Diffusion of O2 in normal and ischemic retinas of anesthetized miniature pigs in normoxia and hyperoxia

Coupling blood flow and neural function in the retina: a model for homeostatic responses to ocular perfusion pressure challenge

Retinal function is known to be more resistant than blood flow to acute reduction of ocular perfusion pressure (OPP). To understand the mechanisms underlying the disconnect between blood flow and neural function, a mathematical model is developed in this study, which proposes that increased oxygen extraction ratio compensates for relative ischemia to sustain retinal function. In addition, the model incorporates a term to account for a pressure-related mechanical stress on neurons when OPP reduction is achieved by intraocular pressure (IOP) elevation. We show that this model, combining ocular blood flow, oxygen extraction ratio, and IOP mechanical stress on neurons, accounts for retinal function over a wide range of OPP manipulations. The robustness of the model is tested against experimental data where ocular blood flow, oxygen tension, and retinal function were simultaneously measured during acute OPP manipulation. The model provides a basis for understanding the retinal hemodynamic responses to short-term OPP challenge.

Retinal oximetry

ABSTRACT.:

PURPOSE

Malfunction of retinal blood flow or oxygenation is believed to be involved in various diseases. Among them are retinal vessel occlusions, diabetic retinopathy and glaucoma. Reliable, non-invasive technology for retinal oxygen measurements has been scarce and most of the knowledge on retinal oxygenation comes from animal studies. This thesis describes human retinal oximetry, performed with novel retinal oximetry technology. The thesis describes studies on retinal vessel oxygen saturation in (1) light and dark in healthy volunteers, (2) central retinal vein occlusion, (3) branch retinal vein occlusion, (4) central retinal artery occlusion, (5) diabetic retinopathy, (6) patients undergoing glaucoma surgery and (7) patients taking glaucoma medication.

METHODS

The retinal oximeter (Oxymap ehf., Reykjavik, Iceland) is based on a fundus camera. An attached image splitter allows the simultaneous capture of four images of the same area of the fundus. Two images are used for further analysis, one acquired with 586 nm light and one with 605 nm light. Light absorbance of retinal vessels is sensitive to oxygen saturation at 605 nm but not at 586 nm. Measurement of reflected light at these wavelengths allows estimation of oxygen saturation in the main retinal vessels. This is performed with custom-made analysis software.

RESULTS

LIGHT AND DARK: After 30 min in the dark, oxygen saturation in retinal arterioles of healthy volunteers was 92 ± 4% (mean ± SD, n = 15). After 5 min in 80 cd/m(2) light, the arteriolar saturation was 89 ± 5%. The decrease was statistically significant (p = 0.008). The corresponding values for retinal venules were 60 ± 5% in the dark and 55 ± 10% in the light (p = 0.020). Similar results were found after alternating 5 min periods of darkness and light. In a second experiment (n = 19), a significant decrease in retinal vessel oxygen saturation was found in 100 cd/m(2) light compared with darkness but 1 and 10 cd/m(2) light had no significant effect. CENTRAL RETINAL VEIN OCCLUSION: In patients with central retinal vein occlusion, the mean saturation in affected retinal venules was 49 ± 12%, while the mean value for venules in the fellow eye was 65 ± 6% (mean ± SD, p = 0.003, n = 8). The retinal arteriolar saturation was the same in affected (99 ± 3%) and the unaffected (99 ± 6%) eyes. The venous oxygen saturation showed much variation between affected eyes. BRANCH RETINAL VEIN OCCLUSION: Median oxygen saturation in venules affected by branch retinal vein occlusion was 59% (range, 12-93%, n = 22), while it was 63% (23-80%) in unaffected venules in the affected eye and 55% (39-80%) in venules in the fellow eye. The difference was not statistically significant (p > 0.05). There was a significant difference between affected arterioles (median 101%; range, 89-115%) and unaffected arterioles (95%, 85-104%) in the affected eye (p < 0.05, n = 18). CENTRAL RETINAL ARTERY OCCLUSION: In a patient with a day's history of central retinal artery occlusion due to temporal arteritis, the mean arteriolar saturation was 71 ± 9% and 63 ± 9% in the venules. One month later, after treatment with prednisolone, the mean arteriolar saturation was 100 ± 4% and the venous saturation 54 ± 5%. DIABETIC RETINOPATHY: When compared with healthy volunteers (n = 31), patients with all categories of diabetic retinopathy had on average 7-10 percentage points higher saturation in retinal arterioles (p < 0.05 for all categories, n = 6-8 in each category). In venules, the saturation was 8-12 percentage points higher (p < 0.05 for all categories). GLAUCOMA SURGERY: Oxygen saturation in retinal arterioles increased by 2 percentage points on average (p = 0.046, n = 19) with surgery, which lowered intraocular pressure from 23 ± 7 mmHg (mean ± SD) to 10 ± 4 mmHg (p < 0.0001). No other significant changes were found (p ≥ 0.35). DORZOLAMIDE: A significant reduction of 3 percentage points was found in arterioles (p < 0.01) and venules (p < 0.05) when patients with glaucoma or ocular hypertension changed from dorzolamide-timolol combination eye drops to timolol alone (n = 6). No change was found in patients, who started on timolol and switched to the combination therapy (p > 0.05, n = 7).

