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Venkatesh R, Joshi A, Maltsev D, Munk M, Prabhu V, Bavaskar S, Mangla R, Ruamviboonsuk P, Chhablani J. Update on central retinal artery occlusion. Indian J Ophthalmol 2024; 72:945-955. [PMID: 38905460 DOI: 10.4103/ijo.ijo_2826_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/13/2024] [Indexed: 06/23/2024] Open
Abstract
The medical condition referred to as "central retinal artery occlusion" (CRAO) was first documented by Albrecht von Graefe in 1859. Subsequently, CRAO has consistently been identified as a serious medical condition that leads to substantial visual impairment. Furthermore, it is correlated with vascular complications that have the potential to affect crucial organs such as the brain and heart. A considerable amount of research has been extensively published on the various aspects of this topic, which is marked by notable debates and misconceptions, especially regarding its management and outcomes. The primary aim of this review article is to analyze the latest developments in the understanding of CRAO, which includes its causes, techniques for retinal imaging, systemic evaluation, and therapeutic strategies, such as vitrectomy. This review article offers readers a comprehensive learning experience to gain knowledge on the fundamental principles and recent advancements in CRAO.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Dmitrii Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Marion Munk
- Department of Retina, Augenarzt Praxisgemeinschaft Gutblick AG, Pfäffikon, Switerland
- Department of Retina, University Hospital Bern, Inselspital, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vishma Prabhu
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Snehal Bavaskar
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rubble Mangla
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Lak Hok, Thailand
- Center of Excellence for Vitreous and Retinal Disease, Rajavithi Hospital, Bangkok, Thailand
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15213, USA
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Meng X, Song M, Zhang K, Lu W, Li Y, Zhang C, Zhang Y. Congenital heart disease: types, pathophysiology, diagnosis, and treatment options. MedComm (Beijing) 2024; 5:e631. [PMID: 38974713 PMCID: PMC11224996 DOI: 10.1002/mco2.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024] Open
Abstract
Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long-term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.
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Affiliation(s)
- Xiao Meng
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Ming Song
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Kai Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Weida Lu
- Shandong Key Laboratory of Cardiovascular Proteomics and Department of Geriatric MedicineQilu Hospital of Shandong UniversityJinanChina
| | - Yunyi Li
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Cheng Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Yun Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
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Kim HR, Kim MJ, Kim S, Chang MS, Kim DJ, Kim BM, Park KY, Kim YB, Lee CS, Byeon SH, Kim SS, Lee SW, Kim YJ. Retinal artery/arteriole occlusion risks after endovascular treatment for unruptured intracranial aneurysm. Stroke Vasc Neurol 2024; 9:295-305. [PMID: 37793900 PMCID: PMC11221302 DOI: 10.1136/svn-2023-002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To evaluate the association between retinal artery/arteriole occlusion (RAO) and unruptured intracranial aneurysm (UIA). METHODS Incident UIA patients from a nationwide cohort (n=253 240) were categorised into three groups based on subsequent treatment: observation (n=208 993), microsurgical clipping (n=14 168) and endovascular treatment (EVT) groups (n=30 079). The incidence and the incident time of RAO were analysed. HRs of RAO and associated risk factors were evaluated. Additionally, a hospital cohort comprising 2569 consecutive UIA patients treated at a tertiary hospital was analysed with detailed clinical information of UIAs. RESULTS In the nationwide cohort analysis, the incidence of RAO was significantly higher in EVT group than in observation and clipping groups, especially within 60 days (early RAO (within 60 days): HR=4.00, 95% CI: 2.44 to 6.56); delayed RAO (after 60 days): HR=1.74, 95% CI: 1.13 to 2.68). Multivariable analysis showed that the presence of chronic kidney disease (p=0.009) and use of a balloon microcatheter during the procedure (p=0.013) were associated with a higher risk of RAO. In hospital cohort analysis, 11 (0.8%) cases of RAO occurred after EVT, whereas none occurred after microsurgical clipping (p<0.001). Patients with RAO were younger and received balloon microcatheters more frequently than their counterparts. Ten cases of RAO (90.9%) occurred in paraclinoid aneurysms, where EVT was preferred over microsurgical clipping. CONCLUSIONS Performing EVT for UIA may increase the risk of subsequent RAO. Care should be taken when treating paraclinoid aneurysms with balloon microcatheters.
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Affiliation(s)
- Hae Rang Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea (the Republic of)
| | - Min Jeoung Kim
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea (the Republic of)
| | - Sunyeup Kim
- Department of Medical AI, Sungkyunkwan University School of Medicine, Suwon, Korea (the Republic of)
| | - Myung Soo Chang
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong Joon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Byung Moon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Keun Young Park
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea (the Republic of)
| | - Yong Joon Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
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Chiabo J, Kauert A, Casolla B, Contenti J, Nahon-Esteve S, Baillif S, Arnaud M. Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion. Br J Ophthalmol 2024; 108:956-962. [PMID: 37722767 PMCID: PMC11228221 DOI: 10.1136/bjo-2023-323972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
AIMS To assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO). METHODS It is a prospective, non-comparative, monocentric study conducted between July 2016 and March 2022. All consecutive patients diagnosed with RAO within 7 days underwent visual acuity measurement, FA, macular optical coherence tomography (OCT) and OCT-angiography. They received two daily HBOT sessions (2.5 atmosphere absolute, 90 min) until revascularisation assessed by FA. Complete ophthalmic follow-up was scheduled at day 14, day 21 and at 1 month. The main outcome measure was a best-corrected visual acuity (BCVA) improvement defined as a decrease ≥0.3 logMAR at 1 month. RESULTS Thirty-one patients were included and received a mean number of 33.9 (13-56) HBOT sessions. Retinal revascularisation was observed in 48.4% and 87.1% of patients at days 14 and 21, respectively. The mean BCVA on referral and at 1 month was 1.51 logMAR and 1.10 logMAR, respectively. Fifteen (48.4%) patients achieved the main outcome measure. Six (19.4%) patients experienced minor barotrauma that did not require HBOT discontinuation. The univariate analysis showed that antiplatelet-treated patients (p=0.044) and patients with a poor initial BCVA (p=0.008) were more likely to achieve a BCVA improvement. OCT-angiography was not sensitive enough to diagnose RAO or assess revascularisation. CONCLUSION In RAO patients monitored by FA until spontaneous revascularisation of the central retinal artery, HBOT was effective and safe.
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Affiliation(s)
- Jeremy Chiabo
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Andreas Kauert
- Hyperbaric Oxygen Therapy, Pasteur 2 University Hospital, Nice, France
| | - Barbara Casolla
- Stroke Unit neurology, Centre Hospitalier Universitaire de Nice Hôpital Pasteur, Nice, France
| | - Julie Contenti
- Emergency medicine, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Sacha Nahon-Esteve
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Stephanie Baillif
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Martel Arnaud
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
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Kim HM, Woo SJ. Clinical characteristics of recurrent non-arteritic retinal artery occlusion. BMJ Open Ophthalmol 2024; 9:e001636. [PMID: 38816011 PMCID: PMC11138310 DOI: 10.1136/bmjophth-2024-001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES To investigate the recurrent non-arteritic retinal artery occlusion (RAO) in the same or opposite eye. METHODS We searched the RAO registry at Seoul National University Bundang Hospital and included patients with recurrent RAO in the present study. Ophthalmic and systemic features were analysed to identify risk factors and visual outcomes. RESULTS Of the 850 patients in the non-arteritic RAO cohort, 11 (1.3%) experienced a second RAO recurrence, either in the same (5 patients; 0.6%) or opposite (6 patients; 0.7%) eye. The same eye group experienced an earlier recurrence (1-2 months, median 1 month) than the opposite eye group, where the time to recurrence was notably longer (8-66 months, median 22 months). Best corrected visual acuity (BCVA) in the same eye group decreased after the recurrence of RAO. In the same eye group, initial BCVA ranged from 20/200 to counting fingers (CF), while BCVA during RAO recurrence ranged from CF to hand motion. When RAO recurred in the opposite eye, the reduction in visual acuity was less severe than the reduction of the initial episode: initial episode ranged from 20/400 to light perception and recurrent episode ranged from 20/25 to 20/400. Patients exhibited varying degrees of carotid (81.8%) and cerebral (9.1%) artery occlusions. Additionally, one patient in each group (total 2 patients, 18.2%) experienced a stroke 6 months after RAO recurrence. CONCLUSIONS Since the RAO recurrences could lead to devastating visual impairment, it is essential to emphasise the importance of risk factor screening to patients while collaborating with neurologists and cardiologists.
