This chapter discusses about the effect of vitreous immune system and biomarkers on the progression of proliferative diabetic retinopathy. Immune system and biomarkers have been believed to have an important role in the progression of diabetic retinopathy (DR) severity. Hyperglycemic will influence immune cells resulting in chronic inflammation on the retina. This condition progressively disrupts the blood-retinal barrier in retina causing those inflammatory molecules and immune cells to transfer from circulation. The transfer of these molecules plays an important part in the progression of proliferative diabetic retinopathy. In addition, biomarkers are indicators for some complex processes happened in our body, and are measured to determine diagnosis and prognosis of some treatment. There are several biomarkers that have been identified in DR patients including biomarkers of oxidative stress, hypoxia-inducible factors, angiogenic factors, pro-inflammatory cytokines, chemokines, cell adhesion molecules, and soluble CD200. The value of these biomarkers will tell us their possible role in the progression of DR. By improving the knowledge of molecular pathway in DR pathophysiology, the advancement of selective therapy approaches could be discovered and the management of DR could be more efficient.
Part of the book: Early Events in Diabetic Retinopathy and Intervention Strategies
Diabetic retinopathy (DR) is a devastating sight-threatening complication of diabetes mellitus (DM). Besides damaging the vascular system of the retina, DM will also destruct the tissue surrounding the retina, including the optic nerve. DR impairs the optic nerve by damaging its conduction and integrity. There are few clinical manifestations of optic nerve changes in DR such as diabetic papillopathy, neovascularization of optic disc, and optic nerve atrophy. These involve metabolic alterations related to DM, production of advanced glycation end products (AGEs), oxidative stress, and hemodynamic changes. Diagnostic tests including visual evoked potential (VEP) and optical coherence tomography (OCT) can detect functional and structural changes. This finding is important as it may reflect the early loss of retinal ganglion cell axons. As the neuronal loss is irreversible, it is pivotal to be able to screen these nervous system changes in the early stage of DR and prevent further deterioration.
Part of the book: Optic Nerve
Age-related macular degeneration (ARMD) is the leading cause of blindness affecting adults. The disease alters the macula, center of the retina, responsible for the keenest vision. Although ARMD is part of the aging process, the exact pathophysiology is still unknown. The evidence suggests that oxidative stress, lipofuscin accumulation, drusen accumulation, chronic inflammation, choroidal neovascularization, and mutations of the complement contribute to the development of ARMD. Early recognition and prompt treatment halt the progression of the disease. The advanced technology in imaging modalities provides comprehensive and complete management at the earliest stage of ARMD.
Part of the book: Visual Impairment and Blindness
The Epstein-Barr Virus (EBV), a member of the Herpesvirus family, occurs commonly and infects more than 90% of people worldwide. Most of systemic EBV infections throughout childhood and adulthood are typically asymptomatic or paucisymptomatic. Even though ocular involvements in EBV infections are infrequently reported, an increasing number of ocular manifestations have been previously reported . Ocular manifestation caused by EBV infection involved all segments of the eye, including oculoglandular syndrome, dry eye syndrome, dacryoadenitis, conjunctivitis, episcleritis, keratitis, uveitis, choroiditis, retinitis, retinal vasculitis, and papillitis. Previous reports found neurologic complications such as papilledema, optic neuritis, ophthalmoplegia, impaired accommodation, and facial nerve palsy. Any atypical ocular inflammatory process should be considered EBV infection in the differential diagnosis. The ocular manifestations of systemic EBV infection are varied and have not been emphasized. And the role of EBV infection in ocular manifestation should be fully described.
Part of the book: Epstein-Barr Virus