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Silverman RH, Urs R, Wapner RJ, Valenzuela IA, Coleman HR, Bearelly S. Correlation of Ocular Plane-Wave Doppler With Optical Coherence Tomography Angiography in Preeclampsia. J Ultrasound Med 2023; 42:2815-2824. [PMID: 37605863 PMCID: PMC10840834 DOI: 10.1002/jum.16320] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a severe complication of pregnancy characterized by hypertension, proteinuria and compromised fetal blood supply. The eye, like other end organs, is affected by this systemic condition, but unlike in other organs, ocular media transparency allows high-resolution optical visualization of the vascular structure of the retina. Our aim was to assess how ultrasound-determined ocular blood-flow correlates with vascular structure of the retina and choriocapillaris determined by optical coherence tomography angiography (OCTA). METHODS Plane-wave ultrasound and OCTA were performed on both eyes of 40 consecutive subjects consisting of normal controls (n = 11), mild PE (n = 5), severe PE (n = 17) and chronic or gestational hypertension (n = 7) within 72 hours following delivery. From ultrasound, we measured pulsatile flow velocity and resistance indices in the central retinal artery (CRA) and vein, the short posterior ciliary arteries (SPCAs) and choroid. From OCTA, we measured vascular density (VD) in the superficial, deep retina and choriocapillaris. We determined differences in Doppler and OCTA parameters among groups and correlations between ultrasound and OCTA. RESULTS In severe PE, flow resistance was reduced with respect to controls. Flow velocity and resistance in the and SPCA were moderately correlated with VD in the choriocapillaris and peripapillary retina, but VD in PE did not differ significantly from controls. CONCLUSIONS Although OCTA parameters were moderately correlated with Doppler ultrasound, OCTA did not demonstrate significant differences between PE and controls postpartum.
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Affiliation(s)
| | - Raksha Urs
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
| | | | - Hanna R. Coleman
- Department of Ophthalmology, Columbia University Irving Medical Center
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Irving Medical Center
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2
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Abdelhakim AH, Sebrow D, Bearelly S, Horowitz JD, Chen RWS. IPSILATERAL BULLOUS EXUDATIVE RETINAL DETACHMENT ASSOCIATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION. Retin Cases Brief Rep 2022; 16:246-252. [PMID: 31800505 DOI: 10.1097/icb.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/10/2023]
Abstract
PURPOSE To describe the first known case of an extracorporeal membrane oxygenation (ECMO)-related complication in an adult. METHODS Case report. RESULTS A 34-year-old man awaiting a lung transplant for interstitial lung disease was connected to an ECMO circuit as a bridge to lung transplant, with a drainage catheter attached to his right internal jugular vein. Shortly after he was cannulated, he developed blurred vision in his right eye and was found to have a progressively worsening bullous exudative retinal detachment. After receiving a lung transplant and getting decannulated from ECMO, his bullous detachment rapidly improved. The patient's clinical course as well as his ophthalmic testing showed findings inconsistent with alternative diagnoses such as central serous chorioretinopathy. His findings were best explained as a complication of ECMO cannulation. CONCLUSION Extracorporeal membrane oxygenation may be associated with bullous exudative retinal detachment in rare cases where there is a possible anatomical or physiological predisposition.
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Affiliation(s)
- Aliaa H Abdelhakim
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University Medical Center, New York, New York; and
- New York-Presbyterian Hospital Columbia Campus, New York, New York
| | - Dov Sebrow
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University Medical Center, New York, New York; and
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University Medical Center, New York, New York; and
| | - Jason D Horowitz
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University Medical Center, New York, New York; and
| | - Royce W S Chen
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University Medical Center, New York, New York; and
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Dar S, De Moraes CG, Karani R, Khan S, Chen R, Blumberg D, Harizman N, Krawitz B, Valenzuela IA, Aliancy J, Tezel T, Horowitz J, Bearelly S, Coleman DJ, Chang S, Cioffi GA, Liebmann JM. Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19. J Glaucoma 2021; 30:750-757. [PMID: 33979109 PMCID: PMC8366515 DOI: 10.1097/ijg.0000000000001877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City. METHODS We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University's Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data. RESULTS Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit. CONCLUSION AND RELEVANCE We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.
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Breazzano MP, Bond JB, Bearelly S, Kim DH, Donahue SP, Lum F, Olsen TW. American Academy of Ophthalmology Recommendations on Screening for Endogenous Candida Endophthalmitis. Ophthalmology 2021; 129:73-76. [PMID: 34293405 DOI: 10.1016/j.ophtha.2021.07.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 07/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
The American Academy of Ophthalmology evaluated the practice of routine screening for intraocular infection from Candida septicemia. In the United States, ophthalmologists are consulted in the hospital to screen for intraocular infection routinely for patients with Candida bloodstream infections. This practice was established in the era before the use of systemic antifungal medication and the establishment of definitions of ocular disease with candidemia. A recent systematic review found a rate of less than 1% of routinely screened patients with endophthalmitis from Candida septicemia. Other studies found higher rates of endophthalmitis but had limitations in terms of inaccuracies in ocular disease classification, lack of vitreous biopsies, selection biases, and lack of longer-term visual outcomes. Some studies attributed ocular findings to Candida infections, rather than other comorbidities. Studies also have not demonstrated differences in medical management that are modified for eye disease treatment; therefore, therapy should be dictated by the underlying Candida infection, rather than be tailored on the basis of ocular findings. In summary, the Academy does not recommend a routine ophthalmologic consultation after laboratory findings of systemic Candida septicemia, which appears to be a low-value practice. An ophthalmologic consultation is a reasonable practice for a patient with signs or symptoms suggestive of ocular infection regardless of Candida septicemia.
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Affiliation(s)
- Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland
| | - John B Bond
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Srilaxmi Bearelly
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, Columbia University Medical Center, New York City, New York
| | - Donna H Kim
- Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Sean P Donahue
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California.
