated with the DC value of BP. Hence, changes in DC in specific cerebral areas of patients with HR reflect functional alterations that provide insight into the pathophysiologic mechanisms of HR.


Assuntos
Encéfalo/patologia , Retinopatia Hipertensiva/fisiopatologia , Imageamento por Ressonância Magnética , Rede Nervosa/patologia , Adulto , Encéfalo/fisiopatologia , Feminino , Humanos , Retinopatia Hipertensiva/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Córtex Pré-Frontal/metabolismo , Córtex Pré-Frontal/patologia , Curva ROC
6.
Nat Biomed Eng ; 5(6): 498-508, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33046867

RESUMO

Retinal blood vessels provide information on the risk of cardiovascular disease (CVD). Here, we report the development and validation of deep-learning models for the automated measurement of retinal-vessel calibre in retinal photographs, using diverse multiethnic multicountry datasets that comprise more than 70,000 images. Retinal-vessel calibre measured by the models and by expert human graders showed high agreement, with overall intraclass correlation coefficients of between 0.82 and 0.95. The models performed comparably to or better than expert graders in associations between measurements of retinal-vessel calibre and CVD risk factors, including blood pressure, body-mass index, total cholesterol and glycated-haemoglobin levels. In retrospectively measured prospective datasets from a population-based study, baseline measurements performed by the deep-learning system were associated with incident CVD. Our findings motivate the development of clinically applicable explainable end-to-end deep-learning systems for the prediction of CVD on the basis of the features of retinal vessels in retinal photographs.


Assuntos
Doença das Coronárias/diagnóstico por imagem , Aprendizado Profundo/estatística & dados numéricos , Retinopatia Hipertensiva/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Colesterol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/etiologia , Doença das Coronárias/patologia , Conjuntos de Dados como Assunto , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Retinopatia Hipertensiva/sangue , Retinopatia Hipertensiva/complicações , Retinopatia Hipertensiva/patologia , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Fotografação , Retina/diagnóstico por imagem , Retina/metabolismo , Retina/patologia , Vasos Retinianos/metabolismo , Vasos Retinianos/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia
7.
Hypertens Res ; 44(3): 325-336, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33311576

RESUMO

Hypertension is a serious global health problem. Hypertensive retinopathy is generally considered to be a predictor of vascular disease elsewhere in the human body. In the past few decades, a variety of grading systems have been proposed for hypertensive retinopathy. However, these grading systems have some limitations. This study utilized optical coherence tomography angiography (OCTA) to investigate the morphological changes and macular retinal microvasculature in depth among 100 patients with hypertensive retinopathy and 66 healthy participants. Five main pathological changes were discovered in hypertensive retinopathy, as follows: focal capillary sparsity, scattered microangioma, focal macular arch ring defects, focal capillary disorder, and focal capillary nonperfusion at the levels of the superficial and deep vascular networks. In addition, we have found that the number of various pathological changes shows an increasing trend as hypertensive retinopathy progresses and may be related to renal damage. Finally, deep vessel density tended to decrease with progressive stages of hypertensive retinopathy and could be the best indicator to predict the risk of hypertensive retinopathy. Our study, therefore, proposes 3 stages of hypertensive retinopathy without macular edema according to the pathophysiology found by OCTA: stage 1 (only focal capillary sparsity), taking the place of KWB grade I; stage 2 (focal capillary sparsity and scattered microangioma), taking the place of KWB grade II; and stage 3 (focal capillary sparsity, scattered microangioma, focal capillary disorder, and nonperfusion), taking the place of KWB grade III. Hence, OCTA may be a potentially useful tool for evaluating the pathophysiology and staging of hypertensive retinopathy. Further longitudinal prospective studies are needed to confirm our findings.


