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   Table of Contents      
EDITORIAL
Year : 2014  |  Volume : 62  |  Issue : 6  |  Page : 669-670

Diagnostic enigmas of retinopathy: New dimensions


Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala, Mumbai, Maharashtra, India

Date of Web Publication8-Jul-2014

Correspondence Address:
Sundaram Natarajan
Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.136203

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How to cite this article:
Natarajan S. Diagnostic enigmas of retinopathy: New dimensions. Indian J Ophthalmol 2014;62:669-70

How to cite this URL:
Natarajan S. Diagnostic enigmas of retinopathy: New dimensions. Indian J Ophthalmol [serial online] 2014 [cited 2019 Oct 16];62:669-70. Available from: http://www.ijo.in/text.asp?2014/62/6/669/136203

Dear Friends,

Diabetic retinopathy is the most serious ophthalmic complication of diabetes mellitus (DM). Although the diagnosis and treatment, target the vascular abnormalities in proliferative diabetic retinopathy (PDR), it is actually the concurrent inflammation and neurodegeneration that precipitates PDR. The common feature in a PDR is neovascularization that leads to visual loss due to vitreous hemorrhage, tractional retinal detachment, and glaucoma. [1] Several classes of growth factors have been implicated to be upregulated resulting in neovascularization, one of which is interleukins. Cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-10 (IL-10) and interferon-gamma (IF-γ) regulate cells and have immune and inflammatory properties. [2] These inflammatory mediators induce oxidative stress within the retinal cells and induce nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), leading to diabetic retinopathy. [3] Also, they stimulate the collagen synthesis including the glial cells and fibroblasts resulting in proliferation and contraction. Many studies have attempted to establish the association between serum interleukin levels and PDR, but hardly any exists on vitreous levels. [4],[5] Mao et al., in this issue evaluated the levels of vitreous IL-1β and IL-10 in patients with PDR using a cohort study design. The authors have found elevated levels of both IL-1β and IL-10 in patients with PDR as compared to normal controls. The same has been confirmed by previous studies with IL-1β antagonist too. [6] The study is limited in assessing only these two cytokines while a large prospectively controlled study evaluated around 27 cytokines including IL-1β, monocyte chemoattractant protein-1, IF-γ-induced protein-10 and vascular endothelial growth factor (VEGF) which have been found to be elevated. [7] Nevertheless, the present study may pave the way for evaluating these new targets in managing diabetic retinopathy.

DM can damage the optic nerve by either raising the intraocular pressure or by causing optic neuropathy. [8] As the diabetic retinopathy leads to a severe, irreversible visual loss, research is underway in early detection of the condition. One of the changes that serve as a signal is the intra retinal layer segmentation. [9] Demir et al., in this issue evaluated the thickness of retinal nerve fiber length and ganglion cell complex in patients with type 2 diabetes mellitus (T2DM) using optic coherence tomography (OCT). The authors have found a nonsignificant thinning of the retinal layers irrespective of diabetic retinopathy status. The literature is inconclusive about this entity in patients with DM. Previous studies have found either no change in the thickness of these layers or only segmental changes. [10],[11] This necessitates a large controlled study to be undertaken in this arena.

Hypertension is another leading cause of retinopathy. Not only has it led to visual impairment but is also a risk indicator of systemic morbidity and mortality. [12] Hypertensive retinal vascular signs can manifest as arteriolar changes such as generalized/focal arteriolar narrowing, arteriovenous nicking and arteriolar wall opacification or can be more advanced retinopathy lesions like microaneurysms, blot and flame-shaped hemorrhages, cotton-wool spots, hard exudates, and optic disk swelling. [13] Of these signs except for optic disk swelling, all others remain nonspecific in diagnosing the condition. As there is a change in the resistance of the orbital arteries, recent studies focus on evaluating the same in hypertensive patients. [14],[15] But these studies are limited in recruiting a mix population of hypertensive individuals irrespective of their age and ophthalmic complications of hypertension where the findings may differ. Akal et al., in this issue published a study which evaluated the resistive index (RI) in geriatric population comparing those with and without retinopathy using color doppler imaging. The authors have found an increase in RI of posterior cerebral artery in hypertensive patients as compared to controls, indicating that it can be an early marker for orbital complications in hypertension.

