Journal List > J Korean Ophthalmol Soc > v.54(1) > 1009418

J Korean Ophthalmol Soc. 2013 Jan;54(1):104-111. Korean.
Published online Jan 15, 2013.  https://doi.org/10.3341/jkos.2013.54.1.104
Copyright © 2013 The Korean Ophthalmological Society
Comparison of Serum Homocysteine, Vitamin B12, Vitamin B6 and Folate Levels in Different Glaucoma Types
Byung Ju Choo, MD,1 Young Hoon Hwang, MD,2 Joo Hwa Lee, MD, PhD,3 and Tai Jin Kim, MD1
1Department of Ophthalmology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
2Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University, Seoul, Korea.
3Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Address reprint requests to Tai Jin Kim, MD. Department of Ophthalmology, Seoul Paik Hospital, #9 Mareunnae-ro, Jung-gu, Seoul 100-032, Korea. Tel: 82-2-2270-0082, Fax: 82-2-2266-6159, Email: lasiklove@hanmail.net
Received February 10, 2012; Accepted October 19, 2012.

Abstract

Purpose

To compare the levels of serum homocysteine, vitamin B12, vitamin B6 and folate in patients with normal-tension glaucoma, pseudoexfoliation glaucoma and high-tension glaucoma.

Methods

Thirty-two healthy subjects, 35 patients with normal-tension glaucoma, 22 patients with pseudoexfoliation glaucoma and 31 patients with high-tension glaucoma were included in the present study. Fasting venous samples were collected from all the participants. The levels of serum homocysteine, vitamin B12, vitamin B6 and folate were measured. One-way analysis of variance was used for the comparison of homocysteine, vitamin B12, vitamin B6 and folate levels among the 4 groups.

Results

The mean homocysteine levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.91 ± 5.11 and 17.60 ± 3.89 µmol/l, respectively, which were significantly higher than that of the control group (p = 0.014, p = 0.013, respectively). The mean vitamin B6 levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.67 ± 14.32 and 17.00 ± 10.58 nmol/l, respectively, which were significantly lower than that of the control group (p = 0.026, p = 0.008, respectively).

Conclusions

Hyperhomocysteinemia may play a role as a risk factor in the development or progression of pseudoexfoliation glaucoma and high-tension glaucoma.

Keywords: High-tension glaucoma; Homocysteine; Normal-tension glaucoma; Pseudoexfoliation glaucoma; Vitamin B6

Figures


Figure 1
Distribution of serum homocysteine (A), vitamin B12 (B), vitamin B6 (C) and folate (D) levels in control, normal-tension glaucoma (NTG), pseudoexfoliation glaucoma (PXG) and high-tension glaucoma groups. Black squares indicate the mean values; vertical bars indicate the 95% confidence intervals.
Click for larger image


Figure 2
Pathways of homocysteine metabolism involving vitamin B12, vitamin B6 and folate.
Click for larger image

Tables


Table 1
Comparison of demographic and clinical characteristics among study groups
Click for larger image


Table 2
Mean ± standard deviation (95% confidence interval) of serum homocysteine, vitamin B12, vitamin B6 and folate in study groups
Click for larger image


Table 3
Correlation between intraocular pressure and serum homocysteine in study groups
Click for larger image

