Could corneal densitometry be used as a diagnostic and screening tool for ocular involvement in patients with gout?

  • Pinar Kosekahya
  • Kadir Gokhan Atilgan
  • Cemile Ucgul Atilgan
  • Kemal Tekin
  • Mustafa Koc
  • Mehtap Caglayan
  • Deniz Ayli
  • Pelin Yilmazbas
Original Paper
  • 26 Downloads

Abstract

Purpose

To evaluate the corneal and tear film characteristics in patients with gout and compare these data with those of healthy subjects and to investigate the correlation of corneal densitometry with uric acid value and duration of disease.

Methods

Forty-one eyes of 41 patients with gout (group 1) and 40 eyes of 40 healthy subjects (group 2) were included in this study. Detailed ophthalmologic examinations were performed on all participants. Corneal tomographic analyses were performed with the Pentacam HR Scheimpflug imaging system (Oculus, Wetzlar, Germany). Maximum keratometry (Kmax), central corneal thickness (CCT), corneal volume (CV), and corneal densitometric values were compared between groups. Tear function tests including Schirmer, tear breakup time, and fluorescein staining were performed and compared between groups.

Results

Groups were similar in terms of age and gender. Kmax, CCT, and CV values were similar between groups. The outcomes of tear function tests were similar between groups. Corneal densitometric values for the 0–2 and 2–6 mm zones of the anterior and center layers were significantly higher in group 1 compared to group 2. This densitometric increase was positively correlated with uric acid levels and gout duration.

Conclusions

Corneal densitometry values of the 0–2 and 2–6 mm zones of the anterior and central layers were higher in patients with gout than those of the control subjects, and the densitometric values increased as uric acid level and disease duration increased.