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minneapolis
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Stern-Ascher CN, North VS, Garg A, Ananth CV, Wapner RJ, Bearelly S. Subfoveal Choroidal Thickness and Associated Changes of Angiogenic Factors in Women with Severe Preeclampsia. Am J Perinatol 2021; 38:482-489. [PMID: 31683325 PMCID: PMC10895649 DOI: 10.1055/s-0039-1698832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Severe preeclampsia complicates roughly 1% of all pregnancies. One defining feature of severe preeclampsia is new onset visual disturbance. The accessibility of the choroid to high-resolution, noninvasive imaging makes it a reasonable target of investigation for disease prediction, stratification, or monitoring in preeclampsia. This study aimed to compare subfoveal choroidal thickness between women with severe preeclampsia and those with normotensive pregnancies, and to investigate associations between such findings and other indicators of disease severity, including gestational age and serum angiogenic factors. STUDY DESIGN We designed a case-control study comprised of 36 women diagnosed with severe preeclampsia (cases) matched to 37 normotensive women (controls) by race/ethnicity and parity, all diagnosed in the postpartum period. All patients underwent enhanced depth imaging spectral-domain optical coherence tomography and serum analysis. RESULTS Cases showed no difference in subfoveal choroidal thickness compared with controls (p = 0.65). Amongst cases, subfoveal choroidal thickness and gestational age at delivery were inversely related (r = 0.86, p < .001). There was a positive association of placental growth factor with subfoveal choroidal thickness amongst cases (r = 0.54, p = 0.002). CONCLUSION This study suggests a relationship between the degree of disease severity and the magnitude of choroidal thickening. We also show an association between this index and placental growth factor level in the postpartum period.
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Affiliation(s)
- Conrad N Stern-Ascher
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Victoria S North
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Aakriti Garg
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Cande V Ananth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York
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6
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Nanda T, Rasool N, Bearelly S. Tacrolimus induced optic neuropathy in post-lung transplant patients: A series of 3 patients. Am J Ophthalmol Case Rep 2021; 22:101056. [PMID: 33778180 PMCID: PMC7985716 DOI: 10.1016/j.ajoc.2021.101056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/17/2020] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Tacrolimus is a commonly used immunosuppressant medication after lung transplantation. In rare cases, tacrolimus causes a medication-induced optic neuropathy (TON) that can lead to significant vision loss. Observations In this series, we describe three cases of TON, 1-10 years after medication use. Two patients were young (22yr and 33yr) females with cystic fibrosis. The last case was a 65yr male with idiopathic pulmonary fibrosis. In 2/3 cases tacrolimus serum levels were normal. Visual acuity ranged from 20/20 to 20/300, and vision loss occurred acutely to sub-acutely, over a span of 2-3 months. Conclusions and importance As presented here, TON can be highly variable. MRI findings are often non-specific, from normal brain findings to extensive white matter changes. There remains an unclear association with graft-versus-host disease and reduced kidney function. Visual findings are often subtle, including color vision aberration and peripheral visual field deficits, both of which usually require an ophthalmologic evaluation. When diagnosed in a timely fashion, TON is at least partially reversible in up to half of all cases. While rare, the cases described here support post-lung transplant ophthalmologic evaluation in those taking high-risk medications.
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Key Words
- ACR, acute cellular rejection
- AKI, acute kidney injury
- CNS, central nervous system
- CT, computed tomography
- Cr, creatinine
- FLAIR, fluid attenuated inversion recovery
- GVHD, graft versus host disease
- JC, John Cunningham
- Lung transplant
- MRI, magnetic resonance imaging
- Neuro-ophthalmology
- OCT, optical coherence topography
- Ophthalmologic examination
- Optic neuropathy
- PET, positron emission tomography
- PRES, posterior reversable encephalopathy syndrome
- TON, tacrolimus optic neuropathy
- Tacrolimus
- Toxicity
- VZV, varicella zoster virus
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Affiliation(s)
- Tavish Nanda
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Nailyn Rasool
- Department of Neuro-Ophthalmology, University of California, San Francisco, CA, United States
| | - Srilaxmi Bearelly
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, United States
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7
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Silverman RH, Urs R, Wapner RJ, Bearelly S. Plane-Wave Ultrasound Doppler of the Eye in Preeclampsia. Transl Vis Sci Technol 2020; 9:14. [PMID: 32974086 PMCID: PMC7490228 DOI: 10.1167/tvst.9.10.14] [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: 05/15/2020] [Accepted: 08/03/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Pre-eclampsia (PE) is a serious complication of pregnancy characterized by high blood pressure, proteinuria, compromised fetal blood supply, and potential organ damage. The superficial location of the eye makes it an ideal target for characterization hemodynamics. Our aim was to discern the impact of PE on ocular blood flow. Methods 18 MHz plane-wave ophthalmic ultrasound scanning was performed on subjects with PE (n = 26), chronic or gestational hypertension (n = 8), and normal controls (n = 19) within 72 hours of delivery. Duplicate three-second long scans of the posterior pole including the optic nerve were acquired at 6000 images/sec for evaluation of the central retinal artery and vein and the short posterior ciliary arteries. The choroid was scanned at 1000 images/sec. Doppler analysis provided values of pulsatile flow velocity and resistance indexes. Results End diastolic velocity was higher, and pulsatility and resistive indexes were significantly lower in the choroid, central retinal artery and short posterior ciliary arteries in PE than in controls. Blood pressure was elevated in PE with respect to controls and was negatively correlated with resistance. Conclusions Although vasoconstriction is considered characteristic of PE, we found reduced resistance in the orbital vessels and choroidal arterioles, implying vasodilation at this level. Future studies incorporating optical coherence tomography angiography for characterization of the retina and choriocapillaris in conjunction with plane-wave ultrasound scanning, particularly in late pregnancy, might address this conundrum. Translational Relevance Use of plane-wave ultrasound scanning for evaluation ocular blood flow in women at risk for PE may offer an avenue towards early detection and clinical intervention.
