Retinal

视网膜
  • 文章类型: Journal Article
    视蛋白视觉颜料捕获光子会将其11-顺式视黄醛(11cRAL)发色团异构化为全反式视黄醛(atRAL),随后分离。为了恢复光敏感度,无配体的apo-opsin与另一个11cRAL结合,形成一种新的视觉颜料。两种酶途径为光感受器提供发色团。视网膜色素上皮细胞的典型视觉周期以低速率供应11cRAL。Müller细胞中的光视觉周期以高速率为视锥提供11-顺式视黄醇(11cROL)发色团前体。虽然棒只能使用11cRAL再生视紫红质,锥体可以使用11cRAL或11cROL再生锥体视觉颜料。我们在斑马鱼视网膜中进行了筛选,并将ZCRDH鉴定为将视锥内段中的11cROL转化为11cRAL的候选酶。对Zcrdh突变斑马鱼的眼睛进行的视黄醇分析显示11cRAL水平降低,11cROL水平升高,提示11cROL转化为11cRAL受损。通过显微分光光度法,分离的Zcrdh突变体视锥细胞失去了从11cROL再生视觉色素的能力。因此,ZCRDH具有锥11cROL脱氢酶的所有预测性质。与ZCRDH最相似的人蛋白是RDH12。通过免疫细胞化学,ZCRDH大量存在于圆锥内段,与报告的RDH12分布相似。最后,RDH12是唯一表现出11cROL-氧化酶催化活性的哺乳动物候选蛋白。这些观察结果表明,哺乳动物中的RDH12是ZCRDH的功能直系同源物,允许锥体,但不是杆,从Müller细胞提供的11cROL再生视觉色素。这种能力允许视锥细胞在日光暴露的视网膜中逃避与视杆竞争的视觉发色团。
    Capture of a photon by an opsin visual pigment isomerizes its 11-cis-retinaldehyde (11cRAL) chromophore to all-trans-retinaldehyde (atRAL), which subsequently dissociates. To restore light sensitivity, the unliganded apo-opsin combines with another 11cRAL to make a new visual pigment. Two enzyme pathways supply chromophore to photoreceptors. The canonical visual cycle in retinal pigment epithelial cells supplies 11cRAL at low rates. The photic visual cycle in Müller cells supplies cones with 11-cis-retinol (11cROL) chromophore precursor at high rates. Although rods can only use 11cRAL to regenerate rhodopsin, cones can use 11cRAL or 11cROL to regenerate cone visual pigments. We performed a screen in zebrafish retinas and identified ZCRDH as a candidate for the enzyme that converts 11cROL to 11cRAL in cone inner segments. Retinoid analysis of eyes from Zcrdh-mutant zebrafish showed reduced 11cRAL and increased 11cROL levels, suggesting impaired conversion of 11cROL to 11cRAL. By microspectrophotometry, isolated Zcrdh-mutant cones lost the capacity to regenerate visual pigments from 11cROL. ZCRDH therefore possesses all predicted properties of the cone 11cROL dehydrogenase. The human protein most similar to ZCRDH is RDH12. By immunocytochemistry, ZCRDH was abundantly present in cone inner segments, similar to the reported distribution of RDH12. Finally, RDH12 was the only mammalian candidate protein to exhibit 11cROL-oxidase catalytic activity. These observations suggest that RDH12 in mammals is the functional ortholog of ZCRDH, which allows cones, but not rods, to regenerate visual pigments from 11cROL provided by Müller cells. This capacity permits cones to escape competition from rods for visual chromophore in daylight-exposed retinas.
