Insight, The Journal of ASORN ASORN Insight 2018 Q3 - Page 9

CONTINUING EDUCATION diabetic complications are usually asymptomatic in early stages, inflammation, opacity, and scarring (Benayoun et al., 2013; Dohl- and most can be prevented or minimized with adequate disease man et al., 2015; Emami-Naeini et al., 2014). control. In this regard, specialized care providers, such as nurse educators, can teach patients how to diminish or eliminate risk factors for disease progression and to recognize clinical deterio- ration that requires care. Immune-mediated corneal transplant rejection occurs when there is pathological lymphangiogenesis combined with heman- giogenesis, two closely linked processes. The influx of vascular cells into the stroma is the major route for disrupting corneal Chronic hyperglycemia induces biochemical changes in endothe- immune privilege. As a result, corneal antigens access lymph lial cells, leading to their degeneration and subsequent hypoxia nodes, and this in turn leads to induction of adaptive immune due to insufficient vascular supply to retinal tissue. This environ- responses, with a subsequent higher rate of graft rejection (Bena- ment increases VEGF release, along with release of many other youn et al., 2013; Patel & Dana, 2009). Management of corneal angiogenic factors, resulting in the proliferative phase charac- graft rejection is based on early detection and aggressive corti- terized by neovascularization (see Figure 1) (Crawford, Alfaro, costeroid therapy (Panda, Vanathi, Kumar, Dash, & Priya, 2007). Kerrison, & Jablon, 2009; Liu, Wang, Sun, & Chen, 2017). Early detection is a great opportunity for nursing and other health Unfortunately, the enhanced production of pro-angiogenic team members to make a prognostic difference for their patients. growth factors leads almost exclusively to pathologic prereti- nal neovascularization, and little revascularization of ischemic Retinopathy of Prematurity retina occurs (Duh, Sun, & Stitt, 2017). A further consequence ROP is a retinal vasoproliferative disease characterized by is diabetic macular edema. Both angiogenesis and inflammation delayed physiological retinal vascular development that may are involved in the pathogenesis of retinal disease in this setting lead to a pathologic vitreous and retinal neovascularization. The (Romero-Aroca et al., 2016). pathology is considered a leading cause of childhood blindness, significantly affecting the future quality of life and longterm Exudative AMD healthcare costs of preterm infants exposed to high concentra- Diabetic retinopathy and AMD cause a disproportionate burden tions of oxygen (Wang, 2016). to the health-care system. At present they are considered the most prevalent retinal diseases affecting quality of life (Bressler, 2004; Song & Wong, 2014). Patients diagnosed with AMD have an upregulation of genes that promote retinal pigment epithelium changes together with an increase in VEGF expres- sion that supports pathological angiogenesis (Ambati, Ambati, Yoo, Ianchulev, & Adamis, 2003). AMD causes significant visual impairment and necessitates frequent therapeutic injections of anti-VEGF agents. 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