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Olena Puzyeyeva, Lee-Anne Khuu, John G. Flanagan, Wai-Ching Lam, Michael H. Brent, Robert Devenyi, Samuel Markowitz, Christopher Hudson; A Prospective Study of Vascular Inflammatory Activity and Retinal Hemodynamics in Patients with Type 2 Non-Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1293.
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To determine prospective change in markers of vascular inflammation, endothelial dysfunction and functional retinal hemodynamics in patients with type 2 non-proliferative diabetic retinopathy (NPDR).
The sample was stratified into mild-to-moderate (M-M) (n=16, 62± 8 y.o) and moderate-to-severe (M-S) (n=8, 59±10y.o) NPDR groups. The severity of NPDR was determined by clinical assessment and stereo fundus photography. We assessed retinal hemodynamics, and markers of vascular inflammation and endothelial dysfunction at baseline (Visit 1) and at 16 months (Visit 2). At both visits, retinal hemodynamics (Canon Laser Blood Flowmeter derived arteriolar diameter, blood velocity, pulsatility and blood flow), inflammatory markers (intercellular adhesion molecule (sICAM-1), vascular adhesion molecule (sVCAM-1), sE-selectin), and endothelial dysfunction markers (von Willebrand factor (vWF)) were evaluated.
There were no significant differences found between visits in terms of diameter, velocity, pulsatility and flow within M-M and M-S. In M-M, VCAM-1 was significantly elevated (p=0.02, 466.6 vs. 568.6 ng/ml) and E-selectin was significantly reduced (p=0.04, 50.6 vs. 37.7ng/ml) in the follow-up visit. There were no significant differences found between visits in ICAM-1 and vWF within each group. At both visits, ICAM-1 was significantly elevated in M-S compared to M-M (p=0.01, 74.5 vs. 263.1 ng/ml and p=0.047, 177.9 vs. 236.3 ng/ml respectively). At both visits, there were no significant differences found in hemodynamic parameters between groups. A1c was not different in the follow-up visits or between groups. In M-S, the magnitude of blood flow change tended to increase with increasing vWF level (r = 0.62, p = 0.09) and there is a positive trend between changes in VCAM-1 and vessel diameter (r=0.67, p=0.07).
Our results show that after 16 months, inflammatory markers (VCAM-1 and E-selectin) significantly changed in both mild-to-moderate and moderate-to-severe NPDR. This suggests that inflammatory activity dynamically changes over time in patients with NPDR.
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