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Agarwal A, Bhatt S, Keshari S, Erckens RJ, Berendschot TTJM, Webers CAB, Agrawal R, Bansal R, Gupta V. Retinal Microvascular Alterations in Patients with Quiescent Posterior and Panuveitis Using Optical Coherence Tomography Angiography. Ocul Immunol Inflamm 2022; 30:1781-1787. [PMID: 34288798 DOI: 10.1080/09273948.2021.1954200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To quantify retinochoroidal vascular parameters using swept-source optical coherence tomography (SS-OCTA) in quiescent posterior and panuveitis. METHODS In this cross-sectional study, subjects with quiescent posterior and panuveitis underwent fundus imaging using SS-OCTA (DRI Triton®, Topcon, Japan). The metrics calculated were fractal dimension (FD), foveal avascular zone (FAZ) area, retinal vascularity index (capillary density index-CDI), and choroidal vascularity index (CVI). RESULTS We included 38 eyes of 20 patients, 9 males aged 34.7 ± 10.5 years, 30 eyes of 30 age- and gender-matched healthy controls, 10 females aged 33.6 ± 8.5 years. Comparing patients with controls, we found a lower FD (p < .001), larger FAZ (p > .001), lower CDI in the superficial plexus (p = .019), and lower CVI (p < .001). We also found lower retinal and choroidal and thicknesses (p < .001 and p = .025, respectively). CONCLUSIONS Patients with quiescent posterior and panuveitis have a significantly reduced retinochoroidal vascular density compared to healthy control subjects.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
| | - Sushil Bhatt
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Keshari
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roel J Erckens
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - C A B Webers
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Rupesh Agrawal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Agarwal A, Abhaypal K, Aggarwal K, Erckens RJ, Berendschot TTJM, Webers CAB, Dogra M, Bansal R, Gupta V. The use of optical coherence tomography angiography in comparing choriocapillaris recovery between two treatment strategies for multifocal choroiditis: a pilot clinical trial. J Ophthalmic Inflamm Infect 2022; 12:12. [PMID: 35275320 PMCID: PMC8917244 DOI: 10.1186/s12348-022-00291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare differences in choriocapillaris flow deficit (CC FD) in multifocal choroiditis (MFC) between two treatment arms using optical coherence tomography angiography (OCTA). METHODS In this prospective randomized clinical trial, patients were randomized to either Group 1 which received standard tapering dose of oral corticosteroids, or Group 2 which received additional dexamethasone implant (or intravitreal methotrexate). The patients were followed-up until 12 weeks using OCTA and other imaging tools. CC FD and visual acuity between the two groups were compared at each visit. RESULTS Twenty-five subjects (17 males; 25 eyes) were studied (11 eyes in Group 1). There were no differences between the visual acuity or CC FD (1.12 versus 1.08 mm2; p = 0.86) at baseline between the groups. However, patients in Group 2 achieved better visual acuity (0.32 ± 0.23 versus 0.15 ± 0.11; p = 0.025) and CC FD (0.54 versus 0.15 mm2; p = 0.008) at 12 weeks. CONCLUSIONS OCTA is a useful tool in monitoring the CC FD recovery after treatment in MFC. Patients receiving intravitreal corticosteroid/methotrexate in addition to systemic corticosteroid showed greater resolution of CC FD on OCTA compared to those receiving only oral corticosteroids.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.
