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Ashok Vardhan, Banushree R, Haripriya Aravind, Pradeep Y Ramulu, Kalpana Narendran, Chandrasekaran Shivakumar, Manas Nath, Ravindran R.D, Alan L Robin; Serum Homocysteine levels in Indian patients with ocular pseudoexfoliation. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1988.
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© ARVO (1962-2015); The Authors (2016-present)
Studies suggest an association between pseudoexfoliation (PEX) and cardiovascular disease. Serum homocysteine (a risk factor for cardiovascular disease) has been noted to be elevated in PEX in some studies, suggesting a potential mechanism for this association. Here, we prospectively compare serum homocysteine levels in a large sample of PEX, PEX glaucoma (PEXG) and a control group with age related cataracts without PEX or glaucoma, all undergoing cataract surgery.
Data reflect a cross-sectional analysis from data collected as part of a multi-centered prospective study designed to evaluate the ocular, systemic, and surgery-related complications associated with PEX. A total of 839 PEX, 20 PEXG and 444 controls undergoing cataract surgery were enrolled from patients presenting to one of four Aravind Eye Hospitals in Tamil Nadu, India. All had blood drawn to specifically determine serum homocysteine levels. A detailed ocular examination was performed to identify and grade specific ocular features reflecting PEX. Serum homocysteine levels were determined using a UV, 2 Point Kinetic (fixed time) Reaction, Enzymatic Recycling method. We considered values exceeding 15 µmol/l to be elevated. We performed statistical data analysis using STATA 14.0 software.
The mean ages of PEX, PEXG and control groups were 64.8±6.8, 65.7±5.7 and 59.9±7.3 years, respectively(p<0.001). Mean serum homocysteine levels were similar in PEX (17.9± 8.3 µmol/l) and PEXG (17.6± 5.6 µmol/l) patients as compared with controls (17.6±8.0 µmol/l, p>0.50 for both). Elevated serum homocysteine was found in 57.5% of PEX, 70% of PEXG and 56.3% of controls (p=0.07). Neither PEX nor PEXG was associated with higher serum homocysteine levels than controls in multivariable models adjusting for age and gender (p >0.5 for both). Higher homocysteine levels were found in males as opposed to females (19.6 vs 15.9, p=<0.001), but no association was observed between age and homocysteine levels (p=0.25). In separate multivariable models, no individual ocular feature was found to be associated with higher serum homocysteine levels, nor was the sum total of PEX-specific slit lamp findings (p=0.45).
Neither PEX nor specific features found in PEX were associated with elevated homocysteine levels in our cohort. Elevated homocysteine levels are unlikely to account for any possible association between PEX and cardiovascular disease.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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