151
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Heitmar R, Nicholl P, Lee B, Lau YC, Lip G. The relationship of systemic markers of haemostasis with retinal blood vessel responses in cardiovascular disease and/or diabetes. Br J Biomed Sci 2018. [PMID: 29521170 DOI: 10.1080/09674845.2017.1420130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Hypercoagulability is a leading factor in diabetes and cardiovascular disease. Retinal vessel responses to flickering light are an important tool for assessing ocular function. We hypothesised a significant relationship between systemic markers of haemostasis and retinal vessel function. Methods Intra-ocular pressure and retinal microcirculation function were measured in 116 patients with diabetes and/or cardiovascular disease using unstimulated and stimulated arterial and venous retinal vessel responses to flickering light. Haemostasis was evaluated by platelet microparticles, soluble P selectin, and five functional markers of fibrin clot formation and lysis, hyperglycaemia by HbA1c. Results Intra-ocular pressure was linked to the rates of clot formation (p = 0.006) and clot dissolution (p = 0.013) whilst central retinal vein equivalent was linked to HbA1c (p = 0.017). In the first of three flickering light cycles only, arterial baseline diameter fluctuation was linked to the lag time to clot formation (p = 0.017), whilst maximum venous dilatation was linked to HbA1c (p = 0.001) and clot density (p = 0.011). HbA1c was linked to venous dilatation amplitude (p = 0.003). There were no significant links between any ocular index and any platelet index. Conclusions In addition to glycaemia, several haemostasis measures, but no measures of platelet activity, are linked to ocular and retinal blood vessel indices in patients with diabetes and/or cardiovascular disease. These associations may have pathophysiological significance.
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Affiliation(s)
- R Heitmar
- a School of Life and Health Sciences , Aston University , Birmingham , UK
| | - P Nicholl
- b Department of Surgery , City Hospital , Birmingham , UK
| | - B Lee
- c Department of Diabetes and Endocrinology , City Hospital , Birmingham , UK
| | - Y C Lau
- d University of Birmingham Institute for Cardiovascular Sciences, City Hospital , Birmingham , UK
| | - Gyh Lip
- d University of Birmingham Institute for Cardiovascular Sciences, City Hospital , Birmingham , UK
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152
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Baciu P, Nofar CM, Spaulding J, Gao H. BRANCH RETINAL ARTERY OCCLUSION ASSOCIATED WITH PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A PATIENT WITH LIVEDO RETICULARIS. Retin Cases Brief Rep 2018; 11:356-360. [PMID: 27490977 DOI: 10.1097/icb.0000000000000370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report the occurrence of a branch retinal artery occlusion with paracentral acute middle maculopathy in an otherwise healthy young man with a history of livedo reticularis (LR). METHODS Retrospective case report. PATIENTS A 21-year-old man with a history of LR being treated with pentoxifylline developed an acute branch retinal artery occlusion with initial best-corrected visual acuity at presentation of 20/80. RESULTS A thorough diagnostic work up was negative for potential causes of branch retinal artery occlusion or LR. The patient was continued on pentoxifylline and started on aspirin 81 mg daily. At five-month follow-up, vision had improved to 20/25. Optical coherence tomography testing showed a hyperreflective band in the inner nuclear layer and outer plexiform layers in the affected eye that ultimately thinned, consistent with paracentral acute middle maculopathy. CONCLUSION To our knowledge, this is the first case of branch retinal artery occlusion occurring in a patient with a history of LR. This could potentially be an early manifestation of Sneddon syndrome, a rare entity characterized by LR and cerebrovascular disease, which has been previously associated with central retinal artery occlusions.
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Affiliation(s)
- Paul Baciu
- *Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan; and †School of Medicine, Wayne State University, Detroit, Michigan
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153
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Grzybowski A, Elikowski W, Gaca-Wysocka M. Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion: Case report. Medicine (Baltimore) 2018; 97:e9255. [PMID: 29505511 PMCID: PMC5943110 DOI: 10.1097/md.0000000000009255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE To analyze cardiovascular risk factors and comorbidity of acute unilateral visual loss due to combined central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). PATIENT CONCERNS Among patients with retinal vein or artery occlusion hospitalized at the Department of Ophthalmology between January 2011 and August 2017, subjects with combined CRVO/CLRAO were selected. All of them underwent ophthalmologic and cardiologic examination, including fluorescein angiography, optical coherence tomography, 12-lead electrocardiogram, transthoracic and transesophageal echocardiography, carotid Doppler sonography, cerebral magnetic resonance imaging, and a panel of laboratory tests. DIAGNOSES Four subjects with coexisting CRVO and CLRAO were found among 146 patients with retinal vein or artery occlusion. There were no other types of concomitance of CRVO and retinal artery occlusion. INTERVENTIONS All patients were treated with low molecular heparin in a full dose for 2 weeks, then with 1 mg/kg once daily for the next 2 weeks, followed by acetylsalicylic acid 75 mg/kg/d. Other medication included long-term statins, angiotensin-converting-enzyme inhibitor in 3 patients and beta-blocker in one patient. OUTCOMES All patients with CRVO/CLRAO presented multiple cardiovascular risk factors, including hypertension, obesity, hyperlipidemia, chronic nicotine addiction, and a positive family history of coronary artery disease or stroke. In all of them, echocardiography revealed left ventricular hypertrophy and atherosclerotic lesions in the descending aorta; in addition, 3 patients had insignificant atherosclerotic plaques in the carotid artery. Also, in 3 subjects, focal ischemic cerebral changes were diagnosed. LESSONS Patients with combined CRVO and CLRAO present numerous cardiovascular risk factors and abnormalities on imaging examinations, which should be routinely evaluated and treated.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, Poznań
- University of Warmia and Mazury, Olsztyn
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154
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Călugăru D, Călugăru M, Ţălu Ş. Ocular hypertension in patients with central/hemicentral retinal vein occlusions: cumulative prevalence and management. Int J Ophthalmol 2018; 11:1173-1178. [PMID: 30046535 PMCID: PMC6048337 DOI: 10.18240/ijo.2018.07.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To prospectively evaluate the cumulative prevalence and the management of ocular hypertension (OH) in patients with unilateral acute central/hemicentral retinal vein occlusions (C/HCRVOs) over the course of 3y. METHODS The study included 57 patients with unilateral acute C/HCRVOs. All patients underwent a comprehensive ophthalmological examination of both eyes. OH associated with C/HCRVO in patients showing a score >5% for the risk of conversion to primary open angle glaucoma (POAG) was treated with OH medication. The treatment aimed for a decrease in intraocular pressure (IOP) to <21 mm Hg with a >22% reduction from the initial values. The cumulative prevalence of OH and the effectiveness of treatment assessed by the cumulative prevalence of conversion from OH to POAG, were estimated. RESULTS Fifteen patients had OH associated with C/HCRVOs, the cumulative prevalence of OH was 29.4% (95% confidence interval, 16.9-41.9). The mean value of the risk score of OH conversion to POAG for the 5 subsequent years was 11.7%±5.4%. The IOP significantly decreased from 25.67±2.16 mm Hg to 18.73±2.96 mm Hg. None of the OH patients converted to POAG during the follow-up period. CONCLUSION The increased cumulative prevalence of OH in C/HCRVO patients indicates that OH is a risk factor for the appearance of venous occlusion. Patients with OH associated with C/HCRVO must be considered to be at high risk for conversion to POAG. Treatment with OH medications prevented conversion to POAG during the 3-year follow-up.
