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Ebeid WM, Kenny MA, Badran TA. Evaluation of Corneal Epithelial Thickness and Dry Eye Disease Tests in Thalassemic Adolescents. Clin Ophthalmol 2021; 15:1425-1431. [PMID: 33854296 PMCID: PMC8040687 DOI: 10.2147/opth.s276335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To assess dry eye disease (DED) in thalassemic adolescents by evaluating corneal epithelial thickness (CET) and various dry eye clinical tests and correlate them to tissue iron overload. Methods The study included 120 Beta-thalassemia patients (11 to 18 years) and 120 matched controls. CET maps were captured using anterior segment optical coherence tomography. OSDI questionnaire was completed. Dry eye tests included Schirmer test, tear film breakup time (TBUT), and ocular surface staining (OSS) with fluorescein and lissamine green. We recorded serum ferritin level, and liver iron concentration (LIC) measured by magnetic resonance imaging. Results Superior and inferior CET was thinner, while map standard deviation (MSD) was higher in thalassemics compared to controls (all P<0.001). Thalassemic group also showed higher OSDI scores (P<0.001), shorter TBUT (P<0.001), and higher OSS grades (P<0.001). Both superior and inferior CET was correlated positively with TBUT, and negatively with OSS (all P < 0.001). Serum ferritin and LIC showed negative correlations with CET (superior and inferior, both P< 0.001), positive correlations with MSD, P< 0.001, as well as with TBUT (P< 0.001), OSS (P< 0.001), and OSDI scores (P< 0.001). Conclusion Thalassemic adolescents had thinner CET with higher thickness’ variability, shorter TBUT and more marked OSS than controls. Correlation of higher serum ferritin and hepatic iron overload with irregular epithelial thinning and more affected dry eye tests results supports our hypothesis that high tissue iron levels could play a pivotal role in DED pathogenesis in thalassemic patients.
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Affiliation(s)
- Weam Mohamed Ebeid
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Adel Kenny
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Fagehi R, Abbadi IM, Abusharha A, Alanazi MA, Malhan H, El-Hiti GA, Masmali AM. Evaluation of the Significance of Tear Ferning Patterns in beta-Thalassemia Patients. Klin Monbl Augenheilkd 2021; 239:804-811. [PMID: 33607687 DOI: 10.1055/a-1353-5747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM This study was designed to evaluate the tear film in beta-thalassemia patients using tear ferning (TF) and phenol red thread (PRT) tests. METHODS Forty beta-thalassemia patients, aged 18 - 38 years (25.7 ± 6.0 years), along with a control group of 40 age-matched subjects with healthy eyes completed the study. All subjects completed the ocular surface disease index (OSDI) first, followed by the TF and PRT tests with a 5-minute gap between the tests. RESULTS Significant differences (Wilcoxon test, p < 0.05) were observed between the beta-thalassemia and control groups in all scores. Among beta-thalassemia patients, OSDI scores indicated eye dryness in 35 subjects (87.5%). PRT showed dryness in 31 subjects (77.5%) in the right and left eyes, and the TF grades were ≥ 2 for the tears collected from 35 subjects (87.5%). There was a strong correlation (r = 0.851, p = 0.001) between the PRT measurements in the right and left eyes. There was a medium correlation between OSDI and TF scores (r = 0.309, p = 0.026) and between OSDI and age (r = 0.365, p = 0.010). Age had a moderate negative correlation (r = - 0.328, p = 0.019) with the PRT obtained from the right eye. CONCLUSION Significant ocular dryness symptom was observed in beta-thalassemia patients, based on the scores collected from TF and PRT tests. Beta-thalassemia patients develop dry eyes, possibly due to several factors, including reduced tear secretion. Therefore, it is important to regularly evaluate both the quality and quantity of tears in patients with beta-thalassemia.