As we look at the pandemic of DM, it would be immensely beneficial to look at ways to prevent these complications caused by oxidative stress rather than just scavenge the free radicals.

Happy Reading!!!

 
  References Top

1.
Demircan N, Safran BG, Soylu M, Ozcan AA, Sizmaz S. Determination of vitreous interleukin-1 (IL-1) and tumour necrosis factor (TNF) levels proliferative diabetic retinopathy. Eye (Lond) 2006;20:1366-9.  Back to cited text no. 1
    
2.
Abcouwer SF. Angiogenic factors and cytokines in diabetic retinopathy. J Clin Cell Immunol 2013;Suppl 1.  Back to cited text no. 2
    
3.
Baeuerle PA. The inducible transcription activator NF-kB: Regulation by distinct protein subunits. Biochim Biophys Acta 1991;1072:63-80.  Back to cited text no. 3
[PUBMED]    
4.
Funatsu H, Yamashita H, Ikeda T, Mimura T, Eguchi S, Hori S. Vitreous levels of interleukin-6 and vascular endothelial growth factor are related to diabetic macular edema. Ophthalmology 2003;110:1690-6.  Back to cited text no. 4
    
5.
Ozturk BT, Bozkurt B, Kerimoglu H, Okka M, Kamis U, Gunduz K. Effect of serum cytokines and VEGF levels on diabetic retinopathy and macular thickness. Mol Vis 2009;15:1906-14.  Back to cited text no. 5
    
6.
Kowluru RA, Odenbach S. Role of interleukin-1beta in the pathogenesis of diabetic retinopathy. Br J Ophthalmol 2004:88:1343-7.  Back to cited text no. 6
    
7.
Dong N, Xu B, Wang B, Chu L. Study of 27 aqueous humor cytokines in patients with type 2 diabetes with or without retinopathy. Mol Vis 2013;19:1734-46.  Back to cited text no. 7
    
8.
Ozdek S, Lonneville YH, Onol M, Yetkin I, Hasanreisoglu BB. Assessment of nerve fiber layer in diabetic patients with scanning laser polarimetry. Eye (Lond) 2002;16:761-5.  Back to cited text no. 8
    
9.
Cabrera DeBuc D, Somfai GM. Early detection of retinal thickness changes in diabetes using Optical Coherence Tomography. Med Sci Monit 2010;16:MT15-21.  Back to cited text no. 9
    
10.
Shahidi AM, Sampson GP, Pritchard N, Edwards K, Vagenas D, Russell AW, et al. Retinal nerve fibre layer thinning associated with diabetic peripheral neuropathy. Diabet Med 2012;29:e106-11.  Back to cited text no. 10
    
11.
Sugimoto M, Sasoh M, Ido M, Wakitani Y, Takahashi C, Uji Y. Detection of early diabetic change with optical coherence tomography in type 2 diabetes mellitus patients without retinopathy. Ophthalmologica 2005;219:379-85.  Back to cited text no. 11
    
12.
Wong TY, McIntosh R. Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality. Br Med Bull 2005;73:57-70.  Back to cited text no. 12
    
13.
Wong TY, Klein R, Klein BE, Tielsch JM, Hubbard LD, Nieto FJ. Retinal microvascular abnormalities, and their relation to hypertension, cardiovascular diseases and mortality. Surv Ophthalmol 2001;46:59-80.  Back to cited text no. 13
    
14.
Ahmetoðlu A, Erdöl H, Simþek A, Gökçe M, Dinç H, Gümele HR. Effect of hypertension and candesartan on the blood flow velocity of the extraocular vessels in hypertensive patients. Eur J Ultrasound 2003;16:177-82.  Back to cited text no. 14
    
15.
Karadeniz-Bilgili MY, Ekmekci Y, Koksal A, Akarsu C, Ziraman I. Effects of hypertension and antihypertensive treatment on retrobulbar circulation detected on Doppler sonography. J Ultrasound Med 2004;23:13-7.  Back to cited text no. 15
    




 

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