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Affiliation(s)
- Dan Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca 400467, Romania
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca 400467, Romania
| | - Ştefan Ţălu
- Department of AET Discipline of Descriptive Geometry and Engineering Graphics, Faculty of Mechanical Engineering, Technical University of Cluj-Napoca, Cluj-Napoca 400012, Romania
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155
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Male With Sudden Left Eye Vision Loss. Ann Emerg Med 2017; 70:921-935. [DOI: 10.1016/j.annemergmed.2017.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Indexed: 11/23/2022]
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156
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Huang X, Yang Y, Duan Y, Kuang YQ, Lin D. Homocysteine in retinal artery occlusive disease: A meta-analysis of cohort studies. Sci Rep 2017; 7:15708. [PMID: 29146987 PMCID: PMC5691205 DOI: 10.1038/s41598-017-16065-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/07/2017] [Indexed: 11/28/2022] Open
Abstract
Few studies have reported the relationship between retinal artery occlusion (RAO) and plasma homocysteine (Hcy) levels. Our goal was to evaluate the association between the plasma Hcy level and the risk of RAO disease. Several databases were searched for all published studies that involved Hcy and RAO. Six studies evaluated hyperhomocysteinemia (hHcy) in retinal artery occlusion patients and controls; the incidence of hHcy in patients with RAO was higher than the control and the pooled odds ratio (OR) was 6.64 (95% confidence interval (CI): 3.42, 12.89). Subgroup analyses showed that the ORs were 4.77 (95% CI: 2.69, 8.46) in Western countries, 22.19 (95% CI: 2.46, 200.37) in Asian countries, 9.70 (95% CI: 4.43, 21.20) in the age matched group, 11.41 (95% CI: 3.32, 39.18) in the sex matched group, 9.70 (95% CI: 4.37, 21.53) in the healthy control group, and 6.82 (95% CI: 4.19, 11.10) in the sample size >30. The mean plasma Hcy level from 5 case-control studies was higher than controls, and the weighted mean difference (WMD) was 6.54 (95% CI: 2.79, 10.29). Retinal artery occlusion is associated with elevated plasma Hcy levels. Our study results suggest that hHcy is probably an independent risk factor for RAO.
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Affiliation(s)
- Xuetao Huang
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China.,Department of Ophthalmology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yezhen Yang
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China
| | - Yiqin Duan
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China
| | - Yi-Qun Kuang
- Institute of Infection and Immunity, Henan University & Centre for Translational Medicine, Huaihe Clinical College, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
| | - Ding Lin
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China.
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157
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Abstract
BACKGROUND Ischemic arterial strokes of the ophthalmic artery and its branches and posterior cerebral artery are common causes of visual disability. Etiologies of stroke affecting the retina, optic nerve, optic radiation, and visual cortex overlap with other types of ischemic strokes. Stenosis of the internal carotid is the most common cause of central retinal artery occlusion (CRAO). One-fourth of patients with CRAO have cerebral strokes. We report recent developments in the acute treatment and secondary prevention of ischemic stroke of relevance to clinicians who encounter patients with acute vision loss. EVIDENCE ACQUISITION A search of Pubmed and practice guidelines over the past 5 years was performed, with a focus on significant changes in treatment and prevention of ischemic stroke. RESULTS Recent randomized controlled trials provide Level I evidence for the use of endovascular therapy with current stent retriever devices for patients with large vessel anterior circulation occlusions within 6 hours of presentation. Number needed to treat to achieve one additional patient with an independent functional outcome was in the range of 3-7, and benefit was additive to that of intravenous tissue plasminogen activator alone. Paroxysmal atrial fibrillation (AF) is a major cause of cryptogenic stroke with incidence expected to rise with the aging population. Since 2014, prolonged 30-day cardiac monitoring has been recommended as a part of transient ischemic attack and stroke workup in patients with cryptogenic stroke. Even longer term monitoring of 6 months to 1 year with external and implantable loop recorders improves rates of diagnosing AF. First available in 2010, the novel anticoagulants-dabigatran, apixaban, rivaroxaban, and edoxaban-have been compared with warfarin in the prevention of stroke in patients with nonvalvular AF. Apixaban demonstrated superiority in safety and efficacy, with the novel anticoagulants as a group having favorable risk-benefit profile at higher dosages compared with standard warfarin therapy. CONCLUSIONS Endovascular therapy is now standard of care for eligible patients with anterior large vessel occlusions. Prolonged cardiac monitoring is recommended for patients with cryptogenic stroke. The novel anticoagulants are an alternative to warfarin in patients with AF.
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158
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Metamorphopsia associated with central retinal vein occlusion. PLoS One 2017; 12:e0186737. [PMID: 29049410 PMCID: PMC5648234 DOI: 10.1371/journal.pone.0186737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/08/2017] [Indexed: 11/24/2022] Open
Abstract
This prospective study aimed to investigate metamorphopsia in eyes with central retinal vein occlusion (CRVO) and included 28 eyes (28 patients) with unilateral CRVO that had macular edema (ME) in the acute phase. The ME was treated with anti-vascular endothelial growth factor agents. At baseline and at 1 and 6 months after initiation of treatment, quantitative measurements of metamorphopsia were performed using M-CHARTS and the retinal morphologic changes were examined by optical coherence tomography. At baseline, metamorphopsia was detected on M-CHARTS in 14 (50.0%) eyes. The mean M-CHARTS score was 0.37 ± 0.53. At 1 month and 6 months after initiation of treatment, there was substantial resolution of ME and significant recovery of visual acuity. In contrast, metamorphopsia was still detected in 16 eyes at 6 months; the mean M-CHARTS scores were 0.29 ± 0.37 at 1 month and 0.32 ± 0.38 at 6 months, and had not significantly improved from baseline (p = 0.580, and p = 0.604, respectively). Although the M-CHARTS score at 6 months was associated with the baseline M-CHARTS score (p = 0.004), it did not have any associations with morphologic parameters at baseline. However, the M-CHARTS score at 6 months was significantly associated with foveal photoreceptor status, height of serous detachment, and parafoveal thickening at 1 month. Metamorphopsia associated with CRVO could be quantified using M-CHARTS, and often persisted in contrast with the recovery of visual acuity and resolution of ME after treatment with anti-vascular endothelial growth factor agents.
