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Published on: June 2, 2022
Efficacy of ophthalmic examinations for predicting vascular calcification in patients undergoing maintenance
Woo Yeong Park1,2, Yaerim Kim1,2, Jin Hyuk Paek1,2
1Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
Insights
Ophthalmic examinations can predict vascular calcification in maintenance hemodialysis (MHD) patients. The conjunctival and corneal calcification (CCC) score, along with invasion extent, correlates with coronary artery calcium (CAC) scores and cardiac function.
Area of Science:
- Nephrology
- Ophthalmology
- Cardiology
Background:
- Vascular calcification is common in maintenance hemodialysis (MHD) patients, affecting both coronary and ocular areas.
- Ophthalmic examinations are not yet fully validated for assessing vascular calcification severity in MHD patients.
Purpose of the Study:
- To validate ophthalmic examinations, specifically the conjunctival and corneal calcification (CCC) score, as a predictor of vascular calcification in MHD patients.
- To investigate the association between ocular calcification, coronary artery calcium (CAC) scores, and cardiac function in MHD patients.
Main Methods:
- Prospective study of 32 MHD patients.
- Assessment of conjunctival and corneal calcification (CCC) using slit lamp and anterior photography, grading severity and extent of invasion.
- Coronary artery calcium (CAC) scoring via computed tomography and echocardiogram for cardiac function evaluation.
Main Results:
- Higher CCC scores and greater corneal invasion extent correlated with significantly higher CAC scores and parathyroid hormone levels.
- Moderate/severe CCC groups exhibited significantly higher CAC scores and parathyroid hormone levels compared to the mild group.
- The CCC score was negatively associated with ejection fraction, indicating poorer cardiac function in patients with more severe ocular calcification.
Conclusions:
- The conjunctival and corneal calcification (CCC) score and its extent of invasion are reliable predictors of vascular calcification in MHD patients.
- Ophthalmic assessment offers a non-invasive method to evaluate systemic vascular calcification burden and associated cardiac risks in MHD patients.
Background:
In maintenance hemodialysis (MHD) patients, vascular calcification can be detected not only in coronary vessels but also in ocular areas. However, ophthalmic examinations are not sufficiently validated to measure the degree of vascular calcification.
Methods:
This study was performed prospectively, involving 32 MHD patients. Calcium deposition in the cornea and conjunctiva was checked using a slit lamp and anterior photography. Conjunctival and corneal calcification (CCC) score was calculated and the severity of CCC was graded. Extent of invasion in the corneal limbus and center was identified. Coronary artery calcium (CAC) deposit was scored using computer tomography, and cardiac function was investigated by echocardiogram. We divided patients into two groups: mild and moderate/severe groups according to the CCC scores.
Results:
Mean CAC scores were 354.6 and 1,494.2 in the mild and moderate/severe groups. Mean extent of invasion in the corneal limbus and center was significantly higher in the moderate/severe groups than in the mild group. Parathyroid hormone was significantly higher in the moderate/severe groups than in the mild group and ejection fraction was significantly lower in the moderate/severe groups than in the mild group. The CCC score was positively associated with the CAC score, the extent of invasion in the corneal limbus and center, and the parathyroid hormone level. The extent of invasion in the corneal limbus and center was positively associated with the CAC score. The CCC score was negatively associated with ejection fraction.
Conclusion:
The CCC score and the extent of invasion in the corneal limbus and center can predict vascular calcification in MHD patients.
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