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  • 文章类型: Journal Article
    海洋微藻用作水产养殖诱饵。为了提高藻类细胞的生长和繁殖利润,高强度光照条件是培养诱饵微藻的标准,可能改变微藻代谢产物的生产。这项研究表明,thalassiosirapseudonana,当受到高强度光线条件时,积累了大量的视网膜(RAL),这些视网膜通过食物链转移并在海洋中转化为全反式维甲酸(atRA)。该研究进一步探索了对个体鱼类和特定组织的毒性作用,以及这种毒性背后的机制。atRA在肝脏中的积累,肠,和脊柱导致结构损伤和组织炎症,以及氧化应激。它还下调涉及免疫功能和生长的关键途径的基因转录水平。此外,它破坏了肠道微生物群落的稳态。对野生动物和人类健康的影响,它们受到微藻代谢产物积累及其通过食物链转移的调节的影响,需要进一步调查,可能具有更广泛的意义。
    Marine microalgae serve as an aquaculture bait. To enhance algal cell growth and breeding profits, high-intensity light conditions are standard for cultivating bait microalgae, potentially altering microalgal metabolite production. This research revealed that Thalassiosira pseudonana, when subjected to high-intensity light conditions, accumulated significant quantities of retinal (RAL) that transferred through the food chain and transformed into all-trans retinoic acid (atRA) in marine medaka. The study further explored the toxic effects on individual fish and specific tissues, as well as the mechanisms behind this toxicity. The accumulation of atRA in the liver, intestine, and spinal column resulted in structural damage and tissue inflammation, as well as oxidative stress. It also down-regulated the gene transcription levels of key pathways involved in immune function and growth. Furthermore, it disrupted the homeostasis of the intestinal microbial communities. The implications for wildlife and human health, which are influenced by the regulation of microalgal metabolite accumulation and their transfer via the food chain, require further investigation and could hold broader significance.
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  • 文章类型: Journal Article
    过高的谷氨酸活性水平可能会损害和杀死神经元。谷氨酸兴奋毒性被认为在许多CNS和视网膜疾病中起关键作用。因此,谷氨酸兴奋性毒性已被用作研究神经元疾病的模型。免疫蛋白,如主要组织相容性复合体(MHC)I类分子及其受体,在许多神经元疾病中发挥重要作用,而T细胞受体(TCR)是MHCI的主要受体。我们之前证明了TCR的一个关键组成部分,CD3ζ,由小鼠视网膜神经节细胞(RGC)表达。CD3ζ或MHCI分子的突变损害了RGC结构和功能的发展。在这项研究中,我们研究了CD3ζ介导的分子信号传导是否调节谷氨酸兴奋毒性中的RGC死亡。我们表明,CD3ζ的突变显着增加了NMDA诱导的兴奋性毒性中的RGC存活。此外,我们发现TCR的几个下游分子,包括Src(原癌基因酪氨酸蛋白激酶)家族激酶(SFKs)和脾酪氨酸激酶(Syk),由RGC表示。选择性抑制SFK成员,Hck,或Syk成员,Syk或Zap70在NMDA诱导的兴奋性毒性中显着增加了RGC的存活率。这些结果为揭示疾病条件下控制RGC死亡的潜在分子机制提供了直接证据。
    Excessive levels of glutamate activity could potentially damage and kill neurons. Glutamate excitotoxicity is thought to play a critical role in many CNS and retinal diseases. Accordingly, glutamate excitotoxicity has been used as a model to study neuronal diseases. Immune proteins, such as major histocompatibility complex (MHC) class I molecules and their receptors, play important roles in many neuronal diseases, while T-cell receptors (TCR) are the primary receptors of MHCI. We previously showed that a critical component of TCR, CD3ζ, is expressed by mouse retinal ganglion cells (RGCs). The mutation of CD3ζ or MHCI molecules compromises the development of RGC structure and function. In this study, we investigated whether CD3ζ-mediated molecular signaling regulates RGC death in glutamate excitotoxicity. We show that mutation of CD3ζ significantly increased RGC survival in NMDA-induced excitotoxicity. In addition, we found that several downstream molecules of TCR, including Src (proto-oncogene tyrosine-protein kinase) family kinases (SFKs) and spleen tyrosine kinase (Syk), are expressed by RGCs. Selective inhibition of an SFK member, Hck, or Syk members, Syk or Zap70, significantly increased RGC survival in NMDA-induced excitotoxicity. These results provide direct evidence to reveal the underlying molecular mechanisms that control RGC death under disease conditions.
