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Chow S.-P.,Royal Victorian Eye and Ear Hospital | Chow S.-P.,Royal Melbourne Hospital | Dean M.M.,Red Cross | Depla J.A.,Vitreo Retinal Unit | And 3 more authors.
Clinical and Experimental Ophthalmology

Background: Mannose-binding lectin plays a central effector role in the lectin pathway of complement activation. Frequently occurring MBL2 polymorphisms result in mannose-binding lectin deficiency, which increases susceptibility to infection. We characterized mannose-binding lectin levels and function in non-inflamed and inflamed human eyes, and evaluated its relationship to blood mannose-binding lectin levels and function. Design: Prospective, observational clinical study with controls and cases. Participants: Twenty-seven patients with paired blood and ocular samples (aqueous and/or vitreous) including 15 controls (non-inflamed) and 12 cases (inflamed). Methods: Blood and ocular samples were collected from controls (n=15) with quiet eyes during elective cataract surgery and cases with inflamed eyes including proven/suspected endophthalmitis (n=11) and herpetic retinal vasculitis (n=1). Mannan-binding and C4 deposition enzyme-linked quantify mannose-binding lectin levels and function. Main Outcome Measures: Blood and ocular mannose-binding lectin levels and function. Results: Of 27 patients, 10 (37%) were mannose-binding lectin-deficient (defined as blood mannose-binding lectin levels <500ng/mL). Blood mannose-binding lectin levels (P= 0.16) or function (P= 0.43) were not significantly different between controls and cases. As expected, there was a high correlation between blood mannose-binding lectin levels and function (r 2= 0.74). However, there was significantly more mannose-binding lectin in inflamed eyes than non-inflamed eyes measured as level (P < 0.01) or C4 deposition function (P < 0.01). Conclusions: Our study demonstrated that mannose-binding lectin is significantly elevated in inflamed human eyes but virtually undetectable in non-inflamed control eyes, suggesting a role in sight-threatening ocular inflammation. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists. Source

Varghese M.,Stjohns Medical College And Hospital | Adhyapak S.M.,Vitreo Retinal Unit | Thomas T.,St Johns Research Institute | Sunder M.,Tufts University | Varghese K.,Stjohns Medical College And Hospital
Therapeutic Advances in Cardiovascular Disease

Objectives: The aim of the study was to explore the association between hypertensive retinopathy, grades of retinopathy and cardiac remodelling. Methods: This was a cross-sectional observational study. A total of 500 consecutive hypertensive adults from the in-patient population were studied for the presence of hypertensive retinopathy by dilated fundoscopy. The presence of cardiac remodelling due to hypertension was studied both by electrocardiography (ECG) and echocardiography. Hypertensive target organ damage in other organs was also screened. In addition, the association of grades of hypertensive retinopathy with target organ damage was also analyzed. Results: Systolic blood pressure (BP) at presentation and duration of hypertension showed no relationship with markers of hypertensive heart disease. However, diastolic BP was significantly higher in patients with retinopathy. Hypertensive retinopathy was diagnosed in 324 subjects of whom 90 had grades 3 and 4 retinopathy. Patients with grades 3 and 4 retinopathy had significant associations with ECG evidence of left ventricular (LV) strain pattern and left atrial enlargement, and a weaker association with left ventricular hypertrophy (LVH) using QRS voltage criteria (Sokolov-Lyon). On echocardiography, grades 3 and 4 retinopathy were significantly associated with LVH, left atrial enlargement and reduced left ventricular ejection fraction (LVEF), as well as with higher creatinine values. A large number of these patients presented with heart failure. Cardiac remodelling was not seen in patients without retinopathy and was uncommon in patients with grades 1 and 2 retinopathy. Conclusion: Grades 3 and 4 retinopathy demonstrated a significant association with LV strain pattern and left atrial enlargement on ECG, LVH and reduced LVEF on echocardiography as well as with heart failure. There was no relationship with systolic BP and duration of hypertension, while diastolic BP showed a significant positive correlation. Signs of hypertensive heart disease were practically absent in patients without hypertensive retinopathy and uncommon in those with grade 1-2 alterations. © SAGE Publications. Source

Delyfer M.-N.,French Institute of Health and Medical Research | Delyfer M.-N.,University Pierre and Marie Curie | Delyfer M.-N.,University of Bordeaux 1 | Raffelsberger W.,French National Center for Scientific Research | And 19 more authors.

