AIm: The aim of this study was to analyze the correlation between serum levels of inflammatory cytokines Il-1β, Il-6, TnF-α and vegF and the presence and severity of diabetic retinopathy (dR) in patients with type 2 diabetes mellitus (dM). PAtIents And methods: In this prospective study we included 38 healthy volunteers (group 1) and 39 patients with type 2 dM (group 2). all participants underwent routine ophthalmological examination and laboratory analysis of the serum cytokines Il-1β, Il-6, TnF-α and vegF. group 2 patients were additionally examined by colour fundus photography and fluorescein angiography to determine the dR stage. We studied the correlation of Il-1β, Il-6, TnF-α and vegF with the presence of dM, the presence and severity of dR, the duration of dM and dR, the serum levels of glycosylated haemoglobin, as well as with hyperlipidemia and the general indicators of inflammation -erythrocyte sedimentation rate (eSR) and fibrinogen. results: The group 2 patients had statistically significantly higher levels of Il-1β (р = 0.01) and Il-6 (р = 0.029) and elevated TnF-α and vegF levels in comparison with group 1 patients. group 2 patients were divided into 5 subgroups depending on the severity of dR: patients without dR (n = 11), patients with mild non-proliferative dR (n = 10), patients with moderate non-proliferative dR (n = 5), and patients with severe non-proliferative dR (n = 2) (total number of non-proliferative dR (n = 17)) and patients with proliferative dR (n = 11). The comparative analysis showed statistically significant differences in the serum levels of Il-1β (р = 0.003), TnF-α (р = 0.002) and vegF (р = 0.005) between the different subgroups. Patients with proliferative dR showed significantly higher values of serum Il-1β (р < 0.0001), Il-6 (р = 0.007), TnF-α (р = 0.002) and vegF (р < 0.0001) compared with the patients with non-proliferative dR. The cytokine serum levels did not correlate with the duration of dM, the duration of dR (except for Il-1β, р = 0.045), and hyperlipidemia (except for TnF-α, р = 0.05). TnF-α (р = 0.05) and vegF (р = 0.047) serum levels correlated with the levels of glycosylated hemoglobin, and Il-1β, TnF-α and vegF correlated with the general indicators of inflammation (eSR and fibrinogen). conclusIon: Serum concentrations of Il-1β, TnF-α and vegF have an effect on the development and progression of dR. They correlate with the presence and severity of the disease. Whether serum cytokines can play the role of a prognostic factor or serve as a means to choose a proper therapeutic agent for the treatment of diabetic retinopathy should be analyzed by further more extensive prospective longitudinal studies in future. key words: diabetic retinopathy, cytokines, interleukins, tumor necrosis factor-α, vascular endothelial growth factor abbreviations useD in the stuDy:

Spectral-domain OCT provided valuable information on retinal morphology and was particularly useful in diagnosing sub-clinical SMD in eyes with DME. It disclosed the presence and strength of macular traction either by partially detached posterior hyaloid or by epiretinal membranes. C-scans and C-scan OCT/SLO fundus image overlays added complementary information for the extent and location of the pathological features. Larger studies which follow subjects longitudinally are needed to explain the pathogenesis and determine the prognosis of SMD.

Citation: Marinov VG, KolevaGeorgieva DN, Sivkova NP, Krasteva MB. The 5-minute Apgar score as a prognostic factor for development and progression of retinopathy of prematurity.Folia Medica 2017;59(1): 78-83. doi: 10.1515/folmed-2017-0011 Background: A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP). Aim: To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP. Materials and methods:The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic signifi cance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA -spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ 2 or Fisher's exact test were used in the statistical analysis. Logistic regression was performed to fi nd signifi cant and independent risk factors for manifestation and progression of ROP. Results: A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically signifi cant risk factors of ROP (р=0.191, р=0.191, respectively), but were signifi cant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively). Conclusion: An Apgar score at 5 minutes of 6 or less was a signifi cant and independent risk factor for progression of ROP to stages requiring treatment. BACKGROUND