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  • 文章类型: Journal Article
    视紫红质(CR)被用作光遗传学的关键工具,和新颖的CR,无论是从自然界中发现的还是通过突变改造的,极大地促进了光遗传学的发展。最近从病毒中发现了CRs,和病毒CR的晶体结构,OLPVR1报告了视网膜席夫碱附近与光驱动的质子泵细菌视紫红质(BR)非常相似的含水氢键网络。在OLPVR1和BR中,近似平面的五边形簇结构由五个氧原子组成,来自水分子的三个氧和来自席夫碱抗衡离子的两个氧。平面五边形团簇稳定了四极杆,希夫碱上的两个正电荷和一个精氨酸,反离子上有两个负电荷,因此在OLPVR1的光门通道功能和BR的光驱动质子泵功能中起着重要作用。尽管有类似的五边形簇结构,目前的FTIR分析显示OLPVR1和BR之间存在不同的氢键网络。质子化的席夫碱与水之间的氢键在OLPVR1中比在BR中更强,内部水分子在OLPVR1中提供的氢键比BR中弱得多。在OLPVR1中,席夫碱和抗衡离子之间的桥接水分子与D76和D200相等地形成氢键,而BR中D85的氢键相互作用强于D212。目前的解释得到了突变结果的支持,其中D76和D200同样用作OLPVR1中的席夫碱抗衡离子,但D85是BR中的主要抗衡离子。这项工作报告了希夫碱区域中高度敏感的氢键网络,通过光诱导的网络改变,这将与每个功能密切相关。
    Channelrhodopsins (CRs) are used as key tools in optogenetics, and novel CRs, either found from nature or engineered by mutation, have greatly contributed to the development of optogenetics. Recently CRs were discovered from viruses, and crystal structure of a viral CR, OLPVR1, reported a very similar water-containing hydrogen-bonding network near the retinal Schiff base to that of a light-driven proton-pump bacteriorhodopsin (BR). In both OLPVR1 and BR, nearly planar pentagonal cluster structures are comprised of five oxygen atoms, three oxygens from water molecules and two oxygens from the Schiff base counterions. The planar pentagonal cluster stabilizes a quadrupole, two positive charges at the Schiff base and an arginine, and two negative charges at the counterions, and thus plays important roles in light-gated channel function of OLPVR1 and light-driven proton pump function of BR. Despite similar pentagonal cluster structures, present FTIR analysis revealed different hydrogen-bonding networks between OLPVR1 and BR. The hydrogen bond between the protonated Schiff base and a water is stronger in OLPVR1 than in BR, and internal water molecules donate hydrogen bonds much weaker in OLPVR1 than in BR. In OLPVR1, the bridged water molecule between the Schiff base and counterions forms hydrogen bonds to D76 and D200 equally, while the hydrogen-bonding interaction is much stronger to D85 than to D212 in BR. The present interpretation is supported by the mutation results, where D76 and D200 equally work as the Schiff base counterions in OLPVR1, but D85 is the primary counterion in BR. This work reports highly sensitive hydrogen-bonding network in the Schiff base region, which would be closely related to each function through light-induced alterations of the network.
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  • 文章类型: Journal Article
    光异构化是微生物和动物视紫红质中的关键光化学反应。众所周知,这种光异构化是高度选择性的;全反式为13-顺式,微生物和动物视紫红质中的11顺式到全反式形式,分别。然而,最近在微生物视紫红质中发现了不寻常的光异构化途径。在酶视紫红质NeoR中,全反式发色团被异构化为7-顺式形式,在室温下是稳定的。虽然,7-cis形式是由视网膜照明产生的,从未报道过全反式视黄醛的质子化席夫碱在溶液中形成7-顺式形式。目前通过羟胺反应制备的视网膜肟的HPLC分析表明,在标准HPLC条件下,全反式和7-顺式形式不能与顺式峰分离。而通过反峰的分析是可能的。因此,我们发现通过溶液中全反式发色团的光反应形成7-顺式形式,无论希夫碱的质子化状态如何。在溶液中全反式质子化视黄醛席夫碱的光吸收下,激发态弛豫伴随着双键异构化,生产7-cis,9-cis,11-cis,或13顺式形式。相比之下,在许多微生物视紫红质中,特定的发色团-蛋白质相互作用强制选择性异构化为13-顺式形式,而是在NeoR进入7-cis.