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159
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Abstract
Retinal artery occlusion leads to profound visual impairment in the affected eye. It is rarely caused by local ophthalmic pathologies. Most patients present with a large number of cardio- and cerebrovascular risk factors. Visual loss is the leading symptom in central retinal artery occlusion (CRAO), whereas a circumscribed visual field defect is claimed in branch retinal artery occlusion (BRAO). Although many attempts have been made to improve the course of the disease, no effective therapy is available. There is some hope that intravenous fibrinolysis could influence the natural course but the therapeutic window is small (ca. 4.5 h), and treatment efficacy is still not proven. It is important for ophthalmologists to guide the patients to a comprehensive and prompt neurological and cardiological diagnostic work-up.
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160
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Iida Y, Muraoka Y, Uji A, Ooto S, Murakami T, Suzuma K, Tsujikawa A, Arichika S, Takahashi A, Miwa Y, Yoshimura N. ASSOCIATIONS BETWEEN MACULAR EDEMA AND CIRCULATORY STATUS IN EYES WITH RETINAL VEIN OCCLUSION. Retina 2017; 37:1896-1904. [DOI: 10.1097/iae.0000000000001433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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161
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Iida Y, Muraoka Y, Ooto S, Suzuma K, Murakami T, Iida-Miwa Y, Ghashut R, Tsujikawa A. Morphologic and Functional Retinal Vessel Changes in Branch Retinal Vein Occlusion: An Optical Coherence Tomography Angiography Study. Am J Ophthalmol 2017; 182:168-179. [PMID: 28837791 DOI: 10.1016/j.ajo.2017.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study aimed to investigate the morphology of the retinal vasculature in eyes with branch retinal vein occlusion (BRVO) using optical coherence tomography (OCT) angiography. DESIGN Observational case series. METHODS Fluorescein angiography (FA) and OCT angiography were used to examine macular area and the retinal vasculature at the affected arteriovenous (AV) crossing in 46 patients with BRVO. RESULTS FA revealed that the affected AV crossing pattern involved arterial overcrossing in 23 eyes (50.0%) and venous overcrossing in 11 eyes (23.9%). However, FA failed to detect the crossing pattern in 10 eyes (21.7%). OCT angiography was significantly more effective for identification of the AV crossing pattern than FA (44 eyes; 95.7%; P = .013). The number of eyes with venous overcrossing detected via OCT angiography (20 eyes, 43.5%) was also higher than that detected via FA (P = .047). OCT angiography revealed that venous narrowing (25.5 ± 21.1 μm) was significantly greater in instances of venous overcrossing than in those of arterial overcrossing (46.4 ± 23.7 μm, P = .005). Macular nonperfusion areas (NPAs) were larger in eyes with venous overcrossing than in those with arterial overcrossing (P = .011 for superficial plexus, P = .049 for deep plexus). The peripheral NPA was significantly larger in eyes with venous overcrossing (65.1 ± 35.3 disc area [DA]) than in those with arterial overcrossing (17.2 ± 24.1 DA; P < .001). CONCLUSIONS Our findings suggest that BRVO characterized by venous overcrossing may be more prevalent than previously reported, and that there is a significant association between NPA size and AV crossing pattern.
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Affiliation(s)
- Yuto Iida
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Iida-Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rima Ghashut
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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162
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Campbell M, Cassidy PS, O'Callaghan J, Crosbie DE, Humphries P. Manipulating ocular endothelial tight junctions: Applications in treatment of retinal disease pathology and ocular hypertension. Prog Retin Eye Res 2017; 62:120-133. [PMID: 28951125 DOI: 10.1016/j.preteyeres.2017.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022]
Abstract
Protein levels of endothelial tight-junctions of the inner retinal microvasculature, together with those of Schlemm's canal, can be readily manipulated by RNA interference (RNAi), resulting in the paracellular clefts between such cells to be reversibly modulated. This facilitates access to the retina of systemically-deliverable low molecular weight, potentially therapeutic compounds, while also allowing potentially toxic material, for example, soluble Amyloid-β1-40, to be removed from the retina into the peripheral circulation. The technique has also been shown to be highly effective in alleviation of pathological cerebral oedema and we speculate that it may therefore have similar utility in the oedematous retina. Additionally, by manipulating endothelial tight-junctions of Schlemm's canal, inflow of aqueous humour from the trabecular meshwork into the Canal can be radically enhanced, suggesting a novel avenue for control of intraocular pressure. Here, we review the technology underlying this approach together with specific examples of clinical targets that are, or could be, amenable to this novel form of genetic intervention.
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Affiliation(s)
- Matthew Campbell
- Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin 2, Ireland.
| | - Paul S Cassidy
- Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin 2, Ireland
| | - Jeffrey O'Callaghan
- Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin 2, Ireland
| | - Darragh E Crosbie
- Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin 2, Ireland
| | - Pete Humphries
- Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin 2, Ireland.
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163
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ASSOCIATION BETWEEN RETINAL HEMORRHAGIC PATTERNS AND PERFUSION STATUS IN EYES WITH ACUTE CENTRAL RETINAL VEIN OCCLUSION. Retina 2017; 37:500-508. [PMID: 27611056 DOI: 10.1097/iae.0000000000001196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate peripheral retinal hemorrhagic patterns in eyes with acute central retinal vein occlusion, and to explore their clinical relevance in differentiating for the retinal perfusion status, through a prospective, and cross-sectional study. METHODS Fifty eyes with acute central retinal vein occlusion were included. Retinal hemorrhagic patterns at the equator and retinal perfusion status were evaluated by ultra-wide field fundus photography and fluorescein angiography. RESULTS Retinal perfusion was categorized as nonischemic in 29 eyes, ischemic in 18 eyes, and undeterminable in 3 eyes. None of the examined eyes had flame-shaped retinal hemorrhages in the periphery. All hemorrhages were rounded-dot or blot and were variable in size. Particle analysis was performed to quantify hemorrhage size, and showed higher values in eyes having larger blot hemorrhages, and lower values in eyes having dot or smaller blot hemorrhages. Mean size of maximum peripheral dot or blot hemorrhage was larger in eyes classified as ischemic (10,763.0 ± 5,946.3 pixels) than as nonischemic (2,839.9 ± 1,153.6 pixels, P < 0.001). The authors calculated area under the curve to investigate the ability of continuous variables to discriminate retinal perfusion status, which was 0.963 (P < 0.001) for mean size of maximum peripheral blot hemorrhages. CONCLUSION The authors objectively evaluated retinal hemorrhagic patterns at the equator in eyes with acute central retinal vein occlusion using particle analysis. The resulting hemorrhage size measurement was considered to be often useful in determining retinal perfusion status. Because they can be noninvasively evaluated with readily available equipment, peripheral hemorrhagic patterns might be good clinical markers of retinal perfusion.
