Cancer is associated with a 2.7 higher risk for intravitreal injection therapy in patients with age-related, diabetic, or vascular occlusive macular edema

Non peer reviewe

Silmätoimenpiteet Suomessa vuosina 2010-2016

Vertaisarvioitu. English summary.Lähtökohdat : Tavoitteena oli saada tietoa silmän osa-alueiden toimenpiteiden merkityksestä ja painoarvosta, alueellisesta määrästä ja ajallisista trendeistä vuosina 2010–2016. Menetelmät : Tutkimusaineiston muodosti THL:n rekisteri, joka kattoi kaikki silmän osa-alueet pohjoismaisen kirurgisen luokituksen mukaisesti. Tulokset : Silmätoimenpiteitä tehtiin eniten Helsingin erityisvastuualueella (37,9 %) ja toiseksi eniten ¬Kuopiossa (18,7 %). Määrällisesti eniten tehtiin kaihikirurgiaa (n = 278 148) ja silmänsisäisiä pistoshoitoja ¬(n = 215 898), joista valtaosa annettiin silmänpohjan kostean ikärappeuman (n = 155 184) tai diabeettisen makulopatian ¬takia (n = 27 774). Neljä yleisintä toimenpidettä – kaihileikkaus, lasiaispistoshoito, verkkokalvon laserhoito ¬ja ¬jälkikaihin avaus – kattoivat 77,6 % kaikista. Toimenpiteistä tai leikkauksista vain 1,3 % johtui silmän ¬seudun tai silmämunan tapaturmasta. Päätelmät : Silmätoimenpiteiden määrät lisääntyivät tutkimusjakson aikana vuosittain jokaisella ¬erityis¬vastuualueella. Kliiniset laaturekisterit olisivat tarpeen arvioitaessa määrällisesti yleisimpien ¬toimenpiteiden vaikuttavuutta.Peer reviewe

Early middle age cholesterol levels and the association with age-related macular degeneration

Purpose To examine whether serum cholesterol in early middle age is associated with age-related macular degeneration (AMD) later in life. Methods A group of Helsinki Businessmen Study (HBS) participants (n = 209) were recruited for the study. Total cholesterol (TC), triglyceride and body mass index (BMI) were measured at the HBS baseline visit in 1964-1973. Lipid subfractions, BMI, smoking status and statin use were recorded in 2011 and fundus photographs graded for AMD in 2005-2012. The subjects were genotyped for the main AMD risk single nucleotide polymorphisms (SNPs). Results TC measured at baseline 1964-1973 was significantly higher in subjects later developing intermediate or late AMD (6.67 mmol/l versus 6.20 mmol/l, p = 0.024) or with drusen size of >= 125 mu m (6.68 mmol/l versus 6.21 mmol/l, p = 0.030) compared with the rest of the study population. TC, LDL and TG values at follow-up 2011 were lower in subjects with AMD compared to those without, whereas HDL levels showed no difference. In multivariate analysis, baseline TC associated with intermediate or late AMD (OR 1.59, p = 0.004) and drusen size >= 125 mu m (OR 1.57, p = 0.006) when corrected for age, BMI, AMD risk SNPs and smoking. Lipid values measured 2011 had no associations after correction. Conclusions High systemic total cholesterol in early middle age may have a role in the initial development of AMD, especially in patients later developing large drusen.Peer reviewe

Statin medication in patients with epiretinal membrane is associated with low intravitreal EPO, TGF-beta-1, and VEGF levels

Peer reviewe

Topical levofloxacin, nepafenac and prednisolone acetate medication after cataract surgery in the biggest tertiary eye hospital in Finland during 2015-2018

Non peer reviewe

A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland

Peer reviewe

Diabetes mellitus and risk of open-angle glaucoma-A population-based follow-up study

Purpose The aim of this study was to investigate the association of diabetes mellitus (DM) and risk of open-angle glaucoma (OAG). Methods This population-based historic cohort consisted of individuals at age >= 40 years with DM treatment initiated 2001-2010 and a reference population matched by age, gender and hospital district. Incidence of OAG was compared between individuals with DM and their matched non-diabetic reference pairs. New glaucoma cases were identified from medication reimbursement certificates and hospital billing records. Incidence rate ratios (IRR) were analysed with Poisson regression models adjusted for age, sex, hospital district, socioeconomic status, systemic medications and chronic diseases. We analysed the sensitivity of the results with adapted input variables and performed a competing events analysis. Results Of the 244 100 study subjects meeting inclusion criteria, 2721 (1.1%) developed OAG. Follow-up spanned from 2001 to 2017. DM was associated with a modestly reduced incidence of OAG when adjusted for confounding factors (IRR 0.92, CI 0.85-0.99). Conclusions In our longitudinal population-based study, we found a modest decrease in the risk of OAG for individuals with DM.Peer reviewe

