Eva Vlková

Duration of Non-Insulin-Dependent Diabetes mellitus and the TNF-β NcoI Genotype as Predictive Factors in Proliferative Diabetic Retinopathy

The object of the study was to investigate the share of the polymorphisms I/D ACE, endothelin 1 4127G/A and TNF-β NcoI in the susceptibility to proliferative diabetic retinopathy (PDR) in non-insulin-dependent diabetes mellitus (NIDDM). Genotypes were detected by polymerase chain reactions and determined in a set of 246 Caucasian NIDDM subjects with defined PDR status. The relevance of genotypes and clinical characteristics to the PDR occurrence was tested using multiple linear regression models and discrimination analysis. The best predictive value for PDR was given by a combination of two parameters – NIDDM duration and the TNF-β genotype (p < 1·10–6 and p = 1·10–2, respectively) with a correct retrograde prediction of 82.6%. A comparison of the TNF-β NcoI allele frequencies revealed no difference between NIDDM and nondiabetic subjects (n = 176), but a statistically significant difference was found between PDR and non-PDR NIDDM subjects (after a correction for the number of comparisons p = 0.03), allele β2 being associated with PDR. Our results identified the allele variant TNF-β2 being associated with PDR in NIDDM. Diabetes duration and the TNF-β NcoI genotype were proven to significantly predict PDR occurrence. The TNF-β2 allele could be regarded as a separate genetic risk factor that increases the relative incidence of PDR in patients with NIDDM.

Polymorphisms 1704G/T, 2184A/G and 2245G/A in the RAGE gene are not associated with diabetic retinopathy in NIDDM - Pilot study

Pilot study perfromed on 531 Caucasian subjects proved that intron polymorphisms 1704G/T, 2184A/G and 2245G/A in the gene encoding receptor of advanced glycation end products (RAGE) are not associated with proliferative diabetic retinopathy in NIDDM.

CD36 gene is associated with intraocular pressure elevation after intravitreal application of anti-VEGF agents in patients with age-related macular degeneration: Implications for the safety of the therapy

ABSTRACT Background: The wet form of age-related macular degeneration (AMD) is characterized by pathological vascularization of the outer retinal layers. The condition responds to treatment with antibodies against vascular endothelial growth factor (VEGF), but the patients receiving such anti-VEGF therapy sometimes show undesirable acute short-term increases in the intraocular pressure (IOP). The cause of this adverse effect is unknown, and here, we are testing a hypothesis that it is related to CD36 gene polymorphisms. Materials and Methods: A group of 134 patients with AMD were given three therapeutic doses of anti-VEGF antibody (ranibizumab) at monthly intervals. Their IOP was measured immediately before and 30 min after each injection. Patients’ DNA was analyzed, and the changes in IOP were matched against seven polymorphisms of the CD36 gene. Results: Three polymorphisms were found to be associated with increases in IOP: rs1049673 (p = 0.006), rs3211931 (p = 0.01), and rs1761667 (p = 0.043) at the time of the third injection only. Pronounced elevations (IOP > 25 mmHg) were associated with rs1049673 polymorphism: GC genotype (p < 0.01) and CC genotype (p < 0.05); both increasing the risk 2.6-fold, the presence of C-allele conferring a 1.5-fold greater risk and with rs3211931 polymorphism: AG genotype (p < 0.01) and GG genotype (p < 0.05); increasing the risk 2.6-fold (AG) and 2.7-fold (GG). Conclusions: CD36 receptor may be involved in mediating the effects of VEGF on IOP. The findings will help to identify the patients at risk of acutely elevated IOP following the anti-VEGF therapy.

Implantation of posterior chamber phakic intraocular lens for myopia and hyperopia - long-term clinical outcomes

PURPOSE To evaluate long-term refractive outcomes of implantable collamer lens (ICL) implantation and late postoperative complications. METHODS We assessed outcomes of patients who underwent ICL implantation (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. It comprised 62 eyes (40 myopic and 22 hyperopic). The average follow-up period was 10.5 years. We evaluated: uncorrected and best-corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), ICL vault, endothelial cell density and late postoperative complications. RESULTS In myopes, the average UCVA was 1.0±0.37 and BCVA 1.18±0.38, in hyperopes 0.78±0.19 and 1.14±0.18, respectively. The average SE in myopes, whose target refraction was emmetropia, was -0.6±0.83 Dsf, in hyperopes +0.73±0.93. Central ICL vault was 206.16μm±105.94, (range 10-427) in myopes, 195.5μm±109.09, (range 20-404) in hyperopes. The most common late postoperative complication was cataract formation. Three myopic eyes (7.5%) developed symptomatic anterior subcapsular opacities with loss of at least two lines of BCVA. Cataract significantly affecting visual acuity occurred in 5 myopic eyes (12.5%) and 2 hyperopic eyes (9.09%). In these eyes, ICL removal and cataract surgery was performed. CONCLUSIONS In our experience, ICL implantation in moderate and high ametropia was effective and relatively safe. The most common late complication was cataract formation. This complication can be managed effectively surgically with good refractive outcomes without loss of BCVA.

Utilization of mathematical processing of retinal images with use of adaptive contrast control (ACC) method to detect quantity of vascular endings

Purpose The authors investigated whether the method of mathematical processing of retinal images with the use of a computer can be used to evaluate ocular background figures of patients with physiologic retinal findings. This method is based on identification of vascular endings in an examined retinal area. When the authors mention vascular endings, they do not refer to factual endings, but recognizable vascular endings; there are no endings in a vascular system. Methods Adaptive contrast control (ACC) method was used to determine a number of vascular endings. The method is based on mathematical processing of a digitized retina picture with the use of a computer. On a digitized retinal picture, the vascular system is identified with the use of the conditional erosion methodology, and the number of vascular endings is then determined. The ACC method was used to process a file of retinal pictures of 38 patients (76 eyes) with physiologic retinal findings. Results Based on the results of statistical analysis, the authors detected that the number of vascular endings showed a normal curve (Gaussian distribution, p=0.05). A tight correlation between quantities of vascular endings in the right and the left eyes was also detected, which means that the quantity of vascular endings in the right and the left eyes is in a very close correlation (p=0.05). Conclusions The authors highlight that the curve of the number of vascular endings of patients with physiologic retinal findings shows a Gaussian distribution.