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Affiliation(s)
- Hyeong Min Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Konkuk University School of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cabral D, Bijon J, Vaz M, Naguib M, Sarraf D, Freund KB. Clinical Implications of Alternating Hypointense Bands on OCT Angiography in Retinal Vascular Occlusive Disease. Ophthalmol Retina 2024:S2468-6530(24)00225-2. [PMID: 38719189 DOI: 10.1016/j.oret.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To demonstrate the relationship between alternating hypointense signal bands on OCT angiography (OCTA), real-time fluorescein angiography (FA), and structural OCT findings in patients with retinal vascular occlusive disease (RVOD). DESIGN Retrospective, consecutive case series. SUBJECTS Consecutive patients with a clinical diagnosis of acute RVOD and alternating bands of hypointense OCTA flow signal on en face projections. METHODS Complete ophthalmic examination and multimodal imaging, including color fundus photography, real-time FA, spectral-domain OCT, and OCTA performed with different instruments having different scan speeds and acquisition protocols. MAIN OUTCOME MEASURES The primary outcomes were: hypointense OCTA band characteristics (number, width, orientation, and location), OCTA acquisition characteristics (speed and scan direction), and FA findings including delayed arteriovenous (AV) transit and pulsatile flow. Secondary outcomes were: structural OCT changes including retinal fluid, paracentral acute middle maculopathy (PAMM) lesion, and a prominent middle limiting membrane (p-MLM) sign. RESULTS OCT angiography hypointense bands were detected in the superficial and deep vascular plexuses in 9 eyes of 9 patients with either partial central retinal vein occlusion (RVO) or nonischemic RVO. When obtained on the same device, hypointense bands were thinner and more numerous at lower (100 kHz) scan speeds compared with higher (200 kHz) scan speeds. Band orientation was parallel to the OCTA scan direction, and their extent correlated with the area of delayed AV transit on FA. Structural OCT showed multiple PAMM lesions in 78% of cases and a p-MLM sign centered in the fovea in 44% of cases. CONCLUSIONS OCT hypointense bands are a novel biomarker in RVOD indicating delayed AV transit and pulsatile filling without the need for dye angiography. Structural OCT often shows PAMM in these eyes and, less commonly, a p-MLM sign. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Diogo Cabral
- Unidade Local de Saúde Almada-Seixal, Almada, Portugal; NMS Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jacques Bijon
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Mariana Vaz
- Unidade Local de Saúde Almada-Seixal, Almada, Portugal
| | - Mina Naguib
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York.
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Moon JY, Garg I, Miller JB, Ludwig CA. SUDDEN MONOCULAR VISION LOSS AFTER SNEEZING AS CAPTURED ON WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY-ANGIOGRAPHY. Retin Cases Brief Rep 2024; 18:407-410. [PMID: 36729527 PMCID: PMC11027971 DOI: 10.1097/icb.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion after a sneeze. Widefield swept-source optical coherence tomography-angiography was used to analyze retinal changes at one-month follow-up. METHODS The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and swept-source optical coherence tomography-angiography were obtained. RESULTS Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. Swept-source optical coherence tomography-angiography showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion. CONCLUSION We report the first case of sneeze-induced combined retinal artery and retinal vein occlusion. The retina is a uniquely accessible window that provides insight into human physiology, and swept-source optical coherence tomography-angiography is a powerful tool that can give further insight into the pathophysiology of an occlusion.
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Affiliation(s)
- Jade Y. Moon
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Ophthalmology, Tulane University, New Orleans, Louisiana
| | - John B. Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
| | - Cassie A. Ludwig
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
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Oh D, Mehra A, Echegaray J, Sobol W. Retinal Artery Reperfusion After Translumenal YAG Laser Embolysis in a Case of Branch Retinal Artery Occlusion. JOURNAL OF VITREORETINAL DISEASES 2024; 8:349-354. [PMID: 38770074 PMCID: PMC11102726 DOI: 10.1177/24741264241240325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To present a potential treatment for embolic branch retinal artery occlusion (BRAO). Methods: A case and its findings were analyzed. Results: A 75-year-old man with a 5-day history of an acute superior visual field defect in the right eye was found to have a BRAO secondary to a Hollenhorst plaque and was treated with translumenal YAG laser embolysis. Reperfusion of the retinal artery was observed on dislodging the Hollenhorst plaque, and improvements were seen in the patient's superior visual field defect. Conclusions: Translumenal YAG laser embolysis could potentially reverse ischemia secondary to embolic RAOs. This case report and the current literature cited suggest a rationale for treatment and supports further study of this technique.
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Affiliation(s)
- David Oh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Park SH, Kim BJ, Kim JH, Kim SC, Kim RB, Han YS. Incidence rates of retinal vascular occlusive diseases from 2011 to 2020 in South Korea: a nationwide cohort study. BMC Ophthalmol 2024; 24:128. [PMID: 38519990 PMCID: PMC10958970 DOI: 10.1186/s12886-024-03397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Retinal vascular occlusions, including retinal vein occlusion and retinal artery occlusion, are common causes of visual impairment. In order to evaluate the national medical burden and help improve ophthalmic health care policy planning, we investigated the incidence of retinal vascular occlusive diseases from 2011 to 2020 in Korea. METHODS This study is a nationwide population-based retrospective study using data from the Korea national health claim database of the Health Insurance Review and Assessment (HIRA) service. We identified retinal vascular occlusive diseases registered from January 1, 2009, to December 31, 2020, according to the retinal vascular occlusion code (H34) and its sub-codes from international classification of disease, tenth revision diagnosis code. We used data from the entire Korean population based on the 2015 census of the population in Korea to calculate standardized incidence rates. RESULTS We identified 348,775 individuals (male, 161,673 [46.4%]; female, 187,102 [53.6%]) with incident retinal vascular occlusion (H34), 10,451 individuals (males, 6,329 [60.6%]; females, 4,122 [39.4%]) with incident central retinal artery occlusion (H34.1), and 252,810 individuals (males, 114,717 [45.4%]; females, 138,093 [54.6%]) with incident retinal vein occlusion (H34.8) during the 10-year study period. The weighted mean incidence rate of retinal vascular occlusion was 70.41 (95% CI, 70.18-70.65) cases/100,000 person-years. The weighted mean incidence rate of central retinal artery occlusion was 2.10 (95% CI, 2.06-2.14) cases/100,000 person-years. The weighted mean incidence rate of retinal vein occlusion was 50.99 (95% CI, 50.79-51.19) cases/100,000 person-years. CONCLUSION The total retinal vascular occlusion and retinal vein occlusion showed a decreasing trend until 2020. However, the central retinal artery occlusion decreased until 2014 and remained stable without a significant further decline until 2020. The incidence of total retinal vascular occlusion and retinal vein occlusion was higher in females than in males, while the incidence of central retinal artery occlusion was higher in males. All retinal vascular occlusive diseases showed an increasing incidence with older age; the peak age incidence was 75-79 years for total retinal vascular occlusion and retinal vein occlusion, and 80-85 years for central retinal artery occlusion.
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Affiliation(s)
- Shin Hyeong Park
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan- gu, Changwon, 51472, Korea
| | - Bum Jun Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan- gu, Changwon, 51472, Korea
| | - Ji Hye Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan- gu, Changwon, 51472, Korea
| | - Seung Chan Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan- gu, Changwon, 51472, Korea.
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Jinju, Korea.
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.
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Li X, Chen T, Li Y, Wang C, Wang Y, Wan Y, Yang A, Xiao X. Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window. J Thromb Thrombolysis 2024; 57:503-511. [PMID: 38114857 DOI: 10.1007/s11239-023-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
Local intra-arterial fibrinolysis (LIF) is a promising therapeutic option for CRAO. However, the narrow time window of 6 h has greatly limited the application of LIF. In this study, we explored the efficacy of LIF beyond the conventional time windows and compared the result with conservative therapy. This prospective study included 179 CRAO patients with baseline visual acuity (VA) ≤ 20/400 treated at Renmin Hospital of Wuhan University. The mean time from vision loss to presentation was 5.5 days. 58 patients received conventional standard therapy (CST) alone.121 patients underwent LIF. Main outcome was VA improvement ≥ 0.3 logMAR. Secondary outcome was a favorable VA outcome of 20/200 or better. Logistic regressions were performed to identify predictors of visual improvement. 43% patients in the LIF group experienced VA improvement versus 19% with CST (P = 0.002). LIF was associated with 4.0-fold higher likelihood of visual improvement compared to CST (P = 0.001). Poor baseline VA (light perception or no light perception) and shortened prothrombin time (PT) were associated with greater chance of visual improvement with LIF. However, LIF showed no significant advantage over CST for favorable VA outcomes. No major complications occurred. LIF beyond the therapeutic time window improved vision in functionally blind CRAO patients and showed better efficacy when compared with CST. PT may be a potential predictor of visual outcome after LIF. Our findings could complement existing time-based treatment guidelines and potentially allow for personalized decisions on the use of LIF beyond time windows.
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Affiliation(s)
- Xuejie Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Ting Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Ying Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Chuansen Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Yuedan Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Yuwei Wan
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China
| | - Anhuai Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China.
| | - Xuan Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China.
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11
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Tiwari V, Bagga SSJ, Prasad R, Mathurkar S. A Review of Current Literature on Central Retinal Artery Occlusion: Its Pathogenesis, Clinical Management, and Treatment. Cureus 2024; 16:e55814. [PMID: 38590501 PMCID: PMC10999893 DOI: 10.7759/cureus.55814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
The ocular analogue of a cerebral stroke is central retinal artery occlusion (CRAO), a medical emergency concerning the eyes. Most patients experience substantial acute vision loss with a visual acuity of 20/400 or worse, resulting in decreased quality of life (QoL) and decreased functional ability. An impending cerebral stroke and ischemic heart disease are also more likely. The four distinct clinical entities that make up CRAO are non-arteritic CRAO, transitory non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, and arteritic CRAO. Depending on the CRAO type, clinical traits, visual results, and treatment all vary greatly. Contrary to current belief, there is a spontaneous improvement in the optical field and vision, mainly in the first week. The likelihood of instinctive development in optical acuity in the first seven days varies greatly. The pathogenesis, epidemiology, and medical features of CRAO will be described in this review, along with present and potential management future options.
