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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 14  |  Issue : 1  |  Page : 22-23 Table of Contents     

Homocysteine levels in plasma of cataract patients with and without pseudoexfoliation syndrome


Department of Ophthalmology, Valiaser Hospital, Birjand Medical University, Southern Khorasan, Iran

Date of Web Publication11-Nov-2009

Correspondence Address:
Gholamhossein Yaghoubi
Valiaser Hospital, Birjand Medical University, Southern Khorasan
Iran
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Purpose. To compare serum homocysteine levels in cataract patients with and without pseudoexfoliation (PXF).
Patients and Methods. This study included 29 patients with cataract and PXF syndrome, as well as 29 age- and sex-matched controls with cataract but without PXF syndrome. Patients with systemic and ocular conditions known to be associated with hyperhomocysteinemia were excluded from the study.
Results. The mean serum homocysteine level was significantly elevated among patients with cataract and PXF syndrome when compared to those without PXF syndrome (16.61 vs. 11.67 ΅mol/L; P = .01). The percentage of patients with PXF syndrome and elevated serum homocysteine was significantly higher than in patients without PXF syndrome (56% vs. 14%; P<.0001). Logistic regression analysis identified elevation in plasma homocysteine levels as a significant risk factor for the development of PXF syndrome (odds ratio = 8.85; 95% confidence interval, 2.40-32.12).
Conclusion. Hyperhomocysteinemia is significantly associated with PXF syndrome in patients with cataract.

Keywords: cataract, homocysteine, pseudoexfoliation


How to cite this article:
Yaghoubi G, Heydari B, Raza MM, Zohre B. Homocysteine levels in plasma of cataract patients with and without pseudoexfoliation syndrome. Middle East Afr J Ophthalmol 2007;14:22-3

How to cite this URL:
Yaghoubi G, Heydari B, Raza MM, Zohre B. Homocysteine levels in plasma of cataract patients with and without pseudoexfoliation syndrome. Middle East Afr J Ophthalmol [serial online] 2007 [cited 2019 Sep 19];14:22-3. Available from: http://www.meajo.org/text.asp?2007/14/1/22/57686

Moderate hyperhomocysteinemia has been related to primary and secondary open-angle glaucoma caused by pseudoexfoliation (PXF) syndrome, a clinically significant systemic disorder of the extracellular matrix that represents the most common identifiable cause of open-angle glaucoma. [1],[2],[3],[4]

Cataract formation is an age-related process that is often associated with PXF syndrome. In this study, we compared serum homocysteine levels in patients with cataract and PXF syndrome to those patients with cataract but without PXF syndrome.


   Patients and Methods Top


Consecutive patients admitted to Valiaser Hospital for cataract surgery were evaluated for the presence or absence of PXF syndrome for possible inclusion in a prospective evaluation of serum homocysteine levels. Patients taking medications or having medical conditions (eg, impaired renal function, cancer) known to affect serum homocysteine levels were excluded from this study. In addition, patients with a previous history of ocular vascular occlusion, inflammatory disease, or glaucoma were excluded from this study, as were patients who were unable or unwilling to give informed consent.

Prior to enrollment in this study, every patient underwent a comprehensive dilated ophthalmic examination. The anterior lens surface was examined using a narrow slit-lamp beam under full illumination and high magnification. A diagnosis of PXF syndrome was established by the presence of typical white deposits on the anterior lens surface, as well as the presence of granular deposits and pregranular radial lines. Gonioscopy was also performed to evaluate the angle for PXF material within the angle and increased pigmentation of the trabecular meshwork.

Informed consent to participate and be enrolled in this study was obtained from 29 patients with cataract and PXF syndrome, as well as from 29 age- and sex-matched patients with cataract but without PXF syndrome. Prior to cataract surgery, fasting serum samples were obtained, frozen, and sent for measurement of plasma homocysteine levels using high performance liquid chromatography. Values exceeding 13 μmol/L were considered elevated.