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164
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ASSOCIATION BETWEEN PARAFOVEAL CAPILLARY NONPERFUSION AND MACULAR FUNCTION IN EYES WITH BRANCH RETINAL VEIN OCCLUSION. Retina 2017; 37:1731-1737. [DOI: 10.1097/iae.0000000000001417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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165
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Soetikno BT, Shu X, Liu Q, Liu W, Chen S, Beckmann L, Fawzi AA, Zhang HF. Optical coherence tomography angiography of retinal vascular occlusions produced by imaging-guided laser photocoagulation. BIOMEDICAL OPTICS EXPRESS 2017; 8:3571-3582. [PMID: 28856036 PMCID: PMC5560826 DOI: 10.1364/boe.8.003571] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 05/20/2023]
Abstract
Retinal vascular occlusive diseases represent a major form of vision loss worldwide. Rodent models of these diseases have traditionally relied upon a slit-lamp biomicroscope to help visualize the fundus and subsequently aid delivery of high-power laser shots to a target vessel. Here we describe a multimodal imaging system that can produce, image, and monitor retinal vascular occlusions in rodents. The system combines a spectral-domain optical coherence tomography system for cross-sectional structural imaging and three-dimensional angiography, and a fluorescence scanning laser ophthalmoscope for Rose Bengal monitoring and high-power laser delivery to a target vessel. This multimodal system facilitates the precise production of occlusions in the branched retinal veins, central retinal vein, and branched retinal arteries. Additionally, changes in the retinal morphology and retinal vasculature can be longitudinally documented. With our device, retinal vascular occlusions can be easily and consistently created, which paves the way for futures studies on their pathophysiology and therapeutic targets.
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Affiliation(s)
- Brian T. Soetikno
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
- Medical Scientist Training Program, Northwestern University, Chicago, IL, USA
- These authors contributed equally to this work
| | - Xiao Shu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- These authors contributed equally to this work
| | - Qi Liu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Wenzhong Liu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Siyu Chen
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Lisa Beckmann
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Amani A. Fawzi
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Hao F. Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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166
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Abstract
Central retinal artery occlusion (CRAO) is caused by partial or complete occlusion of the central retinal artery, most commonly by an embolus from the ipsilateral carotid artery, aortic arch, or heart, and is the ocular equivalent of an acute cerebral ischemic event. The risk factors for a CRAO and acute cerebral ischemia are very similar, if not identical. Because no current therapeutic intervention has been shown to improve visual outcomes compared with the natural history of CRAO, management of CRAO should be focused on secondary prevention of vascular events, such as cerebral ischemia, myocardial infarction, and cardiovascular death.
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Affiliation(s)
- Michael Dattilo
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive, Northeast, Atlanta, GA 30329, USA.
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Neuro-Ophthalmology, Emory Eye Center, 1365-B Clifton Road, Northeast, Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive, Northeast, Atlanta, GA 30329, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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167
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Jin SE, Hwang SJ. Ocular delivery systems for the administration of antibody therapeutics. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-017-0336-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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168
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Cehofski LJ, Honoré B, Vorum H. A Review: Proteomics in Retinal Artery Occlusion, Retinal Vein Occlusion, Diabetic Retinopathy and Acquired Macular Disorders. Int J Mol Sci 2017; 18:ijms18050907. [PMID: 28452939 PMCID: PMC5454820 DOI: 10.3390/ijms18050907] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/08/2017] [Accepted: 04/05/2017] [Indexed: 01/26/2023] Open
Abstract
Retinal artery occlusion (RAO), retinal vein occlusion (RVO), diabetic retinopathy (DR) and age-related macular degeneration (AMD) are frequent ocular diseases with potentially sight-threatening outcomes. In the present review we discuss major findings of proteomic studies of RAO, RVO, DR and AMD, including an overview of ocular proteome changes associated with anti-vascular endothelial growth factor (VEGF) treatments. Despite the severe outcomes of RAO, the proteome of the disease remains largely unstudied. There is also limited knowledge about the proteome of RVO, but proteomic studies suggest that RVO is associated with remodeling of the extracellular matrix and adhesion processes. Proteomic studies of DR have resulted in the identification of potential therapeutic targets such as carbonic anhydrase-I. Proliferative diabetic retinopathy is the most intensively studied stage of DR. Proteomic studies have established VEGF, pigment epithelium-derived factor (PEDF) and complement components as key factors associated with AMD. The aim of this review is to highlight the major milestones in proteomics in RAO, RVO, DR and AMD. Through large-scale protein analyses, proteomics is bringing new important insights into these complex pathological conditions.
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Affiliation(s)
- Lasse Jørgensen Cehofski
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Bent Honoré
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
- Department of Biomedicine, Aarhus University, Ole Worms Allé 3, Building 1182, 024, 8000 Aarhus C, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
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170
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Yoo SJ, Kim JH, Lee TG, Kim JW, Cho SW, Han JI. Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:95-101. [PMID: 28367036 PMCID: PMC5368096 DOI: 10.3341/kjo.2017.31.2.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/25/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab. Methods This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later. Results At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively). Conclusions Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.
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Affiliation(s)
- Su Jin Yoo
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sung Won Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jung Il Han
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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171
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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172
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Espino Barros A, Amram AL, Derham AM, Smith SV, Lee AG. Management of ischemic optic neuropathies. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1291341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Angelina Espino Barros
- Department of Ophthalmology, Centro Médico Zambrano Hellion, San Pedro Garza García, México
| | - Alec L. Amram
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Angeline Mariani Derham
- Department of Ophthalmology, University of Texas Health Science Center San Antonio School of Medicine, San Antonio, TX, USA
| | - Stacy V. Smith
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G. Lee
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York City, NY, USA
- Section of Ophthalmology, UT MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
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173
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[Guidelines from the DOG, RG and BVA: retinal artery occlusion : November 2016 status]. Ophthalmologe 2017; 114:120-131. [PMID: 28160122 DOI: 10.1007/s00347-016-0435-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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174
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Kokona D, Häner NU, Ebneter A, Zinkernagel MS. Imaging of macrophage dynamics with optical coherence tomography in anterior ischemic optic neuropathy. Exp Eye Res 2016; 154:159-167. [PMID: 27914988 DOI: 10.1016/j.exer.2016.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/19/2016] [Accepted: 11/27/2016] [Indexed: 12/13/2022]
Abstract
Anterior ischemic optic neuropathy (AION) is a relatively common cause of visual loss and results from hypoperfusion of the small arteries of the anterior portion of the optic nerve. AION is the leading cause of sudden optic nerve related vision loss with approximately 10 cases per 100'000 in the population over 50 years. To date there is no established treatment for AION and therefore a better understanding of the events occurring at the level of the optic nerve head (ONH) would be important to design future therapeutic strategies. The optical properties of the eye allow imaging of the optic nerve in vivo, which is a part of the CNS, during ischemia. Experimentally laser induced optic neuropathy (eLiON) displays similar anatomical features as anterior ischemic optic neuropathy in humans. After laser induced optic neuropathy we show that hyperreflective dots in optical coherence tomography correspond to mononuclear cells in histology. Using fluorescence-activated flow cytometry (FACS) we found these cells to peak one week after eLiON. These observations were translated to OCT findings in patients with AION, where similar dynamics of hyperreflective dots at the ONH were identified. Our data suggests that activated macrophages can be identified as hyperreflective dots in OCT.