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Affiliation(s)
- Ronald H Silverman
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Raksha Urs
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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8
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Nanda T, Bond JB, Chen RWS, Bearelly S, Russell Day H, Cioffi GA, Handa JT, Arevalo JF, Donahue SP, Breazzano MP. A Measured Approach to Inpatient Ophthalmologic Screening in the COVID-19 Era: A Multicenter Perspective. Ophthalmology 2020; 128:346-348. [PMID: 32777228 PMCID: PMC7413059 DOI: 10.1016/j.ophtha.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/18/2022] Open
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9
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Breazzano MP, Giurgea LT, Day HR, Fragiotta S, Fernández-Avellaneda P, van Dijk EH, Bearelly S, Bond JB. The controversial drive for intervention with ophthalmologic screening for Candida bloodstream infections. Int J Infect Dis 2020; 96:363-364. [DOI: 10.1016/j.ijid.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/01/2020] [Indexed: 01/05/2023] Open
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10
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Nanda T, Breazzano MP, Bearelly S. Clinical utility of pre-transplant ophthalmic consultation for lung transplant recipients: implications in the COVID-19 pandemic era. Graefes Arch Clin Exp Ophthalmol 2020; 259:1669-1671. [PMID: 32572606 PMCID: PMC7306647 DOI: 10.1007/s00417-020-04799-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tavish Nanda
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, Edward S. Harkness Eye Institute, 635 W 165th St, New York, NY, 10032, USA.
| | - Mark P Breazzano
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, Edward S. Harkness Eye Institute, 635 W 165th St, New York, NY, 10032, USA.,Department of Ophthalmology, New York University Langone Health, New York University School of Medicine, New York, NY, USA
| | - Srilaxmi Bearelly
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, Edward S. Harkness Eye Institute, 635 W 165th St, New York, NY, 10032, USA
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11
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Lee W, Paavo M, Zernant J, Stong N, Laurente Z, Bearelly S, Nagasaki T, Tsang SH, Goldstein DB, Allikmets R. Modification of the PROM1 disease phenotype by a mutation in ABCA4. Ophthalmic Genet 2019; 40:369-375. [PMID: 31576780 DOI: 10.1080/13816810.2019.1660382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/10/2023]
Abstract
Background: The extensive phenotypic heterogeneity of monogenic diseases can be largely traced to intragenic variation; however, recent advances in clinical detection and gene sequencing have uncovered the emerging role of non-allelic variation (i.e. genetic trans-modifiers) in shaping disease phenotypes. Identifying these associations are not only of significant diagnostic value, but also provides scientific insight into the expanded molecular etiology of rare diseases. This reports describes the discordant clinical manifestation of a family segregating mutations in ABCA4 and PROM1. Methods: Three patients across a two generation family underwent multimodal imaging and functional testing of the retina including color photography, fundus autofluorescence (AF), spectral domain-optical coherence tomography (SD-OCT) and full-field electroretinography (ffERG). Genetic characterization was carried out by direct Sanger and whole exome sequencing. Results: Clinical examination revealed similar retinal degenerative phenotypes in the proband and her mother. Despite being younger, the proband's phenotype was more advanced and exhibited additional features related to Stargardt disease not found in the mother. Whole exome sequencing identified a pathogenic missense variant in PROM1, c.400C > T, p.(Arg134Cys), as the underlying cause of retinal disease in both the proband and mother. Sequencing of the ABCA4 locus uncovered a single disease-causing variant, c.5714 + 5G > A in the daughter segregating from the father who, surprisingly, also exhibited very subtle disease changes associated with STGD1 despite being a heterozygous carrier. Conclusions: Harboring an additional heterozygous ABCA4 mutation increases severity and confers STGD1-like features in patients with PROM1 disease which provides supporting evidence for their shared pathophysiology and potential treatment prospects.
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Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University , New York , New York , USA
| | - Maarjaliis Paavo
- Department of Ophthalmology, Columbia University , New York , New York , USA
| | - Jana Zernant
- Department of Ophthalmology, Columbia University , New York , New York , USA
| | - Nicholas Stong
- Institute of Genomic Medicine, Columbia University , New York , New York , USA
| | - Zachary Laurente
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University , Chicago , Illinois , USA
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University , New York , New York , USA
| | - Takayuki Nagasaki
- Department of Ophthalmology, Columbia University , New York , New York , USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University , New York , New York , USA.,Department of Pathology & Cell Biology, Columbia University , New York , New York , USA
| | - David B Goldstein
- Institute of Genomic Medicine, Columbia University , New York , New York , USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University , New York , New York , USA.,Department of Pathology & Cell Biology, Columbia University , New York , New York , USA
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12
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Paavo M, Lee W, Merriam J, Bearelly S, Tsang S, Chang S, Sparrow JR. Intraretinal Correlates of Reticular Pseudodrusen Revealed by Autofluorescence and En Face OCT. Invest Ophthalmol Vis Sci 2017; 58:4769-4777. [PMID: 28973322 PMCID: PMC5624777 DOI: 10.1167/iovs.17-22338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/24/2022] Open
Abstract
Purpose We sought to determine whether information revealed from the reflectance, autofluorescence, and absorption properties of RPE cells situated posterior to reticular pseudodrusen (RPD) could provide insight into the origins and structure of RPD. Methods RPD were studied qualitatively by near-infrared fundus autofluorescence (NIR-AF), short-wavelength fundus autofluorescence (SW-AF), and infrared reflectance (IR-R) images, and the presentation was compared to horizontal and en face spectral domain optical coherence tomographic (SD-OCT) images. Images were acquired from 23 patients (39 eyes) diagnosed with RPD (mean age 80.7 ± 7.1 [SD]; 16 female; 4 Hispanics, 19 non-Hispanic whites). Results In SW-AF, NIR-AF, and IR-R images, fundus RPD were recognized as interlacing networks of small scale variations in IR-R and fluorescence (SW-AF, NIR-AF) intensities. Darkened foci of RPD colocalized in SW-AF and NIR-AF images, and in SD-OCT images corresponded to disturbances of the interdigitation (IZ) and ellipsoid (EZ) zones and to more pronounced hyperreflective lesions traversing photoreceptor-attributable bands in SD-OCT images. Qualitative assessment of the outer nuclear layer (ONL) revealed thinning as RPD extended radially from the outer to inner retina. In en face OCT, hyperreflective areas in the EZ band correlated topographically with hyporeflective foci at the level of the RPE. Conclusions The hyperreflective lesions corresponding to RPD in SD-OCT scans are likely indicative of degenerating photoreceptor cells. The darkened foci at positions of RPD in NIR-AF and en face OCT images indicate changes in the RPE monolayer with the reduced NIR-AF and en face OCT signal suggesting a reduction in melanin that could be accounted for by RPE thinning.