    Photoisomerization is a key photochemical reaction in microbial and animal rhodopsins. It is well established that such photoisomerization is highly selective; all-trans to 13-cis, and 11-cis to all-trans forms in microbial and animal rhodopsins, respectively. Nevertheless, unusual photoisomerization pathways have been discovered recently in microbial rhodopsins. In an enzymerhodopsin NeoR, the all-trans chromophore is isomerized into the 7-cis form exclusively, which is stable at room temperature. Although, the 7-cis form is produced by illumination of retinal, formation of the 7-cis form was never reported for a protonated Schiff base of all-trans retinal in solution. Present HPLC analysis of retinal oximes prepared by hydroxylamine reaction revealed that all-trans and 7-cis forms cannot be separated from the syn peaks under the standard HPLC conditions, while it is possible by the analysis of the anti-peaks. Consequently, we found formation of the 7-cis form by the photoreaction of all-trans chromophore in solution, regardless of the protonation state of the Schiff base. Upon light absorption of all-trans protonated retinal Schiff base in solution, excited-state relaxation accompanies double-bond isomerization, producing 7-cis, 9-cis, 11-cis, or 13-cis form. In contrast, specific chromophore-protein interaction enforces selective isomerization into the 13-cis form in many microbial rhodopsins, but into 7-cis in NeoR.
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  • 文章类型: Journal Article
    高荧光(HF)和减少的自发荧光(RA)是眼底自发荧光图像(FAF)中用于评估视网膜色素上皮(RPE)健康的重要生物标志物,在地理萎缩(GA)或中心性浆液性脉络膜视网膜病变(CSCR)中,疾病进展的重要指标。自体荧光图像已经被人类评估者注释,但区分生物标志物(信号是增加还是减少)与正常背景证明具有挑战性,边界对解释特别开放。因此,不同年级学生之间出现显著差异,甚至在重复注释期间在同一分级器中。对内部FAF数据的测试表明,即使是高技能的医学专家,尽管之前讨论和解决了精确的注释指南,在HF分割的Dice评分不超过63-80%,RA的Dice评分仅为14-52%。数据进一步表明,我们的主要注释专家与她自己的一致性是HF的72%Dice评分和RA的51%。鉴于这些数字,自动HF和RA分割的任务不能简单地改进分割分数。相反,我们建议使用分割集成。用一个注释从图像中学习,合奏达到专家般的性能与64-81%的骰子得分的HF和21-41%的RA与我们所有的专家的协议。此外,利用集合网络的均值预测及其方差,我们设计了三元分割,其中FAF图像区域被标记为自信背景,自信的HF,或潜在的HF,确保预测在他们有信心的地方是可靠的(97%精度),同时检测所有专家注释的所有HF实例(99%召回)。
    Hyperfluorescence (HF) and reduced autofluorescence (RA) are important biomarkers in fundus autofluorescence images (FAF) for the assessment of health of the retinal pigment epithelium (RPE), an important indicator of disease progression in geographic atrophy (GA) or central serous chorioretinopathy (CSCR). Autofluorescence images have been annotated by human raters, but distinguishing biomarkers (whether signals are increased or decreased) from the normal background proves challenging, with borders being particularly open to interpretation. Consequently, significant variations emerge among different graders, and even within the same grader during repeated annotations. Tests on in-house FAF data show that even highly skilled medical experts, despite previously discussing and settling on precise annotation guidelines, reach a pair-wise agreement measured in a Dice score of no more than 63-80% for HF segmentations and only 14-52% for RA. The data further show that the agreement of our primary annotation expert with herself is a 72% Dice score for HF and 51% for RA. Given these numbers, the task of automated HF and RA segmentation cannot simply be refined to the improvement in a segmentation score. Instead, we propose the use of a segmentation ensemble. Learning from images with a single annotation, the ensemble reaches expert-like performance with an agreement of a 64-81% Dice score for HF and 21-41% for RA with all our experts. In addition, utilizing the mean predictions of the ensemble networks and their variance, we devise ternary segmentations where FAF image areas are labeled either as confident background, confident HF, or potential HF, ensuring that predictions are reliable where they are confident (97% Precision), while detecting all instances of HF (99% Recall) annotated by all experts.