| | - Khushdeep Abhaypal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Ahalia Eye Care, Delma St, Airport Road, Abu Dhabi, United Arab Emirates
| | - Roel J Erckens
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - C A B Webers
- Maastricht University Medical Centre, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Agarwal A, Handa S, Marchese A, Parrulli S, Invernizzi A, Erckens RJ, Berendschot TTJM, Webers CAB, Bansal R, Gupta V. Optical Coherence Tomography Findings of Underlying Choroidal Neovascularization in Punctate Inner Choroidopathy. Front Med (Lausanne) 2022; 8:758370. [PMID: 35004727 PMCID: PMC8727437 DOI: 10.3389/fmed.2021.758370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: To analyze findings on optical coherence tomography (OCT) suggestive of choroidal neovascularization (CNV) in lesions of punctate inner choroidopathy (PIC). Methods: In this multi-center retrospective study, clinical data of patients with PIC were retrospectively analyzed. Quantitative data (height, width, and volume of PIC lesions), and qualitative data (disruption of ellipsoid zone (EZ)/Bruch's membrane (BM), outer retinal fuzziness, and choroidal back-shadowing) were compared between CNV+ and CNV– groups using Mann–Whitney U-test and Fischer's exact test. Results: In total, 35 eyes (29 patients; 21 women; mean age: 33.3 ± 6.5 years) were selected for analysis. Of the 35 PIC lesions studied, 17 had underlying CNV. Lesions with CNV+ had larger height, width, and volume (p < 0.001) and several distinctive features, such as disruption of EZ and BM, outer retinal fuzziness, and hypo-reflective back-shadowing (p < 0.001) compared with CNV—lesions. Conclusions: Quantitative and qualitative OCT analysis can aid in the prediction of an underlying CNV in the eyes with PIC.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Cleveland Clinic, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Sabia Handa
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alessandro Marchese
- Department of Ophthalmology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore Parrulli
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Roel J Erckens
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, Netherlands
| | - Tos T J M Berendschot
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, Netherlands
| | - C A B Webers
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, Netherlands
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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van Hulten V, Sarodnik C, Driessen JHM, Schaper NC, Geusens PPMM, Webers CAB, Dinant GJ, Ottenheijm RPG, Rasmussen NH, Viggers R, Stehouwer CDA, van der Kallen CJH, Schram MT, Bours SPG, Dagnelie PC, van den Bergh JP. Prevalent Morphometrically Assessed Vertebral Fractures in Individuals With Type 2 Diabetes, Prediabetes and Normal Glucose Metabolism: The Maastricht Study. Front Endocrinol (Lausanne) 2022; 13:832977. [PMID: 35250885 PMCID: PMC8894595 DOI: 10.3389/fendo.2022.832977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/24/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is frequently reported to be associated with an increased fracture risk. Epidemiological data on prevalent morphometric vertebral fractures (VFs) in T2D are sparse and even less is known in the prediabetic state. PURPOSE To determine the association between prevalence and severity of morphometric VFs and glucose metabolism state: normal glucose metabolism (NGM), impaired glucose metabolism (prediabetes) or T2D. METHODS This study included cross-sectional data from 3625 participants of the Maastricht Study who had a vertebral fracture assessment on lateral Dual Energy X-Ray Absorptiometry images. VFs were classified based on morphometric assessment into mild, moderate and severe VFs (respectively 20-24%, 25-39% or ≥40% reduction in expected vertebral body height). Logistic regression models were used to investigate the association between glucose metabolism status and the prevalence and severity of VFs. Analyses were adjusted for subject characteristics and life-style factors. RESULTS T2D individuals were older (62.8 ± 7.5 years old) and less often female (30.5%) compared to the NGM group (57.7 ± 8.5 years old, and 58.8% female, respectively). At least one mild, moderate or severe prevalent VF was found in 8.6% of the men and 2.2% of the women in the T2D group, in 9.4% and 8.4% in the prediabetes group and in 9.1% and 4.8% in the NGM group, respectively. After adjustment T2D in women was associated with a lower probability of having a prevalent VF compared to NGM [adjusted OR 0.25 (95% CI 0.09-0.65)], while this was not the case for prediabetes. Furthermore, women with T2D had a significantly lower probability of a prevalent moderate or severe VF [adjusted OR 0.32 (95% CI 0.11-0.96)]. In men there was no significant association between T2D or prediabetes and prevalent VFs. CONCLUSION Women with T2D had a lower probability of prevalent VFs compared to women with a normal glucose metabolism, while this was not the case for men with T2D and participants with prediabetes.
