Vascular complications and associated comorbidities in newly diagnosed pre-diabetes: is it the tip of the iceberg?

OBJECTIVE: The aim of this study was to investigate the prevalence of microvascular and macrovascular diabetic complications and the associated comorbidities in newly diagnosed pre-diabetic individuals. PATIENTS AND METHODS: This cross-sectional study includes 100 newly diagnosed pre-diabetic individuals. Fasting plasma glucose, HbA1c, and oral glucose tolerance (OGTT) were tested according to the American Diabetes Association's diagnostic criteria for pre-diabetes, besides anthropometric measurements, lipid profiles, and demographic and biochemical parameters. Comorbidities like hypertension, obesity, dyslipidemia etc., were evaluated. All participants were screened for microvascular (retinopathy, nephropathy, neuropathy) and macrovascular [coronary artery disease (CAD) and cerebrovascular event-peripheral artery disease] complications. RESULTS: Microvascular complications were found in 12% of the participants (neuropathy: 4%, nephropathy: 8%) and 19% had macrovascular complications. Of the participants, 21% of the cases presented hypertension, 21% dyslipidemia and 48% obesity. A high probability of developing non-alcoholic fatty liver disease-related fibrosis [estimated using non-alcoholic fatty liver disease fibrosis score (NFS)] was found in 68% of cases. History of dyslipidemia (OR: 5.00, 95% CI: 1.10-22.56; p=0.037) was an independent risk factor for the development of vascular complications. CONCLUSIONS: Diabetic vascular complications were found in approximately one-third of pre-diabetic cases. Dyslipidaemia was found to be an important risk factor for the development of vascular complications in these individuals.

Evaluation of corpus geniculatum laterale and vitreous fluid by magnetic resonance spectroscopy in patients with glaucoma; a preliminary study.

PURPOSE: To determine whether metabolite changes at cellular level occur in vitreous and lateral geniculate body (LGB) in patients with glaucoma by magnetic resonance spectroscopy (MRS). METHODS: A total of 29 eyes of 29 patients with glaucoma, no existing ocular pathology and systemic disease (group 1), and 13 eyes of 13 healthy individuals whose routine ophthalmological examinations were normal (group 2) were included in the study. Single-voxel MRS examination was performed by placing region of interest in vitreous and LGB. Glutamate-glutamine (Glx)/creatin (Cr) ratios and lactate peaks in the vitreous, and the Glx/Cr, N-acetyl aspartate (NAA)/Cr, choline (Cho)/Cr ratios in the ipsilateral area of LGB were evaluated. RESULTS: A statistically significant difference was found between the two groups for the Glx/Cr ratio in both the vitreous and LGB (P=0.0001). There was no statistically significant difference between the two groups for the NAA/Cr, and Cho/Cr ratios in the LGB (P=0.108). A lactate peak was established in the vitreous of 11 glaucoma patients. CONCLUSION: Determining increased Glx/Cr ratios in both the vitreous and LGB of glaucoma patients, supports the theory of apoptosis in the etiopathogenesis of glaucoma. The MRS method, which can measure biochemical structures and metabolites of tissues, and also shows on a single spectrum, may be a new and non-invasive method for confirming the diagnosis of glaucoma and the role of apoptosis in the etiopathogenesis of glaucoma.

The influence of soft contact lenses on the intraocular pressure measurement.

