Retinal vascular signs in diabetes and hypertension - review

Mendonça²,

et al. 2016

Acta Cir. Bras.

PURPOSE:To evaluate the effects of low intensity ultrasound on the healing process of third degree burn wounds in experimentally induced diabetic Wistar rats. METHODS:One hundred rats were divided into: control group; non-diabetic treated group; diabetic control group; diabetic treated group. The therapy was performed with a 3MHz ultrasound application, pulsed emission at 100Hz frequency, modulated at 20% with a dosage of 0.5W/cm 2 during three minutes throughout 30 days. The surgical debridement of the wound was performed once at day 2. The wounds were morphometrically, macroscopically and microscopically evaluated at 3, 7, 14, 21 and 30 days. RESULTS:The wound contraction and collagen quantification were higher in all treated groups. Macroscopically, necrosis was higher in the diabetic control group. Granulation tissue was higher in treated groups during the proliferative and remodeling phase.Microscopically, there were greater mononuclear inflammatory infiltration, angiogenesis and fibroblast quantification in treated groups during the proliferative and remodeling phases.CONCLUSIONS: therapeutic ultrasound is beneficial in the inflammatory and proliferative phases of the healing process because it controlled the necrotic tissue, increased the granulation tissue and wound contraction. However in the remodeling phase it is not beneficial because of the continued angiogenesis and a mononuclear inflammatory infiltration.

supporting

confidence: 88%

Low intensity ultrasound therapy induces angiogenesis and persistent inflammation in the chronic phase of the healing process of third degree burn wounds experimentally induced in diabetic and non-diabetic rats

Mendonça²,

et al. 2016

Acta Cir. Bras.

“…7 Hypertension is associated with arteriosclerosis, atherosclerosis, retinal vessel wall damage, and thromboembolism, all of which contribute to the development of RAO. 35–37 In addition, several studies disclosed that patients with ESRD and hypertension exhibit accelerated carotid atherosclerosis, 24,38 which is the leading cause of embolism and consequent RAO. Therefore, ESRD patients with hypertension should be advised about blood pressure control.…”

Section: Discussionmentioning

confidence: 99%

Risk of Retinal Artery Occlusion in Patients With End-Stage Renal Disease

et al. 2016

There is globally increasing prevalence and incidence in end-stage renal disease (ESRD). These patients are frequently reported to have retinal abnormalities and both diseases share some systemic risk factors. Hence, it is clinically relevant to determine whether ESRD is a predictor of retinal artery occlusion (RAO).To investigate the risk of RAO in ESRD patients.A retrospective, nationwide, matched cohort study. The study included 93,766 ESRD patients recruited between 2000 and 2009 from the Taiwan National Health Insurance Research Database. The same number control group included age- and sex-matched patients without ESRD selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2011.The incidence and risk of RAO were compared between the 2 groups. The hazard ratio (HR) for RAO after adjustment for potential confounders was calculated using Cox proportional hazards regression. Kaplan–Meier analysis was used to calculate the cumulative RAO incidence rate.In total, 237 ESRD patients and 73 controls exhibited RAO during follow-up; thus, the RAO incidence rate in ESRD patients was 4.49 times (95% confidence interval (CI), 3.45–5.83) that in the control patients. After adjustment for potential confounders, including diabetes mellitus, hypertension, hyperlipidemia, congestive heart failure, and coronary artery disease, ESRD patients were 2.78 times (95% CI, 2.02–3.84) more likely to develop RAO in cohort for the total sample. Among patients with hypertension, the RAO incidence rate was significantly higher in the ESRD group, and hypertension significantly increased RAO risk even after adjustment for other confounders in the cohort.ESRD increases the risk of RAO, particularly in ESRD patients with hypertension. Therefore, clinicians should educate ESRD patients about RAO and ensure appropriate blood pressure control.

“…The impact of hypertension on retinal vascular health has been extensively studied, and the literature is fairly consistent in reporting AVR reductions 12–14. It is interesting to note that AVR reductions among individuals with hypertension have been associated with measures of MRI-derived brain atrophy 3…”

mentioning

confidence: 99%

Retinal Vessel Abnormalities Are Associated with Elevated Fasting Insulin Levels and Cerebral Atrophy in Nondiabetic Individuals

et al. 2009

Objective-We sought to determine the impact of insulin resistance short of diabetes on the arteriolar-to-venular ratio (AVR). In addition, we ascertained whether AVR was related to cerebral atrophy. Design-Cross-sectional designParticipants-Forty-six non-diabetic subjects with normal glucose tolerance and varying degrees of insulin resistance, 43 to 77 years of age.Methods-Insulin resistance was assessed by fasting insulin and the homeostasis model assessment. AVR was determined using digital retinal photography with a non-mydriatic camera and retinal data were analyzed using a reliable semi-automated method. Cerebral atrophy was derived by means of manual tracing and thresholding procedures on structural magnetic resonance images. Main outcome measures-AVR, cerebral atrophyResults-We found that hyperinsulinemia negatively impacted on AVR. Furthermore, AVR was associated with cerebral atrophy. Both these findings were independent of the effects of age and hypertension.Conclusions-These novel findings indicate that insulin resistance short of diabetes and independent of age and hypertension has a negative impact on retinal vessel health. Moreover impaired retinal vessel health was related to brain atrophy also independent of hypertension and white matter hyperintensities. Given the connections between retinal and cerebral vasculature, this may offer a partial explanation for the presence of cognitive and brain abnormalities among individuals with insulin resistance.