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Affiliation(s)
- Veerle van Hulten
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Cindy Sarodnik
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Johanna H. M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Nicolaas C. Schaper
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Piet P. M. M. Geusens
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - Carol A. B. Webers
- University Eye Clinic Maastricht, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ramon P. G. Ottenheijm
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Nicklas H. Rasmussen
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Viggers
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Coen D. A. Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Carla J. H. van der Kallen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Miranda T. Schram
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Sandrine P. G. Bours
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Pieter C. Dagnelie
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Joop P. van den Bergh
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Subdivision of Endocrinology, Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- *Correspondence: Joop P. van den Bergh,
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Dabir S, Rajan M, Parasseril L, Bhatt V, Samant P, Webers CAB, Berendschot TTJM. Early Visual Functional Outcomes and Morphological Responses to Anti-Vascular Growth Factor Therapy in Diabetic Macular Oedema Using Optical Coherence Tomography Angiography. Clin Ophthalmol 2021; 15:331-339. [PMID: 33536741 PMCID: PMC7850571 DOI: 10.2147/opth.s285388] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Diabetic macular oedema (DME) is a vision-threatening complication of diabetic retinopathy. Spectral domain optical coherence tomography angiography (OCTA) is useful for assessing DME. We performed serial OCTA measurements before and after 3 monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to understand its relationship with best corrected visual acuity (BCVA), central macular thickness (CMT) and vascular indices. Methods OCTA assessment consisting of 6 × 6 mm scans centred on fovea and en-face retinal angiograms were obtained. Scans were done at baseline and at 1 month following each of the 3 intravitreal injections of anti-VEGF (ranibizumab, Lucentis®). Results Our prospective study included 24 eyes of 24 subjects, aged 63.0 ± 5.0 years. There was a mean gain of 0.07 LogMAR (3 letters) and reduction of CMT, vessel density (VD) and perfusion density (PD) by end of 3rd month. CMT was independently associated with improvement in BCVA. There were significant reductions in FAZ area, VD and PD over 3 months from baseline. Conclusion At three months, intravitreal anti-VEGF therapy is associated with visual function recovery in DME, with reduction in CMT being the most reliable predictor of response. OCTA shows a reduction in VD and PD respectively suggestive of reduced macular perfusion in the short term. Simultaneous reduction in FAZ size can be due to reversal of manual displacement of the retinal capillaries resulting from resolution of intraretinal oedema.
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Affiliation(s)
- Supriya Dabir
- Department of Retina, Rajan Eye Care Pvt Ltd, Chennai, India
| | - Mohan Rajan
- Department of Retina, Rajan Eye Care Pvt Ltd, Chennai, India
| | - Liji Parasseril
- Department of Retina, Rajan Eye Care Pvt Ltd, Chennai, India
| | | | - Preetam Samant
- Department of Retina, PD Hinduja Hospital and Medical Research Center, Mumbai, India
| | - C A B Webers
- University Eye Clinic, Maastricht, the Netherlands
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Hubens WHG, Beckers HJM, Gorgels TGMF, Webers CAB. Increased ratios of complement factors C3a to C3 in aqueous humor and serum mark glaucoma progression. Exp Eye Res 2021; 204:108460. [PMID: 33493474 DOI: 10.1016/j.exer.2021.108460] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/06/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We recently performed a combined analysis of publicly available proteomic studies of aqueous humor (AH) of patients with primary open angle glaucoma (POAG). This analysis revealed changes in complement protein concentrations in the AH of progressive POAG patients, which suggested that the complement system may play a role in POAG progression. As the