Lymphatic Vascular Structures : A New Aspect in Proliferative Diabetic Retinopathy

Diabetic retinopathy (DR) is the most common diabetic microvascular complication and major cause of blindness in working-age adults. According to the level of microvascular degeneration and ischemic damage, DR is classified into non-proliferative DR (NPDR), and end-stage, proliferative DR (PDR). Despite advances in the disease etiology and pathogenesis, molecular understanding of end-stage PDR, characterized by ischemia- and inflammation-associated neovascularization and fibrosis, remains incomplete due to the limited availability of ideal clinical samples and experimental research models. Since a great portion of patients do not benefit from current treatments, improved therapies are essential. DR is known to be a complex and multifactorial disease featuring the interplay of microvascular, neurodegenerative, metabolic, genetic/epigenetic, immunological, and inflammation-related factors. Particularly, deeper knowledge on the mechanisms and pathophysiology of most advanced PDR is critical. Lymphatic-like vessel formation coupled with abnormal endothelial differentiation and progenitor cell involvement in the neovascularization associated with PDR are novel recent findings which hold potential for improved DR treatment. Understanding the underlying mechanisms of PDR pathogenesis is therefore crucial. To this goal, multidisciplinary approaches and new ex vivo models have been developed for a more comprehensive molecular, cellular and tissue-level understanding of the disease. This is the first step to gain the needed information on how PDR can be better evaluated, stratified, and treated.Peer reviewe

Statin use and the reoperation rates in glaucoma filtration surgery - population-based cohort study

Purpose To examine the association of systemic statin therapy and reoperation rate after glaucoma filtration surgery (GFS). Methods This is a population-based, historic cohort study of 2705 eyes undergoing GFS in Finland between July 2009 and December 2016. GFSs were identified from national administrative healthcare registers. Baseline sociodemographic and health characteristics were documented. Reoperation rates of GFS subgroups were analysed, with statin users compared to non-users. The outcomes were modelled using a Poisson regression model adjusted for age, sex, education, statin use, chronic comorbidities, and cataract surgery with incident rate ratios (IRR) as the main outcome measure. Results The cohort contained 2263 subjects with open-angle glaucoma (OAG), 823 men and 1440 women. Surgery was performed on 2705 eyes. First documented procedures: deep sclerectomy (DS) (n = 1601), trabeculectomy (TRE) (799) and glaucoma drainage device (GDD) implantation (305) respectively. In total, 438 secondary operations were performed during the 7.5-year (median 2.25 years) follow-up period. The reoperation rates were 19% after DS, 12% after TRE, and 13% after GDD. Of the surgical procedures, 32% were performed on eyes of patients receiving statin therapy. Statin users showed no difference in reoperation rates (IRR 1.06, CI 0.82-1.37). In subgroups, no difference was observed in the reoperation rates adjusted with statin use after filtration surgery (DS, TRE) (IRR 1.06, CI 0.8-1.40) or GDD implantation (0.57, CI 0.20-1.63). Conclusion Systemic statin therapy among surgically treated OAG patients had no impact on secondary surgery rates following DS, TRE or GDD implantation.Peer reviewe

Deregulation of ocular nucleotide homeostasis in patients with diabetic retinopathy

Clear signaling roles for ATP and adenosine have been established in all tissues, including the eye. The magnitude of signaling responses is governed by networks of enzymes; however, little is known about the regulatory mechanisms of purinergic signaling in the eye. By employing thin-layer chromatographic assays with 3H-labeled substrates, this study aimed to evaluate the role of nucleotide homeostasis in the pathogenesis of vitreoretinal diseases in humans. We have identified soluble enzymes ecto-5'-nucleotidase/CD73, adenylate kinase-1, and nucleoside diphosphate kinase in the vitreous fluid that control active cycling between proinflammatory ATP and anti-inflammatory adenosine. Strikingly, patients with proliferative form of diabetic retinopathy (DR) had higher adenylate kinase activity and ATP concentration, when compared to non-proliferative DR eyes and non-diabetic controls operated for rhegmatogenous retinal detachment, macular hole, and pucker. The non-parametric correlation analysis revealed positive correlations between intravitreal adenylate kinase and concentrations of ATP, ADP, and other angiogenic (angiopoietins-1 and -2), profibrotic (transforming growth factor-similar to 1), and proteolytic (matrix metalloproteinase-9) factors but not erythropoietin and VEGF. Immunohistochemical staining of postmortem human retina additionally revealed selective expression of ecto-5'-nucleotidase/ CD73 on the rod-and-cone-containing photoreceptor cells. Collectively, these findings provide novel insights into the regulatory mechanisms that influence purinergic signaling in diseased eye and open up new possibilities in the development of enzyme-targeted therapeutic approaches for prevention and treatment of DR.Peer reviewe