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Affiliation(s)
- Varun Tiwari
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Simerjeet Singh J Bagga
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapneel Mathurkar
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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12
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Venkatesh R, Mangla R, Parmar Y, Chitturi SP, Yadav NK, Chhablani J. Abnormal retinal vessel filling in central retinal artery occlusion. Clin Exp Optom 2024:1-5. [PMID: 38184849 DOI: 10.1080/08164622.2023.2298781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
CLINICAL RELEVANCE Central retinal artery occlusion (CRAO) is an ophthalmic emergency with a poor prognosis. Several initial CRAO presentation factors can influence the final visual outcome. Fluorescein angiography filling of retinal vessels in CRAO has not been studied in great detail. BACKGROUND The aim of this paper is to study the aberrant filling of the retinal vessels on fluorescein angiography in patients with CRAO and understand its clinical relevance. METHODS Cases of CRAO diagnosed between June 2017 and May 2022 and who had undergone a fundus fluorescein angiography were included. Comparisons were made between the cases with and without aberrant filling of the retinal vessel. RESULTS Twenty-two eyes of 22 patients (14 males and 8 females) with CRAO underwent fluorescein angiography. Ages of the patients ranged from 18 to 73 years, while time interval between development of acute onset vision problems and presentation to the retinal clinic ranged from a minimum of 1 day to a maximum of 30 days. Snellen visual acuity at presentation ranged from perception of light (PL +) to 6/6. On fluorescein angiography, aberrant flow of the fluorescein dye into the retinal vein was observed in four of the 22 (18%) eyes with CRAO. All these cases showed a patient's temporal cilioretinal artery. The cases with aberrant filling of the retinal vessels showed a better presenting visual acuity (6/6-6/60), lesser severity of inner retinal damage and a better final visual acuity (6/6-6/60) compared to CRAO cases without aberrant filling. CONCLUSION Aberrant filling of the retinal vein can be seen on fluorescein angiography in eyes with CRAO and a patent temporal cilioretinal artery. Such eyes with aberrant retinal vessel filling have a better visual prognosis.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | | | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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13
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Chen Y, Tung HF, Hwang JF. Infrared images help to identify retinal emboli in hemodynamic retinal artery occlusion. Taiwan J Ophthalmol 2024; 14:137-139. [PMID: 38654982 PMCID: PMC11034682 DOI: 10.4103/tjo.tjo-d-22-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 04/26/2024] Open
Abstract
To report a case of stroke with internal carotid artery (ICA) occlusion and retinal artery occlusion (RAO) with multiple emboli identified by infrared images. The patient presented with acute blurred vision and slurred speech since woke up in the morning. Carotid Doppler ultrasonography showed severe left ICA stenosis with the decreased flow. Computed tomography angiography demonstrated left ICA critical stenosis with compensatory flows from the right ICA. There was coexistent RAO with multiple emboli, silver-wiring, and segmentation of the retinal artery. More hyperreflective emboli were uncovered by infrared images of spectral-domain optical coherence tomography. Embolism may accompany with the compensatory flow for ICA occlusion. RAO patients should have thorough carotid evaluations, especially those with multiple retinal emboli.
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Affiliation(s)
- Yu Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiao-Fan Tung
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Jiunn-Feng Hwang
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
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14
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Smith CE, Kukolja J. Prevalence and risk factors of ischemic monocular vision loss and concurrent brain ischemia. Eur Stroke J 2023; 8:982-988. [PMID: 37593943 PMCID: PMC10683730 DOI: 10.1177/23969873231191577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/09/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION We performed a retrospective cohort study to identify predictors of concurrent asymptomatic brain ischemia in patients with ischemic monocular vision loss. PATIENTS AND METHODS An inpatient database research of admissions to the Helios University Hospital Wuppertal, Germany between 01/2016 and 12/2020 was conducted. Inclusion criteria were confirmed diagnosis of transient monocular vision loss (MVL), retinal artery occlusion (RAO), and magnetic resonance imaging (MRI) of the brain within 10 days of MVL. Silent brain ischemia (SBI) was defined as diffusion restrictions with corresponding reduced apparent diffusion coefficient in MRI and an absence of neurological deficits besides those complying with MVL in clinical examination. The prevalence and cardiovascular predictors of SBI were analyzed with logistic regression and an artificial neural network. RESULTS One hundred fourteen out of 475 patients treated with monocular vision loss were included in this study. The mean age was 67.7 ± 13.6 years. 48.2% were male and 47.4% had RAO. MRI scan of the brain was performed after 3.9 ± 2.3 days and detected SBI in 17%. Age ⩾67 years, cardiac etiology of MVL, and cerebral ischemia in medical history were revealed as predictors of SBI in MRI. CONCLUSIONS Patients older than 66 years, with a suspected cardiac embolism as the cause of RAO and previous cerebral ischemia, are more likely to present SBI in cerebral MRI. Therefore, MR imaging, particularly in these patients, can be useful.
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Affiliation(s)
- Cathy E Smith
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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15
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Ramachandran S, Chavan K, Padhi TR, Takkar B, Karande S, Kelgaonkar A, Panda KG, Padhy SK. Central retinal artery occlusion following pediatric blunt ocular trauma. Indian J Ophthalmol 2023; 71:3626-3632. [PMID: 37991294 PMCID: PMC10788753 DOI: 10.4103/ijo.ijo_3337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. METHODOLOGY The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. RESULTS A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. CONCLUSION CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.
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Affiliation(s)
- Sivaranjan Ramachandran
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Kasturi Chavan
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Tapas R Padhi
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Brijesh Takkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayali Karande
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Krushna G Panda
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikanta K Padhy
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
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16
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Lincke JB, Christe L, Unterlauft JD, Zinkernagel MS, Zysset-Burri DC. Microbiome and Retinal Vascular Diseases. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1675-1682. [PMID: 36963629 DOI: 10.1016/j.ajpath.2023.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/26/2023]
Abstract
The gut microbiome consists of more than a thousand different microbes and their associated genes and microbial metabolites. It influences various host metabolic pathways and is therefore important for homeostasis. In recent years, its influence on health and disease has been extensively researched. Dysbiosis, or imbalance in the gut microbiome, is associated with several diseases. Consequent chronic inflammation may lead to or promote inflammatory bowel disease, obesity, diabetes mellitus, atherosclerosis, alcoholic and non-alcoholic liver disease, cirrhosis, hepatocellular carcinoma, and other diseases. The pathogenesis of the three most common retinal vascular diseases, diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion, may also be influenced by an altered microbiome and associated risk factors such as diabetes mellitus, atherosclerosis, hypertension, and obesity. Direct cause-effect relationships remain less well understood. A potential prevention or treatment modality for these diseases could be targeting and modulating the individual's gut microbiome.
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Affiliation(s)
- Joel-Benjamin Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Lucine Christe
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Jan Darius Unterlauft
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Denise C Zysset-Burri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland
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17
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Yao B, Dong Z, Xue Y, Meng H, Wang F. Case report: acute isolated cilioretinal artery occlusion secondary to percutaneous coronary intervention. J Cardiothorac Surg 2023; 18:297. [PMID: 37848980 PMCID: PMC10583427 DOI: 10.1186/s13019-023-02379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION This case report aims to describe in detail the acute isolated cilioretinal artery occlusion (CLRAO) secondary to complicated therapeutic percutaneous coronary intervention (PCI). CASE DESCRIPTION A 68-year-old Chinese man with coronary artery disease (CAD) complained of sudden, sharp chest pain. Coronary angiography revealed severe stenoses of the coronary arteries. The patient was then treated with PCI. One hour after the procedure, the patient presented with a sudden reduction in vision in the right eye. The patient was diagnosed with acute isolated CLRAO and treated with Salvia miltiorrhiza injections. CONCLUSIONS This is the report to provide a detailed description of acute isolated CLRAO secondary to therapeutic PCI treated with Salvia miltiorrhiza. The visual prognosis of the untreated patients is poor. Suitable management and prevention are essential for interventional cardiologists to prevent these complications.
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Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Zhaoyang Dong
- Department of Ophthalmology, Nanjing Jiangning Hospital of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Yuanfeng Xue
- Department of General Practice, Nanjing Lishui District Baima Health Hospital, Nanjing, Jiangsu Province, China
| | - Haoyu Meng
- Department of Cardiology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Fei Wang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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18
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Mileski KM, Biousse V, Newman NJ, Flowers AM, Chan W, Dattilo M. Optometric Practice Patterns for Acute Central and Branch Retinal Artery Occlusion. J Neuroophthalmol 2023:00041327-990000000-00467. [PMID: 37733470 DOI: 10.1097/wno.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Optometrists are often the first providers to evaluate patients with acute vision loss and are often the first to diagnose a central retinal artery occlusion (CRAO). How quickly these patients present to the optometrist, are diagnosed, and referred for evaluation are major factors influencing the possibility of acute therapeutic intervention. Our aim was to survey the U.S. optometric community to determine current optometric practice patterns for management of CRAO. METHODS An anonymous seven-question survey was emailed in 2020 to the 5,101 members of the American Academy of Optometry and the 26,502 members of the American Optometric Association. RESULTS Of 31,603 optometrists who were sent the survey, 1,926 responded (6.1%). Most respondents (1,392/1,919, 72.5%) worked in an optometry-predominant outpatient clinic and were less than 30 minutes from a certified stroke center (1,481/1,923, 77.0%). Ninety-eight percent (1,884/1,922) of respondents had diagnosed less than 5 CRAOs in the previous year, and 1,000/1,922 (52.0%) had not diagnosed a CRAO in the prior year. Of the optometrists who diagnosed at least one CRAO in the previous year, 661/922 (71.7%) evaluated these patients more than 4 hours after the onset of vision loss. Optometrists who diagnosed a CRAO or branch retinal artery occlusion referred patients to an emergency department (ED) affiliated with a certified stroke center (844/1,917, 44.0%), an outpatient ophthalmology clinic (764/1,917, 39.9%), an ED without a stroke center (250/1,917, 13.0%), an outpatient neurology clinic (20/1,917, 1.0%), or other (39/1,917, 2.0%); most (22/39, 56.4%) who responded "other" would refer to a primary care physician. CONCLUSIONS Optometrists are likely the first providers to evaluate patients with acute vision loss, including from a retinal artery occlusion. However, only 6.1% of optometrists responded to our survey despite 2 reminder emails, likely reflecting the lack of exposure to acute retinal artery occlusions, and a potential lack of interest of optometrists in participating in research. Of the optometrists who reported evaluating a CRAO in the previous year, less than 29% saw the patient within 4 hours of vision loss. In addition, a large portion of optometrists are referring acute CRAO patients to outpatient ophthalmology clinics, delaying appropriate acute management. Therefore, it is imperative that optometrists and ophthalmologists are educated to view acute retinal arterial ischemia as an acute stroke and urgently refer these patients to an ED affiliated with a stroke center. The delay in patient presentation and these referral patterns make future clinical trials for acute CRAO challenging.
