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conferenceseries
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Volume 9
J Clin Exp Ophthalmol, an open access journal
ISSN: 2155-9570
Ophthalmology Summit 2018
February 26-27, 2018
February 26-27, 2018 | Berlin, Germany
19
th
Global Ophthalmology Summit
Modification of biochemical may prevent diabetic retinopathy
Lakshmi Kanta Mondal
Regional Institute of Ophthalmology, India
Statement of the Problem:
Modification of hyperglycemia induced different biochemical pathways and modulation of
up regulated expression of angiogenic vascular endothelial growth factor (VEGF) and its receptor 2 (VEGF, VEGFR2) by
peripheral retinal laser photocoagulation (PHC) may prevent vision loss owing to diabetic retinopathy (DR) in type 2 diabetes
mellitus (DM). Unutilized enormous intracellular glucose in insulin nondependent tissues including retina, leads to increased
formation of advanced glycation end products, activation of polyol pathway, anaerobic glycolysis and oxidative stress, resulting
in glutamate toxicity and lipid peroxidation. Ultimately all these pathways converge to upregulation of proangiogenic VEGF
and VEGFR2, the crucial player of the development of DR.
Purpose:
The purpose of the present pilot study is to assess the effects of supplementation of B-vitamins (B1, B2, B3, B5 and B6),
vitamin E and precedent peripheral laser PHC for pathological retinal degeneration and retinal breaks, on the development of DR.
Methodology:
Two hundred patients of diagnosed type2 DM, who had been treated by oral antidiabetic medication along
with B-vitamins and vitamin E since 2004, are included in this ongoing study. Baseline detailed fundus examinations excluded
the presence of retinopathy. Twenty seven subjects of this group received peripheral retinal laser PHC for symptomatic retinal
breaks. Baseline biochemical parameters like lactate/pyruvate ratio, advanced glycation end products (AGEs), malondialdehyde
(MDA), VEGF and VEGFR2 were determined. Yearly fundus examinations were documented to detect the features of DR.
Findings:
Twenty seven patients who received laser PHC and B-vitamins and vitamin E, do not show any feature of DR. Thirty
two among 160 patients who received B-vitamins and vitamin E, developed very mild microangiopathy. Thirteen patients lost
the follow-up.
Conclusion:
Glycolysis and citric acid cycle should run uninterruptedly to prevent biochemical derangements which leads
to increased expression of VEGF and VEGFR2. Previous peripheral retinal laser PHC probably create inhibitory signal for
secretion of angiogenic VEGF and VEGFR2.
Flow chart→
Anomalous glycolysis→altered L/P ratio and NAD+ /NADH→reductive stress in cellular level Increased lactate→lowering
of cellular pH→reduced action of GLAST→glutamate toxicity→increased intracellular Ca++ →increased lipid
peroxidation→diminished activity of G6PD→reduced function of deformed RBC→localized tissue hypoxia→upregulation of
VEGF Unutilized glucose→increased AGEs→AGE+RAGE interaction→activation ofNADPH oxidase→increased endothelial
and pericyte ROS production→upregulation of NF-kB→upregulation of VEGF Supplementation of B-vitamins→adequate
supply of oxidized cofactors(NAD+ ,FAD,FMN,Pyridoxamine) →continuity of glycolysis and citric acid cycle→reduced
biochemical derangements→less production of angiogenic VEGF and VEGFR2 Previous laser PHC→inhibitory signal on
angiogenic VEGF→less chance of microangiopathy
Lakshmi Kanta Mondal, J Clin Exp Ophthalmol 2018, Volume 9
DOI: 10.4172/2155-9570-C1-078