A study on relationship between severity of diabetic retinopathy and subclinical hypothyroidism

Background: Subclinical hypothyroidism (SCH) is defined as an asymptomatic condition characterized by normal serum levels of free thyroxine and elevated serum concentration of thyrotropin (>4.0µIU/ml). Association between diabetic retinopathy and SCH is unclear. Aim was to study the relationship between severity of diabetic retinopathy and SCH in patients of diabetic retinopathy with type 2 diabetes mellitus.Methods: 120 patients of diabetic retinopathy with known type 2 diabetes mellitus were taken and categorized them according to severity of diabetic retinopathy as per ETDRS classification. Serum thyrotropin (TSH) and free thyroxine (FT4) concentration were measured in all 120 patients. Patients with normal TSH and FT4 values are euthyroid patients and those with normal FT4 but TSH value >4µIU/ml are considered as having subclinical hypothyroidism. Severity of diabetic retinopathy is compared between the euthyroid and subclinical hypothyroid group.Results: Out of the 120 patients included in the study, 72 (60%) were male and 48 (40%) were female. 97 patients (80.83%) were Euthyroid and 23 patients (19.17%) had subclinical hypothyroidism. It was observed that prevalence of more severe form of diabetic retinopathy (severe NPDR and PDR) was higher in SCH group as compared to euthyroid group. Severity of diabetic retinopathy was compared with serum TSH level and it was seen that severity of diabetic retinopathy significantly increases with increase in serum TSH value.Conclusions: Patients with SCH had more severe form of diabetic retinopathy as compared to patients with euthyroidism. Severity of diabetic retinopathy significantly increases with increase in serum TSH value

Association between C-reactive protein and age-related macular degeneration

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment among the elderly, worldwide affecting 30-50 million individuals. Inflammation is now increasingly thought to be a key risk factor for AMD. The association of CRP with AMD has been reported in only a few studies, with somewhat inconsistent results. The present study was undertaken to determine the association between AMD and serum CRP levels.Methods: A total of 53 patients diagnosed of any form of AMD fulfilling inclusion and exclusion criteria were included. A 5 mL sample of venous blood (non-fasting) was collected to determine serum high-sensitivity CRP levels (hsCRP). Different stages of AMD and serum hs CRP level were compared using one-way ANOVA test and calculated p value <0.05 was considered as statistically significant. Comparison between the two groups, one with risk factor and one without risk factor was performed using student-t test and calculated p value <0.05 was considered statistically significant.Results: Out of 53 patients 21 were having early AMD, 21 were having intermediate AMD and 11 were having advanced AMD. The mean serum hs CRP level was 0.14±0.05 mg/dL, 0.20±0.09 mg/dL and 0.28±0.08 mg/dL in early, intermediate and advanced AMD respectively. When statistically analysed the difference of mean serum hs CRP level among the three groups was found to be statistically significant.Conclusions: Type of AMD influence the baseline hsCRP level. Smoking and diabetes are associated with higher baseline serum hsCRP in all stages of AMD

A clinical study of optic nerve involvement in patients with tuberculosis attending a tertiary health care center in North East

 Background: To screen for ocular finding of optic nerve involvement in patients with tuberculosis and documents these findings.Methods: The hospital based observational study was carried out in a tertiary care hospital in Assam  for  the duration of July 2018 to June 2019 in 384 diagnosed cases of tuberculosis patients who fulfil  the inclusion criteria during the study period.Results: 11 cases with optic nerve involvement was found out of 384 tuberculosis patients. Most common presenting complain was blurring of vision. Unilateral involvement was maximum. Most common finding was disc oedema.  Ocular TB cases was higher in extrapulmonary TB patients.Conclusions: Diagnosis of ocular Tb is mainly presumptive, based on history, clinical examination, adjunctive diagnostic tests and response to anti tuberculous therapy. Amongst 384 TB cases ocular manifestations were found in 11 cases and therefore, we can conclude that ocular manifestations hold significance in extra pulmonary manifestations of TB. So, TB patients need to have routine ocular examination for the early diagnosis and timely management

Evaluation of thickness of retinal nerve fiber layer and ganglion cell layer with inner plexiform layer in patients without diabetic retinopathy and mild diabetic retinopathy in type 2 diabetes mellitus patients using spectral-domain optical coherence tomography

Background: A widely accepted pathogenesis of DR consists of microvascular abnormalities. However recent investigations have demonstrated neurodegenerative alterations before the appearance of microvascular changes in patients with DM. Aim of the study was to evaluate thickness of retinal nerve fiber layer and ganglion cell layer with inner plexiform layer in patent without diabetic retinopathy and mild diabetic retinopathy in type 2 diabetic patients using spectral domain optical coherence tomography.Methods: Thirty patients with type 2 diabetes mellitus without diabetic retinopathy, 30 with mild diabetic retinopathy and 30 healthy controls are taken considering inclusion and exclusion criteria. GCL-ILM and RNFL thickness was measured in each individual and measurements were compared using one way ANOVA test and Pearson’s correlation was performed to evaluate the linear correlation between variables and calculated p value &lt;0.05 was regarded as significant.Results: The average RNFL thickness was 86.18±8.44μm and 91.79±4.77μm in diabetic patients and controls respectively (p=0.002). Furthermore, for two different groups of diabetic patients, the average RNFL thickness was 86.74±11.18μm in the no DR group and 85.62±11.10μm in the mild DR group (p=0.697). The average GCL-IPL thickness was 79.95±4.32μm and 84.66±3.26μm in diabetic patients and controls, respectively (p=&lt;0.001). Furthermore, for two different groups of diabetic patients, the average GCL-IPL thickness was 80.15±5.78μm in the no DR group and 79.75±5.70μm in the mild DR group (p=0.788).Conclusions: There was a statistically significant reduction of the mean GCL-IPL and RNFL thickness in type 2 diabetic patients with no or mild DR compared with a homogenous control group indicating neuroretinal changes occur before vascular changes of diabetic retinopathy. But the correlation of average RNFL thickness and GCL-IPL thickness was not statistically significant with the duration of diabetes and HbA1c value