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Affiliation(s)
- Kelsey M Mileski
- Departments of Ophthalmology (KMM, VB, NJN, AMF, WC, MD), Neurology (VB, NJN), and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia
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Balla S, Vajas A, Pásztor O, Rentka A, Lukucz B, Kasza M, Nagy A, Fodor M, Nagy V. Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1680. [PMID: 37763799 PMCID: PMC10534709 DOI: 10.3390/medicina59091680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.
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Affiliation(s)
- Szabolcs Balla
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Attila Vajas
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Orsolya Pásztor
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Anikó Rentka
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Balázs Lukucz
- Department of Technology and Economics, University of Budapest, 1111 Budapest, Hungary;
| | - Márta Kasza
- Medical Centre, Hungarian Defence Forces, 1134 Budapest, Hungary;
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Mariann Fodor
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Valéria Nagy
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
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Chen T, Wang Y, Li X, Feng J, Yang H, Li Y, Feng H, Xiao X. Sex differences in major adverse cardiovascular and cerebrovascular event risk among central retinal artery occlusion patients. Sci Rep 2023; 13:14930. [PMID: 37696870 PMCID: PMC10495358 DOI: 10.1038/s41598-023-42247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023] Open
Abstract
To estimate the association between central retinal artery occlusion (CRAO) and major adverse cardiovascular and cerebrovascular events (MACCE), including their clinical characteristics, blood markers, and the contribution of CRAO to MACCE, as well as to assess any sex differences. This retrospective cohort study included continuous new-onset CRAO patients and 1:4 controls during the same period. Correlations of CRAO with the incidence of MACCE during follow-up and the sex-related differences were studied. One hundred and twenty-four CRAO patients and four hundred and ninety-six controls were enrolled. Neutrophil-to-lymphocyte ratio (NLR, P = 0.014) and high-sensitivity C-reactive protein (hs-CRP, P = 0.038) were tended to be higher in CRAO patients. After the follow-up period, 78 patients experienced MACCE. Multivariate Cox regression analysis showed that CRAO was a predictor of the occurrence of MACCE (HR 2.321, 95% CI 1.439-3.744, P = 0.001). Sex subgroups indicated that age, diabetes, current smoking, CRAO, NLR and hs-CRP increased the risk factor of MACCE in males (All P < 0.05) and CRAO, NLR, low-density lipoprotein cholesterol (LDL-C) and hs-CRP were independent influencing factors for females (All P < 0.05). New-onset CRAO significantly increases the probability of MACCE and is associated with a poor prognosis. The sex-related differences suggested that effective prevention of the occurrence of MACCE in high-risk patients requires that attention be given to individualized risk factors corresponding to sexes.
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Affiliation(s)
- Ting Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Yuedan Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Xuejie Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Jiaqing Feng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Hongxia Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Ying Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China
| | - Hui Feng
- Information Center, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China.
| | - Xuan Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jie Fang Road, Wuhan, 430060, Hubei, China.
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Hayreh SS, Hayreh SB. Uveal vascular bed in health and disease: uveal vascular bed anatomy. Paper 1 of 2. Eye (Lond) 2023; 37:2590-2616. [PMID: 37142776 PMCID: PMC10482978 DOI: 10.1038/s41433-023-02416-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 05/06/2023] Open
Abstract
The uveal vascular bed is the largest vascular system in the eye and has a role in supplying almost every tissue in the eyeball. This makes it the most important ocular vascular system. This is an up-to-date review of the literature of the entire uveal vascular bed in health based on detailed anatomy of the posterior ciliary arteries (PCAs), anterior ciliary arteries, cilioretinal arteries, and vortex veins. Although postmortem injection cast preparations gave us useful information on the morphology of the choroidal vascular bed; in vivo studies showed that they misled us for centuries about the in vivo situation. According to the postmortem cast studies, the uveal vascular bed has no segmental distribution, the uveal vessels anastomose freely with one another, there are inter-arterial and arteriovenous anastomoses in the choroid, and the choriocapillaris form a freely communicating and an uninterrupted vascular bed in the entire choroid.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual, College of Medicine, University of Iowa, Iowa City, IA, USA
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22
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Feltgen N, Agostini H. Retinal Vascular Occlusion and Underlying Generalized Vascular Diseases. Klin Monbl Augenheilkd 2023; 240:1071-1076. [PMID: 37216967 DOI: 10.1055/a-2097-0938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Retinal vascular occlusion not only threatens vision loss but is also associated with other systemic risk factors and vascular diseases. Interdisciplinary cooperation is of great importance in these patients. The risk factors hardly differ between arterial and venous retinal occlusions, which is due to the special anatomy of retinal vessels. Major underlying conditions associated with retinal vascular occlusion include arterial hypertension, diabetes mellitus, dyslipidemia, cardiac disease, particularly atrial fibrillation, or vasculitis of large- and middle-sized arteries. Every new diagnosed retinal vascular occlusion should therefore be taken as an occasion to search for risk factors and possibly adjust an already existing therapy in order to prevent further vascular events.
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Affiliation(s)
- Nicolas Feltgen
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Deutschland
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Venkatesh R, Sharief S, Prashanti CVS, Reddy NG, Mangla R, Parmar Y, Anilkumar A, Yadav NK, Chhablani J. Aberrant filling of the retinal vein on fluorescein angiography in branch and hemi-central retinal artery occlusion. Eye (Lond) 2023; 37:2659-2663. [PMID: 36577803 PMCID: PMC10482961 DOI: 10.1038/s41433-022-02379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To study aberrant filling of the retinal vessels on fluorescein angiography (FA) images in patients with branch (BRAO) or hemi-central retinal artery occlusions (hemi-CRAO) and correlate with associated changes on optical coherence tomography (OCT). METHODS Cases of acute BRAO or hemi-CRAO having FA and OCT images at presentation between June 2017 to May 2022 were included. Comparisons were made between the cases with and without aberrant filling of the retinal vessel. RESULTS Thirty-nine eyes of 39 patients with acute retinal artery occlusions underwent FA and OCT imaging. Seven of the ten cases with either BRAO or hemi-CRAO showed aberrant filling of the retinal vein on FA. No case with CRAO showed aberrant filling on FA. The cases with aberrant filling showed a better presenting visual acuity and lesser severity of retinal ischemia on OCT. Shunts between the retinal artery in the unaffected region and the retinal vein in the affected segment was seen in two eyes. The remaining five eyes showed no arteriovenous anastomosis. Cases with aberrant filling had a better visual function even at the last visit. CONCLUSION Aberrant retinal vein filling across the horizontal median raphe in the affected region in BRAO or hemi-CRAO eyes had less severity of retinal ischemia and better presenting and final visual acuities. Reduced perfusion in retinal capillaries with altered retinal vascular anatomy or arteriovenous shunts could be probable reasons for the development of this FA finding. Presence of aberrant filling of the retinal vein could indicate better final visual prognosis.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India.
| | - Shama Sharief
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Chitturi Venkata Sai Prashanti
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
| | - Rubble Mangla
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Yash Parmar
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Aaditi Anilkumar
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
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Liu W, Bai D, Kou L. Progress in central retinal artery occlusion: a narrative review. J Int Med Res 2023; 51:3000605231198388. [PMID: 37712755 PMCID: PMC10504844 DOI: 10.1177/03000605231198388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Central retinal artery occlusion (CRAO) is a catastrophic ophthalmic emergency that severely impairs a patient's visual function, often reducing visual acuity to counting fingers or worse. Progress in CRAO research has provided new information regarding its epidemiological characteristics and led to useful assessments through various ophthalmic examinations. Additional insights about CRAO have been gained through studies of its pathophysiological mechanisms, improving intervention timing and enhancing patient prognosis. Treatment for CRAO has evolved, particularly with assistance from surgical instruments and surgical robots. Although surgical treatment is now possible, this option is not widely recognized by ophthalmologists. Conservative therapies have limited benefits compared with the natural course of disease. Recently, pars plana vitrectomy plus endovascular surgery has received considerable interest among ophthalmologists because of its potential efficacy in the treatment of CRAO. Considering the inconsistencies in rationale and efficacy of CRAO treatment modalities, it is important to distinguish between treatment effects and the natural courses of various CRAO subclasses. This narrative review explores progress in CRAO epidemiology, pathophysiology, ophthalmic examination, and treatment.