CONCLUSIONS

Dual wavelength oximetry can be used to non-invasively measure retinal vessel oxygen saturation in health and disease. The results indicate that retinal vessel oxygen saturation is (1) increased in the dark, (2) lower in venules affected by central retinal vein occlusions, (3) variable in branch retinal vein occlusion, (4) lower in retinal arterioles in central retinal artery occlusion, (5) increased in diabetic retinopathy, (6-7) mildly affected by glaucoma surgery or dorzolamide.

Oxygen saturation in branch retinal vein occlusion

PURPOSE

The aim of this study was to test whether oxygen saturation in retinal blood vessels is affected by branch retinal vein occlusion (BRVO).

METHODS

The spectrophotometric retinal oximeter is based on a fundus camera. It simultaneously captures images of the retina at 586 and 605 nm and calculates optical density (absorbance) of retinal vessels at both wavelengths. The ratio of the two optical densities is approximately linearly related to haemoglobin oxygen saturation. Relative oxygen saturation was measured in retinal blood vessels in 24 patients with BRVO. Friedman's test and Dunn's post test were used for statistical analyses.

RESULTS

  Oxygen saturation in occluded venules ranged from 12% to 93%. The median oxygen saturation was 59% (range 12-93%, n = 22) in affected retinal venules, 63% (23-80%) in unaffected venules in the BRVO eye and 55% (39-80%) in venules in the fellow eye (p = 0.66). Corresponding values for arterioles were 101% (89-115%, n = 18), 95% (85-104%) (p < 0.05) and 98% (84-109%).

CONCLUSIONS

Venular saturation in BRVO is highly variable between patients. Hypoxia is seen in some eyes but not in others. This may reflect variable severity of disease, degree of occlusion, recanalization, collateral circulation, tissue atrophy, arteriovenous diffusion or vitreal transport of oxygen.

Retinal blood flow measurements in branch retinal vein occlusion using scanning laser Doppler flowmetry

PURPOSE

To determine capillary blood flow measurements in eyes with branch retinal vein occlusion using a scanning laser Doppler flowmeter.

METHODS

Retinal capillary blood flow in branch retinal vein occlusion areas and corresponding ipsilateral nonbranch retinal vein occlusion areas, 11 equivalent areas of the contralateral fellow eye of 12 consecutive untreated branch retinal vein occlusion patients, and 16 eyes of 11 age-matched normal control subjects were measured with scanning laser Doppler flowmetry. A template consisting of eight squares, each with a field of 100 x 100 microm (10 x 10 pixel) with space interval of 500 microm equidistant horizontally and vertically was used to obtain blood flow measurements in all subjects. Mean blood volume, flow, and velocity were obtained by averaging the mean values measured in each field. We avoided measurement over large retinal vessels to prevent the aliasing artifact of blood cells from moving faster than the sampling frequency.