PURPOSE: To evaluate the influence of silicone hydrogel contact lenses on the intraocular pressure (IOP) measurement using Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), and Pascal dynamic contour tonometry (DCT). METHODS: We included in the study 40 eyes of 40 patients who did not have any ocular or systemic diseases or contraindications to contact lens use. We measured and recorded the IOP values of each patient using NCT without and with contact lenses (groups 1 and 2, respectively), using DCT without and with contact lenses (groups 3 and 4, respectively), and using GAT without contact lenses (group 5). RESULTS: The mean IOP value of group 1 was 14.55 ± 2.95 mm Hg and 13.92 ± 2.58 mm Hg in group 2. We detected no statistically significant difference between group 1 and group 2 (P=0.053). The mean IOP values for group 3 and group 4 were 16.26 ± 2.33 mm Hg and 15.19 ± 2.40 mm Hg, respectively. We detected a statistically significant difference between groups 3 and 4 (P=0.005). Group 5's mean IOP value was 12.97 ± 2.65 mm Hg. IOP values measured with DCT were statistically significantly higher compared with IOP values measured with NCT and GAT (P<0.0001 and P<0.0001, respectively). Additionally, IOP values measured with NCT were statistically significantly higher compared with IOP values measured with GAT (P<0.0001). CONCLUSION: According to the results of our study, silicone hydrogel soft contact lens use does not significantly affect IOP values measured with NCT, but it affects IOP values measured with DCT.

Gain in visual acuity after cataract surgery improves postural stability and mobility.

OBJECTIVES: Vision plays an important role in postural stability. It has also been shown that visual information from the environment and visual cues significantly contribute to balance skills. The aim of this study was to investigate the effects of visual acuity on postural stability and mobility before and after cataract surgery. METHODS: The study group was composed of 25 male and 11 female patients (age 57-84, mean 66.6 +/- 4.7) who had been operated for age-related cataract. Postural stability and mobility were assessed before and four weeks after the surgery by means of Biodex stability system (BSS), Tinetti, Time up and go (TUG) and Functional reach (FR) tests, as well as by gait analysis (gait velocity, step length, step width, cadence, stride length). RESULTS: Postoperative visual acuity was significantly improved. Gait velocity and cadence increased significantly but step length, stride length, and step width did not change significantly. Postoperative improvement of Tinetti balance, TUG and FR tests were significant. Similarly, antero-posterior stability index (APSI), mediolateral stability index (MLSI) and overall stability index (OSI) that were examined with BSS improved significantly after the cataract surgery. CONCLUSION: These results demonstrated that gain in visual acuity after cataract surgery improves the postural stability and mobility of patients (Tab. 2, Fig. 1, Ref. 29). Full Text in free PDF www.bmj.sk.

Comparison of preoperative and postoperative anterior segment measurements with Pentacam in horizontal muscle surgery.

PURPOSE: To evaluate the effect of horizontal muscle surgery (recession or recession plus resection) on the anterior chamber parameters in patients after strabismus surgery. METHODS: The Scheimpflug of 18 eyes of 12 patients with horizontal deviations were recorded just before surgery and 1 month after surgery. The power of anterior surface of cornea in horizontal and vertical axis, thinnest corneal thickness, anterior chamber depth, anterior chamber volume, and cornea volume were analyzed. The clinical characteristics of patients, the size of the deviations, the surgical doses, and observed responses to surgery were reviewed. RESULTS: There were six male and six female patients with an average age of 11.4 years (range, 4 to 22 years). Mean preoperative deviation was 47.91 PD (range, 20 to 75 PD), eight patients had esotropia with 57.5 PD average deviation (range, 40 to 75 PD), and four patients had exotropia with 28.75 PD average deviation (range, 20 to 35 PD). Of these 18 eyes, 12 eyes had horizontal muscle recession and 6 eyes had recession plus resection surgery. At the end of 1 month, three patients were orthophoric and eight patients had residual deviations varying between 16 and 35 PD. Preoperative and postoperative comparison of the whole study group documented insignificant changes in anterior chamber parameters and in keratometer readings. However, after dividing patients into two groups-recession or recession plus resection group-only one parameter, anterior chamber volume, was significantly reduced in recession plus resection group. CONCLUSIONS: Patients with strabismus who undergo recession plus resection procedure are prone to change in anterior chamber volume. Study with larger groups and long follow-up is necessary for clearer documentation of alterations at anterior chamber parameters.