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Sideri AM, Kanakis M, Katsimpris A, Karamaounas A, Brouzas D, Petrou P, Papakonstaninou E, Droutsas K, Kandarakis S, Giannopoulos G, Georgalas I. Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI. Transl Vis Sci Technol 2023; 12:8. [PMID: 37145590 PMCID: PMC10168007 DOI: 10.1167/tvst.12.5.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Purpose To investigate the morphological and functional correlation between microvascular retinal changes in optical coherence tomography angiography (OCTA) and the microvascular coronary circulation in patients with ST elevation myocardial infarction (STEMI) coronary heart disease (CHD). Methods A total of 330 eyes from 165 participants (88 cases and 77 controls) were enrolled and imaged. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density was measured in the central (1 mm) and perifoveal (1-3 mm) areas and in the superficial foveal avascular zone (FAZ) and choriocapillaris (3 mm). These parameters were then correlated to the left ventricular ejection fraction (LVEF), and the number of affected coronary arteries. Results Decreased vessel densities in the SCP and DCP and choriocapillaris were positively correlated to the LVEF values (P = 0.006, P = 0.026, and P = 0.002, respectively). No statistically significant correlation between the SCP and DCP central area or FAZ area was found. Regarding the number of affected vessels, significant negative correlations were revealed for the SCP and DCP central vessel densities (P < 0.001 and P < 0.001, respectively) and the SCP perifoveal vascular density (P = 0.009). Conclusions OCTA vascular indices are significantly correlated with morphological and functional parameters in patients with STEMI CHD. SCP vascular density especially seems to be a promising biomarker for the extent of both macrovascular damage (number of affected coronary arteries) and microvascular damage, as mirrored in the decreased LVEF at admission. Translational Relevance OCTA vascular indices offer a valuable insight into the microvascular status of coronary circulation.
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Affiliation(s)
- Anna-Maria Sideri
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Menelaos Kanakis
- School of Medicine, University of Patras, University Eye Clinic, Rion University Hospital, Patras, Greece
| | - Andreas Katsimpris
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Aristotelis Karamaounas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Dimitrios Brouzas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Petros Petrou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Evangelia Papakonstaninou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos Droutsas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Stylianos Kandarakis
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Georgalas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
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2
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Lal B, Alonso-Caneiro D, Read SA, Carkeet A. Diurnal changes in choroidal optical coherence tomography angiography indices over 24 hours in healthy young adults. Sci Rep 2023; 13:3551. [PMID: 36864086 PMCID: PMC9981752 DOI: 10.1038/s41598-023-30433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
This prospective study investigated the magnitude and pattern of variation in choroidal optical coherence tomography angiography (OCT-A) indices every 4 h over 24 h in healthy young myopic (n = 24) and non-myopic (n = 20) adults. Choriocapillaris and deep choroid en-face images from macular OCT-A scans were analysed from each session to extract magnification-corrected vascular indices including choriocapillaris flow deficit number, size and density and deep choroid perfusion density in the sub-foveal, sub-parafoveal, and sub-perifoveal regions. Choroidal thickness was also obtained from structural OCT scans. Significant variations over 24 h (P < 0.05) were observed in most of the choroidal OCT-A indices excluding sub-perifoveal flow deficit number, with peaks observed between 2 to 6 AM. For myopes, peaks occurred significantly earlier (3-5 h), and the diurnal amplitude was significantly greater for sub-foveal flow deficit density (P = 0.02) and deep choroidal perfusion density (P = 0.03) compared with non-myopes. Choroidal thickness also showed significant diurnal changes (P < 0.05) with peaks between 2 to 4 AM. Significant correlations were found between diurnal amplitudes or acrophases of choroidal OCT-A indices and choroidal thickness, intraocular pressure, and systemic blood pressure. This provides the first comprehensive diurnal assessment of choroidal OCT-A indices over 24 h.