Assuntos
Retinopatia Hipertensiva , Microvasos , Vasos Retinianos , Humanos , Retinopatia Hipertensiva/diagnóstico por imagem , Retinopatia Hipertensiva/patologia , Microvasos/diagnóstico por imagem , Microvasos/patologia , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Tomografia de Coerência Óptica
9.
Exp Eye Res ; 193: 107981, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32088240

RESUMO

Preeclampsia (PE) is a hypertensive complication of pregnancy. Its cause is still unknown and it could be a risk factor for future ophthalmic problems. Retinal vascular bed alterations have been described as a consequence of PE, suggesting a retinopathy. Factors related to angiogenesis and vascular permeability, such as vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) or components of the renin angiotensin aldosterone system (RAAS), prorrenin/renin receptor ((P)RR) and angiotensin II type I receptor (AT1R) have been located in the retina, participating in other retinopathies, but it is unknown if they could participate in PE. Our aim was to elucidate whether VEGF, PEDF, (P)RR and AT1R could be modified during PE and during hypertension induced in rats with a history of PE. We used female Wistar rats and subrrenal aortic coarctation to induce PE, and after delivery, we induced a second hit by Nω-nitro-L-arginine methyl ester (L-NAME) administration. We measured blood pressure, proteinuria and pups development. In both models, eye fundal exploration and immunoblot for VEGF, PEDF, (P)RR and AT1R were performed. We found that the development of hypertension occurred faster in previously PE rats than in normal animals. VEGF, PEDF, (P)RR and AT1R were increased in PE, but in L-NAME-induced hypertension only (P)RR and AT1R were altered. Eye fundal data indicated that PE induced a level I retinopathy, but L-NAME induced a faster and more severe retinopathy in previously PE animals compared to previously normal pregnancy rats. These results indicate that PE predisposes to development of a faster and more severe retinopathy after a second hit. They also suggest that VEGF and PEDF seem to participate only in PE retinopathy, but in both models, RAAS components seem to have a more critical participation.


Assuntos
Indutores da Angiogênese/metabolismo , Retinopatia Hipertensiva/metabolismo , Pré-Eclâmpsia/metabolismo , Prenhez , Sistema Renina-Angiotensina/fisiologia , Retina/patologia , Vasos Retinianos/patologia , Animais , Permeabilidade Capilar , Modelos Animais de Doenças , Feminino , Retinopatia Hipertensiva/etiologia , Retinopatia Hipertensiva/patologia , Pré-Eclâmpsia/patologia , Gravidez , Ratos , Ratos Wistar , Retina/metabolismo , Vasos Retinianos/metabolismo
10.
J. bras. nefrol ; 41(4): 580-584, Out.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1056602

RESUMO

Abstract In kidney biopsies reviews, scleroderma renal crisis (SRC) is characterized by vascular endothelial injuries, C4d deposits on peritubular vessels, and acute and chronic injuries coexisting on the same biopsy. The clinical signs of thrombotic microangiopathy (TMA) are described in systemic sclerosis (SSc), nevertheless, it has not been related to acute injuries described on kidney biopsies. We report a case of SRC in a patient with scleroderma-dermatomyositis overlap syndrome, which also showed clinical and histopathological data of TMA. On fundus examination, a severe acute hypertensive retinopathy was found. The kidney biopsy showed severe endothelial damage with widening of mucoid cells at the level of the intima, focal concentric proliferation on most small arterioles, and C3, C4d, and IgM deposits along the capillary walls. The genetic study of complement only showed the presence of membrane cofactor protein (MCP) risk haplotypes, without other genetic complement disorders. We understand that in a patient with TMA and SSc, the kidney damage would be fundamentally endothelial and of an acute type; moreover, we would observe clear evidence of complement activation. Once further studies correlate clinical-analytical data with anatomopathological studies, it is likely that we will be forced to redefine the SRC concept, focusing on the relationship between acute endothelial damage and complement activation.


