Značaj ateroskleroze u pseudoeksfolijativnom glaukomu
Sažetak
Uvod/Cilj. Pseudoeksfolijativni sindrom je sistemski poremećaj starijeg životnog doba, koji se karakteriše povećanom proizvodnjom i akumulacijom elastičnog mikrofibrilarnog materijala u različitim tkivima tela: koži, vezivnom tkivu unutrašnjih organa, perifernim krvnim sudovima i oku. Cilj istraživanja bio je da se utvrdi značaj aterosklerotičnih promena u karotidnim arterijama u razvoju pseudoeksfolijativnog sindroma i pseudoekfolijativnog glaukoma. Metode. Studijom je bilo obuhvaćeno 120 bolesnika, po 40 bolesnika u svakoj od tri definisane grupe: sa pseudoeksfolijativnim sindromom (XFS), sa pseudoeksfolijativnim glaukomom (XFG) i kontrolna grupa bez XFG (uparena po starosti i polu). Uzorci krvi su sakupljeni kod bolesnika pre operacije katarakte. Nivo (ukupnog holesterola, low-density lipoprotein – LDL, high density lipoprotein – HDL i triglicerida u serumu analizirani su standardnim laboratorijskim tehnikama. Standardna ultrasonografija karotidnih arterija urađena je kod svih ispitanika. Rezultati. Lipidni profil bio je poremećen kod bolesnika sa XFS i XFG, sa statističkom značajnošću u odnosu na kontrolnu grupu (p < 0,01). Sistolni i dijastolni pritisak bio je statistički značajno povišen kod bolesnika sa XFS i XFG (p < 0.01). Indeks rezistencije bio je povećan kod bolesnika sa XFG (p < 0,01), dok je intimamedija komples bio statistički značajno produžen kod bolesnika sa XFG (p < 0.01). Zaključak. Poremećen profil lipida sa povišenim indeksom rezistencije i debljinom intimomedija kompleksa kao i povišenim sistolnim i dijestolnim pritiskom su ključni nalazi kod bolesnika sa razvijenim XFG. Zbog toga ih treba uzeti u obzir kao faktore rizika. Čini se da je teško da se inhibira proces proizvodnje pseudoeksfolijacija u celom telu, ali i da se uz pravilnu terapiju (antihipertnenzivni lekovi, kardiotonici, itd) i uz adekvatan režim ishrane, proces razvoja pseudoeksfolijativnog glaukoma može da prekine.
Reference
Scharfenberg E, Schlötzer-Schrehardt U. PEX syndrome. Clinical diagnosis and systemic manifestations. Der Ophthalmologe 2012; 109(10): 952−61.
Ritch R, Schlotzer-Schrehardt U, Konstas A. Why is glaucoma as-sociated with exfoliation syndrome. Prog Ret Eye Res 2003; 22(3): 253−75.
Schlötzer-Schrehardt UM, Koca MR, Naumann GO, Volkholz H. Pseudoexfoliation syndrome. Ocular manifestation of a sys-temic disorder. Arch Ophthalmol 1992; 110(12): 1752−6.
Streeten BW, Li ZY, Wallace RN, Eagle RC, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol 1992; 110(12): 1757−62.
Asano N, Schlötzer-Schrehardt U, Naumann GO. A histopatholog-ic study of iris changes in pseudoexfoliation syndrome. Oph-thalmology 1995; 102(9): 1279−90.
Parodi MB, Bondel E, Saviano S, Ravalico G. Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma. Acta Ophthalmol Scand 2000; 78(4): 437−42.
Naumann G. Pseudoexfoliation syndrome for the comprehen-sive ophthalmologist Intraocular and systemic manifestations Historical image. Ophthalmology 1998; 105(6): 951−68.
Leibovitch I, Kurtz S, Shemesh G, Goldstein M, Sela B, Lazar M, et al. Hyperhomocystinemia in Pseudoexfoliation Glaucoma. J Glaucoma 2003; 12(1): 36−9. 1
Schumacher S, Schlotzer-Schrehardt U, Martus P, Lang W, Naumann GO. Pseudoexfoliation syndrome and aneurysm of the ab-dominal aorta. Lancet 2001; 357(9253): 359−60.
Rathcke CN, Vestergaard H. YKL-40, a new inflammatory marker with relation to insulin resistance and with a role in en-dothelial dysfunction and atherosclerosis. Inflamm Res 2006; 55(6): 221−7.
Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with inceased vascular risk. Am J Ophthalmol 1997; 124(5): 685−7.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arte-rial hypertension: The Task Force for the Management of Ar-terial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28(12): 1462−536.
Schlotzer-Schrehardt U, von der Mark K, Sakai LY, Naumann GO. Increased extracellular deposition of fibrillin-containing fibrils in pseudoexfoliatin syndrome. Invest Ophthalmol Vis Sci 1997; 38(5): 970−84.
Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001; 45(4): 265−315.
Hoeks AP, Brands PJ, Smeets FA, Reneman RS. Assessment of the distensibility of superficial arteries. Ultrasound Med Biol 1990; 16(2): 121−8.
Visontai Z, Merisch B, Kollai M, Holló G. Increase of carotid ar-tery stiffness and decrease of baroreflex sensitivity in exfolia-tion syndrome and glaucoma. Br J Ophthalmol 2006; 90(5): 563−7.
Kastrup J, Johansen JS, Winkel P, Hansen JF, Hildebrandt P, Jensen GB, et al. High serum YKL-40 concentration is associated with cardiovascular and all-cause mortality in patients with stable coronary artery disease. Eur Heart J 2009; 30(9): 1066−72.
Turkyılmaz K, Oner V, Kırbas A, Sevim MS, Sekeryapan B, Zgur GO, et al. Serum YKL-40 levels as a novel marker of inflam-mation and endothelial dysfunction in patients with pseudoex-foliation syndrome. Eye 2013; 2(7): 854−9.
Damji KF, Bains HS, Stefansson E, Loftsdottir M, Sverrisson T, Thorgeirsson E,et al.Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation. Ophthalmic Genet 1998; 19(4): 175−85.
Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362(6423): 801−9.
Tezel G. Oxidative stress in glaucomatous neurodegeneration: mechanisms and consequences. Prog Retin Eye Res 2006; 25(5): 490−513.
Liu T, Clark RK, McDonnell PC, Young PR, White RF, Barone FC, et al. Tumor necrosis factor-alpha expression in ischemic neu-rons. Stroke 1994; 25(7): 1481−8.
Andrikopoulos KG, Alexopoulos KD, Gartaganis PS. Pseudoexfoli-ation syndrome and cardiovascular diseases. World J Cardiol 2014; 26(8): 847−54.
Agafonova VV, Frankovska-Gerlak MZ, Sokolovskaia TV, Brizhak PE, Bessarabov AN. Occurrence and characteristics of cardio-vascular pathology in patients with pseudoexfoliative glauco-ma. Vestn Oftalmol 2013; 129(6): 34−7. (Russian)
Benda T. Cardiovascular diseases occurrence in patients with pseudoexfoliative syndrome and pseudoexfoliative glaucoma. Cesk Slov Oftalmol 2011; 67(1): 12−5. (Czech)