proteomic studies could not provide information on the activity of the complement system, we addressed this question in the current study. METHODS Blood serum and AH were obtained from 30 patients: 10 progressive POAG, 10 stable POAG and, as controls, 10 cataract patients. Glaucoma patients with a visual field Mean Deviation (MD) change of at least 1.0 dB/year were considered progressive; a MD change of less than 0.5 dB/year was considered stable. The ratio between the levels of complement factors C3a and C3 was used as indicator for activation of the complement cascade. The factors were measured with commercially available ELISA kits. RESULTS AH levels of complement factors C3 and C3a did not significantly differ between groups. In serum, complement factor C3 did not differ between groups whereas C3a was significantly elevated in progressive POAG patients compared to controls (p < 0.05). The resulting complement C3a/C3 ratio was significantly higher in progressive POAG patients in both AH (p < 0.05) and serum (p < 0.01), and this ratio significantly correlated between the two body fluids (p < 0.001). Furthermore, there was a strong correlation between disease progression and C3a/C3 activation ratio both in AH (p < 0.01) and in serum (p < 0.001). The higher the complement C3a/C3 ratio, the faster the disease progression. CONCLUSION Significant increases in AH and serum complement C3a/C3 ratios were observed in progressive POAG patients but not in stable POAG patients. Furthermore, the complement C3a/C3 ratio correlated strongly with the rate of disease progression in both AH and serum. These findings suggest that activation of the complement system plays a role in glaucoma progression and that progressive glaucoma patients may have systemic changes in complement activation.
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Affiliation(s)
- W H G Hubens
- University Eye Clinic Maastricht, Maastricht Medical Center, Maastricht, the Netherlands; Research School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - H J M Beckers
- University Eye Clinic Maastricht, Maastricht Medical Center, Maastricht, the Netherlands
| | - T G M F Gorgels
- University Eye Clinic Maastricht, Maastricht Medical Center, Maastricht, the Netherlands
| | - C A B Webers
- University Eye Clinic Maastricht, Maastricht Medical Center, Maastricht, the Netherlands
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Hubens WHG, Mohren RJC, Liesenborghs I, Eijssen LMT, Ramdas WD, Webers CAB, Gorgels TGMF. The aqueous humor proteome of primary open angle glaucoma: An extensive review. Exp Eye Res 2020; 197:108077. [PMID: 32470343 DOI: 10.1016/j.exer.2020.108077] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/26/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND We reviewed the literature on the aqueous humor (AH) proteome of primary open angle glaucoma (POAG) patients in order to obtain deeper insight into the pathophysiology of POAG. METHODS We searched Pubmed and Embase up to May 2019 for studies that compared AH protein composition between POAG (cases) and cataract (controls). Untargeted studies (measuring the whole proteome, by LC-MS/MS) were divided into two subgroups depending on the type of surgery during which POAG AH was collected: glaucoma filtration surgery (subgroup 1) or cataract surgery (subgroup 2). We reanalyzed the raw data (subgroup 1) or combined the reported data (subgroup 2) to perform GO enrichment (GOrilla) and pathway analysis (Pathvisio). RESULTS Out of 93 eligible proteomic studies, seven were untargeted studies that identified 863 AH proteins. We observed 73 differentially expressed proteins in subgroup 1 and 87 differentially expressed proteins in subgroup 2. Both subgroups were characterized by activation of the acute immune response, dysregulation of folate metabolism and dysregulation of the selenium micronutrient network. For subgroup 1 but not for subgroup 2, proteins of the complement system were significantly enriched. CONCLUSION AH proteome of POAG patients shows strong activation of the immune system. In addition, analysis suggests dysregulation of folate metabolism and dysregulation of selenium as underlying contributors. In view of their glaucoma surgery, POAG patients of subgroup 1 most likely are progressive whereas POAG patients in subgroup 2 most likely have stable POAG. The proteome difference between these subgroups suggests that the complement system plays a role in POAG progression.