Resumo Nas revisões de biópsias renais, a crise renal esclerodérmica (CRE) é caracterizada por lesões endoteliais vasculares, depósitos de C4d em vasos peritubulares e lesões agudas e crônicas que coexistem na mesma biópsia. Os sinais clínicos de microangiopatia trombótica (MAT) são descritos na esclerose sistêmica (ES); no entanto, não foram relacionados às lesões agudas descritas nas biópsias renais. Relatamos um caso de CRE em um paciente com síndrome de superposição de esclerodermia-dermatomiosite, que também apresentou dados clínicos e histopatológicos de MAT. No exame de fundo do olho, foi encontrada uma retinopatia hipertensiva aguda grave. A biópsia renal mostrou lesão endotelial grave com alargamento das células mucoides ao nível da íntima, proliferação concêntrica focal na maioria das pequenas arteríolas e depósitos de C3, C4d e IgM ao longo das paredes dos capilares. O estudo genético do complemento mostrou apenas a presença de haplótipos de risco da proteína cofator de membrana (PCM), sem outros distúrbios genéticos do complemento. Entendemos que em um paciente com MAT e ES, o dano renal seria fundamentalmente endotelial e do tipo agudo; além disso, observaríamos evidências claras de ativação do complemento. Uma vez que novos estudos correlacionam dados clínico-analíticos com estudos anatomopatológicos, é provável que sejamos forçados a redefinir o conceito de CRE, enfocando a relação entre dano endotelial agudo e ativação do complemento.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença de Raynaud/complicações , Transtornos da Visão/etiologia , Injúria Renal Aguda/etiologia , Rim/irrigação sanguínea , Capilares/metabolismo , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Imuno-Histoquímica , Papiledema/patologia , Dermatomiosite/complicações , Dermatomiosite/imunologia , Retinopatia Hipertensiva/diagnóstico , Retinopatia Hipertensiva/patologia , Retinopatia Hipertensiva/tratamento farmacológico , Injúria Renal Aguda/diagnóstico , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiologia , Rim/patologia , Rim/diagnóstico por imagem
11.
Invest Ophthalmol Vis Sci ; 60(2): 473-487, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30707220

RESUMO

Purpose: It has been suggested that arteriolar annuli localized in retinal arterioles regulate retinal blood flow acting as sphincters. Here, the morphology and protein expression profile of arteriolar annuli have been analyzed under physiologic conditions in the retina of wild-type, ß-actin-Egfp, and Nestin-gfp transgenic mice. Additionally, to study the effect of hypertension, the KAP transgenic mouse has been used. Methods: Cellular architecture has been studied using digested whole mount retinas and transmission electron microscopy. The profile of protein expression has been analyzed on paraffin sections and whole mount retinas by immunofluorescence and histochemistry. Results: The ultrastructural analysis of arteriolar annuli showed a different cell population found between endothelial and muscle cells that matched most of the morphologic criteria established to define interstitial Cajal cells. The profile of protein expression of these vascular interstitial cells (VICs) was similar to that of interstitial Cajal cells and different from the endothelial and smooth muscle cells, because they expressed ß-actin, nestin, and CD44, but they did not express CD31 and α-SMA or scarcely express F-actin. Furthermore, VICs share with pericytes the expression of NG2 and platelet-derived growth factor receptor beta (PDGFR-ß). The high expression of Ano1 and high activity of nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase observed in VICs was diminished during hypertensive retinopathy suggesting that these cells might play a role on the motility of arteriolar annuli and that this function is altered during hypertension. Conclusions: A novel type of VICs has been described in the arteriolar annuli of mouse retina. Remarkably, these cells undergo important molecular modifications during hypertensive retinopathy and might thus be a therapeutic target against this disease.


Assuntos
Células Endoteliais/patologia , Hipertensão/patologia , Retinopatia Hipertensiva/patologia , Células Intersticiais de Cajal/patologia , Artéria Retiniana/patologia , Actinas/metabolismo , Animais , Anoctamina-1/metabolismo , Pressão Arterial , Arteríolas/patologia , Células Endoteliais/metabolismo , Proteínas de Fluorescência Verde/metabolismo , Histocitoquímica , Receptores de Hialuronatos/metabolismo , Retinopatia Hipertensiva/metabolismo , Células Intersticiais de Cajal/metabolismo , Camundongos , Camundongos Endogâmicos ICR , Camundongos Transgênicos , Microscopia Eletrônica de Transmissão , Microscopia de Fluorescência , NADPH Desidrogenase/metabolismo , Nestina/metabolismo
12.
J Bras Nefrol ; 41(4): 580-584, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30806445

RESUMO

In kidney biopsies reviews, scleroderma renal crisis (SRC) is characterized by vascular endothelial injuries, C4d deposits on peritubular vessels, and acute and chronic injuries coexisting on the same biopsy. The clinical signs of thrombotic microangiopathy (TMA) are described in systemic sclerosis (SSc), nevertheless, it has not been related to acute injuries described on kidney biopsies. We report a case of SRC in a patient with scleroderma-dermatomyositis overlap syndrome, which also showed clinical and histopathological data of TMA. On fundus examination, a severe acute hypertensive retinopathy was found. The kidney biopsy showed severe endothelial damage with widening of mucoid cells at the level of the intima, focal concentric proliferation on most small arterioles, and C3, C4d, and IgM deposits along the capillary walls. The genetic study of complement only showed the presence of membrane cofactor protein (MCP) risk haplotypes, without other genetic complement disorders. We understand that in a patient with TMA and SSc, the kidney damage would be fundamentally endothelial and of an acute type; moreover, we would observe clear evidence of complement activation. Once further studies correlate clinical-analytical data with anatomopathological studies, it is likely that we will be forced to redefine the SRC concept, focusing on the relationship between acute endothelial damage and complement activation.