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Affiliation(s)
- Maarjaliis Paavo
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - John Merriam
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Stephen Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Stanley Chang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
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13
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Garg A, Blumberg DM, Al-Aswad LA, Oll M, Yzer S, Forbes M, Allikmets RL, Bearelly S. Associations Between β-Peripapillary Atrophy and Reticular Pseudodrusen in Early Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:2810-2815. [PMID: 28564702 PMCID: PMC5455172 DOI: 10.1167/iovs.16-20343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/24/2022] Open
Abstract
Purpose Choroidal thinning has been associated with reticular pseudodrusen (RPD) and β-peripapillary atrophy (β-PPA), which have been linked to normal-tension glaucoma (NTG). This analysis sought to determine whether RPD are independently associated with β-PPA in early AMD patients. Secondary outcomes included the association of RPD and preexisting diagnosis of glaucoma, cup-to-disc ratio (CDR), subfoveal choroidal thickness (SFCT), and IOP. Methods This prospective cross-sectional study examined 78 age- and sex-matched early AMD patients: 43 RPD patients (63 eyes) and 35 non-RPD patients (64 eyes). Exclusion criteria included advanced AMD, high myopia, and vitreoretinal conditions/surgery. RPD and non-RPD groups were identified by confocal scanning laser ophthalmoscopy. β-PPA as well as CDR were graded on digital, nonstereoscopic fundus photos. SFCT was measured on spectral-domain optical coherence tomography for 69 patients (35 RPD and 34 non-RPD). IOP and glaucoma diagnosis were extracted from charts. Results β-PPA had a greater prevalence in RPD than non-RPD (44% vs. 19%, P = 0.002); however, this relationship was not significant when SFCT was added to the model (P = 0.150). A preexisting diagnosis of glaucoma (P = 0.156), CDR (P = 0.176), and IOP (P = 0.98) was not different between groups. Conclusions RPD in early AMD are associated with presence of β-PPA, but choroidal thickness is a confounder in this relationship. Because β-PPA is a common finding in NTG, focusing on a potential shared pathway between RPD and NTG could improve the understanding of pathophysiology and expand therapies for each condition.
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Affiliation(s)
- Aakriti Garg
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Dana M Blumberg
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Lama A Al-Aswad
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Maris Oll
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Suzanne Yzer
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Max Forbes
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Rando L Allikmets
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States 2Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Srilaxmi Bearelly
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, United States
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Lee W, Schuerch K, Zernant J, Collison FT, Bearelly S, Fishman GA, Tsang SH, Sparrow JR, Allikmets R. Genotypic spectrum and phenotype correlations of ABCA4-associated disease in patients of south Asian descent. Eur J Hum Genet 2017; 25:735-743. [PMID: 28327576 DOI: 10.1038/ejhg.2017.13] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Variants in the ABCA4 gene are the most common cause of juvenile-onset blindness affecting close to 1 in 10 000 people worldwide. Disease severity varies largely according to genotype, which can be specific to ethnic and racial groups. Here we investigate the spectrum of ABCA4 variation and its phenotypic expression in 38 patients of South Asian descent, notably from India, Pakistan, Bangladesh and Sri Lanka. Sequencing of all exons and flanking intronic sequences of ABCA4 revealed disease-causing variants in all patients: 3 in 2.6%, 2 in 81.6% and 1 in 15.8%. Altogether, 36 distinct variants were identified, including 9 previously not described. The most frequent variant c.5882G>A, p.(G1961E) was found in half the patients, the highest ever reported in a single study cohort. The South Asian founder variant c.859-9T>C was identified along with other founder variants ascribed to Danish, Chinese, Mexican and African patients. Patients carrying c.5882G>A, p.(G1961E) exhibited a consistently confined disease phenotype, normal quantitative autofluorescence (qAF) levels and preserved full-field ERG (ffERG) while c.859-9T>C resulted in widespread disease, significantly elevated qAF and reduced to non-detectable ffERG. South Asian patients present with a relatively unique ABCA4 profile comprised of various ethnic founder variants resulting in two or three major retinal phenotypes.
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Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Frederick T Collison
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | | | - Gerald A Fishman
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
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Duncker T, Stein GE, Lee W, Tsang SH, Zernant J, Bearelly S, Hood DC, Greenstein VC, Delori FC, Allikmets R, Sparrow JR. Quantitative Fundus Autofluorescence and Optical Coherence Tomography in ABCA4 Carriers. Invest Ophthalmol Vis Sci 2016; 56:7274-85. [PMID: 26551331 DOI: 10.1167/iovs.15-17371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess whether carriers of ABCA4 mutations have increased RPE lipofuscin levels based on quantitative fundus autofluorescence (qAF) and whether spectral-domain optical coherence tomography (SD-OCT) reveals structural abnormalities in this cohort. METHODS Seventy-five individuals who are heterozygous for ABCA4 mutations (mean age, 47.3 years; range, 9-82 years) were recruited as family members of affected patients from 46 unrelated families. For comparison, 57 affected family members with biallelic ABCA4 mutations (mean age, 23.4 years; range, 6-67 years) and two noncarrier siblings were also enrolled. Autofluorescence images (30°, 488-nm excitation) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference. The gray levels (GLs) of each image were calibrated to the reference, zero GL, magnification, and normative optical media density to yield qAF. Horizontal SD-OCT scans through the fovea were obtained and the thicknesses of the outer retinal layers were measured. RESULTS In 60 of 65 carriers of ABCA4 mutations (age range, 9-60), qAF levels were within normal limits (95% confidence level) observed for healthy noncarrier subjects, while qAF levels of affected family members were significantly increased. Perifoveal fleck-like abnormalities were observed in fundus AF images in four carriers, and corresponding changes were detected in the outer retinal layers in SD-OCT scans. Thicknesses of the outer retinal layers were within the normal range. CONCLUSIONS With few exceptions, individuals heterozygous for ABCA4 mutations and between the ages of 9 and 60 years do not present with elevated qAF. In a small number of carriers, perifoveal fleck-like changes were visible.