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Affiliation(s)
- Barsha Lal
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia.
| | - David Alonso-Caneiro
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Scott A Read
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Andrew Carkeet
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
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3
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Müller M, Schottenhamml J, Hosari S, Hohberger B, Mardin CY. APSified OCT-angiography analysis: Macula vessel density in healthy eyes during office hours. PLoS One 2023; 18:e0282827. [PMID: 36893212 PMCID: PMC9997993 DOI: 10.1371/journal.pone.0282827] [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: 01/04/2022] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE Optical coherence tomography angiography (OCT-A) can visualize retinal capillary microcirculation non-invasively. In order to investigate potential factors influencing OCT-A diagnostics, the aim of the present study was to determine circadian changes in macular vessel density (VD) in healthy adults during office hours, considering axial length (AL) and subfoveal choroidal thickness (CT). METHODS In the prospective study 30 eyes of 30 healthy subjects (mean age 28.7 ± 11.8, range 19-60 years) were recruited who underwent repeated measurements of AL, subfoveal CT and three-layer macula VD (superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP)) on a single day at three predetermined timepoints (9 AM, 3 PM, and 9 PM). For better intra- and interindividual scan comparability, the new Anatomic Positioning System function (APS, part of Glaucoma Module Premium Edition [GMPE], Heidelberg Engineering, Germany) allowing analysis of identical retinal areas, was used for quantitative OCT-A analysis. RESULTS Overall mean macula VD was unchanged during office hours in SVP, ICP and DCP, respectively (p>0.05). In addition, AL and CT showed no statistically significant changes over time (p>0.05). Rather, a large interindividual variance of VD with different peak time was observed. Contrary to the overall data, sectorial VD changed in dependency of office hours in all layers with an increase of VD in SVP between 9 AM and 9 PM (p = 0.003), in ICP between 3 PM and 9 PM (p = 0.000), in DCP between 9 AM and 9 PM (p = 0.048), and 3 PM and 9 PM (p = 0.000), respectively. CONCLUSION Overall mean macula VD, subfoveal CT and AL tended not to show statistically significant changes over time in this cohort, whereas a regional analysis of VD did. Therefore, a circadian influence on capillary microcirculation should be kept in mind. Moreover, the results highlight the importance of a more detailed analysis of VD in different sectors and different vascular layers. In addition, the pattern of diurnal variation could vary inter-individually, thus a patient-specific fluctuation pattern would need to be considered when evaluating these parameters in clinical practice.
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Affiliation(s)
- Meike Müller
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Julia Schottenhamml
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- Department of Computer Science, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Sami Hosari
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Christian Y. Mardin
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- * E-mail:
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4
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Clasky DP, Meunier L, Wells LA. Modeling the Effects of Disease, Drug Properties, and Material on Drug Transport From Intraocular Lenses. Transl Vis Sci Technol 2022; 11:14. [PMID: 35575775 PMCID: PMC9123490 DOI: 10.1167/tvst.11.5.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Surgically implanted intraocular lenses (IOLs) may be used as drug-delivery devices, but their effectiveness is not well defined. Computational fluid dynamics models were developed to investigate the capability of IOLs to release drugs at therapeutic concentrations. Methods Models were generated using COMSOL Multiphysics. Primary open-angle glaucoma (POAG) and wet age-related macular degeneration (AMD) were simulated by reducing aqueous vein and choroidal blood flow, respectively. Release of dexamethasone, ganciclovir, or dextran was studied using common IOL materials, polydimethylsiloxane (PDMS) and poly(2-hydroxyethyl methacrylate) (PHEMA). Results Drug clearance proceeds mainly through choroidal blood flow. When fully constricted, maximum concentration at the choroid (Cmax) values increased by 32.4% to 39,800%. Compared to dexamethasone, Cmax in different tissues decreased by 6.07% to 96.0% for ganciclovir and dextran, and clearance rates decreased by 16% to 69% for ganciclovir and by 92% to 100% for dextran. Using PDMS as the IOL reduced clearance rates by 91.3% to 94.6% compared to PHEMA. Conclusions In diseased eyes, drugs accumulate mainly in posterior tissue; thus, choroidal drug toxicity must be assessed prior to IOL implantation in POAG and AMD patients. Moreover, drug properties modulated concentration profiles in all ocular segments. The hydrophobic small-molecule dexamethasone attained the highest concentrations and cleared the fastest, whereas hydrophilic macromolecular dextran attained the lowest concentrations and cleared the slowest. Furthermore, high concentrations were achieved quickly following release from PHEMA, whereas PDMS allowed for sustained release. Translational Relevance In silico results can guide scientists and clinicians regarding important physiological and chemical factors that modulate tissue drug concentrations from drug-eluting IOLs.