Assuntos
Injúria Renal Aguda/etiologia , Rim/irrigação sanguínea , Doença de Raynaud/complicações , Transtornos da Visão/etiologia , Injúria Renal Aguda/diagnóstico , Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Capilares/metabolismo , Dermatomiosite/complicações , Dermatomiosite/imunologia , Humanos , Retinopatia Hipertensiva/diagnóstico , Retinopatia Hipertensiva/tratamento farmacológico , Retinopatia Hipertensiva/patologia , Imuno-Histoquímica , Rim/diagnóstico por imagem , Rim/patologia , Masculino , Pessoa de Meia-Idade , Papiledema/patologia , Doença de Raynaud/patologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico
13.
Arq. bras. oftalmol ; 82(1): 72-77, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-973866

RESUMO

ABSTRACT A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).


RESUMO Um homem de 33 anos apresentou-se à nossa clínica com baixa visão em ambos os olhos que começou uma semana antes. A acuidade visual foi de 20/63 no olho direito e 20/50 no olho esquerdo. O exame de fundo de olho revelou sinais de retinopatia hipertensiva; então, adotou-se uma abordagem multidisciplinar para o diagnóstico e tratamento desse paciente. Consultamos os departamentos de nefrologia e cardiologia neste caso. Ao diagnosticar hipertensão maligna e insuficiência renal, o paciente foi colocado em hemodiálise. Sua acuidade visual era 20/20 aos 6 meses, enquanto a avaliação foveal com angiotomografia de coerência óptica não revelou perda de densidade capilar superficial e profunda acentuada e aumento da zona avascular foveal nem uma diminuição no fluxo de disco e na densidade capilar peripapilar radial. O diagnóstico precoce e o tratamento da hipertensão maligna são fundamentais na preveção da progressão de danos nos órgãos-alvo, incluindo os olhos. A Angiografia por tomografia de coerência óptica pode ser útil nos casos em que a angiografia com fluoresceína do fundo de olho é relativamente contraindicada (por exemplo, insuficiência renal).


Assuntos
Humanos , Masculino , Adulto , Angiografia/métodos , Tomografia de Coerência Óptica/métodos , Retinopatia Hipertensiva/diagnóstico por imagem , Hipertensão Maligna/diagnóstico por imagem , Vasos Retinianos/patologia , Vasos Retinianos/diagnóstico por imagem , Fatores de Tempo , Capilares/patologia , Capilares/diagnóstico por imagem , Progressão da Doença , Insuficiência Renal Crônica , Retinopatia Hipertensiva/patologia , Hipertensão Maligna/patologia
14.
Arq Bras Oftalmol ; 82(1): 72-77, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30652771

RESUMO

A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).


Assuntos
Angiografia/métodos , Hipertensão Maligna/diagnóstico por imagem , Retinopatia Hipertensiva/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Capilares/diagnóstico por imagem , Capilares/patologia , Progressão da Doença , Humanos , Hipertensão Maligna/patologia , Retinopatia Hipertensiva/patologia , Masculino , Insuficiência Renal Crônica , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Fatores de Tempo
15.
J Korean Med Sci ; 33(8): e54, 2018 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-29441752

RESUMO

A congenital bladder diverticulum (CBD) is caused by inherent muscular weakness instead of obstruction of the bladder outlet. The major clinical conditions are recurrent urinary tract infection (UTI) and voiding dysfunction. This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. After the non-functioning right kidney and ureter and the bilateral diverticula were removed, the left ureter was reimplanted in the bladder. Pathologic findings showed chronic pyelonephritis and partial loss of the bladder musculature in the diverticular wall. This observation indicates that dilated CBD can cause latent UTI, ureteral obstruction, hydronephrosis, and secondary hypertension.