RESULTS

Branch retinal vein occlusion areas have significantly decreased microvascular blood volume (P = .0009), flow (P = .02), and velocity (P = .016) compared with ipsilateral nonbranch retinal vein occlusion areas in the same eye. Branch retinal vein occlusion areas also have decreased blood volume (P = .001), flow (P = .0042), and velocity (P = .0044) compared with areas of contralateral fellow eyes of branch retinal vein occlusion subjects. Branch retinal vein occlusion areas have significantly decreased blood volume (P = .0012), flow (P = .008), and velocity (P = .02) compared with age-matched normal areas.

CONCLUSION

Average retinal blood volume, flow, and velocity in areas of branch retinal vein occlusion are significantly lower than in healthy retinas. The ability to noninvasively measure hemodynamic changes in the retinal capillary bed may be relevant to development of new therapies for retinovascular disease.

The influence of intraocular pressure and systemic oxygen tension on the intravascular pO2 of the pig retina as measured with phosphorescence imaging

The intravascular oxygen tension (pO2) of the pig retina was determined by measuring the phosphorescence lifetime of an intravenously injected dye. Pseudocolor images of the intravascular retinal pO2 were obtained. The method is noninvasive except for the application of the dye. The measurement system was adapted to a fundus camera. The systemic arterial oxygen pressure (PaO2) as well as the intraocular pressure (IOP) were altered. In the measurements the pO2 of the choriocapillaris was close to the systemic PaO2. Under normoxia, the retinal veins showed a lower pO2 of about 40 mm Hg. We found evidence of an autoregulation of the retinochoroidal pO2. The retina and the optic nerve head showed an autoregulation of the intravascular pO2 at low IOP, but were more sensitive to a moderate elevation of the IOP of about 40 mm Hg, as compared to the choroidal pO2. The pO2 of the choriocapillaris seemed to change little until the considerably high IOP value of about 50 mm Hg was attained. This behavior is due to either the high perfusion reserve capacity of the choroid or to autoregulation. Although our experiments refer to the perfusion of the pig eye, the results provide indirect evidence that even during a glaucoma attack the human choroid might be able to maintain a reasonable oxygen supply to the retina, whereas the intravascular pO2 of the retinal vessels and of the optic nerve head decrease strongly. The adaptation to a fundus camera facilitates a future clinical application if a nontoxic dye can be developed.

Oxygen distribution in the retinal and choroidal vessels of the cat as measured by a new phosphorescence imaging method

The oxygen tension in the vessels of the retina and optic nerve head has been measured noninvasively with a new phosphorescence imaging method. A phosphorescent oxygen-dependent probe, injected into the bloodstream of cats, was excited with a flash of light and the phosphorescence lifetime of the probe was measured. A simple Stern-Volmer relationship was used to convert lifetime to oxygen tension, and two-dimensional maps of intravascular oxygen tension were produced. We describe the equipment and the methodology for obtaining oxygen maps.

Scatter photocoagulation restores tissue hypoxia in experimental vasoproliferative microangiopathy in miniature pigs

Experimental retinal branch vein occlusion using argon laser photocoagulation in miniature pigs induced the development of ischemic retinal territories associated with preretinal neovascularization. Preretinal partial pressure of oxygen (PO2) measurements on the ischemic territories, using O2-sensitive microelectrodes, established that the ischemic retinal areas were hypoxic. Scatter photocoagulation of these ischemic hypoxic territories restores the local PO2 to the normal values within 2 weeks. Hence, the reported inhibitory effect of photocoagulation on the development of retinal neovascularization could be due to a reversal effect on tissue hypoxia.