Keywords

Corneal densitometry Gout Tear film tests 

Notes

Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

References

  1. 1.
    Li EK (2004) Gout: a review of its aetiology and treatment. Hong Kong Med J 10:261–270PubMedGoogle Scholar
  2. 2.
    Dalbeth N, Merriman TR, Stamp LK (2016) Gout. Lancet 388:2039–2052CrossRefPubMedGoogle Scholar
  3. 3.
    Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum 63:3136–3141CrossRefPubMedGoogle Scholar
  4. 4.
    Singh JA, Reddy SG, Kundukulam J (2011) Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol 23:192–202PubMedPubMedCentralGoogle Scholar
  5. 5.
    Cameron JS, Moro F, Simmonds HA (1993) Gout, uric acid and purine metabolism in paediatric nephrology. Pediatr Nephrol 7:105–118CrossRefPubMedGoogle Scholar
  6. 6.
    Akizuki S (1982) A population study of hyperuricemia and gout in Japan—analysis of sex, age and occupational differences in thirty-four thousand people living in Nagano Prefecture. Ryumachi 22:201–208PubMedGoogle Scholar
  7. 7.
    Anton FM, Garcia Puig J, Ramos T, Gonzalez P, Ordas J (1986) Sex differences in uric acid metabolism in adults: evidence for a lack of influence of estradiol-17 beta (E2) on the renal handling of urate. Metabolism 35:343–348CrossRefPubMedGoogle Scholar
  8. 8.
    Bardin T, Bouee S, Clerson P, Chales G, Flipo RM, Liote F, Perez V, Poiraud T, Schaeverbeke T, Richette P (2016) Prevalence of gout in the adult population of France. Arthritis Care Res 68:261–266CrossRefGoogle Scholar
  9. 9.
    Kuo CF, Grainge MJ, Zhang W, Doherty M (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11:649–662CrossRefPubMedGoogle Scholar
  10. 10.
    Terkeltaub R (2010) Update on gout: new therapeutic strategies and option. Nat Rev Rheumatol 6:30–38CrossRefPubMedGoogle Scholar
  11. 11.
    Singh JA (2016) Gout: will the “King of Diseases” be the first rheumatic disease to be cured? BMC Med 14:180CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Morris WR, Fleming JC (2003) Gouty tophus at the lateral canthus. Arch Ophthalmol 121:1195–1197CrossRefPubMedGoogle Scholar
  13. 13.
    Ferry AP, Safir A, Melikian HE (1985) Ocular abnormalities in patients with gout. Ann Ophthalmol 17:632–635PubMedGoogle Scholar
  14. 14.
    Topping NC, Cassels-Brown A, Chakrabarty A, Cronin P, Ross S, Russell J, Tesha P (2003) Uric acid crystals presenting as an orbital mass. Eye (Lond) 17(3):427–429CrossRefGoogle Scholar
  15. 15.
    Coassin M, Piovanetti O, Stark WJ, Green WR (2006) Urate deposition in the iris and anterior chamber. Ophthalmology 113(3):462–465CrossRefPubMedGoogle Scholar
  16. 16.
    Slansky HH, Kubara T (1968) Intranuclear urate crystals in corneal epithelium. Arch Ophthalmol 80(3):338–344CrossRefPubMedGoogle Scholar
  17. 17.
    Fishman RS, Sunderman FW (1966) Band keratopathy in gout. Arch Ophthalmol 75(3):367–369CrossRefPubMedGoogle Scholar
  18. 18.
    Bernad B, Narvaez J, Diaz-Torné C, Diez-Garcia M, Valverde J (2006) Clinical image: corneal tophus deposition in gout. Arthritis Rheum 54(3):1025CrossRefPubMedGoogle Scholar
  19. 19.
    Sarma P, Das D, Deka P, Deka AC (2010) Subconjunctival urate crystals: a case report. Cornea 29(7):830–832CrossRefPubMedGoogle Scholar
  20. 20.
    Alnawaiseh M, Rosentreter A, Prokosch V, Eveslage M, Eter N, Zumhagen L (2016) Changes in corneal densitometry in patients with Fuchs endothelial dystrophy after endothelial keratoplasty. Curr Eye Res 3:1–5Google Scholar
  21. 21.
    Alnawaiseh M, Rosentreter A, Eveslage M, Eter N, Zumhagen L (2015) Changes in corneal transparency after cross-linking for progressive keratoconus: long-term follow-up. J Refract Surg 31:614–618CrossRefPubMedGoogle Scholar
  22. 22.
    Enders P, Holtick U, Schaub F, Tuchscherer A, Hermann MM, Scheid C, Cursiefen C, Bachmann BO (2017) Corneal densitometry for quantification of corneal deposits in monoclonal gammopathies. Cornea 36(4):470–475CrossRefPubMedGoogle Scholar
  23. 23.
    Alnawaiseh M, Zumhagen L, Zumhagen S, Schulte L, Rosentreter A, Schubert F, Eter N, Mönnig G (2016) Corneal densitometry as a novel technique for monitoring amiodarone therapy. Ophthalmology 123(11):2294–2299CrossRefPubMedGoogle Scholar
  24. 24.
    Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D et al (2015) 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 67:2557–2568CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lemp MA (1973) Breakup of the tear film. Int Ophthalmol Clin 13:97–102CrossRefPubMedGoogle Scholar
  26. 26.
    Lemp MA et al (2007) The definition and classification of dry eye disease: Report of the Definition and Classification Subcommittee of the international Dry Eye WorkShop (2007). Ocul Surf 5(2):75–92.  https://doi.org/10.1016/S1542-0124(12)70081-2 CrossRefGoogle Scholar
  27. 27.
    Halberg GP, Berens C (1961) Standardized Schirmer tear test kit. Am J Ophthalmol 51:840–842CrossRefPubMedGoogle Scholar
  28. 28.
    Shankar H, Taranath D, Santhirathelagan CT, Pesudovs K (2008) Anterior segment biometry with the Pentacam: comprehensive assessment of repeatability of automated measurements. J Cataract Refract Surg 34:103–113CrossRefPubMedGoogle Scholar
  29. 29.
    O’Donnell C, Wolffsohn JS (2004) Grading of corneal transparency. Cont Lens Anterior Eye 27:161–170CrossRefPubMedGoogle Scholar
  30. 30.
    Meek KM, Knupp C (2015) Corneal structure and transparency. Prog Retin Eye Res 49:1–16CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Özyol P, Ozyol E (2016) Assessment of corneal backward light scattering in diabetic patients. Eye Contact Lens Oct 3. [Epub ahead of print]Google Scholar
  32. 32.
    Anayol MA, Bostancı B, Şekeroğlu MA, Şimşek M, Günaydın S, Yılmazbaş P (2017) Assessment of corneal densitometry in rheumatoid arthritis patients. Turk J Ophthalmol 47(3):125–129PubMedPubMedCentralGoogle Scholar
  33. 33.
    Koh S, Maeda N, Ikeda C, Asonuma S, Mitamura H, Oie Y, Soma T, Tsujikawa M, Kawasaki S, Nishida K (2014) Ocular forward light scattering and corneal backward light scattering in patients with dry eye. Invest Ophthalmol Vis Sci 55:6601–6606CrossRefPubMedGoogle Scholar
  34. 34.
    Coassin M, Piovanetti O, Stark WJ, Green WR (2006) Urate deposition in the iris and anterior chamber. Ophthalmology 113:462–465CrossRefPubMedGoogle Scholar
  35. 35.
    Sousa JM, Trevisani VF, Modolo RP, Gabriel LA, Vieira LA, Freitas D (2011) Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases. Arq Bras Oftalmol 74:405–409CrossRefPubMedGoogle Scholar
  36. 36.
    Serpell G (1978) Ophthalmic gout. Aust J Opthalmol 6:77–79CrossRefGoogle Scholar
  37. 37.
    Muenzler WS, Gerber M (1963) Uveitis associated with hyperuricemia. Am J Ophthalmol 55:289–291CrossRefGoogle Scholar
  38. 38.
    Yulek F, Cagil N, Orhan N, Midillioglu IK, Erten S, Simsek S (2009) Gout attack with unusual ocular complications. Rheumatol Int 29:557–559CrossRefPubMedGoogle Scholar
  39. 39.
    Kwok AK, Yam JC, Ting J, Ng DS, Kwok VO, Chen Y (2015) Simultaneous central retinal vein occlusion and branch retinal artery occlusion in a young patient with gout. J Clin Exp Ophthalmol 6:3Google Scholar
  40. 40.
    Luo C, Chen X, Jin H, Yao K (2017) The association between gout and cataract risk: a meta-analysis. PLoS ONE 12:0180188Google Scholar
  41. 41.
    Burgos F, Capone RC (1996) Ocular and systemic manifestations of gout. Clin Eye Vis Care 8:155–163CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Pinar Kosekahya
    • 1
  • Kadir Gokhan Atilgan
    • 2
  • Cemile Ucgul Atilgan
    • 1
  • Kemal Tekin
    • 3
  • Mustafa Koc
    • 1
  • Mehtap Caglayan
    • 4
  • Deniz Ayli
    • 2
  • Pelin Yilmazbas
    • 1
  1. 1.Department of OphthalmologyUlucanlar Eye Training and Research HospitalAnkaraTurkey
  2. 2.Department of NephrologyDiskapi Yildirim Beyazıt Training and Research HospitalAnkaraTurkey
  3. 3.Department of OphthalmologyKars State HospitalKarsTurkey
  4. 4.Department of OphthalmologyGazi Yasargil Training and Research HospitalDiyarbakirTurkey

Personalised recommendations