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Affiliation(s)
- Danielle P Clasky
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada
| | - Louise Meunier
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada
| | - Laura A Wells
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada.,Centre for Health Innovation, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Diener R, Leclaire MD, Eckardt F, Lauermann JL, Alnawaiseh M, Eter N, Treder M. CILIORETINAL ARTERIES INFLUENCE OPTIC NERVE HEAD, PERIPAPILLARY, AND MACULAR VESSEL DENSITIES IN HEALTHY EYES: An Optical Coherence Tomography Angiography Study. Retina 2021; 41:2399-2406. [PMID: 33990118 DOI: 10.1097/iae.0000000000003208] [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: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To analyze the influence of a cilioretinal artery (CRA) on macular and peripapillary vessel density in healthy eyes as measured using optical coherence tomography angiography. METHODS A total of 83 eyes of 83 patients were included in this study. Optical coherence tomography angiography was performed using the RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 3 × 3-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Optical coherence tomography angiography images of the optic nerve head were screened for the presence of a CRA. RESULTS In 31 eyes, a CRA was detected (37.3%). The vessel density in eyes with a CRA was significantly lower within the optic nerve head (P = 0.005) but higher in the peripapillary capillary network (P < 0.001) and (whole en face) macular superficial capillary plexus (P = 0.025), when compared with eyes with no CRA. CONCLUSION Our findings reveal that in eyes with a CRA, the vessel density in the peripapillary and macular superficial capillary plexus is increased, whereas the optic nerve head perfusion (as indicated by vessel density in the inside disk region) is decreased. This has to be considered when analyzing quantitative optical coherence tomography angiography parameters in scientific and clinical applications.
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Affiliation(s)
- Raphael Diener
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Martin D Leclaire
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Franziska Eckardt
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Jost L Lauermann
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
- Department of Ophthalmology, Fulda Medical Center, Fulda, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maximilian Treder
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
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6
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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7
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Assessment of the choroidal structure in pregnant women in the first trimester. Sci Rep 2021; 11:4629. [PMID: 33633327 PMCID: PMC7907119 DOI: 10.1038/s41598-021-84204-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
We investigated the anatomical differences in the choroidal structure between pregnant women in the first trimester of pregnancy and age-matched healthy nonpregnant women using enhanced depth imaging optical coherence tomography (EDI-OCT) and choroidal binarization analysis. The main parameters measured in the two study groups, namely, pregnant women in the first trimester and healthy nonpregnant women, were choroidal thickness and the choroidal luminal area. Binarization of the EDI-OCT images from each patient was performed, and the choroidal vascularity index (CVI) was calculated. The correlations between the baseline characteristics of the subjects and the CVI were investigated using linear mixed model analysis. As a result, there was no statistically significant difference in the mean age, best-corrected visual acuity, axial length, central retinal thickness, subfoveal choroidal thickness, systolic blood pressure (BP), or diastolic BP between the two study groups. Conversely, a significant difference was observed in the CVI (P = 0.012) between the two groups. The multivariate analysis identified a significant correlation between the CVI and the systolic BP (P = 0.0044, linear mixed test). Taken together, a larger choroidal luminal area was associated with a higher systolic BP, especially in the first trimester of pregnancy. Our findings may provide further insight into the choroidal changes that occur during pregnancy.
