Association of vascular endothelial growth factor a gene (VEGFA) polymorphisms, rs699947 and rs1570360, with diabetic retinopathy and altered VEGF secretion in the Pakistani patients with type 2 diabetes mellitus: a casecontrol study.

OBJECTIVE: To investigate the association of vascular endothelial growth factor A gene polymorphisms 2578C/A (rs699947) and 1154G/A (rs1570360) with type 2 diabetes mellitus, diabetic retinopathy and serum vascular endothelial growth factor levels in Pakistani patients. METHODS: The case-control study was conducted from Jan 2017 to Dec 2018 after approval from the ethics review board of Riphah International University, Islamabad, Pakistan, and comprised type 2 diabetes mellitus patients of either gender with diabetic retinopathy in group A, and without diabetic retinopathy in group B. Non-diabetic healthy individuals were enrolled in control group C. Genotyping was done by amplification refractory mutation system-polymerase chain reaction and serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. RESULTS: Of the 450 subjects, 150(33.3%) were in each of the 3 groups. The mean age in group A was 58.16±9.42, in group B 56.25±8.5 years and in group C it was 55.90±10.90. The proportion of Punjabi ethnicity was significantly high in group B compared to other groups (p<0.05). There was no significant association of rs699947 and rs1570360 genotypic and allelic frequencies in group B compared to group A. Further, rs699947 AA genotype was significantly associated with proliferative diabetic retinopathy compared to group A (p<0.05). Minor allele A showed significant association in groups A and B compared to group C (p<0.05). Significantly raised serum vascular endothelial growth factor levels were found in group B compared to group A (p<0.05), and were associated with rs699947 and rs1570360 heterozygosity in group A (p<0.05). Also, rs699947 genotype showed significant association with groups A and B in Punjabi and Pathan ethnicities (p<0.05) and with Kashmiri ethnicity in group B (p<0.05). CONCLUSIONS: There was a strong association of vascular endothelial growth factor 2578C/A (rs699947) gene polymorphism with proliferative diabetic retinopathy in type 2 diabetic Pakistani patients, suggesting its role in the pathogenesis of this condition.

Results of endoscopic endonasal dacrocystorhinostomy.

OBJECTIVES: To analyse the results of Endonasal Endoscopic Dacrocystorhinostomy regarding complications and success rate. METHODS: The prospective quasi-experimental study was conducted at the Departments of Otolaryngology and Ophthalmology of Islamic International Medical College Teaching Hospital, Rawalpindi, from August 2008 to July 2012. Patients presenting with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in the study. Endonasal Endoscopic Dacrocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacrocystorhinostomy tube. Complications during and after the procedure were recorded. RESULTS: Of the 31 patients in the study, 27 (87%) were females and 4 (13%) were males with an overall mean age of 45.7 +/- 13.4 years (range: 21-70). The duration of symptoms ranged between 6 months and 13 years (Mean: 4.1 +/- 3.2). Average duration of endoscopic dacrocystorhinostomy was 40 +/- 17.5 minutes (range: 25-70). The tube was removed 6 months after operation in 27 (87%) patients and after 3 months in 4 (13%). Complications encountered were peroperative haemorrhage in 4 (13%), ecchymosis in 2 (6%), nasal adhesions in 3 (9.6%), granulations at osteotomy site in 1 (3.2%), retrograde tube displacement in 3 (9.6%) and symblepheron in 1 (3.2%) patient. Of the total, 26 (84%) patients were symptom-free 6 months after the removal of the tube. Two (6.4%) patients underwent revision surgery and were symptom-free 6 months after the removal of the tube. Overall success rate of the procedure was 28 (90%). CONCLUSIONS: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.