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Affiliation(s)
- Weishai Liu
- Department of Ophthalmology, Ankang Hospital of Traditional Chinese Medicine, Ankang City, China
| | - Dan Bai
- Department of Ophthalmology, Ankang Hospital of Traditional Chinese Medicine, Ankang City, China
| | - Lieling Kou
- Department of Ophthalmology, Ankang Hospital of Traditional Chinese Medicine, Ankang City, China
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Zakaria NA, Cheng TC, Nasaruddin RA, Che Hamzah J. Neovascular Glaucoma Complicating Central Retinal Artery Occlusion Despite Cilioretinal Artery Sparing. Cureus 2023; 15:e43303. [PMID: 37700979 PMCID: PMC10492658 DOI: 10.7759/cureus.43303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
This case report aims to describe a case of unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing, which was complicated by neovascular glaucoma (NVG). A 75-year-old Indian woman with underlying normal tension glaucoma presented with the sudden onset of painless generalized blurring of the right eye's vision for a week. Her right eye vision was hand motion with the presence of a right relative afferent pupillary defect. Fundus examination revealed retinal whitening over the macula sparing the papillomacular bundle with generalized retinal arteriolar attenuation, which was suggestive of right CRAO with cilioretinal artery sparing. Systemic examination revealed high blood pressure (175/75 mmHg) without ocular bruit or audible murmur on auscultation. Optical coherence tomography of the macula showed inner retinal thickening over the temporal macula. Ultrasound carotid Doppler and computed tomography angiography of the carotid showed more than 75% stenosis over the right distal internal carotid artery. Unfortunately, she developed rubeosis iridis over her right eye two weeks after her presentation, which required pan-retinal photocoagulation. She subsequently progressed to NVG, requiring maximum anti-glaucoma medications to stabilize intraocular pressure. In conclusion, CRAO is a sight-threatening medical emergency. Thorough investigations are required to determine the underlying cause so that early intervention can be done to reduce the risk of a similar attack in the fellow eye and the risk of a cerebrovascular event or cardiac ischemia, which could be life-threatening. The presence of a cilioretinal artery does not prevent ocular neovascularization in CRAO. Hence, patients should also be closely monitored after the initial diagnosis to prevent devastating complications such as NVG.
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Affiliation(s)
- Nur Aisyah Zakaria
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Teck Chee Cheng
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Rona A Nasaruddin
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
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26
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Mangla R, Venkatesh R, Prabhu V, Acharya I, Handa A, Thadani A, Joshi A, Yadav NK, Chhablani J. Mid-phase pinpoint hyperfluorescent spots on fundus fluorescein angiography in acute central retinal artery occlusion - a novel imaging finding. Int J Retina Vitreous 2023; 9:40. [PMID: 37408021 DOI: 10.1186/s40942-023-00478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To describe the development and outcome of mid-phase pinpoint hyperfluorescent spots (MPHS) on fundus fluorescein angiography (FFA) in acute (< 7-day symptom onset) central retinal artery occlusion (CRAO) patients. METHODS This retrospective study included acute CRAO patients who underwent multimodal imaging utilizing optical coherence tomography (OCT) and FFA between June 2017 and January 2023. The correlation of FFA images with the OCT images in various stages and severity of CRAO were studied. RESULTS Twenty-three FFA studies on 23 patients with acute CRAO were included. In 11 (48%) cases, an important finding noted on FFA was the presence of single or multiple MPHS with adjacent minimal late vascular leakage. Of these 11 cases, eight (73%) were males and median age was 41 years (inter quartile range: 33-55 years). Visual acuity ranged from 'light perception' to 6/18, and these patients presented anytime on the same day to seven days after symptom onset. On OCT, three eyes had severe CRAO, seven eyes had moderate CRAO, and one eye had mild CRAO. MPHS were primarily observed at the posterior pole and more frequently observed in moderate CRAO severity. During follow-up, the MPHS and retinal vessel staining on FFA disappeared as the CRAO showed signs of resolution. CONCLUSION MPHS at the posterior pole on FFA in acute CRAO patients could indicate a more severe occlusion and poor visual outcomes, even after treatment. This finding is most likely caused by red blood cell aggregation or rouleaux formation. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Ashit Handa
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Atul Thadani
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Cheemalapati S, Babu SM. An Ocular Emergency Often Ignored. Cureus 2023; 15:e41754. [PMID: 37575852 PMCID: PMC10421348 DOI: 10.7759/cureus.41754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Branch retinal artery occlusion (BRAO) is a relatively rare vascular disorder characterized by the occlusion of one or more branches of the central retinal artery, with an incidence of around 5 per 100,000 persons per year. Its ability to cause permanent vision loss in a specific visual field makes it a significant clinical obstacle that requires careful management. We describe a case of a 77-year-old male patient, a known hypertensive (on medication and whose hypertension was under control), presented with sudden painless loss of vision in the superior field of his right eye. Timely and accurate diagnosis is crucial to initiate appropriate management. Patients with hypertension should be routinely screened for its various micro- and macrovascular complications, and prophylactic therapy/management should be started wherever warranted.
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Affiliation(s)
- Shashank Cheemalapati
- Internal Medicine, JSS Medical College and Hospital/JSS Academy of Higher Education & Research (JSSAHER), Mysore, IND
| | - Suresh M Babu
- Internal Medicine, JSS Medical College and Hospital/JSS Academy of Higher Education & Research (JSSAHER), Mysore, IND
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Okonkwo ON, Adenuga OO, Nkanga D, Ovienria W, Ibanga A, Agweye CT, Oyekunle I, Akanbi T. Prevalence and systemic associations of retinal vascular occlusions in Sub-Saharan Africa. Ann Afr Med 2023; 22:279-285. [PMID: 37417014 PMCID: PMC10445699 DOI: 10.4103/aam.aam_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/03/2022] [Accepted: 01/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.
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Affiliation(s)
| | - Olukorede O. Adenuga
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Dennis Nkanga
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Wilson Ovienria
- Department of Ophthalmology, Irrua Specialist Hospital, Edo, Nigeria
| | - Affiong Ibanga
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chineze Thelma Agweye
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Idris Oyekunle
- Department of Retina, Eye Foundation Hospital, Lagos, Nigeria
| | - Toyin Akanbi
- Department of Retina, Eye Foundation Hospital, Lagos, Nigeria
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Nicholson AT, Sullivan MA, Corliss BM. Maxillary artery pseudoaneurysm causing retinal artery occlusion. Am J Ophthalmol Case Rep 2023; 30:101830. [PMID: 37034463 PMCID: PMC10074497 DOI: 10.1016/j.ajoc.2023.101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
Purpose To report a novel case of central retinal artery occlusion in a 44-year-old male caused by emboli from a non-traumatic maxillary artery pseudoaneurysm. Observations A 44-year-old male with history of hypertension presented to clinic with painless vision loss in his left eye. He was found to have a central retinal artery occlusion. Ocular massage and intraocular pressure lowering agents were administered and the patient was transferred to the emergency department for cerebrovascular work-up. Remarkably, the patient had rapid symptom improvement from no light perception to 20/70 after ocular massage and IOP agents. Neuroimaging studies discovered a maxillary artery pseudoaneurysm with anastomotic branches to the internal carotid artery via the foramen rotundum and Vidian artery. Endovascular embolization was performed to prevent further thromboembolic event. Conclusion and Importance We believe this to be the first reported case of retinal artery occlusion caused by a maxillary artery pseudoaneurysm. This case demonstrates that visual deficits can be the presenting symptom of a non-traumatic maxillary artery pseudoaneurysm.
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30
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Okonkwo ON, Agweye CT, Akanbi T. Neuroprotection for Nonarteritic Central Retinal Artery Occlusion: Lessons from Acute Ischemic Stroke. Clin Ophthalmol 2023; 17:1531-1543. [PMID: 37284058 PMCID: PMC10239763 DOI: 10.2147/opth.s403433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
Nonarteritic central retinal artery occlusion (NA-CRAO) is a variant of acute ischemic stroke (AIS) and is a cause of sudden severe loss of vision. There are guidelines by the American Heart Association and the American Stroke Association for the care of CRAO patients. This review explores the basis of retinal neuroprotection for CRAO and its potential for improving the outcome of NA-CRAO. Recently, there have been significant advances in research into the use of neuroprotection to treat retinal diseases, including retinal detachment, age-related macular degeneration, and inherited retinal diseases. Also, neuroprotective research in AIS has been extensive, and newer drugs tested, including Uric acid, Nerinetide, and Otaplimastat, with promising results. Progress in cerebral neuroprotection after AIS offers hope for retinal neuroprotection after CRAO; and a possibility of extrapolating research findings from AIS into CRAO. Combining neuroprotection and thrombolysis can extend the therapeutic window for NA-CRAO treatment and potentially improve outcomes. Experimented neuroprotection for CRAO includes Angiopoietin (Comp Ang1), KUS 121, Gene therapy (XIAP), and hypothermia. Efforts in the field of neuroprotection for NA-CRAO should focus on better imaging to delineate the penumbra after an acute episode of NA-CRAO (using a combination of high-definition optical coherence angiography and electrophysiology). Also, research should explore details of pathophysiologic mechanisms involved in NA-CRAO, allowing for further neuroprotective intervention, and closing the gap between preclinical and clinical neuroprotection.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Ikeja, Lagos, Nigeria
| | - Chineze Thelma Agweye
- Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Cross River, Nigeria
| | - Toyin Akanbi
- Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Ikeja, Lagos, Nigeria
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Iyer SS, Radhakrishnan NS, Roohipourmoallai R, Guerin CM, Maylath JS, Garson N. Chronic ocular small vessel disease: An overview of diabetic retinopathy and its relationship with cardiovascular health. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 29:100270. [PMID: 38510674 PMCID: PMC10945896 DOI: 10.1016/j.ahjo.2023.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/22/2024]
Abstract
Diabetic retinopathy (DR) is a potentially blinding disease originating from small vessel damage in the retina in chronic hyperglycemic states. DR has a complex multi-pathway driven pathogenesis resulting in diabetic macular edema and retinal ischemia, the former being the most common cause of vision impairment in DR. Hypoxia induced cytokines stimulate vascular endothelial growth factor (VEGF) production and subsequent angiogenesis with resultant mechanical retinal damage over time. Anti-VEGF therapy is effective for the treatment of center-involving diabetic macular edema. There is evolving evidence showing the effectiveness of anti-VEGF as both adjuvant and monotherapy in the treatment of proliferative DR, however laser photocoagulation continues to remain the standard of care. DR in large cohort studies has been shown to be an independent risk factor for the development of cardiovascular disease and mortality. In addition, changes in retinal vascular caliber ratios may have implications for risk of macrovascular events with a gender discrepancy towards women.