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Affiliation(s)
- Raied Fagehi
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim M Abbadi
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Ali Abusharha
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Mana A Alanazi
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Hafiz Malhan
- Hematology department, Prince Mohammed Bin Nasser Hospital, Gizan, Saudi Arabia
| | - Gamal A El-Hiti
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Ali M Masmali
- Department of Optometry, King Saud University, Riyadh, Saudi Arabia
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Abstract
Background To evaluate the intraocular pressure (IOP), anterior chamber angle (ACA), and globe biometric parameters in β-thalassemia major children and the correlations of these changes. Materials and methods Eighty-four eyes were included (42 eyes of thalassemia patients and 42 eyes of control). All participates underwent head circumference and height measurements, full ophthalmic examination, anterior segment optical coherence tomography (AS-OCT), and A-scan biometry. Results The temporal angle of anterior chamber (T-ACA) was significantly narrower in thalassemia patients with p value = 0.008. While the nasal angle showed a nonsignificant narrowing with p value = 0.153. This narrowing was positively correlated with the height, and negatively correlated with the head circumference. Intraocular pressure was statistically higher in thalassemia patients with p value = 0.000. The increased IOP was positively correlated with the head circumference and the lens thickness (LT) and negatively correlated with T-ACA, axial length (AL), vitreous chamber depth (VCD), and anterior chamber depth (ACD). Axial length, ACD, and VCD significantly decreased with p value = 0.000 for all with a positive correlation with the height and a negative correlation with the head circumference. The LT increased in thalassemia group with p value = 0.000. This increase was positively correlated with the head circumference and negatively with the height. Also, there was steeper corneal curvature in thalassemia group with p value = 0.023 and 0.015 (for K1 and K2, respectively). No significant change was observed in corneal thickness in both groups with p value = 0.810. Conclusion Narrower T-ACA, increased IOP, shorter (AL, VCD, and ACD), steeper corneal curvature, and thicker lens were found in thalassemia patients. How to cite this article El-Haddad NSM. Anterior Chamber Angle, Intraocular Pressure, and Globe Biometric Parameters in the Children with β-Thalassemia Major. J Curr Glaucoma Pract 2020;14(1):30–36.
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Affiliation(s)
- Nermien SM El-Haddad
- Ophthalmology Department, Al-Azher University, Faculty of Medicine, Cairo, Egypt
- Nermien SM El-Haddad, Ophthalmology Department, Al-Azher University, Faculty of Medicine, Cairo, Egypt, Phone: +20 1014466263, e-mail:
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Heydarian S, Jafari R, Dailami KN, Hashemi H, Jafarzadehpour E, Heirani M, Yekta A, Mahjoob M, Khabazkhoob M. Ocular abnormalities in beta thalassemia patients: prevalence, impact, and management strategies. Int Ophthalmol 2019; 40:511-527. [PMID: 31602527 DOI: 10.1007/s10792-019-01189-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Beta thalassemia (β-thalassemia) is a hereditary disease caused by defective globin synthesis and can be classified into three categories of minor (β-TMi), intermedia (β-TI), and major (β-TM) thalassemia. The aim of our study is to investigate the effects of β-thalassemia and its treatment methods on different parts of the eye and how early-diagnostic methods of ocular complications in this disorder would prevent further ocular complications in these patients by immediate treatment and diet change. METHODS We developed a search strategy using a combination of the words Beta thalassemia, Ocular abnormalities, Iron overload, chelation therapy to identify all articles from PubMed, Web of Science, Scopus, and Google Scholar up to December 2018. To find more articles and to ensure that databases were thoroughly searched, the reference lists of selected articles were also reviewed. RESULTS Complications such as retinopathy, crystalline lens opacification, color vision deficiency, nyctalopia, depressed visual field, reduced visual acuity, reduced contrast sensitivity, amplitude reduction in a-wave and b-wave in Electroretinography (ERG), and decrease in the Arden ratio in Electrooculography (EOG) have all been reported in β-thalassemia patients undergoing chelation therapy. CONCLUSION Ocular problems due to β-thalassemia may be a result of anemia, iron overload in the body tissue, side effects of iron chelators, and the complications of orbital bone marrow expansion.