Assuntos
Divertículo/diagnóstico , Retinopatia Hipertensiva/patologia , Obstrução Ureteral/diagnóstico , Bexiga Urinária/anormalidades , Adolescente , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Creatinina/sangue , Divertículo/congênito , Humanos , Retinopatia Hipertensiva/tratamento farmacológico , Rim/diagnóstico por imagem , Masculino , Pielonefrite/patologia , Recidiva , Tomografia de Coerência Óptica , Tomografia Computadorizada por Raios X , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Infecções Urinárias/diagnóstico
16.
Microvasc Res ; 118: 36-43, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29476757

RESUMO

Hypertension and diabetes mellitus represent modifiable risk factors for vascular disease. They cause microvascular remodeling, and ultimately result in end-organ damage. Therefore, development of methods for noninvasive quantification of the effects of hypertension and diabetes mellitus on microvasculature is of paramount importance. The two goals of the study were: 1) to characterize the geometric complexity and inhomogeneity of retinal vasculature in hypertensive retinopathy (HR) and in proliferative diabetic retinopathy (PDR) by using box counting fractal dimension and lacunarity analysis, and 2) to determine if the combination of these two parameters can be used to describe differences in the vascular tree geometry between HR and PDR. The extended set of retinal images from the publicly available STARE database was manually segmented by our expert, validated, and made available for other researchers to use. The healthy retinal vascular network has a higher complexity (fractal dimension) compared to that in HR and in PDR. However, there is no difference in microvascular complexity between HR and PDR. The inhomogeneity of the retinal microvascular tree (lacunarity) was higher in PDR compared to HR. Lacunarity and fractal dimension together quantitatively characterize microvascular geometry in the retina with higher specificity than fractal analysis alone.


Assuntos
Retinopatia Diabética/patologia , Fractais , Retinopatia Hipertensiva/patologia , Interpretação de Imagem Assistida por Computador/métodos , Microvasos/patologia , Fotografação , Vasos Retinianos/patologia , Bases de Dados Factuais , Humanos , Reconhecimento Automatizado de Padrão , Valor Preditivo dos Testes
17.
Comput Methods Programs Biomed ; 154: 123-141, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29249337

RESUMO

BACKGROUND AND OBJECTIVES: Hypertensive Retinopathy (HR) is a retinal disease which happened due to consistent high blood pressure (hypertension). In this paper, an automated system is presented that detects the HR at various stages using arteriovenous ratio and papilledema signs through fundus retinal images. METHODS: The proposed system consists of two modules i.e. vascular analysis for calculation of arteriovenous ratio and optic nerve head (ONH) region analysis for papilledema.  First module uses a set of hybrid features in Artery or Vein (A/V) classification using support vector machine (SVM) along with its radial basis function (RBF) kernel for arteriovenous ratio. In second module, proposed system performs analysis of ONH region for possible signs of papilledema. This stage utilizes different features along with SVM and RBF for classification of papilledema. RESULTS: The first module of proposed method shows average accuracies of 95.10%, 95.64% and 98.09%for images of INSPIRE-AVR, VICAVR, and local dataset respectively. The second module of proposed method achieves average accuracies of 95.93% and 97.50% on STARE and local dataset respectively. CONCLUSIONS: The system finally utilizes results from both modules to grade HR with good results. The presented system is a novel step towards automated detection and grading of HR disease and can be used as clinical decision support system.


Assuntos
Técnicas de Apoio para a Decisão , Retinopatia Hipertensiva/patologia , Papiledema/patologia , Artéria Retiniana/patologia , Veia Retiniana/patologia , Algoritmos , Fundo de Olho , Humanos , Retinopatia Hipertensiva/classificação , Retinopatia Hipertensiva/diagnóstico , Oftalmoscopia , Máquina de Vetores de Suporte
18.
Clin Exp Hypertens ; 39(8): 711-717, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28678631