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8
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Rommel F, Rothe M, Kurz M, Prasuhn M, Grisanti S, Ranjbar M. Evaluating diurnal variations in retinal perfusion using optical coherence tomography angiography. Int J Retina Vitreous 2020; 6:22. [PMID: 32518691 PMCID: PMC7271533 DOI: 10.1186/s40942-020-00227-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/27/2020] [Indexed: 01/05/2023] Open
Abstract
Background Optical coherence tomography angiography (OCTA) is a non-invasive tool for imaging and quantifying the retinal and choroidal vasculature as well as perfusion state in healthy eyes. Choroidal perfusion is subject to diurnal variation, showing lowest perfusion in the morning and highest in the afternoon. In this index study, OCTA was used to investigate diurnal changes of the retinal perfusion in healthy adult eyes and to identify impacting factors since retinal perfusion is known to be mainly determined by autoregulatory mechanisms. Methods A prospective study was conducted on healthy volunteers, each of whom underwent repeated measurements of mean arterial pressure (MAP), intraocular pressure (IOP), macular volume (MV), subfoveal choroidal thickness (SFCT), foveal avascular zone (FAZ) and retinal perfusion of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and full retina (FR) slab at 7 a.m. and 4 p.m. Possible influence of MAP or IOP on the retinal perfusion was evaluated. Results A total of 22 eyes of 22 participants (mean age 55.91 ± 14.84) were analysed. Significant diurnal changes from 7 a.m. to 4 p.m. were observed for MAP (p < 0.001) and SFCT (p = 0.017). The perfusion of SCP, DCP and FR as well as the size of the FAZ and the MV did not show significant fluctuation during the day. No significant correlation between MAP or IOP and retinal perfusion values were detectable. Conclusion OCTA-based analysis of the retina in healthy adults demonstrated a steady perfusion of both plexus during the day, independently of changes in MAP. These findings support the theory of autoregulatory mechanisms of the retinal blood flow.
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Affiliation(s)
- Felix Rommel
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.,Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Matthias Rothe
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.,Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Maximilian Kurz
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.,Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Michelle Prasuhn
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.,Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Mahdy Ranjbar
- Department of Ophthalmology, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.,Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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9
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Impact of Cardiovascular Disease Risk Factors on Subfoveal Choroidal Thickness by Enhanced-depth Spectral Domain Optical Coherence Tomography. Optom Vis Sci 2020; 97:73-80. [PMID: 32011578 DOI: 10.1097/opx.0000000000001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
SIGNIFICANCE Risk stratification plays a large role in cardiovascular disease (CVD) management. Spectral-domain optical coherence tomography (SD-OCT) allows for noninvasive analysis of the ophthalmic vasculature, with potential for systemic disease surveillance. Subfoveal choroidal thickness (SFCT) may serve as a marker for CVD risk and play a role in risk stratification. PURPOSE This study aimed to explore the association of major CVD risk factors CVD on SFCT measured from SD-OCT images in a general population of U.S. veterans. METHODS One hundred fifty veterans were prospectively recruited at the Jamaica Plain VA Hospital (Boston, MA). A total of 143 participants were included in the final analysis. The SFCT was manually measured from Spectralis SD-OCT macular scans, and medical chart review was analyzed for CVD data. The SFCT measurements were correlated with CVD risk factors and CVD clinical makers while controlling for age and refractive error. Mean differences in SFCT between those with and without CVD risk factors were analyzed. RESULTS In multivariate analysis, diabetes diagnosis was independently associated with thinner subfoveal choroid (P = .001) and hypertension and hyperlipidemia with thicker subfoveal choroid (P = .006 and P = .05). After adjusting for age and refractive error, veterans with diabetes had thinner choroids than those without (P = .02), and veterans with hypertension and hyperlipidemia had thicker choroids than those without, although these differences did not reach statistical significance (P = .07 and P = .1). CONCLUSIONS Comorbid risk factors for CVD are independently associated with optical coherence tomography-derived measurements of subfoveal choroidal thickness in a vasculopathic population of U.S. veterans, and there are detectable differences in subfoveal choroidal thickness between groups with and without CVD risk factors. Larger studies with adequate controls and longitudinal design are necessary to assess the clinical role of SFCT measurements in CVD risk analysis.