Background: Retinal detachment often leads to a severe and permanent loss of vision and its therapeutic management remains to this day exclusively surgical. We have used surgical specimens to perform a differential analysis of the transcriptome of human retinal tissues following detachment in order to identify new potential pharmacological targets that could be used in combination with surgery to further improve final outcome. Methodology/Principal Findings: Statistical analysis reveals major involvement of the immune response in the disease. Interestingly, using a novel approach relying on coordinated expression, the interindividual variation was monitored to unravel a second crucial aspect of the pathological process: the death of photoreceptor cells. Within the genes identified, the expression of the major histocompatibility complex I gene HLA-C enables diagnosis of the disease, while PKD2L1 and SLCO4A1 -which are both down-regulated- act synergistically to provide an estimate of the duration of the retinal detachment process. Our analysis thus reveals the two complementary cellular and molecular aspects linked to retinal detachment: an immune response and the degeneration of photoreceptor cells. We also reveal that the human specimens have a higher clinical value as compared to artificial models that point to IL6 and oxidative stress, not implicated in the surgical specimens studied here. Conclusions/Significance: This systematic analysis confirmed the occurrence of both neurodegeneration and inflammation during retinal detachment, and further identifies precisely the modification of expression of the different genes implicated in these two phenomena. Our data henceforth give a new insight into the disease process and provide a rationale for therapeutic strategies aimed at limiting inflammation and photoreceptor damage associated with retinal detachment and, in turn, improving visual prognosis after retinal surgery. © 2011 Delyfer et al. Source

Nadal J.,Macula Unit | Delas B.,Vitreo Retinal Unit | Pinero A.,Vitreo Retinal Unit

PURPOSE: To report the results of vitrectomy with internal limiting membrane peeling and C3F8 tamponade for macular hole without postoperative face-down posturing in 208 eyes. METHODS: The study included 208 eyes on an uncontrolled retrospective review, undergoing pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and C3F8 tamponade, without subsequent face-down posturing. All patients were followed-up at 1 day, 1 week, 3 months, and 12 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 1 day, 1 week, 3 months, and 12 months postoperatively. Pre-and postoperative visual acuity by Snellen chart was compared. RESULTS: In 208 eyes with idiopathic macular hole, preoperative mean visual acuity was 20/200 and final visual acuity was 20/40 (P = 0.00017). Anatomic macular hole closure rate was 81.3%. CONCLUSION: In agreement with published studies, combined phacovitrectomy without face-down posturing after macular hole surgery seems effective and safe, showing anatomical improvement and favorable best-corrected visual acuity. Isolating the macula from vitreous fluid with a large long-lasting gas-fill may render postoperative posturing unnecessary. Eliminating face-down posturing may increase patient acceptance and compliance. Copyright © by Ophthalmic Communications Society, Inc. Source

Shah N.,Vitreo Retinal Unit | Laidlaw D.A.H.,Vitreo Retinal Unit | Laidlaw D.A.H.,Eye and Mouth Unit | Shah S.P.,London School of Hygiene and Tropical Medicine | And 3 more authors.
Investigative Ophthalmology and Visual Science

Purpose. The goals of this study were to investigate the effectiveness of computerized repeating and averaging of visual acuity measurements in reducing test-retest variability (TRV) and to estimate the increase in sensitivity and specificity that would be achieved in diagnosing visual acuity change. Methods. Timed, paired ETDRS chart and computerized acuity mean measurement (CAMM) were performed in 100 subjects. CAMM(n) scores were the running mean of consecutive measurements. Bland-Altman methods were used to calculate 95% ranges for TRV. Results. The 95% TRV range of ETDRS measurements and the CAMM score after 6 (CAMM6) measurements were, respectively, 8 and 5.7 ETDRS letters (P = 0.02). CAMM6 offered a pragmatically optimum tradeoff between reduced TRV and test time. A measured change of 5 letters or more in the absence of true change was observed in 13% (95% CI, 8%-21%) with the ETDRS chart and 4% (95% CI, 2%-10%) with CAMM6 measurements. To achieve ≥95% test sensitivity (assuming 95% test specificity), change criteria of 15 and 11 letters must be set with an ETDRS chart and CAMM6, respectively. CAMM6 measurement times were longer (mean 234 seconds vs. 74 seconds) for the ETDRS chart. Conclusions. Compared with the current gold standard, computerized repeating and averaging of acuity measurements improve specificity and sensitivity when identifying true changes. The 160-second increase in test time should be set against the considerable economic and clinical benefits that may result. © 2011 The Association for Research in Vision and Ophthalmology, Inc. Source

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