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Affiliation(s)
- Samira Heydarian
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Jafari
- Department of Ophthalmology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Ebrahim Jafarzadehpour
- Department of Optometry, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Heirani
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monireh Mahjoob
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jafari R, Heydarian S, Karami H, Shektaei MM, Dailami KN, Amiri AA, Rezaee MRS, Far AAF. Ocular abnormalities in multi-transfused beta-thalassemia patients. Indian J Ophthalmol 2016; 63:710-5. [PMID: 26632126 PMCID: PMC4705706 DOI: 10.4103/0301-4738.170986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS The aim of this study was to assess ocular changes in thalassemia patients who have received multiple transfusions and chelate binding therapy in order to avoid iron accumulation. SETTINGS AND DESIGN A cross-sectional study. SUBJECTS AND METHODS A total of 54 thalassemia major patients were selected as case group, and 54 age- and sex-matched healthy subjects were regarded as a control group. Ocular examination included visual acuity, refraction testing, slit lamp examination, funduscopy, tonometry, perimetry, tear break-up time test, and color vision testing were performed for all the participants. We computed the frequency and duration of blood transfusion, the mean serum ferritin level, pretransfusion hemoglobin concentration, and type, duration, and daily dose of chelation therapy for thalassemia patients based on their records. STATISTICAL ANALYSIS USED All data analysis was performed using SPSS, version 19. RESULTS All the thalassemic patients were asymptomatic, but abnormal ocular findings (dry eye (33.3%), cataract (10.2%), retinal pigment epithelium degeneration (16.7%), color vision deficiency (3.7%), and visual field defects (33.7%)) were seen in 68.5% of thalassemic group. The prevalence of ocular abnormalities in normal group was 19.4%, which was significantly lower than that in thalassemia patients (P = 0.000). No significant correlation was found between ocular abnormalities and mean serum ferritin level (P = 0.627) and mean hemoglobin concentration (P = 0.143). Correlation of number of blood transfusion with the presence of ocular abnormalities was found to be statistically significant (P = 0.005). CONCLUSIONS As life expectancy for beta-thalassemia patients extends, regular ophthalmological evaluation to detect early changes in their ocular system is recommended.
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Affiliation(s)
| | - Samira Heydarian
- Department of Optometry, School of Paramedical Science, Mashhad University of Medical Sciences, Mashhad, Iran
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Liaska A, Petrou P, Georgakopoulos CD, Diamanti R, Papaconstantinou D, Kanakis MG, Georgalas I. β-Thalassemia and ocular implications: a systematic review. BMC Ophthalmol 2016; 16:102. [PMID: 27390837 PMCID: PMC4938965 DOI: 10.1186/s12886-016-0285-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Beta-thalassemia is a severe genetic blood disorder caused by a mutation in the gene encoding for the beta chains of hemoglobin. Individuals with beta-thalassemia major require regular lifelong Red Blood Cell transfusions to survive. Ocular involvement is quite common and may have serious implications. Methods Extensive review of observational studies on beta-thalassemia, to determine the prevalence and spectrum of ocular abnormalities, by clinical examination and multimodal imaging, and to investigate risk factors for their development. Results Frequency of ocular involvement differs among various studies (41.3–85 %, three studies). Ocular findings in beta-thalassemia may correlate to the disease itself, iron overload or the chelating agents used. Beta-thalassemia ocular manifestations include ocular surface disease, as demonstrated by tear function parameters (two studies). Lens opacities are present in 9.3–44 % (five studies). Lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively (two studies). Ocular fundus abnormalities characteristic of pseudoxanthoma elasticum (PXE), including peau d’orange, angioid streaks, pattern dystrophy-like changes, and optic disc drusen are a consistent finding in seven studies. Patients with PXE-like fundus changes were older than patients without these fundus changes (two studies). Age (two studies) and splenectomy (one study) had the strongest association with presence of PXE-like fundus changes. Increased retinal vascular tortuosity independently of the PXE-like fundus changes was found in 11–17.9 % (three studies), which was associated with aspartate amino transferase, hemoglobin and ferritin levels (two studies). Fundus autofluorescence and electrophysiological testing (ERG and EOG) may indicate initial stages or more widespread injury than is suggested by fundus examination (two studies). Conclusions Beta-thalassemia may present with various signs, both structural and functional. Pseudoxanthoma elasticum like fundus changes are a frequent finding in patients with b-thalassemia. These changes increase with duration or severity of the disease. Retinal vascular tortuosity may be an additional disease manifestation related to the severity and duration of anemia and independent of the PXE-like syndrome. Patients with long-standing disease need regular ophthalmic checkups because they are at risk of developing PXE-like fundus changes and potentially of subsequent choroidal neovascularization.
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Affiliation(s)
- Aliki Liaska
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Petros Petrou
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Ramza Diamanti
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | | | - Menelaos G Kanakis
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, Athens University, Mesogeion 154, Athens, 11527, Greece.