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Affiliation(s)
- Siva S.R. Iyer
- Vitreoretinal Associates, Gainesville, FL, United States of America
| | - Nila S. Radhakrishnan
- University of Florida College of Medicine, Department of Medicine, United States of America
| | - Ramak Roohipourmoallai
- University of South Florida College of Medicine, Department of Ophthalmology, United States of America
| | - Cynthia M. Guerin
- Texas Tech Department of Ophthalmology and Visual Sciences, United States of America
| | - Jeremy S. Maylath
- Texas Tech Department of Ophthalmology and Visual Sciences, United States of America
| | - Nickolas Garson
- University of Florida College of Medicine, Department of Ophthalmology, United States of America
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Blair NP, Matei N, Leahy S, Rahimi M, Shahidi M. The accumulated oxygen deficit as an indicator of the ischemic retinal insult. Exp Eye Res 2023; 230:109439. [PMID: 36931487 PMCID: PMC10133208 DOI: 10.1016/j.exer.2023.109439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
We here attempt to improve quantification of the ischemic retinal insult, that is, what is imposed on the retinal tissue by ischemia, especially in experimental models of ischemia. The ischemic retinal insult initiates the ischemic retinal injury (or outcome). Accordingly, it is reasonable to assume that the better the quantification of the insult, the better the correlation with, and thereby estimation of, the injury. The insult seldom has been quantified in terms of the relevant physiological factors, especially in connection with the rate of oxygen delivery (DO2). We here propose the accumulated oxygen deficit (AO2D) as an indicator of the ischemic retinal insult. We hypothesized that AO2D is correlated with the rate of oxygen metabolism measured 1 h after reperfusion following an episode of ischemia (MO2_1_Hr). Previously, we showed that MO2_1_Hr is related to the electroretinogram amplitude and the retinal thickness when they are measured seven days after reperfusion. We studied 27 rats, as well as 26 rats from our published data on retinal ischemia in which we had measurements of DO2 and duration of ischemia (T) of various levels and durations. We also measured DO2 in 29 rats treated with sham surgery. Ischemia was induced by either ipsilateral or bilateral common carotid artery occlusion or by ophthalmic artery occlusion, which gave a wide range of DO2. DO2 and MO2_1_Hr were evaluated based on three types of images: 1) red-free images to measure vessel diameters, 2) fluorescence images to estimate blood velocities by the displacement of intravascular fluorescent microspheres over time, and 3) phosphorescence images to quantify vascular oxygen tension from the phosphorescence lifetime of an intravascular oxygen sensitive phosphor. Loss of oxygen delivery (DO2L) was calculated as the difference between DO2 under normal/sham condition and DO2 during ischemia. AO2D, a volume of oxygen, was calculated as the product DO2L and T. Including all data, the linear relationship between AO2D and MO2_1_Hr was significant (R2 = 0.261, P = 0.0003). Limiting data to that in which T or DO2L was maximal also yielded significant relationships, and revealed that DO2L at a long duration of ischemia contributed disproportionately more than T to MO2_1_Hr. We discuss the potential of AO2D for quantifying the ischemic retinal insult, predicting the ischemic retinal injury and evaluating the likelihood of infarction.
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Affiliation(s)
- Norman P Blair
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA.
| | - Nathanael Matei
- Department of Ophthalmology, University of Southern California, 1450 San Pablo St, Suite 4700, Los Angeles, CA 9003, USA.
| | - Sophie Leahy
- Department of Ophthalmology, University of Southern California, 1450 San Pablo St, Suite 4700, Los Angeles, CA 9003, USA.
| | - Mansour Rahimi
- Department of Ophthalmology, University of Southern California, 1450 San Pablo St, Suite 4700, Los Angeles, CA 9003, USA.
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, 1450 San Pablo St, Suite 4700, Los Angeles, CA 9003, USA.
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Vestergaard N, Cehofski LJ, Alsing AN, Kruse A, Nielsen JE, Schlosser A, Sorensen GL, Honoré B, Vorum H. Large-Scale Protein Analysis of Experimental Retinal Artery Occlusion. Int J Mol Sci 2023; 24:ijms24097919. [PMID: 37175625 PMCID: PMC10177937 DOI: 10.3390/ijms24097919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Retinal artery occlusion (RAO) is a devastating condition with no effective treatment. The management of RAO could potentially be improved through an in-depth understanding of the molecular alterations in the condition. This study combined advanced proteomic techniques and an experimental model to uncover the retinal large-scale protein profile of RAO. In 13 pigs, RAO was induced with an argon laser and confirmed by fluorescein angiography. Left eyes serving as controls received a sham laser without inducing occlusion. Retinal samples were collected after one, three, or six days and analyzed with liquid chromatography-tandem mass spectrometry. In RAO, 36 proteins were differentially regulated on day one, 86 on day three, and 557 on day six. Upregulated proteins included clusterin, vitronectin, and vimentin, with several proteins increasing over time with a maximum on day six, including clusterin, vimentin, osteopontin, annexin-A, signal transducer, and the activator of transcription 3. On day six, RAO resulted in the upregulation of proteins involved in cellular response to stress, hemostasis, innate immune response, and cytokine signaling. Downregulated proteins were involved in transmission across chemical synapses and visual phototransduction. This study identified the upregulation of multiple inflammatory proteins in RAO and the downregulation of proteins involved in visual pathways.
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Affiliation(s)
- Nanna Vestergaard
- Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Lasse Jørgensen Cehofski
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | - Anders Kruse
- Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Anders Schlosser
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense C, Denmark
| | - Grith Lykke Sorensen
- Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense C, Denmark
| | - Bent Honoré
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Mairot K, Gascon P, Stolowy N, Comet A, Attia R, Beylerian M, Granel B, Jarrot PA, Cohen DJ, Guez G, Levy N, Denis D, David T. Paracentral Acute Middle Maculopathy as a Specific Sign of Arteritic Anterior Ischemic Optic Neuropathy. Am J Ophthalmol 2023; 248:1-7. [PMID: 36228776 DOI: 10.1016/j.ajo.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study is to assess the diagnostic accuracy of paracentral acute middle maculopathy (PAMM) in the setting of anterior ischemic optic neuropathy (AION) to distinguish arteritic (A-AION) from nonarteritic (NA-AION) type. DESIGN Retrospective cross-sectional diagnostic evaluation. METHODS PAMM was evaluated by 3 physicians blinded to diagnosis using macular spectral-domain optical coherence tomography. We studied 45 patients with AION. Of those, 28 had NA-AION and 17 had A-AION. The study was conducted in the Department of Ophthalmology at the Hospital of Marseille-Assistance Publique, France, from January 1, 2018, to March 31, 2022. RESULTS PAMM were only found in the A-AION group (N = 4) (P = .0143). As a distinctive sign of A-AION, we found a specificity of 100% (95% IC, 88.06%-100%) and a positive predictive value of 100%. In contrast, sensitivity and negative predictive value were lower, 19.1% (95% IC, 5.5-42.0) and 63.0% (95% CI, 58.1-67.7), respectively. CONCLUSIONS The PAMM finding is highly specific for A-AION in the setting of AION. According to our results, macular spectral-domain optical coherence tomography looking for PAMM should be performed with any patient presenting with AION.
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Affiliation(s)
- Kevin Mairot
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.).
| | - Pierre Gascon
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.)
| | - Natacha Stolowy
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - Alban Comet
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.)
| | - Ruben Attia
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.)
| | - Marie Beylerian
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - Brigitte Granel
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - Pierre-André Jarrot
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - David Jacob Cohen
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.)
| | | | - Natanael Levy
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - Danièle Denis
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Independent researcher (D.J.C., G.G.).; Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
| | - Thierry David
- From the Centre Hospitalier Universitaire de l'Hôpital Nord, (K.M., P.G., N.S., A.C., R.A., M.B., B.G., P.-A.J., N.L., D.D., T.D.); Faculty of Medicine, Aix-Marseille University (N.S., M.B., B.G., P.-A.J., N.L., D.D., T.D.), Marseille, France
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Hwang DDJ, Lee KE, Kim Y, Kim MS, Rim TH, Kim M, Kim H, Kyoung DS, Park JI. Incidence of Retinal Artery Occlusion and Related Mortality in Korea, 2005 to 2018. JAMA Netw Open 2023; 6:e233068. [PMID: 36897587 DOI: 10.1001/jamanetworkopen.2023.3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
IMPORTANCE It remains unclear whether comorbidities in patients with retinal artery occlusion (RAO), a rare retinal vascular disorder, differ by subtype and whether mortality is higher. OBJECTIVE To examine the nationwide incidence of clinically diagnosed, nonarteritic RAO, causes of death, and mortality rate in patients with RAO compared with that in the general population in Korea. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study examined National Health Insurance Service claims data from 2002 to 2018. The population of South Korea was 49 705 663, according to the 2015 census. Data were analyzed from February 9, 2021, to July 30, 2022. MAIN OUTCOMES AND MEASURES The nationwide incidence of any RAO, including central RAO (CRAO; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code, H34.1) and noncentral RAO (other RAO; ICD-10 code, H34.2) was estimated using National Health Insurance Service claims data from 2002 to 2018, with 2002 to 2004 as the washout period. Furthermore, the causes of death were evaluated and the standardized mortality ratio was estimated. The primary outcomes were the incidence of RAO per 100 000 person-years and the standardized mortality ratio (SMR). RESULTS A total of 51 326 patients with RAO were identified (28 857 [56.2%] men; mean [SD] age at index date: 63.6 [14.1] years). The nationwide incidence of any RAO was 7.38 (95% CI, 7.32-7.44) per 100 000 person-years. The incidence rate of noncentral RAO was 5.12 (95% CI, 5.07-5.18), more than twice that of CRAO (2.25 [95% CI, 2.22-2.29]). Mortality was higher in patients with any RAO than in the general population (SMR, 7.33 [95% CI, 7.15-7.50]). The SMR for CRAO (9.95 [95% CI, 9.61-10.29]) and for noncentral RAO (5.97 [95% CI, 5.78-6.16]) showed a tendency toward a gradual decrease with increasing age. The top 3 causes of death in patients with RAO were diseases of the circulatory system (28.8%), neoplasms (25.1%), and diseases of the respiratory system (10.2%). CONCLUSIONS AND RELEVANCE This cohort study found that the incidence rate of noncentral RAO was higher than that of CRAO, whereas SMR was higher for CRAO than noncentral RAO. Patients with RAO show higher mortality than the general population, with circulatory system disease as the leading cause of death. These findings suggest that it is necessary to investigate the risk of cardiovascular or cerebrovascular disease in patients newly diagnosed with RAO.