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Affiliation(s)
- Despina Kokona
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nathanael U Häner
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Department of Clinical Research, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
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175
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Histologisch nachgewiesene Riesenzellarteriitis und Sehverlust. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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176
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Abstract
PURPOSE It is unknown whether sudden vision loss (SVL) is an independent marker for future cardiovascular disease (CVD) events in African Americans. We examined the hazard of future stroke or myocardial infarction (MI) and mortality associated with self-reported SVL lasting 24 hours or longer in a cohort of African Americans enrolled in the Jackson Heart Study (JHS). METHODS The study sample comprised 4670 African Americans aged 20-95 years enrolled in the JHS without previous coronary heart disease or stroke at baseline. All participants who responded to the question "Have you ever had any sudden loss of vision or blurring, lasting 24 hours or longer?" on the baseline stroke questionnaire were included in the study. Ten years of follow-up data was used. Cox proportional hazards modeling was used to examine the association between SVL (n = 142) and risk of future stroke/MI and mortality. RESULTS In age- and sex-adjusted Cox models, SVL was significantly associated with higher hazards of future stroke/MI (hazard ratio, HR, 2.08, 95% confidence interval, CI, 1.09-3.96) and mortality (HR 1.73, 95% CI 1.07-2.78). After adjusting for diabetes mellitus, total/high-density lipoprotein cholesterol ratio, smoking, hypertension and income, the relationships between SVL and future stroke/MI (adjusted HR 1.51, 95% CI 0.78-2.90) or mortality (adjusted HR 1.29, 95% CI 0.78-2.11) were no longer significant. CONCLUSIONS Self-reported SVL lasting 24 hours or longer was significantly associated with future stroke/MI and mortality, but its effect is likely a surrogate for underlying CVD risk factors rather than being an independent predictor.
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Affiliation(s)
- Paul B Greenberg
- a Division of Ophthalmology , Alpert Medical School, Brown University , Providence , RI , USA.,b School of Public Health , Brown University , Providence , RI , USA.,c Section of Ophthalmology , Providence VA Medical Center , Providence , RI , USA
| | - Allison J Chen
- a Division of Ophthalmology , Alpert Medical School, Brown University , Providence , RI , USA.,b School of Public Health , Brown University , Providence , RI , USA.,c Section of Ophthalmology , Providence VA Medical Center , Providence , RI , USA
| | - Wen-Chih Wu
- d Division of Cardiology , Alpert Medical School, Brown University , Providence , RI , USA.,e Section of Cardiology , Providence VA Medical Center , Providence , RI , USA
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177
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Association between retinal hemorrhagic pattern and macular perfusion status in eyes with acute branch retinal vein occlusion. Sci Rep 2016; 6:28554. [PMID: 27334338 PMCID: PMC4917831 DOI: 10.1038/srep28554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
This prospective study included 63 eyes with acute branch retinal vein occlusion (BRVO) to evaluate the retinal hemorrhagic patterns at the posterior poles and explore their clinical relevance in macular perfusion differentiation. Retinal hemorrhagic patterns and macular perfusion status were evaluated via fundus photography and fluorescein angiography, respectively. Macular perfusion was judged as nonischemic in 30, ischemic in 28, and undeterminable in 5 among the 63 eyes. Predominant hemorrhagic patterns were flame-shaped in 39 (67.2%) and non-flame-shaped in 19 (32.8%) eyes. All 39 eyes with a flame-shaped hemorrhage showed a nonischemic macula. Of the 19 eyes classified as having a non-flame-shaped hemorrhage, 13 (68.4%) had an ischemic macula and 6 (31.6%) had a nonischemic macula (P < 0.001). Parallelism in eyes with a flame-shaped hemorrhage was higher than in those with a non-flame-shaped hemorrhage (P < 0.001), and in those with a nonischemic macula versus those with an ischemic macula (P < 0.001). The area under the curve for parallelism was 0.975 (P < 0.001), suggesting an accurate diagnostic parameter for macular perfusion differentiation. In conclusion, we objectively evaluated retinal hemorrhagic patterns at the posterior pole in BRVO using the parallelism method, which was useful in differentiating macular perfusion status.
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178
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Murakami T, Okamoto F, Iida M, Sugiura Y, Okamoto Y, Hiraoka T, Oshika T. Relationship between metamorphopsia and foveal microstructure in patients with branch retinal vein occlusion and cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 2016; 254:2191-2196. [DOI: 10.1007/s00417-016-3382-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 02/03/2023] Open
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179
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Metamorphopsia Associated with Branch Retinal Vein Occlusion. PLoS One 2016; 11:e0153817. [PMID: 27123642 PMCID: PMC4849670 DOI: 10.1371/journal.pone.0153817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To apply M-CHARTS for quantitative measurements of metamorphopsia in eyes with acute branch retinal vein occlusion (BRVO) and to elucidate the pathomorphology that causes metamorphopsia. METHODS This prospective study consisted of 42 consecutive patients (42 eyes) with acute BRVO. Both at baseline and one month after treatment with ranibizumab, metamorphopsia was measured with M-CHARTS, and the retinal morphological changes were examined with optical coherence tomography. RESULTS At baseline, metamorphopsia was detected in the vertical and/or horizontal directions in 29 (69.0%) eyes; the mean vertical and horizontal scores were 0.59 ± 0.57 and 0.52 ± 0.67, respectively. The maximum inner retinal thickness showed no association with the M-CHARTS score, but the M-CHARTS score was correlated with the total foveal thickness (r = 0.43, p = 0.004), the height of serous retinal detachment (r = 0.31, p = 0.047), and the maximum outer retinal thickness (r = 0.36, p = 0.020). One month after treatment, both the inner and outer retinal thickness substantially decreased. However, metamorphopsia persisted in 26 (89.7%) of 29 eyes. The posttreatment M-CHARTS score was not correlated with any posttreatment morphological parameters. However, the posttreatment M-CHARTS score was weakly correlated with the baseline total foveal thickness (r = 0.35. p = 0.024) and closely correlated with the baseline M-CHARTS score (r = 0.78, p < 0.001). CONCLUSIONS Metamorphopsia associated with acute BRVO was quantified using M-CHARTS. Initial microstructural changes in the outer retina from acute BRVO may primarily account for the metamorphopsia.