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Affiliation(s)
- W H G Hubens
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - R J C Mohren
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - I Liesenborghs
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands; Maastricht Centre of Systems Biology (MaCSBio), Maastricht University, Maastricht, the Netherlands
| | - L M T Eijssen
- Department of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Bioinformatics - BiGCaT, NUTRIM, Maastricht University, Maastricht, the Netherlands
| | - W D Ramdas
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - C A B Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
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Hanssen NMJ, Scheijen JLJM, Houben AJHM, van de Waarenburg M, Berendschot TTJM, Webers CAB, Reesink KD, van Greevenbroek MMJ, van der Kallen C, Schaper NC, Schram MT, Henry RMA, Stehouwer CDA, Schalkwijk CG. Fasting and post-oral-glucose-load levels of methylglyoxal are associated with microvascular, but not macrovascular, disease in individuals with and without (pre)diabetes: The Maastricht Study. Diabetes Metab 2020; 47:101148. [PMID: 32058030 DOI: 10.1016/j.diabet.2020.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/25/2020] [Accepted: 02/02/2020] [Indexed: 01/11/2023]
Abstract
AIMS Reactive dicarbonyl compounds, such as methylglyoxal (MGO), rise during an oral glucose tolerance test (OGTT), particularly in (pre)diabetes. Fasting MGO levels are associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with poorly controlled type 2 diabetes mellitus (T2DM). Yet, whether fasting or post-OGTT plasma MGO levels are associated with vascular disease in people with (pre)diabetes is unknown. METHODS Subjects with normal glucose metabolism (n=1796; age: 57.9±8.2 years; 43.3% men), prediabetes (n=478; age: 61.6±7.6 years; 54.0% men) and T2DM (n=669; age: 63.0±7.5 years; 67.0% men) from the Maastricht Study underwent OGTTs. Plasma MGO levels were measured at baseline and 2h after OGTT by mass spectrometry. Prior CVD was established via questionnaire. CKD was reflected by estimated glomerular filtration rate (eGFR) and albuminuria; retinopathy was assessed using retinal photographs. Data were analyzed using logistic regression adjusted for gender, age, smoking, systolic blood pressure, total-to-HDL cholesterol ratio, triglycerides, HbA1c, BMI and medication use. Odd ratios (ORs) were expressed per standard deviation of LN-transformed MGO. RESULTS Fasting and post-OGTT MGO levels were associated with higher ORs for albuminuria ≥30mg/24h [fasting: 1.12 (95% CI: 0.97-1.29); post-OGTT: 1.19 (1.01-1.41)], eGFR<60mL/min/1.73 m2 [fasting: 1.58 (95% CI: 1.38-1.82), post-OGTT: 1.57 (1.34-1.83)] and retinopathy [fasting: 1.59 (95% CI: 1.01-2.53), post-OGTT: 1.38 (0.77-2.48)]. No associations with prior CVD were found. CONCLUSION Fasting and post-OGTT MGO levels were associated with microvascular disease, but not prior CVD. Thus, therapeutic strategies directed at lowering MGO levels may prevent microvascular disease.