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Affiliation(s)
- Daniel Duck-Jin Hwang
- Department of Ophthalmology, Hangil Eye Hospital, Incheon, Korea
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, Incheon, Korea
| | | | - Yuwon Kim
- Data Science Team, Evidnet Co Ltd, Seoul, Korea
| | | | | | - Mina Kim
- Data Science Team, Hanmi Pharm Co Ltd, Seoul, Korea
| | - Hasung Kim
- Data Science Team, Hanmi Pharm Co Ltd, Seoul, Korea
| | | | - Ji In Park
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Korea
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Li P, He Y, Wang P, Wang J, Shi G, Chen Y. Synthesizing multi-frame high-resolution fluorescein angiography images from retinal fundus images using generative adversarial networks. Biomed Eng Online 2023; 22:16. [PMID: 36810105 PMCID: PMC9945680 DOI: 10.1186/s12938-023-01070-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Fundus fluorescein angiography (FA) can be used to diagnose fundus diseases by observing dynamic fluorescein changes that reflect vascular circulation in the fundus. As FA may pose a risk to patients, generative adversarial networks have been used to convert retinal fundus images into fluorescein angiography images. However, the available methods focus on generating FA images of a single phase, and the resolution of the generated FA images is low, being unsuitable for accurately diagnosing fundus diseases. METHODS We propose a network that generates multi-frame high-resolution FA images. This network consists of a low-resolution GAN (LrGAN) and a high-resolution GAN (HrGAN), where LrGAN generates low-resolution and full-size FA images with global intensity information, HrGAN takes the FA images generated by LrGAN as input to generate multi-frame high-resolution FA patches. Finally, the FA patches are merged into full-size FA images. RESULTS Our approach combines supervised and unsupervised learning methods and achieves better quantitative and qualitative results than using either method alone. Structural similarity (SSIM), normalized cross-correlation (NCC) and peak signal-to-noise ratio (PSNR) were used as quantitative metrics to evaluate the performance of the proposed method. The experimental results show that our method achieves better quantitative results with structural similarity of 0.7126, normalized cross-correlation of 0.6799, and peak signal-to-noise ratio of 15.77. In addition, ablation experiments also demonstrate that using a shared encoder and residual channel attention module in HrGAN is helpful for the generation of high-resolution images. CONCLUSIONS Overall, our method has higher performance for generating retinal vessel details and leaky structures in multiple critical phases, showing a promising clinical diagnostic value.
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Affiliation(s)
- Ping Li
- grid.54549.390000 0004 0369 4060School of Optoelectronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Yi He
- grid.9227.e0000000119573309Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 China ,grid.59053.3a0000000121679639School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026 China
| | - Pinghe Wang
- grid.54549.390000 0004 0369 4060School of Optoelectronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Jing Wang
- grid.9227.e0000000119573309Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 China ,grid.59053.3a0000000121679639School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026 China
| | - Guohua Shi
- grid.9227.e0000000119573309Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163 China ,grid.59053.3a0000000121679639School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230026 China
| | - Yiwei Chen
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.
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Kim HR, Lee NK, Lee CS, Byeon SH, Kim SS, Lee SW, Kim YJ. Retinal Vascular Occlusion Risks in High Blood Pressure and the Benefits of Blood Pressure Control. Am J Ophthalmol 2023; 250:111-119. [PMID: 36736752 DOI: 10.1016/j.ajo.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to evaluate the association of retinal vascular occlusion, including retinal vein occlusion (RVO) and retinal artery occlusion (RAO), with stages of hypertension. DESIGN Nationwide, population-based retrospective cohort study. METHODS Based on baseline blood pressure (BP) as defined by the 2017 American College of Cardiology/American Heart Association guideline, participants were categorized into 4 BP groups. For the BP change measurement, BP groups were defined based on the combination of baseline and follow-up BP categories. The composite retinal vascular occlusion events and hazard ratios (HRs) of retinal vascular occlusion according to BP groups were estimated. RESULTS With normal BP as the reference, multivariate-adjusted HRs for retinal vascular occlusion were significantly higher than in other BP groups, showing much higher HRs in stage 2 hypertension than in stage 1 (HR, 1.10 for elevated BP; 1.07 for stage 1 hypertension; and 1.32 for stage 2 hypertension). Individual disease analysis showed consistent statistical significance in RVO, whereas RAO showed nonsignificant results. Lowering BP significantly decreased the HRs of retinal vascular occlusion in both stage 1 and stage 2 hypertension (HR, 0.88 and 0.73, respectively). However, once hypertension was diagnosed, the risk of retinal vascular occlusion was higher compared to that in the normal BP groups. CONCLUSIONS Elevated BP, stage 1 hypertension, and stage 2 hypertension were all associated with higher retinal vascular occlusion risks than was normal BP. Controlling hypertension appears to reduce the risk of subsequent retinal vascular occlusion; however, the incidence rate was still be significantly higher than that in persons who maintained a normal BP.
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Affiliation(s)
- Hae Rang Kim
- From the Department of Ophthalmology (H.R.K.), CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Nang Kyeong Lee
- Department of Precision Medicine (N.K.L., S.W.L.), Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology (C.S.L., S.H.B., S.S.K., Y.J.K.), Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology (C.S.L., S.H.B., S.S.K., Y.J.K.), Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology (C.S.L., S.H.B., S.S.K., Y.J.K.), Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine (N.K.L., S.W.L.), Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
| | - Yong Joon Kim
- Department of Ophthalmology (C.S.L., S.H.B., S.S.K., Y.J.K.), Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes. Am J Med 2023; 136:179-185. [PMID: 36170938 DOI: 10.1016/j.amjmed.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion. METHODS We retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up. RESULTS After 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years. CONCLUSION Among individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.
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GCL loss in BRAO. PLoS One 2023; 18:e0279920. [PMID: 36603006 DOI: 10.1371/journal.pone.0279920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Our recent publication used optical coherence tomography (OCT) to follow thinning of the retinal ganglion cell layer (GCL) in central retinal artery occlusion (CRAO). Thinning of the inner layers also occurs in patients with branch retinal artery occlusion (BRAO). The mechanism for such thinning may be partially due to proteolysis by a calcium-activated protease called calpain. Calpain inhibitor SNJ-1945 ameliorated the proteolysis in a past series of model experiments. The purposes of the present retrospective study were to: 1) use segmentation analysis of OCT images to follow the loss of retinal layers in BRAO compared to CRAO patients, and 2) predict the number of patients and days of observation needed for a clinical trial of a calpain inhibitor against BRAO. METHODS A retrospective, case control study was conducted by computer-aided search in a medical records database for BRAO (ICD10 Code H34.239) with at least one OCT procedure (CPT: 92134). Non-proliferative, co-morbid eye diseases were allowed in the patient data base, and manual correction of auto-segmentation errors was performed. GCL thickness changes were followed over time and Cohen-d/sample size statistics were used to predict minimal patients needed for drug trials. RESULTS The thickness of the GCL layer in BRAO decreased rapidly with time as in CRAO, but in more limited quadrants. The data, as fit to a single-phase decay curve, showed that GCL thickness could be used to provide sample size statistics in a clinical trial to test a calpain inhibitor. For example, a 60-day trial with a 60% effective inhibitor would need a minimum of 29 patients. CONCLUSIONS Using thickness changes in the GCL layer to monitor the efficacy of potential inhibitors against BRAO and CRAO is practical in human trials requiring a reasonable number of patients and relatively short trial period. TRANSLATIONAL RELEVANCE Measurement of GCL thickness would be a useful indicator of amelioration of BRAO and CRAO progression in a clinical trial of a putative inhibitor.
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Huang L, Wang Y, Zhang R. Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2023; 261:103-113. [PMID: 35947182 DOI: 10.1007/s00417-022-05797-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO). METHODS PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded. RESULTS Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6 h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6 h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT. CONCLUSIONS IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.
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Affiliation(s)
- Lele Huang
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Yujie Wang
- Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China
| | - Ruijun Zhang
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, 110001, People's Republic of China.
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Management of ocular arterial ischemic diseases: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1-22. [PMID: 35838806 DOI: 10.1007/s00417-022-05747-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients. METHODS A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines. RESULTS Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients. CONCLUSION Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .