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  • 文章类型: Journal Article
    眼部新生血管形成是临床环境中失明的主要原因。眼睛的病理性血管生成可分为角膜新生血管(CoNV),视网膜新生血管形成(RNV,包括糖尿病性视网膜病变和早产儿视网膜病变),和脉络膜新生血管(CNV)基于异常新生血管的解剖位置。尽管抗血管内皮生长因子(VEGF)药物具有广泛的临床应用,并且是新生血管性眼病的有效治疗方法。这种治疗策略仍然存在许多缺陷。最近,新的证据表明,巨噬细胞在生理性和病理性血管生成过程中至关重要。单核细胞-巨噬细胞谱系多样且可塑,它们可以在不同的激活模式之间转换,并具有不同的功能。由于巨噬细胞对炎症和血管生成具有明显的调节作用,巨噬细胞在眼科领域的研究越来越多。这里,我们详细介绍了巨噬细胞是如何激活的,以及不同亚型的巨噬细胞在眼部新生血管形成的发病机制中的作用。由于巨噬细胞的子集多样性和紧密调节的分子和代谢表型,巨噬细胞的复杂性最近已成为中心阶段。在这次审查中,我们揭示了与眼部新生血管相关的巨噬细胞亚群的功能和表型特征,需要更深入的研究来探索巨噬细胞调节血管生成以及巨噬细胞极化的具体机制。基于巨噬细胞表型和功能的定向分化调控可能是未来治疗和管理眼部新生血管的有效方法。
    Ocular neovascularization is the leading cause of blindness in clinical settings. Pathological angiogenesis of the eye can be divided into corneal neovascularization (CoNV), retinal neovascularization (RNV, including diabetic retinopathy and retinopathy of prematurity), and choroidal neovascularization (CNV) based on the anatomical location of abnormal neovascularization. Although anti-Vascular endothelial growth factor (VEGF) agents have wide-ranging clinical applications and are an effective treatment for neovascular eye disease, many deficiencies in this treatment strategy remain. Recently, emerging evidence has demonstrated that macrophages are vital during the process of physiological and pathological angiogenesis. Monocyte-macrophage lineage is diverse and plastic, they can shift between different activation modes and have different functions. Due to the obvious regulatory effect of macrophages on inflammation and angiogenesis, macrophages have been increasingly studied in the field of ophthalmology. Here, we detail how macrophage activated and the role of different subtypes of macrophages in the pathogenesis of ocular neovascularization. The complexity of macrophages has recently taken center stage owing to their subset diversity and tightly regulated molecular and metabolic phenotypes. In this review, we reveal the functional and phenotypic characterization of macrophage subsets associated with ocular neovascularization, more in-depth research is needed to explore the specific mechanisms by which macrophages regulate angiogenesis as well as macrophage polarization. Targeted regulation of macrophage differentiation based on their phenotype and function could be an effective approach to treat and manage ocular neovascularization in the future.
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  • 文章类型: Journal Article
    背景:已在患有心血管疾病(如动脉高血压)的患者中发现了视网膜微血管异常,糖尿病,和颈动脉疾病.我们进行了系统评价和荟萃分析(PROSPERO注册号CRD42024506589),以通过光学相干断层扫描(OCT)和光学相干断层扫描血管造影(OCTA)探讨视网膜血管作为诊断和监测冠状动脉疾病(CAD)患者的生物标志物的潜力。
    方法:我们系统地检查了Pubmed,Embase,和WebofScience数据库从成立到2023年11月,比较了CAD患者和对照组之间的视网膜微血管特征。如果他们报告了具有标准偏差的样品平均值或具有范围和/或四分位间范围的中值(其计算为平均值和标准偏差),则包括研究。审查经理5.4(Cochrane协作,2020)采用随机-效应逆方差法,采用加权均差和95%置信区间(CI)计算合并效应大小。
    结果:11项符合纳入标准的研究纳入荟萃分析。结果表明视网膜神经纤维层明显减少(WMD-3.11[-6.06,-0.16]),中央凹下脉络膜(WMD-58.79[-64.65,-52.93]),与对照组相比,CAD患者的总体视网膜厚度(WMD-4.61[-7.05,-2.17])(p<0.05)。此外,冠心病患者的血管黄斑密度明显较低,特别是在浅表毛细血管丛(中央凹血管密度WMD-2.19[-3.02,-1.135],p<0.0001)。此外,与对照组相比,CAD患者的中央凹无血管区面积在统计学上较大(WMD52.73[8.79,96.67],p=0.02)。除中央凹下脉络膜厚度外,大多数特征的异质性是显着的(I2>50%),视网膜厚度,浅凹血管密度。
    结论:当前的荟萃分析表明,视网膜血管形成可以作为一种非侵入性生物标志物,为评估冠状动脉功能障碍提供标准常规检查以外的其他见解。
    BACKGROUND: Retinal microvascular anomalies have been identified in patients with cardiovascular conditions such as arterial hypertension, diabetes mellitus, and carotid artery disease. We conducted a systematic review and meta-analysis (PROSPERO registration number CRD42024506589) to explore the potential of retinal vasculature as a biomarker for diagnosis and monitoring of patients with coronary artery disease (CAD) through optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).