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Doughty MJ. Comparison of Morphology of Bulbar Conjunctival Cells Assessed by Impression Cytology versus Scrape and Smear Methods. Curr Eye Res 2014; 39:973-81. [DOI: 10.3109/02713683.2014.891750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aksoy A, Aslankurt M, Aslan L, Gül O, Garipardıç M, Celik O, Okumuş S, Ozdemir M, Ozdemir G. Ocular findings in children with thalassemia major in Eastern Mediterranean. Int J Ophthalmol 2014; 7:118-21. [PMID: 24634876 DOI: 10.3980/j.issn.2222-3959.2014.01.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/29/2013] [Indexed: 01/05/2023] Open
Abstract
AIM To investigate ophthalmologic findings in children with thalassemia major (TM) and compare the findings with healthy controls. METHODS In a cross-sectional study, 43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination, tear function tests including the Schirmer test, fluorescein tear break-up time (BUT), ultrasound pachymetry, and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. RESULTS The mean best corrected visual acuity was 1.34±0.75 in TM and 1.08±0.28 in controls. It was found lower than 0.1 logMAR unit in 10 (23.2%) children with TM and 2 (4.2%) in controls, and the difference was statistically significant (P<0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98±20.45µm in controls (P>0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group (P<0.01). The mean BUT score was 9.62±1.28 in TM and 9.73±0.6s in the control group (P>0.05). CONCLUSION In TM, while corneal thickness, axial length, and BUT are close to controls, the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.
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Affiliation(s)
- Adnan Aksoy
- Department of Ophthalmology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Murat Aslankurt
- Department of Ophthalmology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Lokman Aslan
- Department of Ophthalmology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Ozlem Gül
- Department of Pediatric Haematology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Mesut Garipardıç
- Department of Pediatric Haematology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Oğuz Celik
- Department of Ophthalmology, Faculty of Medicine, Gaziantep University, Gaziantep 27240, Turkey
| | - Seydi Okumuş
- Department of Ophthalmology, Faculty of Medicine, Gaziantep University, Gaziantep 27240, Turkey
| | - Murat Ozdemir
- Department of Ophthalmology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
| | - Gökhan Ozdemir
- Department of Ophthalmology, KSU Faculty of Medicine, Kahramanmaraş 46050, Turkey
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Abstract
BACKGROUND Thalassaemia major is associated with characteristic findings in craniofacial bony structures and thereby may render abnormal bony orbit and subsequently distinctive ocular biometry. The purpose of the present study was to evaluate the ocular refractive and biometric characteristics in patients with thalassaemia major. METHODS This case-controlled study comprised 94 eyes of 47 patients with thalassaemia major and 88 eyes of 44 age- and sex-matched healthy control subjects. All participants had a complete ocular examination including slitlamp biomicroscopy, fundoscopy, ocular biometry, keratometry, refraction and analysis using Fourier transformation. RESULTS There were no significant differences in spherical equivalent (p = 0.66) and total astigmatism (p = 0.83) between groups. Mean uncorrected vision and visual acuities (logMar) were similar (p = 0.32 and p = 0.71, respectively). Compared with controls, thalassaemic patients had a shorter axial length (23.01 ± 0.12 [SEM] mm versus 23.46 ± 0.12 mm, p = 0.035), thicker crystalline lens (4.01 ± 0.11 mm versus 3.87 ± 0.1 mm, p = 0.046) and steeper average keratometry (44.02 ± 0.24 D versus 43.44 ± 0.24, p = 0.03). Fifty-seven per cent of thalassaemic patients had against-the-rule astigmatism (total), while 64.6 per cent of controls showed a with-the-rule pattern (p < 0.05). These patterns were also found for corneal astigmatism. The magnitudes of total, corneal and lenticular astigmatism were similar among groups. Regression analysis showed significant correlation between corneal (J0 and J45) and total (J0 and J45) astigmatism. The correlations were less prominent between lenticular and total J0 and J45. The mean intraocular pressure was 14.68 ± 0.27 mmHg and 13.3 ± 0.26 mmHg in the thalassaemia and control groups, respectively (p < 0.001). Six eyes (12.8 per cent) of four patients in the thalassaemia group had posterior subcapsular cataract, while the condition had not been observed in controls (p = 0.049). CONCLUSIONS Shorter axial length, thicker lens, steeper corneal curvature and more against-the-rule pattern were characteristic findings in patients with thalassaemia major.
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Maria C, Leonardo R, Pietro R, Mario V, Isabella V, Diana T. Erythrocytes anion transport and oxidative change in β-thalassaemias. Cell Biol Int 2010; 34:655-62. [DOI: 10.1042/cbi20090472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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