   Results Top


The results of serum homocysteine levels in patients with cataract and PXF syndrome, as well as in those with cataract but without PXF syndrome, are summarized in [Table 1]. There were no statistically significant differences between the 2 groups with respect to age and gender [Table 2]. The mean serum homocysteine level was significantly elevated among patients with cataract and with PXF syndrome when compared to those with cataract but without PXF syndrome (16.61 vs 11.67 μmol/L; P = .01). Among the PXF syndrome patients, hyperhomocysteinemia was present in both male and female patients. The percentage of patients with PXF syndrome who had elevated serum homocysteine levels was significantly higher than in patients without PXF syndrome (56% vs. 14%, P< 0.0001). Logistic regression analysis identified elevation in plasma homocysteine levels as a significant risk factor for the development of PXF syndrome (odds ratio = 8.85; 95% confidence interval, 2.40-32.12).


   Discussion Top


Hyperhomocysteinemia is known to be associated with risk factor in many geriatric multisystem diseases, [5] especially premature vascular disease, [5] sensorineural hearing loss, [6] asymptomatic myocardial dysfunction, [7] myocardial infarction, [7] stroke, [5] and Alzheimer's disease. [5] The proposed mechanisms of this association are angiotoxicity, neurotoxicity, and inhibition of collagen crosslinking. [5]

Genetically, hyperhomocysteinemia is caused by polymorphism in the methylenetetrahydrofolate reductase gene. [8],[9] Impaired DNA synthesis caused by this genetic abnormality may explain its association with cataractogenesis. [8],[9] This hypothesis is supported by evidence that folate supplementation, which lowers serum homocysteine levels, may be protective against cataract. However, elevated levels of homocysteine cannot be the sole explanation for cataract formation because homocysteine levels were elevated in patients with cataract and PXF syndrome in the present study, but were not elevated in patients with cataract who did not have PXF syndrome.

In cases both with and without glaucoma, [1],[2],[3],[4] a strong relationship exists between elevated levels of serum homocysteine and open-angle glaucoma, [3],[8] as well as with PXF syndrome. Altintas et al [3] proposed that this association may explain the increased risk of vascular disease in patients with PXF syndrome. The current study provides additional evidence that homocysteine levels are also elevated in patients with PXF syndrome and cataract, whether or not glaucoma is present.

Acknowledgements: We wish to thank our nurse, Mahmonir Sanaei, for assistance in conducting this study.

 
   References Top

1.Bleich S, Roedl J, Von Ahsen N, et al. Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma. Am J Ophthalmol 2004;138:162-164.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol 2003;136:41-46.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Altintas O, Maral H, Yuksel N, et al. Homocysteine and nitric oxide levels in plasma of patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2005;243:677-683.  Back to cited text no. 3      
4.Leibovitch I, Kurtz S, Shemesh G, et al. Hyperhomocysteinemia in pseudoexfoliation glaucoma. J Glaucoma 2003;12:36-39.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Kuo HK, Sorond FA, Chen JH, et al. The role of homocysteine in multisystem age-related problems: a systematic review. J Gerontol A Biol Sci Med Sci 2005;60:1190-1201.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Shaban RI, Asfour WM. Ocular pseudoexfoliation associated with hearing loss. Saudi Med J 2004;25:1254-1257.  Back to cited text no. 6  [PUBMED]    
7.Bojic L, Ermacora R, Polic S. et al. Pseudoexfoliation syndrome and asymptomatic myocardial dysfunction. Graefes Arch Clin Exp Ophthalmol 2005;243:446-449.  Back to cited text no. 7      
8.Mossbock G, et al. Methylenetetrahydrofolatereductase (MTHFR) 677C>T polymorphism and open angle glaucoma. Mol Vis 2006;12:356-359.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Zetterberg M, Tasa G, Prince JA, et al. Methylenetetrahydrofolate reductase genetic polymorphisms in patients with cataract. Am J Ophthalmol 2005;140:932-934.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  



 
 
    Tables

  [Table 1], [Table 2]



 

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