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180
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Gong H, Song Q, Wang L. Manifestations of central retinal artery occlusion revealed by fundus fluorescein angiography are associated with the degree of visual loss. Exp Ther Med 2016; 11:2420-2424. [PMID: 27313672 DOI: 10.3892/etm.2016.3175] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/08/2015] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to investigate the association between central visual impairment and the characteristics of fundus fluorescein angiography (FFA) in patients with central retinal artery occlusion (CRAO). A total of 63 patients were diagnosed with CRAO by FFA. The visual dysfunction was classified into severe, mild and light degrees. Tropicamide was administered for mydriasis. FFA examination was performed using Heidelberg retinal tomography. The associations of age, gender and disease course with CRAO type were analyzed. Three types of manifestations were identified by FFA in 63 eyes, including poor perfusion (18 cases), exudation (22 cases) and mixed types (23 cases) of CRAO. No significant difference was found in age (F=0.171, P=0.844) and disease course (F=0.016, P=0.984) among the three types of CRAO. Similarly, no significant difference was found in gender among the three types of CRAO (χ2=0.176, P=0.916). The damage to vision caused by the exudation type of CRAO was not as severe as that caused by the poor perfusion and mixed types of CRAO. The distributions of damage severity caused by the poor perfusion and mixed types of CRAO were similar. In conclusion, the FFA observations for CRAO can be classified into three types of manifestations. The damage to vision in patients with CRAO is likely to be associated with poor perfusion in the retinal artery rather than exudation affecting the retina or optic disc. The patterns of clinical manifestations are not associated with age, gender or disease course.
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Affiliation(s)
- Hongxia Gong
- Department of Traditional Chinese Medicine, Tianjin Eye Hospital, Tianjin Medical University, Heping, Tianjin 300000, P.R. China
| | - Qiuying Song
- Visual Function Inspection Section, Tianjin Eye Hospital, Tianjin Medical University, Heping, Tianjin 300000, P.R. China
| | - Lanhui Wang
- Department of Ocular Fundus Disease, Tianjin Eye Hospital, Tianjin Medical University, Heping, Tianjin 300000, P.R. China
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181
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Grachev YV. [Neurological manifestations of giant cell arteritis]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:82-89. [PMID: 26977631 DOI: 10.17116/jnevro20161161182-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article describes clinical, including neurological manifestations, of giant cell arteritis (GCA) - granulomatous vasculitis of large and medium-sized vessels, predominantly craniofacial, including precerebral and cerebral, arteries. Histopathological features of GCA are illustrated by the schemes of panarteritis and «postarteritis» (proliferative and fibrotic changes in the intima, underlying the development of cerebrovascular disorders). The main clinical manifestations of GCA are described as 3 groups of symptoms: general constitutional symptoms; manifestations of vasculitis of craniofacial, precerebral and cerebral arteries; polymyalgia rheumaticа. The authors present their own version of the taxonomy of visual disturbances in patients with GCA. Diagnostic steps in patients with suggestive signs of GCA are described. Therapeutic regimens of use of glucocorticoids for suggestion/diagnosis of GCA are presented.
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Affiliation(s)
- Yu V Grachev
- Institute of General Pathology and Pathophysiology, Moscow
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182
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Jonas JB. Medical Therapy for Macular Edema Secondary to Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2016; 5:93-4. [PMID: 26987127 DOI: 10.1097/apo.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jost B Jonas
- From the Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
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183
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Shirakata Y, Fujita T, Nakano Y, Shiraga F, Tsujikawa A. Pars Plana Vitrectomy Combined with Internal Limiting Membrane Peeling to Treat Persistent Macular Edema after Anti-Vascular Endothelial Growth Factor Treatment in Cases of Ischemic Central Retinal Vein Occlusion. Case Rep Ophthalmol 2016; 7:1-8. [PMID: 26889152 PMCID: PMC4748766 DOI: 10.1159/000443322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling in cases of ischemic central retinal vein occlusion (CRVO) where macular edema (ME) persisted after anti-vascular endothelial growth factor (anti-VEGF) treatment. METHODS Fifteen eyes with ischemic CRVO-related ME were included in the study. Nine were treated with panretinal photocoagulation after initial examination. Anti-VEGF agents were injected intravitreally. Persistent ME was treated with PPV combined with ILM peeling. During surgery, laser photocoagulation was further applied to the non-perfused area. RESULTS Mean retinal thickness gradually decreased after surgery (p = 0.024 at 6 months), although visual acuity did not improve significantly during the follow-up period (14.7 ± 11.6 months). Neovascular glaucoma subsequently developed in three cases and a trabeculectomy was performed in one case. CONCLUSION In eyes with ischemic CRVO, PPV combined with ILM peeling contributed to a reduction in persistent ME. However, there was no significant improvement in visual acuity.