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[Retinal arterial occlusions (RAV) : S2e guidelines of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 7 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:15-29. [PMID: 36525048 DOI: 10.1007/s00347-022-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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Ikegami Y, Numaga J, Okano N, Fukuda S, Yamamoto H, Terada Y. Response to: The diagnosis of central retinal artery occlusion after mRNA-SARS-CoV-2 vaccination. QJM 2022; 115:882-883. [PMID: 35088865 DOI: 10.1093/qjmed/hcac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Y Ikegami
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
| | - J Numaga
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
| | - N Okano
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
| | - S Fukuda
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
| | - H Yamamoto
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
| | - Y Terada
- From the Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo 173-0015, Japan
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Ørskov M, Vorum H, Larsen TB, Skjøth F. Evaluation of Risk Scores as Predictive Tools for Stroke in Patients with Retinal Artery Occlusion: A Danish Nationwide Cohort Study. TH OPEN : COMPANION JOURNAL TO THROMBOSIS AND HAEMOSTASIS 2022; 6:e429-e436. [PMID: 36632285 PMCID: PMC9713298 DOI: 10.1055/s-0042-1758713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022]
Abstract
Purpose We investigated the 1-year risk of stroke in patients with retinal artery occlusion and evaluated the predictive and discriminating abilities of contemporary risk stratification models for embolic stroke. Methods This register-based cohort study included 7,906 patients with retinal artery occlusion from Danish nationwide patient registries between 1995 and 2018. The study population was stratified according to the number of points obtained in the stroke risk scores: the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score. The 1-year risk of stroke within strata was evaluated and compared using the cox proportional hazards model. Furthermore, the discrimination of the risk scores as predictive tools for stroke risk assessment was investigated using C-statistics, Brier score, and the index of prediction accuracy. Results The stroke event rate in patients with retinal artery occlusion increased as the score increased for both risk scores, ranging from 3.62 (95% confidence interval [CI]: 2.46-5.31) per 100 person-years to 13.25 (95% CI: 11.78--14.89) per 100-person-years for increasing levels of the CHA 2 DS 2 -VASc score and from 3.97 (95% CI: 2.97-5.32) per 100 person-years to 16.43 (95% CI: 14.01-19.27) per 100 person-years for increasing levels of the ESSEN Stroke Risk score. Using a risk score of 0 as a reference, the difference was statistically significant for retinal artery occlusion patients with a CHA 2 DS 2 -VASc score of 2 or above and for all levels of the ESSEN Stroke Risk score. The C-statistics for the risk scores was 61% (95% CI: 58%-63%) and 62% (95% CI: 59-64%) for the CHA 2 DS 2 -VASc score and ESSEN Stroke Risk score, respectively. Conclusion The results suggested that the use of the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score was applicable for risk stratification of stroke in patients with retinal artery occlusion, but discrimination was poor due to low specificity.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark,Address for correspondence Marie Ørskov, MSc Aalborg Thrombosis Research Unit and Department of Cardiology, Aalborg University HospitalAalborg, Denmark; Hobrovej 18-22, DK-9000 AalborgDenmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Flemming Skjøth
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark,Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Antaki F, Milad D, Hamel T. Acute retinal ischaemia associated with paracentral acute middle maculopathy detected on multimodal imaging: a premonitory sign of severe carotid occlusive disease. BMJ Case Rep 2022; 15:e252266. [PMID: 36442909 PMCID: PMC9710327 DOI: 10.1136/bcr-2022-252266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A man in his 60s presented with a subacute paracentral scotoma and preserved visual acuity in the left eye. He was found to have a very subtle area of deep retinal whitening at the macula and multiple retinal cholesterol emboli. Optical coherence tomography (OCT) with En face imaging revealed globular paracentral acute middle maculopathy (PAMM). A diagnosis of PAMM associated with branch artery occlusion was made and the patient was immediately transferred to the nearest stroke centre. Investigations revealed severe carotid occlusive disease for which the patient underwent carotid endarterectomy. Paracentral scotomas in patients with little clinical findings on fundus examination should raise the suspicion for PAMM, which is easily identifiable on OCT. Eye care professionals must recognise PAMM as a possible sign of acute retinal arterial ischaemia-an ocular and systemic emergency that requires immediate referral to specialised stroke centres.
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Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniel Milad
- Department of Ophthalmology, Université de Montréal, Montréal, Québec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Thierry Hamel
- Clinique d'Ophthalmologie Brome-Missisquoi, Cowansville, Québec, Canada
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Venkatesh R, Mangla R, Thadani A, Sharief S, Chhablani J. Nasal origin of cilioretinal artery in central retinal artery occlusion. Clin Exp Optom 2022:1-4. [DOI: 10.1080/08164622.2022.2141102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Atul Thadani
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Shama Sharief
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Jia YJ, Liu HB, Qin Y, Liu JH, Jia FL, Zhang H, Li JH, Li YJ. Received anti-VEGF therapy in a patient with CRAO sparing the CLRA with subretinal fluid: A case report. Medicine (Baltimore) 2022; 101:e31204. [PMID: 36397396 PMCID: PMC9666146 DOI: 10.1097/md.0000000000031204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Central retinal artery occlusion (CRAO) sparing the cilioretinal artery (CLRA) with severe subretinal fluid and non-characteristic cherry-red spot is uncommon. In the present case, the patient received an intravitreal injection of anti- vascular endothelial growth factor, which is very rare. PATIENT CONCERNS A 59-year-old man underwent vitrectomy of the left eye for diabetic retinopathy and vitreous hemorrhage. Six months after the operation, the patient presented with sudden painless visual-acuity decline in his left eye and was diagnosed with CRAO; his best corrected visual acuity was weak light perception. Whole retinal edema was seen on the fundus, and macular gray retinal opacification was present without a characteristic cherry-red spot. Optical coherence tomography revealed subretinal fluid (SRF) in the papillomacular bundle and inner retinal thickening. Fundus fluorescein angiography confirmed that the central retinal artery was not filled at 40 seconds and that the CLRA supplied a part of the macular area. Eight months after the second intravitreal injection of ranibizumab, Optical coherence tomography showed a significant reduction in inner retinal hyperreflectivity and the thickness of the nasal macular retina. The SRF was clearly absorbed, and the visual acuity improved to 1.1 logMAR units. DIAGNOSIS Atypical CRAO. INTERVENTIONS The patient was treated with intravitreal injection of anti-VEGF in his left eye. The thickness of the nasal macular retina decreased. OUTCOMES The SRF was clearly absorbed, and the patient's visual acuity significantly improved. LESSONS When CRAO occurs in patients with diabetic retinopathy sparing the CLRA, the non-characteristic cherry-red spot may be due to macular inner retinal edema, SRF and other factors. According to the patient's condition, anti-vascular endothelial growth factor can be administered as appropriate to inhibit choroidal neovascularization, reduce SRF in the macular retina, and save some vision.
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Affiliation(s)
- Yu-Jie Jia
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Hong-Bo Liu
- Department of Emergency Medicine, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Yuan Qin
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Jing-Hui Liu
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Fa-Li Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Han Zhang
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Jia-Hao Li
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Ying-Jun Li
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
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Parikh P, Mohamed M, Bat T, Nero A, Wang A, Yates SG, Ufret-Vincenty RL. Parafoveal acute middle maculopathy (PAMM) in sickle cell disease after discontinuation of hydroxyurea. Am J Ophthalmol Case Rep 2022; 28:101753. [DOI: 10.1016/j.ajoc.2022.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/22/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
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Gu Y, Hao S, Liu K, Gao M, Lu B, Sheng F, Zhang L, Xu Y, Wu D, Han Y, Chen S, Zhao W, Lou X, Wang X, Li P, Chen Z, Yao K, Fu Q. Airborne fine particulate matter (PM 2.5) damages the inner blood-retinal barrier by inducing inflammation and ferroptosis in retinal vascular endothelial cells. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156563. [PMID: 35690207 DOI: 10.1016/j.scitotenv.2022.156563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
This study was the first to explore the effect of airborne fine particulate matter (PM2.5) exposure on the inner blood-retinal barrier (iBRB). In this study, retinal vascular permeability and diameter were enhanced in the PM2.5-exposed animal model (1 mg/mL PM2.5, 10 μL per eye, 4 times per day, 3 days), together with observable retinal edema and increased inflammation level in retina. PM2.5-induced cell damage in human retinal microvascular endothelial cells (HRMECs) occurred in a time- and dose-dependent manner. Decreased cell viability, proliferation, migration, and angiogenesis, as well as increased apoptosis and inflammation, were observed. Iron overload and excessive lipid oxidation were also discovered after PM2.5 exposure (25, 50, and 100 μg/mL PM2.5 for 24 h), along with significantly altered expression of ferroptosis-related genes, such as prostaglandin-endoperoxide synthase 2, glutathione peroxidase 4, and ferritin heavy chain 1. Moreover, Ferrostatin-1, an inhibitor of ferroptosis, evidently alleviated the PM2.5-induced cytotoxicity of HRMECs. The present study investigated the in vivo effects of PM2.5 on retinas, revealing that PM2.5 exposure induced retinal inflammation, vascular dilatation, and caused damage to the iBRB. The crucial role of ferroptosis was discovered during PM2.5-induced HRMEC cytotoxicity and dysfunction, indicating a potential precautionary target in air pollution-associated retinal vascular diseases.
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Affiliation(s)
- Yuzhou Gu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Shengjie Hao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Kaiyuan Liu
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mengqin Gao
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Bing Lu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Feiyin Sheng
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Li Zhang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Yili Xu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Di Wu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Yu Han
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Shuying Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Wei Zhao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China
| | - Xiaoming Lou
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Xiaofeng Wang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Peng Li
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Zhijian Chen
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China.
| | - Ke Yao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China.
| | - Qiuli Fu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang Province, China.
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50
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Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules 2022; 27:molecules27175398. [PMID: 36080164 PMCID: PMC9458226 DOI: 10.3390/molecules27175398] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
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