    METHODS: We systematically examined original articles in the Pubmed, Embase, and Web of Science databases from their inception up to November 2023, comparing retinal microvascular features between patients with CAD and control groups. Studies were included if they reported sample mean with standard deviation or median with range and/or interquartile range (which were computed into mean and standard deviation). Review Manager 5.4 (The Cochrane Collaboration, 2020) software was used to calculate the pooled effect size with weighted mean difference and 95% confidence intervals (CI) by random-effects inverse variance method.
    RESULTS: Eleven studies meeting the inclusion criteria were incorporated into the meta-analysis. The findings indicated a significant decrease in the retinal nerve fiber layer (WMD -3.11 [-6.06, -0.16]), subfoveal choroid (WMD -58.79 [-64.65, -52.93]), and overall retinal thickness (WMD -4.61 [-7.05, -2.17]) among patients with CAD compared to controls (p < 0.05). Furthermore, vascular macular density was notably lower in CAD patients, particularly in the superficial capillary plexus (foveal vessel density WMD -2.19 [-3.02, -1.135], p < 0.0001). Additionally, the foveal avascular zone area was statistically larger in CAD patients compared to the control group (WMD 52.73 [8.79, 96.67], p = 0.02). Heterogeneity was significant (I2 > 50%) for most features except for subfoveal choroid thickness, retina thickness, and superficial foveal vessel density.
    CONCLUSIONS: The current meta-analysis suggests that retinal vascularization could function as a noninvasive biomarker, providing additional insights beyond standard routine examinations for assessing dysfunction in coronary arteries.
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  • 文章类型: Journal Article
    背景:眼部缺血综合征(OIS)是一种罕见的动脉粥样硬化性颈动脉狭窄,可导致永久性视力丧失。由于缺乏意识,这种严重致残综合征仍未得到诊断和治疗;特别是因为它需要加速多学科护理。由于脑血管疾病的患病率增加,早期诊断和治疗的相关性正在增加。
    方法:非动脉炎性OIS介入治疗后的长期视觉和脑血管结局仍未得到很好的描述,这是这篇简明综述的目的。我们进行了PubMed搜索,以包括2002年至2023年之间的所有英语出版物(队列研究和案例报告)。
    结果:共有33项研究(479例患者)报告了颈动脉内膜切除术治疗OIS的结果(CEA,304名患者,19项研究),和颈动脉支架置入术(CAS,175名患者,14项研究)。447例(93.3%)患者的视力结果改善或没有恶化。未报告围手术期中风。很少有视觉症状恶化(35例患者,7.3%);它们发生在继发于眼部灌注不足(3例)的术后即刻,以及由于全身性动脉粥样硬化疾病的进展而在术后后期。据报道,1例患者(0.21%)因CEA后复发性狭窄而出现症状复发,这是与CAS成功管理。这些研究都没有报道经颈动脉血运重建(TCAR)的结果,长期手术结果或卒中发生率。
    结论:OIS仍然是一种未被诊断的疾病。早期诊断和及时治疗对于OIS症状的逆转或稳定至关重要。血管外科和眼科服务之间的加速多学科方法对于促进及时治疗和优化结果是必要的。如果早期诊断,CEA和CAS都与视觉改善有关,和预防进行性视力丧失。
    BACKGROUND: Ocular ischemic syndrome (OIS) is a rare presentation of atherosclerotic carotid artery stenosis that can result in permanent visual loss. This severely disabling syndrome remains under diagnosed and undertreated due to lack of awareness; especially since it requires expedited multidisciplinary care. The relevance of early diagnosis and treatment is increasing due to an increasing prevalence of cerebrovascular disease.
