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Janos Feher, Illes Kovacs, Filippo Cruciani, Luca Gualdi, Cristina Mannino, Federica Gualdi, Corrado Balacco Gabrieli, Ophthalmic Neuroscience Program; Clinical and Ultrastructural Evidence of Systemic Low Grade Inflammation in AMD. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1013.
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The aim of this study is to test clinical signs of chronic low-grade inflammation of AMD patients. Although accumulating evidence suggests that inflammation plays a crucial role in the development of AMD, several aspects of the origin and the pathogenic mechanism of inflammation have not been explored in depth. One line of studies has suggested that local inflammation at the levels of the RPE-photoreceptors are restricted to the macula; while others have described a wider systemic involvement in AMD.
In this clinical study 98 patients (48 diagnosed with AMD and an equal number of age and sex matched controls without AMD) were involved. Ocular examination comprised: (i) fundus examination for grading macular status (no AMD, grade early, intermediate and advanced AMD); (ii) ocular surface and eyelid examination to reveal tear film status and inflammatory signs; (iii) general examination to reveal associated diseases and disorders with a particular attention to inflammatory diseases, like metabolic syndrome, neurodegenerative diseases, mood and behavior diseases and cancer; (iv) laboratory tests searching for signs of inflammation. (v) histological examination of autopsy retinas with special attention to comorbid diseases.
(i) Both ocular surface and retina showed increased sensitivity to environmental stimuli in AMD compared to controls, as shown by topical irritation test of the ocular surface and macular photo-stress test, (ii) AMD patients reported significantly higher comorbidity of inflammatory diseases and metabolic syndrome compared to control, furthermore advanced AMD patients were more involved by comorbid diseases, (iii) AMD patients showed significantly higher white blood cell count, erythrocyte sedimentation and lower vitamin D values compared to controls, (iv) Histopathologic pictures showed more severe alterations of the photoreceptors, of the RPE, of Bruch’s membrane and of the choriocapillary in AMD with metabolic syndrome.
Our results suggest that (i) inflammatory phenotype may be a decisive factor to the development of AMD, (ii) new diagnostic and treatment strategies should consider AMD as an ocular manifestation of a systemic low-grade inflammation (iii) this diagnostic procedure is clinically very simple, inexpensive and useful for routine ocular examination.
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