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Affiliation(s)
- N M J Hanssen
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - J L J M Scheijen
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A J H M Houben
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - M van de Waarenburg
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - T T J M Berendschot
- Department of Ophthalmology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C A B Webers
- Department of Ophthalmology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - K D Reesink
- School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Department of Biomedical Engineering, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - M M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - N C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - R M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Hoevenaars JGMM, Schouten JSAG, van den Borne B, Beckers HJM, Webers CAB. Knowledge Base and Preferred Methods of Obtaining Knowledge of Glaucoma Patients. Eur J Ophthalmol 2018; 15:32-40. [PMID: 15751237 DOI: 10.1177/112067210501500106] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To gather information regarding patient's understanding of glaucoma and the manner in which patients wish to learn about the disease with the intent of improving patient education. METHODS Forty-four of sixty randomly selected ophthalmologists (73%) asked four of their patients consecutively to complete a questionnaire about glaucoma. The selection of questions was based on focus group interviews and suggestions from several experts. Topics included knowledge about glaucoma and its treatment, the need for information, and preferred providers and methods of patient education. RESULTS Fifty percent of the patients had 49% or less correct answers to questions about glaucoma or its treatment. Per item the correct answers ranged from 5% to 90%. Lack of knowledge was associated with low level of education, short duration of glaucoma, high age, and no preference for the Internet as method of supplying information. These variables, however, did not identify groups with a considerable lack of knowledge sufficiently accurately to target patient education. A high need for information was observed and included information about the patient's own glaucoma. Almost all patients preferred the ophthalmologist and many also a nurse or a representative of the Glaucoma Patient Society as providers of information. Written material was the preferred method. CONCLUSIONS Patient education should address all patients. A patient education program should cover a wide range of topics with a focus on general information through written material and information tailored to the individual glaucoma patient's needs. The ophthalmologist is a key- person, but others could play an important role in patient education.
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Affiliation(s)
- J G M M Hoevenaars
- Department of Ophthalmology, Maastricht University Hospital, Maastricht - The Netherlands
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Mokhles P, Schouten JSAG, Beckers HJM, Webers CAB. Does the World Health Organization criterion adequately define glaucoma blindness? Clin Ophthalmol 2017; 11:473-480. [PMID: 28280297 PMCID: PMC5338935 DOI: 10.2147/opth.s129605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/26/2022] Open
Abstract
Purpose Blindness in glaucoma is difficult to assess with merely the use of the current World Health Organization (WHO) definition (a visual field restricted to 10° in a radius around central fixation), as this criterion does not cover other types of visual field loss that are encountered in clinical practice and also depict blindness. In this study, a 5-point ordinal scale was developed for the assessment of common visual field defect patterns, with the purpose of comparing blindness as outcome to the findings with the WHO criterion when applied to the same visual fields. The scores with the two methods were compared between two ophthalmologists. In addition, the variability between these assessors in assessing the different visual field types was determined. Methods Two glaucoma specialists randomly assessed a sample of 423 visual fields from 77 glaucoma patients, stripped of all indices and masked for all patient variables. They applied the WHO criterion and a 5-point ordinal scale to all visual fields for the probability of blindness. Results The WHO criterion was mostly found applicable and in good agreement for both assessors to visual fields depicting central island of vision or a temporal crescent. The percentage of blindness scores was higher when using the ordinal scale, 21.7% and 19.6% for assessors A and B, respectively, versus 14.4% and 11.3% for the WHO criterion. However, Kappa was lower, 0.71 versus 0.78 for WHO. Conclusions The WHO criterion is strictly applied and shows good agreement between assessors; however, blindness does not always fit this criterion. More visual fields are labeled as blind when a less stringent criterion is used, but this leads to more interobserver variability. A new criterion that describes the extent, location, and depth of visual field defects together with their consequence for the patient’s quality of life is needed for the classification of glaucoma blindness.