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Affiliation(s)
- Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Gregory E Stein
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Donald C Hood
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Psychology, Columbia University, New York, New York, United States
| | | | - François C Delori
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
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Lee W, Nõupuu K, Oll M, Duncker T, Burke T, Zernant J, Bearelly S, Tsang SH, Sparrow JR, Allikmets R. The external limiting membrane in early-onset Stargardt disease. Invest Ophthalmol Vis Sci 2014; 55:6139-49. [PMID: 25139735 DOI: 10.1167/iovs.14-15126] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 12/30/2022] Open
Abstract
PURPOSE To describe pathologic changes of the external limiting membrane (ELM) in young patients with early-onset Stargardt (STGD1) disease. METHODS Twenty-six STGD1 patients aged younger than 20 years with confirmed disease-causing adenosine triphosphate-binding cassette, subfamily A, member 4 (ABCA4) alleles and 30 age-matched unaffected individuals were studied. Spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (AF), and color fundus photography (CFP) images, as well as full-field electroretinograms were obtained and analyzed for one to four visits in each patient. RESULTS The ELM in all patients exhibited a distinct thickening that was not observed in unaffected individuals. In addition, accumulations of reflective deposits were noted in the outer nuclear layer in every patient. Four patients exhibited a concave protuberance or bulging of a thickened and hyperreflective ELM band within the fovea containing preserved photoreceptors. Longitudinal SD-OCT data in several patients revealed the persistence of this ELM abnormality over a period of time (1-4 years). Furthermore, the edges of the inner segment ellipsoid band appeared to recede earlier than the ELM band in active lesions. CONCLUSIONS Structural changes seen in the ELM of this cohort may reflect a gliotic response to cellular stress at the photoreceptor level in early-onset STGD1.
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Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Kalev Nõupuu
- Department of Ophthalmology, Columbia University, New York, New York, United States Eye Clinic, Tartu University Hospital, Tartu, Estonia
| | - Maris Oll
- Department of Ophthalmology, Columbia University, New York, New York, United States Eye Clinic, Tartu University Hospital, Tartu, Estonia
| | - Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Tomas Burke
- Department of Ophthalmology, Royal United Hospital, Bath, United Kingdom
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
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Garg A, Wapner RJ, Ananth CV, Dale E, Tsang SH, Lee W, Allikmets R, Bearelly S. Choroidal and retinal thickening in severe preeclampsia. Invest Ophthalmol Vis Sci 2014; 55:5723-9. [PMID: 25074772 DOI: 10.1167/iovs.14-14143] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare choroidal thickness and retinal macular volume (RMV) among three groups of women: severe preeclampsia postpartum, normotensive postpartum, and normotensive nongravid. While visual disturbances often accompany severe preeclampsia, the underlying choroidal and retinal changes responsible for these symptoms have not been described. METHODS This case-control study was based on 15 severe preeclampsia cases and 15 ethnicity- and parity-matched normotensive controls recruited during the postpartum hospital stay. A reference group of 19 age-matched, nongravid, normotensive women was also studied. Choroidal thickness and RMV were measured by using enhanced depth imaging spectral-domain optical coherence tomography. Two retinal specialists, one of whom was masked to the case-control status, reviewed all images. RESULTS Severe preeclampsia cases demonstrated greater mean choroidal thickness (425 ± 90 μm vs. 354 ± 140 μm; P = 0.021) and RMV (9.0 ± 0.4 mm(3) vs. 8.7 ± 0.5 mm(3); P = 0.006) than controls. In contrast, control and reference groups were similar with respect to choroidal thickness (354 ± 140 μm vs. 363 ± 82 μm; P = 0.764) and RMV (8.7 ± 0.5 mm(3) vs. 8.8 ± 0.4 mm(3); P = 0.870). Follow-up imaging of two severe preeclampsia cases within 3 months of delivery revealed decreasing choroidal thickness. CONCLUSIONS Our results demonstrate subclinical retinal and choroidal thickening in the setting of severe preeclampsia. This is the likely source of its associated visual phenomena and may reflect rising levels of vascular endothelial growth factor. Retinal and choroidal markers could serve as novel predictive markers of severe preeclampsia.