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Affiliation(s)
- Yukari Shirakata
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Takamatsu, Okayama, Japan
| | - Tomoyoshi Fujita
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Takamatsu, Okayama, Japan
| | - Yuki Nakano
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Takamatsu, Okayama, Japan
| | - Fumio Shiraga
- Department of Ophthalmology, Okayama University, Okayama, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Takamatsu, Okayama, Japan
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184
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Kang SI, Kim YC. Central Retinal Artery Occlusion Masquerading as Branch Retinal Artery Occlusion. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:390-391. [PMID: 27729760 PMCID: PMC5057016 DOI: 10.3341/kjo.2016.30.5.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sung Il Kang
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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185
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Muraoka Y, Tsujikawa A, Takahashi A, Iida Y, Murakami T, Ooto S, Suzuma K, Uji A, Yoshimura N. Foveal Damage Due to Subfoveal Hemorrhage Associated with Branch Retinal Vein Occlusion. PLoS One 2015; 10:e0144894. [PMID: 26661582 PMCID: PMC4677927 DOI: 10.1371/journal.pone.0144894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
To investigate the functional and morphologic prognoses of eyes with subfoveal hemorrhage from acute branch retinal vein occlusion (BRVO), and to examine the effect of intravitreal ranibizumab injection (IVR) on these prognoses, we assessed 81 eyes with acute BRVO, of which 38 did not receive IVR [IVR(-) group], and 43 were treated with IVR [IVR(+) group] for macular edema. The foveal morphologic changes were examined via optical coherence tomography (OCT). At initial examination, 63 eyes exhibited subfoveal hemorrhage. At final examination, the defect lengths in the foveal external limiting membrane (ELM) and ellipsoid lines in these eyes were longer, and final VA was significantly poorer, compared with eyes without subfoveal hemorrhage. In comparisons between the final measurements in eyes with subfoveal hemorrhage in the IVR(-) and IVR(+) groups, while there were no differences in initial ocular conditions, final VA was significantly better in the IVR(+) group. The defects in the ELM and ellipsoid lines in the IVR(+) group were shorter than those of the IVR(-) group (p = 0.002 in both). Final VA was correlated with the defect lengths of foveal ELM and ellipsoid lines in both the IVR(-) and IVR(+) groups (both p < 0.001). In addition, the defect lengths of foveal ELM and ellipsoid lines were closely correlated with the duration of subfoveal hemorrhage (both p < 0.001). BRVO-associated subfoveal hemorrhage caused damage to the foveal photoreceptors, and visual dysfunction. However, IVR improved these prognoses, by accelerating the absorption of the subfoveal hemorrhage.
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Affiliation(s)
- Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuto Iida
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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186
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Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications. ANATOMY RESEARCH INTERNATIONAL 2015; 2015:591961. [PMID: 26635976 PMCID: PMC4655262 DOI: 10.1155/2015/591961] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
Abstract
Anatomy of ophthalmic artery has been thoroughly studied and reviewed in many anatomical and surgical textbooks and papers. Issues of interest are its intracranial and extracranial course, its branches, its importance for vision, and its interaction with various intracranial pathologies. Improvement of our understanding about pathophysiology of certain diseases like aneurysm formation, central retinal artery occlusion, and retinoblastoma and also invention of new therapeutic modalities like superselective catheterization, intra-arterial fibrinolysis, and intra-arterial chemotherapy necessitate a reappraisal of its anatomy from a clinical point of view. The aim of this review is to examine clinical anatomy of ophthalmic artery and correlate it with new diagnostic and therapeutic applications.
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187
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Abstract
The retinal venous pressure (RVP) can be measured non-invasively. While RVP is equal to or slightly above intraocular pressure (IOP) in healthy people, it is often markedly increased in patients with eye or systemic diseases. Beside a mechanical obstruction, the main cause of such an elevation is a local dysregulation of a retinal vein, particularly a constriction induced by endothelin-1 (ET-1). A local increase of ET-1 can result from a high plasma level, as ET-1 can diffuse from the fenestrated capillaries of the choroid into the optic nerve head (ONH), bypassing the blood retinal barrier. A local increase can also result from increased local production either by a sick neighboring artery or retinal tissue. Generally, the main factors increasing ET-1 are inflammations and hypoxia, either locally or in a remote organ. RVP is known to be increased in patients with glaucoma, retinal vein occlusion (RVO), diabetic retinopathy, high mountain disease, and primary vascular dysregulation (PVD). PVD is the major vascular component of Flammer syndrome (FS). An increase of RVP decreases perfusion pressure, which heightens the risk for hypoxia. An increase of RVP also elevates transmural pressure, which in turn heightens the risk for retinal edema. In patients with RVO, a high level of RVP may not only be a consequence but also a potential cause of the occlusion; therefore, it risks causing a vicious circle. Narrow retinal arteries and particularly dilated retinal veins are known risk indicators for future cardiovascular events. As the major cause for such a retinal venous dilatation is an increased RVP, RVP may likely turn out to be an even stronger predictor.
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Affiliation(s)
- Josef Flammer
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
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188
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Atrial Fibrillation and Coronary Artery Disease as Risk Factors of Retinal Artery Occlusion: A Nationwide Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:374616. [PMID: 26558268 PMCID: PMC4628970 DOI: 10.1155/2015/374616] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/26/2015] [Indexed: 12/23/2022]
Abstract
We use Taiwanese national health insurance research database (NHIRD) to investigate whether thrombolism (carotid artery disease (CAD) as a surrogate) or embolism (atrial fibrillation (AF) as a surrogate) plays roles in later retinal artery occlusion (RAO) development and examine their relative weights. The relative risks of RAO between AF and CAD patients and controls were compared by estimating the crude hazard ratio with logistic regression. Kaplan-Meier analysis was used to calculate the cumulative incidence rates of developing RAO, and a log-rank test was used to analyze the differences between the survival curves. Separate Cox proportional hazard regressions were done to compute the RAO-free rate after adjusting for possible confounding factors such as age and sex. The crude hazard ratios were 7.98 for the AF group and 5.27 for the CAD group, and the adjusted hazard ratios were 8.32 and 5.34 for the AF and CAD groups, respectively. The observation time with RAO-free was shorter for AF compared with CAD group (1490 versus 1819 days). AF and CAD were both risk factors for RAO with different hazard ratios. To tackle both AF and CAD is crucial for curbing RAO.