Aim: To measure the macular thickness, macular volume and peripapillary retinal nerve fiber layer (RNFL) in healthy Caucasian chil&shy;dren using spectral domain optical coherence tomography (SDOCT) and analyze the correlation of these values with age, refraction, and biometric measurements. Materials and methods: In this cross-sectional study, we recruited 270 healthy children (150 female and 120 male) aged 6 to 17 years with no ocular abnormalities. All children underwent a detailed eye examination. The measurements were obtained using a SDOCT device (SOCT Copernicus REVO). Main outcome measures were macular thickness, macular volume and RNFL thickness. Their correlations with age, refractive error, anterior chamber depth (ACD) and axial length (AL) was analyzed. Right eyes of all subjects were selected for analysis. Results: In this study group (mean age 10.70&plusmn;2.82 years), the average peripapillary RNFL thickness was 117.11&plusmn;9.15 &mu;m, the central macular thickness was 232.10&plusmn;15.81 &mu;m, the average macular thickness was 286.70&plusmn;9.82 &mu;m, and the average macular volume was 8.01&plusmn;0.28 mm&sup3;. The average values for the biometric data were: axial length &ndash; 23.16&plusmn;0.94 mm, anterior chamber depth &ndash; 3.64&plusmn;0.26 mm, the spherical equivalent (SE) value &ndash; +0.81&plusmn;0.58 diopter. Central macular thickness, inner macular thickness (superior, inferior, nasal, temporal quadrants) values, total macular thickness and macular volume were significantly higher in males than in females. We found a positive correlation between central macular thickness, inner nasal macular thickness, outer inferior macular thickness values, and age. Also, we found a significant correlation between the average macular thickness values and the average macular volume values (p<0.0001). RNFL measurements did not correlate with age (p=0.199). Almost all macular parameters were consistently positively cor&shy;related with SE. A significant correlation was also found between the central macular thickness, inner inferior macular thickness, inner nasal macular thickness and the ACD. We found a significant correlation between the average macular thickness, macular volume, inner superior macular thickness, outer macular thickness (superior, inferior, nasal, temporal quadrants) values and the AL. Conclusion: This study found normal reference ranges for RNFL and macular parameters measured by SOCT Copernicus REVO in healthy Caucasian children aged 6-17 years. This normative values could be very useful in early diagnosing and monitoring of optic neuropathy, glaucoma and macular diseases in childhood.

Optical coherence tomography-angiography (OCT-A) is a relatively new non-invasive imaging technique which provides three-dimensional visualization of the retinal and choroidal microvasculature. Recently, OCT-A is widely used in the diagnosis of age-related macular degeneration (AMD). Purpose: To compare 3 quantitative indexes of foveal avascular zone (FAZ)-area (A), perimeter (Pm), and circularity (C) in patients with early and intermediate nonexudative AMD and healthy subjects using OCT-A. Methods: Eighty-nine patients with nonexudative AMD (n = 89 eyes) were enrolled in the study. They were compared with sex-and age-matched control group of 66 healthy subjects (n = 66 eyes). The patients with nonexudative AMD were divided into 2 subgroups-early AMD (n = 42 eyes) and intermediate AMD (n = 47 eyes). All participants underwent OCT-A (3 × 3 mm scans, Cirrus HD-OCT, Angioplex, Carl Zeiss Meditec, Dublin, CA). Results: There was no statistically significant difference in all 3 assessed indexes between the early AMD subgroup and the control group (A − P = 0.139; Pm − P = 0.230; and C − P = 0.191). There was also no statistically significant difference in all 3 assessed indexes between the intermediate AMD subgroup and the control group (A − P = 0.106, Pm − P = 0.124, and C − P = 0.102, respectively). Conclusions: According to our results from the assessment of FAZ in patients with early and intermediate AMD, we hypothesize that macular perfusion remains fairly unchanged in the nonexudative stages of the disease. OCT-A is a reliable technique for visualizing and quantifying FAZ in patients with nonexudative AMD.