References
1. Flammer J, Orgül S, Costa VP, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res 2002;21:359–393.
2. Hayreh SS. Blood flow in the optic nerve head and factors that may influence it. Prog Retin Eye Res 2001;20:595–624.
3. Ritch R. Exfoliation syndrome: beyond glaucoma. Arch Ophthalmol 2008;126:859–861.
4. Carroll JF, Tyagi SC. Extracellular matrix remodeling in the heart of the homocysteinemic obese rabbit. Am J Hypertens 2005;18(5 Pt 1):692–698.
5. Mujumdar VS, Aru GM, Tyagi SC. Induction of oxidative stress by homocyst(e)ine impairs endothelial function. J Cell Biochem 2001;82:491–500.
6. Ramakrishnan S, Sulochana KN, Lakshmi S, et al. Biochemistry of homocysteine in health and diseases. Indian J Biochem Biophys 2006;43:275–283.
7. Finkelstein JD. The metabolism of homocysteine: pathways and regulation. Eur J Pediatr 1998;157:S40–S44.
8. Biousse V, Newman NJ, Sternberg P Jr. Retinal vein occlusion and transient monocular visual loss associated with hyperhomocystinemia. Am J Ophthalmol 1997;124:257–260.
9. Cahill M, Karabatzaki M, Meleady R, et al. Raised plasma homocysteine as a risk factor for retinal vascular occlusive disease. Br J Ophthalmol 2000;84:154–157.
10. Pianka P, Almog Y, Man O, et al. Hyperhomocystinemia in patients with nonarteritic anterior ischemic optic neuropathy, central retinal artery occlusion, and central retinal vein occlusion. Ophthalmology 2000;107:1588–1592.
11. Loewenstein A, Goldstein M, Winder A, et al. Retinal vein occlusion associated with methylenetetrahydrofolate reductase mutation. Ophthalmology 1999;106:1817–1820.
12. Brown BA, Marx JL, Ward TP, et al. Homocysteine: a risk factor for retinal venous occlusive disease. Ophthalmology 2002;109:287–290.
13. Kang SS, Zhou J, Wong PW, et al. Intermediate homocysteinemia: a thermolabile variant of methylenetetrahydrofolate reductase. Am J Hum Genet 1988;43:414–421.
14. Jacques PF, Bostom AG, Wilson PW, et al. Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort. Am J Clin Nutr 2001;73:613–621.
15. Selhub J, Jacques PF, Wilson PW, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693–2698.
16. Ueland PM, Nygård O, Vollset SE, Refsum H. The Hordaland Homocysteine Studies. Lipids 2001;36 Suppl:S33–S39.
17. Vine AK, Stader J, Branham K, et al. Biomarkers of cardiovascular disease as risk factors for age-related macular degeneration. Ophthalmology 2005;112:2076–2080.
18. Roedl JB, Bleich S, Schlötzer-Schrehardt U, et al. Increased homocysteine levels in tear fluid of patients with primary open-angle glaucoma. Ophthalmic Res 2008;40:249–256.
19. Bleich S, Jünemann A, von Ahsen N, et al. Homocysteine and risk of open-angle glaucoma. J Neural Transm 2002;109:1499–1504.
20. Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol 2003;136:41–46.
21. Fan BJ, Chen T, Grosskreutz C, et al. Lack of association of polymorphisms in homocysteine metabolism genes with pseudoexfoliation syndrome and glaucoma. Mol Vis 2008;14:2484–2491.
22. Stamler JS, Osborne JA, Jaraki O, et al. Adverse vascular effects of homocysteine are modulated by endothelium-derived relaxing factor and related oxides of nitrogen. J Clin Invest 1993;91:308–318.
23. Tsai JC, Perrella MA, Yoshizumi M, et al. Promotion of vascular smooth muscle cell growth by homocysteine: a link to atherosclerosis. Proc Natl Acad Sci U S A 1994;91:6369–6373.
24. Tang L, Mamotte CD, Van Bockxmeer FM, Taylor RR. The effect of homocysteine on DNA synthesis in cultured human vascular smooth muscle. Atherosclerosis 1998;136:169–173.
25. Rodgers GM, Conn MT. Homocysteine, an atherogenic stimulus, reduces protein C activation by arterial and venous endothelial cells. Blood 1990;75:895–901.
26. Rodgers GM, Kane WH. Activation of endogenous factor V by a homocysteine-induced vascular endothelial cell activator. J Clin Invest 1986;77:1909–1916.
27. Clement CI, Goldberg I, Healey PR, Graham SL. Plasma homocysteine, MTHFR gene mutation, and open-angle glaucoma. J Glaucoma 2009;18:73–78.
28. Cumurcu T, Sahin S, Aydin E. Serum homocysteine, vitamin B12 and folic acid levels in different types of glaucoma. BMC Ophthalmol 2006;6:6.
29. Leibovitch I, Kurtz S, Shemesh G, et al. Hyperhomocystinemia in pseudoexfoliation glaucoma. J Glaucoma 2003;12:36–39.
30. Altintaş O, Maral H, Yüksel 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.
31. Fan BJ, Chen T, Grosskreutz C, et al. Lack of association of polymorphisms in homocysteine metabolism genes with pseudoexfoliation syndrome and glaucoma. Mol Vis 2008;14:2484–2491.
32. Fingert JH, Kwon YH, Moore PA, et al. The C677T variant in the methylenetetrahydrofolate reductase gene is not associated with disease in cohorts of pseudoexfoliation glaucoma and primary open-angle glaucoma patients from Iowa. Ophthalmic Genet 2006;27:39–41.
33. Turaçli ME, Tekeli O, Ozdemir F, Akar N. Methylenetetrahydrofolate reductase 677 C-T and homocysteine levels in Turkish patients with pseudoexfoliation. Clin Experiment Ophthalmol 2005;33:505–508.
34. 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.
35. Roedl JB, Bleich S, Reulbach U, et al. Homocysteine in tear fluid of patients with pseudoexfoliation glaucoma. J Glaucoma 2007;16:234–239.
36. Puustjärvi T, Blomster H, Kontkanen M, et al. Plasma and aqueous humour levels of homocysteine in exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2004;242:749–754.
37. Roedl JB, Bleich S, Reulbach U, et al. Homocysteine levels in aqueous humor and plasma of patients with primary open-angle glaucoma. J Neural Transm 2007;114:445–450.
38. Brunelli T, Prisco D, Fedi S, et al. High prevalence of mild hyperhomocysteinemia in patients with abdominal aortic aneurysm. J Vasc Surg 2000;32:531–536.
39. Roedl JB, Bleich S, Reulbach U, et al. Vitamin deficiency and hyperhomocysteinemia in pseudoexfoliation glaucoma. J Neural Transm 2007;114:571–575.
40. Brosnan JT, Brosnan ME. The sulfur-containing amino acids: an overview. J Nutr 2006;136 6 Suppl:1636S–1640S.
41. Stipanuk MH, Ueki I. Dealing with methionine/homocysteine sulfur: cysteine metabolism to taurine and inorganic sulfur. J Inherit Metab Dis 2011;34:17–32.
42. Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. Lancet 1999;354:407–413.