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189
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Kornhauser T, Schwartz R, Goldstein M, Neudorfer M, Loewenstein A, Barak A. Bevacizumab treatment of macular edema in CRVO and BRVO: long-term follow-up. (BERVOLT study: Bevacizumab for RVO long-term follow-up). Graefes Arch Clin Exp Ophthalmol 2015; 254:835-44. [DOI: 10.1007/s00417-015-3130-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/05/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022] Open
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190
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Xu Y, Liu X, Cheng L, Su L, Xu X. A light-emitting diode (LED)-based multispectral imaging system in evaluating retinal vein occlusion. Lasers Surg Med 2015; 47:549-558. [PMID: 26172103 DOI: 10.1002/lsm.22392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Yupeng Xu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine; Shanghai Jiaotong University; Shanghai 200080 P. R. China
| | - Xiaoxiao Liu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine; Shanghai Jiaotong University; Shanghai 200080 P. R. China
| | - Lu Cheng
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine; Shanghai Jiaotong University; Shanghai 200080 P. R. China
| | - Li Su
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine; Shanghai Jiaotong University; Shanghai 200080 P. R. China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine; Shanghai Jiaotong University; Shanghai 200080 P. R. China
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191
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Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy. Prog Retin Eye Res 2015; 49:82-119. [PMID: 26113210 DOI: 10.1016/j.preteyeres.2015.06.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/13/2015] [Accepted: 06/18/2015] [Indexed: 12/15/2022]
Abstract
The rationale behind hyperacute fibrinolytic therapy for cerebral and retinal arterial occlusion is to rescue ischaemic cells from irreversible damage through timely restitution of tissue perfusion. In cerebral stroke, an anoxic tissue compartment (the "infarct core") is surrounded by a hypoxic compartment (the "ischaemic penumbra"). The latter comprises electrically-silent neurons that undergo delayed apoptotic cell death within 1-6 h unless salvaged by arterial recanalisation. Establishment of an equivalent hypoxic compartment within the inner retina following central retinal artery occlusion (CRAO) isn't widely acknowledged. During experimental CRAO, electroretinography reveals 3 oxygenation-based tissue compartments (anoxic, hypoxic and normoxic) that contribute 32%, 27% and 41% respectively to the pre-occlusion b-wave amplitude. Thus, once the anoxia survival time (≈2 h) expires, the contribution from the infarcted posterior retina is irreversibly extinguished, but electrical activity continues in the normoxic periphery. Inbetween these compartments, an annular hypoxic zone (the "penumbra obscura") endures in a structurally-intact but functionally-impaired state until retinal reperfusion allows rapid recovery from electrical silence. Clinically, residual circulation of sufficient volume flow rate generates the heterogeneous fundus picture of "partial" CRAO. Persistent retinal venous hypoxaemia signifies maximal extraction of oxygen by an enduring "polar penumbra" that permeates or largely replaces the infarct core. On retinal reperfusion some days later, the retinal venous oxygen saturation reverts to normal and vision improves. Thus, penumbral inner retina, marginally oxygenated by the choroid or by residual circulation, isn't at risk of delayed apoptotic infarction (unlike hypoxic cerebral cortex). Emergency fibrinolytic intervention is inappropriate, therefore, once the duration of CRAO exceeds 2 h.
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192
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Increased expression of angiogenic and inflammatory proteins in the vitreous of patients with ischemic central retinal vein occlusion. PLoS One 2015; 10:e0126859. [PMID: 25978399 PMCID: PMC4433200 DOI: 10.1371/journal.pone.0126859] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/08/2015] [Indexed: 02/07/2023] Open
Abstract
Background Central retinal vein occlusion (CRVO) is a common disease characterized by a disrupted retinal blood supply and a high risk of subsequent vision loss due to retinal edema and neovascular disease. This study was designed to assess the concentrations of selected signaling proteins in the vitreous and blood of patients with ischemic CRVO. Methods Vitreous and blood samples were collected from patients undergoing surgery for ischemic CRVO (radial optic neurotomy (RON), n = 13), epiretinal gliosis or macular hole (control group, n = 13). Concentrations of 40 different proteins were determined by an ELISA-type antibody microarray. Results Expression of proteins enriched in the vitreous (CCL2, IGFBP2, MMP10, HGF, TNFRSF11B (OPG)) was localized by immunohistochemistry in eyes of patients with severe ischemic CRVO followed by secondary glaucoma. Vitreal expression levels were higher in CRVO patients than in the control group (CRVO / control; p < 0.05) for ADIPOQ (13.6), ANGPT2 (20.5), CCL2 (MCP1) (3.2), HGF (4.7), IFNG (13.9), IGFBP1 (14.7), IGFBP2 (1.8), IGFBP3 (4.1), IGFBP4 (1.7), IL6 (10.8), LEP (3.4), MMP3 (4.3), MMP9 (3.6), MMP10 (5.4), PPBP (CXCL7 or NAP2) (11.8), TIMP4 (3.8), and VEGFA (85.3). In CRVO patients, vitreal levels of CCL2 (4.2), HGF (23.3), IGFBP2 (1.23), MMP10 (2.47), TNFRSF11B (2.96), and VEGFA (29.2) were higher than the blood levels (vitreous / blood, p < 0.05). Expression of CCL2, IGFBP2, MMP10, HGF, and TNFRSF11B was preferentially localized to the retina and the retinal pigment epithelium (RPE). Conclusion Proteins related to hypoxia, angiogenesis, and inflammation were significantly elevated in the vitreous of CRVO patients. Moreover, some markers known to indicate atherosclerosis may be related to a basic vascular disease underlying RVO. This would imply that local therapeutic targeting might not be sufficient for a long term therapy in a systemic disease but hypothetically reduce local changes as an initial therapeutic approach.
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193
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Shen LJ, Chen YQ, Cheng D, Zhang C, Jiang L, Hong M, Kang QY. In VivoRetinal Vein Bypass Surgery in a Porcine Model. Curr Eye Res 2014; 41:79-87. [DOI: 10.3109/02713683.2014.997887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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194
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Sowka JW, Vollmer LA, Au M. Atypical retinal vaso-occlusion with structural and functional resolution. Optom Vis Sci 2014; 92:e6-11. [PMID: 25360702 DOI: 10.1097/opx.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose is to report a patient with primary open-angle glaucoma that developed sudden painless unilateral vision loss, a sequential ophthalmoscopic appearance with features of both central retinal artery and later central retinal vein occlusion, and objective visual system dysfunction in the form of a relative afferent pupil defect, who spontaneously recovered vision along with complete resolution of the pupillary defect over several weeks. CASE REPORT A 50-year-old woman with a long-standing history of glaucoma presented with acute, painless vision loss in one eye, a pallid retina with a cherry red macula, diffuse retinal hemorrhages, and a relative afferent pupil defect. Spectral domain optical coherence tomography and fluorescein angiography were essentially normal with neither retinal edema nor retinal ischemia to account for the visual dysfunction. Over the course of 2 months, the patient regained vision and the relative afferent pupil defect, typically a permanent manifestation of retinal destruction, resolved. CONCLUSIONS Not all retinal vaso-occlusive phenomena can be completely attributed to a central retinal vein or artery occlusion. In the patient presented, there was no objective diagnostic testing that revealed a cause for the patient's vision loss or relative afferent pupillary defect. This combined with the complete recovery of vision and resolution of the relative afferent pupillary defect underscores a lack of comprehensive understanding of retinal vaso-occlusive disease.
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Affiliation(s)
- Joseph W Sowka
- *OD, FAAO †OD Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida (all authors)
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195
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Nicholson JD, Leiba H, Goldenberg-Cohen N. Translational Preclinical Research may Lead to Improved Medical Management of Non-Arteritic Anterior Ischemic Optic Neuropathy. Front Neurol 2014; 5:122. [PMID: 25071709 PMCID: PMC4092366 DOI: 10.3389/fneur.2014.00122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/25/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- James D Nicholson
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center , Petach Tikva , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Hana Leiba
- Department of Ophthalmology, Kaplan Medical Center , Rehovot , Israel ; Hebrew University Hadassah Medical Center , Jerusalem , Israel
| | - Nitza Goldenberg-Cohen
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center , Petach Tikva , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel ; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel , Petach Tikva , Israel
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