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Affiliation(s)
- Aakriti Garg
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Elizabeth Dale
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University, New York, New York, United States
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Marsiglia M, Boddu S, Bearelly S, Xu L, Breaux BE, Freund KB, Yannuzzi LA, Smith RT. Association between geographic atrophy progression and reticular pseudodrusen in eyes with dry age-related macular degeneration. Invest Ophthalmol Vis Sci 2013; 54:7362-9. [PMID: 24114542 DOI: 10.1167/iovs.12-11073] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [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: 01/10/2023] Open
Abstract
PURPOSE To evaluate geographic atrophy (GA) progression in eyes with dry AMD and to determine factors related to GA expansion, notably reticular pseudodrusen (RPD), also known as subretinal drusenoid deposits (SDD) or reticular macular disease (RMD). METHODS This was a retrospective cohort study of patients with dry AMD who were diagnosed with GA in at least one eye and were imaged with sequential fundus autofluorescence (FAF) and/or near infrared reflectance (NIR-R) imaging. Images were analyzed for the presence of GA within the macular region. Geographic atrophy progression was measured in the fields of a modified Wisconsin grid and spatially correlated with RPD. Factors also evaluated for association with GA progression included initial GA size and pattern. RESULTS The study sample included 126 eyes of 92 patients, with an average follow up of 20.4 months (SD = 11.7). At baseline, 93.6% of eyes had RPD, and the average GA area was 2.8 mm(2) (SD = 2.9). The average GA progression rate was 0.8 mm(2)/y (SD = 0.6), with a statistically significant difference between the unilobular and multilobular phenotype groups (0.3 mm(2)/y vs. 0.9 mm(2)/y, P = 0.02). Patients in the lower 50th percentile of initial GA area had a lower progression rate than patients in the upper 50th percentile (0.6 mm(2)/y vs. 1.1 mm(2)/y, P < 0.001). Geographic atrophy progression was more frequent in fields with RPD than in those without RPD (74.2% vs. 41.7%, P < 0.001). CONCLUSIONS The high correlation between the presence of RPD (also known as SDD or RMD) and the presence of GA, and the expansion of GA into areas with these lesions suggest that they are an early manifestation of the process leading to GA.
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Affiliation(s)
- Marcela Marsiglia
- Department of Ophthalmology, New York University Langone Medical Center, New York, New York
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Garg A, Oll M, Yzer S, Chang S, Barile GR, Merriam JC, Tsang SH, Bearelly S. Reticular pseudodrusen in early age-related macular degeneration are associated with choroidal thinning. Invest Ophthalmol Vis Sci 2013; 54:7075-81. [PMID: 24071958 DOI: 10.1167/iovs.13-12474] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [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: 11/24/2022] Open
Abstract
PURPOSE To compare choroidal thickness (CT) measurements in early AMD between patients with and without reticular pseudodrusen (RPD) using spectral-domain optical coherence tomography (SD-OCT). METHODS This cross-sectional study examined 84 age- and sex-matched AMD patients (40 RPD [63 eyes], 44 non-RPD [75 eyes]). Fundus photographs and scanning laser ophthalmoscopy images were graded to identify RPD and non-RPD groups by three retinal specialists (MO, SY, SB) who were masked to corresponding SD-OCTs. CT at the fovea and 2400 to 3000 μm superior and inferior to the fovea was measured on SD-OCT by a grader (AG) and reviewed by a retinal specialist (SB). Only images with a clear posterior choroidal margin were analyzed (six eyes excluded due to poor image quality), and enhanced depth imaging SD-OCT was used when available (20 of 138 eyes). Greatest retinal thickness (RT) on horizontal foveal SD-OCT was also recorded. RESULTS Mean CTs in the superior, foveal, and inferior macula in RPD (191.3 μm ± 57.9 SD, 176.3 μm ± 60.5 SD, 179.7 μm ± 56.24 SD) were significantly less than that of non-RPD (228.0 μm ± 66.1 SD, 216.5 μm ± 70.3 SD, 224.4 μm ± 71.9 SD; P = 0.0010, P = 0.0005, P = 0.0001, respectively), as was greatest RT (P = 0.0301). CONCLUSIONS CT was thinner throughout the macula in the RPD group as compared with the non-RPD group. The current analysis supports an association between RPD and a thinned choroidal layer and is consistent with a choroidal etiology of RPD. CT may be integral to understanding RPD, and may be helpful in stratifying AMD progression risk.
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Affiliation(s)
- Aakriti Garg
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
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A. Martillo M, Marsiglia M, D. Lee M, Pumariega N, Bearelly S, Smith RT. Is reticular macular disease a choriocapillaris perfusion problem? Med Hypothesis Discov Innov Ophthalmol 2012; 1:37-41. [PMID: 24600618 PMCID: PMC3939745] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The etiology of reticular macular disease (RMD), a sub-phenotype of age-related macular degeneration (AMD), is controversial and has not been clarified. RMD is suspected to be a multifactorial, complex disease with genetic, environmental, and systemic factors playing an important role in its origin. Findings from combinations of different imaging modalities suggest that the pattern that characterizes this condition is associated with an alteration of the choriocapillaris blood flow. If the choroid is indeed affected in RMD, the possible linkage with inflammatory or other systemic diseases could be better supported.
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Affiliation(s)
| | - Marcela Marsiglia
- Department of Ophthalmology, New York University, New York, USA,Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, USA,LuEsther T. Mertz Retinal Research Center and Manhattan Eye, Ear and Throat Hospital, New York USA
| | - Michele D. Lee
- Department of Ophthalmology, New York University, New York, USA
| | | | - Srilaxmi Bearelly
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, USA
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Jain N, Farsiu S, Khanifar AA, Bearelly S, Smith RT, Izatt JA, Toth CA. Quantitative comparison of drusen segmented on SD-OCT versus drusen delineated on color fundus photographs. Invest Ophthalmol Vis Sci 2010; 51:4875-83. [PMID: 20393117 PMCID: PMC2939301 DOI: 10.1167/iovs.09-4962] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 01/16/2010] [Accepted: 03/21/2010] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Spectral domain-optical coherence tomography (SD-OCT) may be useful for efficient measurement of drusen in patients with age-related macular degeneration (AMD). Areas identified as drusen from semiautomated segmentation of drusen on SD-OCT were compared to those identified from review of digital color fundus photographs (CFPs). METHODS Twelve eyes with nonneovascular AMD were prospectively imaged with digital CFP and SD-OCT. For each eye, areas on CFP in which at least two of three retina specialists agreed on drusen presence produced the composite CFP drusen map. Automated image analysis produced another CFP map. Areas identified as drusen by segmentation on SD-OCT B-scans were plotted as the SD-OCT drusen map. The CFP and SD-OCT maps were compared and agreement was quantified. Disagreement was characterized into distinct types, and the frequency of each type was quantified. RESULTS There was general agreement between CFP and SD-OCT in identifying presence and absence of drusen, with mean agreement in 82% ± 9% of total image pixels. Most disagreement (80% ± 15%) occurred at drusen margins. There was a trend toward greater detection of drusen with SD-OCT in eyes with larger drusen and with hyperpigmentation. There was a trend toward greater detection of smaller drusen by CFP. CONCLUSIONS Good agreement was demonstrated in drusen detection between CFP and SD-OCT. Areas of disagreement underscore limitations of CFP-based measurement of drusen, particularly in the sizing of large, soft drusen. SD-OCT shows great promise as an adjunctive tool for assessing drusen burden in AMD. (ClinicalTrials.gov number, NCT00734487.).