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Affiliation(s)
- P Mokhles
- University Eye Clinic Maastricht, Maastricht, the Netherlands
- Correspondence: P Mokhles, Maastricht University Medical Center, University Eye Clinic Maastricht, P.Debyelaan 25, 6229 HX, the Netherlands, Tel +31 43 387 5346, Fax +31 43 387 5343, Email
| | - JSAG Schouten
- University Eye Clinic Maastricht, Maastricht, the Netherlands
| | - HJM Beckers
- University Eye Clinic Maastricht, Maastricht, the Netherlands
| | - CAB Webers
- University Eye Clinic Maastricht, Maastricht, the Netherlands
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van Gestel A, Webers CAB, Beckers HJM, van Dongen MCJM, Severens JL, Hendrikse F, Schouten JSAG. The relationship between visual field loss in glaucoma and health-related quality-of-life. Eye (Lond) 2010; 24:1759-69. [PMID: 21057519 DOI: 10.1038/eye.2010.133] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE to investigate the relationship between visual field loss and health-related quality-of-life (HRQOL) in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG). METHODS we conducted a cross-sectional study among 537 OHT and POAG patients from seven hospitals in The Netherlands. Clinical information was obtained from medical files. Patients completed a questionnaire, containing generic HRQOL instruments (EQ-5D and Health Utilities Index mark 3), vision-specific National Eye Institute Visual Functioning Questionnaire (VFQ-25), and glaucoma-specific Glaucoma Quality-of-Life questionnaire (GQL-15). The impact of visual field loss on HRQOL scores was analysed with multiple linear regression analyses. RESULTS a relationship between mean deviation (MD) and HRQOL was found after adjusting for age, gender, visual acuity, medication side effects, laser trabeculoplasty, and glaucoma surgery. We found interaction between MD in both eyes for GQL and VFQ-25 scores. The relationship between MD and utility was non-linear, with utility only affected at MD-values below -25 dB in the better eye. Visual acuity, side effects, and glaucoma surgery independently affected HRQOL. Binocular MD and MD in the better eye had similar impacts on HRQOL, whereas MD in the worse eye had an independent effect. HRQOL was affected more by binocular defects in the inferior than in the superior hemifield. CONCLUSION visual field loss in progressing glaucoma is independently associated with a loss in both disease-specific and generic quality-of-life. It is important to prevent progression, both in early and in advanced glaucoma, especially in patients with inferior hemifield defects and severe defects in either eye.
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Affiliation(s)
- A van Gestel
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
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Goezinne F, La Heij EC, Berendschot TTJM, Tahzib NG, Koetsier LS, Hoevenaars JGMM, Liem ATA, Kijlstra A, Webers CAB, Hendrikse F. Patient ignorance is the main reason for treatment delay in primary rhegmatogenous retinal detachment in The Netherlands. Eye (Lond) 2008; 23:1393-9. [DOI: 10.1038/eye.2008.272] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Peeters A, Schouten JSAG, Webers CAB, Prins MH, Hendrikse F, Severens JL. Cost-effectiveness of early detection and treatment of ocular hypertension and primary open-angle glaucoma by the ophthalmologist. Eye (Lond) 2006; 22:354-62. [PMID: 17128205 DOI: 10.1038/sj.eye.6702637] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the most cost-effective case-finding strategy for the ophthalmologist to detect and treat ocular hypertension (OH) and primary open-angle glaucoma (POAG) at an early stage to prevent blindness. DESIGN A Markov cost-effectiveness simulation model. METHODS Three case-finding strategies are analysed and compared. The simulated cohort consists of all initial patients of at least 40 years old visiting an ophthalmic practice. All patients undergo ophthalmoscopy, but tonometry is routinely performed to: (1) all initial patients, (2) high-risk patients only, or (3) no one. The population characteristics are based on data of 1000 initial patients. Transition probabilities are taken from the literature. The (direct) costs of diagnosis and treatment represent those for the Netherlands. The time-horizon of the model is 20 years. An annual discount rate of 4% is used. MAIN OUTCOME MEASURES Costs, proportion of patients becoming blind, years of blindness. RESULTS The costliest strategy (1) leads to least blindness. The incremental cost-effectiveness ratio, which shows extra costs per year of vision saved in comparison to the cheapest strategy (3), is lower for strategy (1) than for strategy (2). It amounts to euro1707, not including extra costs due to blindness (eg associated with the use of disability facilities). When such costs exceed euro1707 per patient per year, which is most likely, then strategy (1) becomes cost saving. CONCLUSION It is most cost-effective to routinely perform tonometry to all initial ophthalmic patients to prevent blindness due to glaucoma.
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Affiliation(s)
- A Peeters
- Department of Ophthalmology, Maastricht University Hospital, Maastricht, The Netherlands
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