    METHODS: The long-term visual and cerebrovascular outcomes following intervention for nonarteritic OIS, remain poorly described and were the objective of this concise review. We conducted a PubMed search to include all English language publications (cohort studies and case reports) between 2002 and 2023.
    RESULTS: A total of 33 studies (479 patients) report the outcomes of treatment of OIS with carotid endarterectomy (CEA, 304 patients, 19 studies), and carotid artery stenting (CAS, 175 patients, 14 studies). Visual outcomes were improved or did not worsen in 447 patients (93.3%). No periprocedural stroke was reported. Worsening visual symptoms were rare (35 patients, 7.3%); they occurred in the immediate postoperative period secondary to ocular hypoperfusion (3 patients) and in the late postoperative period due to progression of systemic atherosclerotic disease. Symptomatic recurrence due to recurrent stenosis after CEA was reported in 1 patient (0.21%); this was managed successfully with CAS. None of these studies report the results of transcarotid artery revascularization, the long-term operative outcome or stroke rate.
    CONCLUSIONS: OIS remains to be an underdiagnosed condition. Early diagnosis and prompt treatment are crucial in reversal or stabilization of OIS symptoms. An expedited multidisciplinary approach between vascular surgery and ophthalmology services is necessary to facilitate timely treatment and optimize outcome. If diagnosed early, both CEA and CAS have been associated with visual improvement and prevention of progressive visual loss.
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  • 文章类型: Journal Article
    遗传性黄斑营养不良(iMDs)是一组遗传性疾病,影响视网膜的中心区域。为了研究iMDs的遗传基础,我们使用单分子分子逆转探针对1352例诊断为iMDs的黄斑病变相关基因进行测序.在这个群体中,39.8%的患者被认为是由49个不同基因中的460个不同变异的遗传解释,其中73个是新变异。一些影响拼接。前五名最常见的致病基因是ABCA4(37.2%),PRPH2(6.7%),CDHR1(6.1%),PROM1(4.3%)和RP1L1(3.1%)。有趣的是,几乎三分之一的患者(28.1%)发现了外显率不完全的变异,因此,部分患者可能无法仅通过报告的变异来解释.除CDHR1:c.783G>A和CNGB3:c.188G>A外,还包括八个先前报道的外显率不完全的变体。值得注意的是,不常规进行变异定相分离分析-这是一个限制,这也可能影响整体诊断率。Therelativelyhighprobandsofprobandswithoutanyputativecausativevariant(60.2%)highlightstheneedtoexplorevariantswithcompletelypenetrance,疾病的潜在修饰因子以及iMDs和年龄相关性黄斑变性之间的遗传重叠。我们的结果为iMDs的遗传前景提供了有价值的见解,并值得未来探索以确定其他黄斑病变基因的参与。
    Inherited macular dystrophies (iMDs) are a group of genetic disorders, which affect the central region of the retina. To investigate the genetic basis of iMDs, we used single-molecule Molecular Inversion Probes to sequence 105 maculopathy-associated genes in 1352 patients diagnosed with iMDs. Within this cohort, 39.8% of patients were considered genetically explained by 460 different variants in 49 distinct genes of which 73 were novel variants, with some affecting splicing. The top five most frequent causative genes were ABCA4 (37.2%), PRPH2 (6.7%), CDHR1 (6.1%), PROM1 (4.3%) and RP1L1 (3.1%). Interestingly, variants with incomplete penetrance were revealed in almost one-third of patients considered solved (28.1%), and therefore, a proportion of patients may not be explained solely by the variants reported. This includes eight previously reported variants with incomplete penetrance in addition to CDHR1:c.783G>A and CNGB3:c.1208G>A. Notably, segregation analysis was not routinely performed for variant phasing-a limitation, which may also impact the overall diagnostic yield. The relatively high proportion of probands without any putative causal variant (60.2%) highlights the need to explore variants with incomplete penetrance, the potential modifiers of disease and the genetic overlap between iMDs and age-related macular degeneration. Our results provide valuable insights into the genetic landscape of iMDs and warrant future exploration to determine the involvement of other maculopathy genes.
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