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Affiliation(s)
| | - Sina Farsiu
- From the Departments of Ophthalmology and
- Biomedical Engineering, Duke University Medical Center, Durham, North Carolina; and
| | | | - Srilaxmi Bearelly
- From the Departments of Ophthalmology and
- the Department of Ophthalmology, Columbia University, New York, New York
| | - R. Theodore Smith
- the Department of Ophthalmology, Columbia University, New York, New York
| | - Joseph A. Izatt
- From the Departments of Ophthalmology and
- Biomedical Engineering, Duke University Medical Center, Durham, North Carolina; and
| | - Cynthia A. Toth
- From the Departments of Ophthalmology and
- Biomedical Engineering, Duke University Medical Center, Durham, North Carolina; and
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Bearelly S, Toth CA. Author reply. Ophthalmology 2010. [DOI: 10.1016/j.ophtha.2010.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bearelly S, Rao S, Fekrat S. Anaphylaxis following intravenous fluorescein angiography in a vitreoretinal clinic: report of 4 cases. Can J Ophthalmol 2009; 44:444-5. [DOI: 10.3129/i09-068] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bearelly S, Chau FY, Koreishi A, Stinnett SS, Izatt JA, Toth CA. Spectral domain optical coherence tomography imaging of geographic atrophy margins. Ophthalmology 2009; 116:1762-9. [PMID: 19643488 DOI: 10.1016/j.ophtha.2009.04.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 04/02/2009] [Accepted: 04/06/2009] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To test in vivo whether spectral domain optical coherence tomography (SD-OCT) provides adequate resolution for reproducible measurement of photoreceptor (PR) layer at the margins of geographic atrophy (GA), and if it delineates the relationship between PR layer and retinal pigment epithelium at the margins of GA. DESIGN Prospective consecutive case series. PARTICIPANTS Patients with GA secondary to nonneovascular age-related macular degeneration (AMD) identified during routine follow-up at Duke Eye Center between January 3, 2006, and June 3, 2007, and who consented to participate in this study. METHODS We used SD-OCT to image eyes. Multiple B-scans from each eye were saved and independently graded by 2 graders and the following locations were marked: (1) site where PR thickness began to decline below its baseline, (2) site where PR layer disappeared, and (3) site of the GA margin. These data were processed to calculate the locations of PR losses relative to GA margins and were categorized as (A) bridging across GA margins, (B) entirely within GA margins, or (C) entirely outside GA margins. MAIN OUTCOME MEASURES Location of PR loss (bridging across GA margins, entirely within GA margins, or entirely outside GA margins) was calculated. Distances from the GA margin were measured for beginning and ending of PR loss. Interobserver agreement was determined for categories of PR loss as well as locations of PR loss relative to the GA margin. RESULTS We analyzed 500 unique scans. The PR loss occurred most frequently bridging across the GA margin (65% scans), second most frequently entirely inside the GA margin (29% scans), and least frequently entirely outside the GA margin (6% scans). Loss of PR started an average of 61 microm (standard deviation [SD] +/- 235) outside the GA margin, ended an average of 311+/-273 microm inside the GA margin, and spanned an average of 372+/-179 microm. CONCLUSIONS Relative to GA margins in non-neovascular AMD with GA, SD-OCT provides adequate resolution for quantifying PR loss. It may also serve as a means of tracking disease progression in future interventional trials. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Srilaxmi Bearelly
- The Duke Center for Macular Diseases and Albert Eye Research Institute, Duke University Eye Center, Erwin Road, Durham, NC 27710, USA.
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Cousins SW, Bearelly S, Reinoso MA, Chi SL, Espinosa-Heidmann DG. Dynamic indocyanine green angiography-guided focal thermal laser treatment of fibrotic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2008; 246:1677-83. [DOI: 10.1007/s00417-008-0905-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/23/2008] [Accepted: 06/28/2008] [Indexed: 11/29/2022] Open
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Bearelly S, Mruthyunjaya P, Tzeng JP, Suñer IJ, Shea AM, Lee JT, Kowalski JW, Curtis LH, Schulman KA, Lee PP. Identification of patients with diabetic macular edema from claims data: a validation study. ACTA ACUST UNITED AC 2008; 126:986-9. [PMID: 18625948 DOI: 10.1001/archopht.126.7.986] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in administrative billing data from a convenience sample of physician offices. METHODS A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the kappa statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion. RESULTS The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records (kappa = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84; kappa = 0.64). CONCLUSIONS The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.
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Bearelly S, Espinosa-Heidmann DG, Cousins SW. The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation. Br J Ophthalmol 2007; 92:191-6. [DOI: 10.1136/bjo.2007.118760] [Citation(s) in RCA: 11] [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: 11/04/2022]
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Bearelly S, Cooney MJ, Stinnett S, Fekrat S. Intravitreal triamcinolone for cystoid macular edema related to branch retinal vein occlusion. ACTA ACUST UNITED AC 2007; 38:317-20. [PMID: 17726219 DOI: 10.1007/bf02697214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 11/30/1999] [Accepted: 09/08/2006] [Indexed: 10/22/2022]
Abstract
We retrospectively evaluated the effectiveness of intravitreal triamcinolone in treating 19 eyes with macular edema related to branch retinal vein occlusion (BRVO). Eyes with nonischemic BRVO respond more favorably than those with ischemic BRVO. A single injection of intravitreal triamcinolone led to elevated intraocular pressure in 3 of 19 eyes (16%). Half of phakic eyes had progression of cataract. Retreatment may be necessary.
