Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report

Hyperhomocysteinemia (HHcy) affects bone remodeling since destructive process in cortical alveolar bone has been linked with it, however; the mechanism remains at large. HHcy increases pro-inflammatory cytokines viz. TNF-α, IL-1b, IL-6 and IL-8 that leads to a cascade that negatively impacts methionine-metabolism and homocysteine cycling. Further, chronic inflammation decreases vitamins B12, B6 and folic acid that are required for methionine-homocysteine homeostasis. This study aims to investigate a HHcy mouse model (cystathionine β-synthase deficient; CBS+/-) for studying the potential pathophysiological changes, if any, in the periodontium (gingiva, periodontal ligament, cement and alveolar bone). We compared periodontium, side-by-side; CBS+/- model with that of wild-type; WT (C57BL/6J) mice. Histology and histomorphometry of mandibular bone along with gene expression analyses were carried out. Also, pro-angiogenic proteins and metalloproteinases were studied. To our knowledge, this research shows, for the first time, a direct connection between periodontal disease during CBS deficiency thereby suggesting the existence of disease drivers during hyperhomocysteinemic condition. Our findings offer opportunities to develop diagnostics/therapeutics for the people who suffer from chronic metabolic disorders like HHcy.

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Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Gupta,

Singla,

Gupta

et al. 2024

Annals of Cardiac Anaesthesia

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Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross-clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro-embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro-embolization, inflammation, hemodilution, and hypothermia. While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.

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Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report

Cited by 3 publications

References 32 publications

Hyperhomocysteinemia and low folate levels as the only risk factors in pseudo-Foster Kennedy syndrome

Hyperhomocysteinemia and low folate levels as the only risk factors in pseudo-Foster Kennedy syndrome

Hyperhomocysteinemia: an instigating factor for periodontal disease

Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

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