RESUMO

The pathogenesis of visual dysfunction in stroke remains unclear. The objective of this study was to explore retinal damage in stroke spontaneously hypertensive rats (SHR) and evaluate the role of curcumin in the retinal injury after stroke. Mature male SHR were used as the animal model for hypertension and age-matched male Wistar-Kyoto (WKY) rats as the normotensive controls. The rat model of stroke was made by bilateral vertebral artery electrocoagulation combined with transient bilateral common carotid artery ligation. The animals were randomly divided into sham group, ischemia/reperfusion group, solvent control group, and curcumin treatment group. Each group was subdivided into 2 h, 6 h, 24 h, 72 h, and 7 day after reperfusion. Blood pressure was measured in SHR and WKY rats. Eye fundus was examined in living animals, and then, tissue specimens were collected for histologic examination, terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end labeling, and immunohistochemistry. Retinopathy, induced by I/R, was more serious in rats with hypertension than that in normotensive rats (retinal thickness index, p = 0.004). The number of apoptosis in retinal capillary cells and neurons reduced significantly in the curcumin-treated groups. Curcumin treatment inhibited phosphorylated c-Jun N-terminal kinase (JNK) expression in SHR after retinal I/R injury. Thus, hypertension aggravated retinal I/R injury after stroke. Curcumin, a specific inhibitor of JNK, can prevent the development of hypertensive retinopathy after I/R injury by inhibiting apoptosis in retinal capillary cells and neurons.


Assuntos
Curcumina/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Hipertensão/complicações , Retinopatia Hipertensiva/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Acidente Vascular Cerebral/complicações , Animais , Apoptose/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Isquemia Encefálica/complicações , Capilares/citologia , Curcumina/farmacologia , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Retinopatia Hipertensiva/etiologia , Retinopatia Hipertensiva/patologia , Proteínas Quinases JNK Ativadas por Mitógeno/antagonistas & inibidores , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Masculino , Neurônios/fisiologia , Substâncias Protetoras/uso terapêutico , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Retina/diagnóstico por imagem , Retina/patologia
19.
Oxid Med Cell Longev ; 2017: 3940241, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29410732

RESUMO

Ischemic retinopathies (IRs), such as retinopathy of prematurity (ROP), diabetic retinopathy (DR), and (in many cases) age-related macular degeneration (AMD), are ocular disorders characterized by an initial phase of microvascular changes that results in ischemia, followed by a second phase of abnormal neovascularization that may culminate into retinal detachment and blindness. IRs are complex retinal conditions in which several factors play a key role during the development of the different pathological stages of the disease. Increasing evidence reveals that oxidative stress and inflammatory processes are important contributors to the pathogenesis of IRs. Despite the beneficial effects of the photocoagulation and anti-VEGF therapy during neovascularization phase, the need to identify novel targets to prevent initial phases of these ocular pathologies is still needed. In this review, we provide an update on the involvement of oxidative stress and inflammation in the progression of IRs and address some therapeutic interventions by using antioxidants and anti-inflammatory agents.


Assuntos
Retinopatia Diabética/metabolismo , Retinopatia Hipertensiva/metabolismo , Inflamação/metabolismo , Inflamação/patologia , Estresse Oxidativo/fisiologia , Retinopatia da Prematuridade/metabolismo , Retinopatia Diabética/patologia , Humanos , Retinopatia Hipertensiva/patologia , Estresse Oxidativo/genética , Retinopatia da Prematuridade/patologia
20.
Bull Exp Biol Med ; 162(2): 184-186, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27909968

RESUMO

The period of forming of superficial vascular plexus during physiological retinal angiogenesis was shorter in C57Bl/6 mice. Experiments on the model of oxygen-induced retinopathy showed that avascular and vascularized zones in BALB/c mice on day 17 are smaller than in C57Bl/6 mice are by 5 and 1.5 times, respectively. The obtained results confirmed the importance of phenotype of retinal macrophages in the regulation of processes of both physiological and pathological retinal angiogenesis.


Assuntos
Retinopatia Hipertensiva/patologia , Macrófagos/citologia , Neovascularização Patológica/patologia , Fenótipo , Retina/patologia , Neovascularização Retiniana/patologia , Animais , Fluoresceína-5-Isotiocianato/química , Retinopatia Hipertensiva/induzido quimicamente , Retinopatia Hipertensiva/imunologia , Imuno-Histoquímica , Imunofenotipagem , Macrófagos/classificação , Macrófagos/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Neovascularização Patológica/induzido quimicamente , Neovascularização Patológica/imunologia , Neovascularização Fisiológica/imunologia , Oxigênio/efeitos adversos , Lectinas de Plantas/química , Retina/imunologia , Neovascularização Retiniana/induzido quimicamente , Neovascularização Retiniana/imunologia , Especificidade da Espécie , Estreptavidina/química
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