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Affiliation(s)
- Srilaxmi Bearelly
- Albert Eye Research Institute, Duke University Eye Center, Department of Ophthalmology, Durham, NC 27710, USA.
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Fackler TK, Reddy S, Bearelly S, Stinnett S, Fekrat S, Cooney MJ. Retrospective Review of Eyes with Neovascular Age-related Macular Degeneration Treated with Photodynamic Therapy with Verteporfin and Intravitreal Triamcinolone. Ann Acad Med Singap 2006. [DOI: 10.47102/annals-acadmedsg.v35n10p701] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Aim: To review the outcomes of eyes with neovascular age-related macular degeneration (AMD) treated with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection.
Materials and Methods: We retrospectively reviewed the outcomes of consecutive eyes with neovascular AMD that received an intravitreal triamcinolone injection within 1 week of their first PDT and had at least 6 months of follow-up. Eyes were retreated with PDT at 3-month intervals if angiographic leakage was present.
Results: Twenty-six eyes from 24 patients were identified. The mean visual acuity at baseline was 20/118 (median 20/112). The mean visual acuity decreased to 20/138 at 9 months (P = 0.24, n = 15) and to 20/174 at 12 months (P = 0.23, n = 8). The change in visual acuity from baseline was not statistically significant at any time point. The mean central foveal thickness by OCT measured 342 µm at baseline and decreased to 296 µm at 12 months (P = 0.31). Sixty-two per cent of eyes required no additional PDT at 12 months. Nineteen per cent of 26 eyes had a rise in intraocular pressure that was controlled with topical medication alone.
Conclusion: Photodynamic therapy with verteporfin combined with intravitreal triamcinolone injection in the treatment of neovascular AMD may be superior to PDT alone by decreasing visual loss and reducing the number or retreatments.
Key words: Choroidal neovascularisation, Macular degeneration, Photodynamic therapy,
Triamcinolone, Verteporfin
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Affiliation(s)
| | - Shantan Reddy
- Manhattan Eye, Ear, and Throat Hospital, New York, USA
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Fackler TK, Reddy S, Bearelly S, Stinnett S, Fekrat S, Cooney MJ. Retrospective review of eyes with neovascular age-related macular degeneration treated with photodynamic therapy with verteporfin and intravitreal triamcinolone. Ann Acad Med Singap 2006; 35:701-5. [PMID: 17102894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM To review the outcomes of eyes with neovascular age-related macular degeneration (AMD) treated with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection. MATERIALS AND METHODS We retrospectively reviewed the outcomes of consecutive eyes with neovascular AMD that received an intravitreal triamcinolone injection within 1 week of their first PDT and had at least 6 months of follow-up. Eyes were retreated with PDT at 3-month intervals if angiographic leakage was present. RESULTS Twenty-six eyes from 24 patients were identified. The mean visual acuity at baseline was 20/118 (median 20/112). The mean visual acuity decreased to 20/138 at 9 months (P = 0.24, n = 15) and to 20/174 at 12 months (P = 0.23, n = 8). The change in visual acuity from baseline was not statistically significant at any time point. The mean central foveal thickness by OCT measured 342 microm at baseline and decreased to 296 microm at 12 months (P = 0.31). Sixty-two per cent of eyes required no additional PDT at 12 months. Nineteen per cent of 26 eyes had a rise in intraocular pressure that was controlled with topical medication alone. CONCLUSION Photodynamic therapy with verteporfin combined with intravitreal triamcinolone injection in the treatment of neovascular AMD may be superior to PDT alone by decreasing visual loss and reducing the number or retreatments.
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Affiliation(s)
- Tamara K Fackler
- Duke Eye Center, Albert Eye Research Institute, North Carolina, USA
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Affiliation(s)
- Tamara K Fackler
- Duke Eye Center and Albert Eye Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA
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Joy SV, Scates AC, Bearelly S, Dar M, Taulien CA, Goebel JA, Cooney MJ. Ruboxistaurin, a protein kinase C beta inhibitor, as an emerging treatment for diabetes microvascular complications. Ann Pharmacother 2005; 39:1693-9. [PMID: 16160002 DOI: 10.1345/aph.1e572] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [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: 11/27/2022] Open
Abstract
OBJECTIVE To review current clinical data regarding the pharmacologic actions of ruboxistaurin (LY333531) mesylate, an inhibitor of protein kinase C (PKC) beta, and its role to potentially reduce the development and/or the progression of diabetic microvascular complications. DATA SOURCES Primary literature was obtained via a MEDLINE search (1966-August 2004) and through review of pertinent abstracts and presentations at major medical meetings. STUDY SELECTION AND DATA EXTRACTION Literature relevant to PKC physiology, the pharmacokinetics of ruboxistaurin, and data evaluating the use of ruboxistaurin in treating diabetic microvascular complications in human and relevant animal models was reviewed. DATA SYNTHESIS PKC is part of a group of intracellular signaling molecules activated in response to various specific hormonal, neuronal, and growth factor stimuli. Hyperglycemia leads to PKC beta 1 and 2 isoform activation, which experimentally has been shown to contribute to the development and progression of diabetic microvascular complications (retinopathy, nephropathy, neuropathy) through various biochemical mechanisms. Animal and/or human studies using ruboxistaurin mesylate, a novel, highly selective inhibitor of PKC beta, have shown delay in the progression and, in some cases, reversal of diabetic retinopathy, nephropathy, and neuropathy. CONCLUSIONS Ruboxistaurin mesylate, by inhibiting excessive activation of certain PKC isoforms, has the potential to reduce the burden of microvascular complications for patients with diabetes.
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Affiliation(s)
- Scott V Joy
- Department of Medicine, Duke University Medical Center, Durham, NC 27705-0493, USA
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