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10
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Lipecz A, Miller L, Kovacs I, Czakó C, Csipo T, Baffi J, Csiszar A, Tarantini S, Ungvari Z, Yabluchanskiy A, Conley S. Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions. GeroScience 2019; 41:813-845. [PMID: 31797238 PMCID: PMC6925092 DOI: 10.1007/s11357-019-00138-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative stress, mitochondrial dysfunction, and impaired resistance to molecular stressors in the choriocapillaris are also considered in terms of their contribution to the pathogenesis of AMD. The pathogenic roles of cardiovascular risk factors that exacerbate microvascular aging processes, such as smoking, hypertension, and obesity as they relate to AMD and choroid and choriocapillaris changes in patients with these cardiovascular risk factors, are also discussed. Finally, future directions and opportunities to develop novel interventions to prevent/delay AMD by targeting fundamental cellular and molecular aging processes are presented.
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Affiliation(s)
- Agnes Lipecz
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lauren Miller
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA
| | - Illes Kovacs
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
| | - Cecília Czakó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Baffi
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Stefano Tarantini
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA.
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Chua J, Chin CWL, Tan B, Wong SH, Devarajan K, Le TT, Ang M, Wong TY, Schmetterer L. Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension. Sci Rep 2019; 9:5819. [PMID: 30967575 PMCID: PMC6456612 DOI: 10.1038/s41598-019-41917-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/20/2019] [Indexed: 12/29/2022] Open
Abstract
We investigated the characteristics of the choriocapillaris flow voids using optical coherence tomography angiography (OCTA) in 85 patients (164 eyes) with hypertension (mean ± SD age, 56 ± 11 years; 45% women; 20% poorly controlled BP; 16% diabetes) who are without ocular diseases and determined possible correlations with systemic vascular risk factors. Data on 24-hour ambulatory blood pressure (BP), serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. OCTA imaging (6 × 6 mm scans; AngioVue) with quantitative microvascular analysis of the choriocapillaris was performed. Linear regression was used to investigate the association of systemic risk factors with area (percentage), size (pixels) and number of choriocapillaris flow voids. Diabetes (β = 0.33; 95% CI, 0.02 to 0.63) and daytime systolic BP (β = -0.13; 95% CI, -0.24 to -0.02) were associated with areas of flow voids. Age (β = 0.21; 95% CI, 0.06 to 0.36) and daytime diastolic BP (β = -0.18; 95% CI, -0.34 to -0.02) were associated with size of flow voids. Age (β = -21.21; 95% CI, -31.79 to -10.63) and nighttime diastolic BP (β = 13.89; 95% CI, 0.61 to 27.17) were associated with number of flow voids. Kidney parameters were not associated with any features of flow voids. In patients with hypertension, a higher BP appeared to increase blood flow in the choriocapillaris which needs to be considered when using the OCTA to study eye diseases in hypertensives.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Si Han Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kavya Devarajan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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12
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Tran HDM, Tran YH, Tran TD, Jong M, Coroneo M, Sankaridurg P. A Review of Myopia Control with Atropine. J Ocul Pharmacol Ther 2018; 34:374-379. [PMID: 29715053 DOI: 10.1089/jop.2017.0144] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Myopia is a global public health issue with a worldwide prevalence of ∼30% and is estimated to rise to 50% by 2050. In addition to the burden associated with routine management of the condition, high myopia predisposes the eye to sight-threatening complications such as myopic maculopathy and glaucoma in adult life. Controlling onset and progression of myopia at a young age can reduce the risk of morbidity associated with high myopia. Progression of myopia can be slowed with various optical, environmental, and pharmaceutical strategies, of which atropine has proven to be the most effective. High-dose atropine (0.5%-1%) is the most effective, but it has significant trade-offs with respect to rebound of myopia on discontinuation and side effects such as photophobia and difficulty with near work (decreased accommodation). Low doses of atropine have been trialed and show a dose-dependent efficacy. However, its mode of action on the ocular tissues leading to slowing eye growth remains unclear and multiple mechanisms and sites in the eye have been postulated to play a role. This review summarizes the role of atropine in controlling myopia and the mechanisms studied to date.
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Affiliation(s)
- Huy D M Tran
- 1 Myopia Program, Brien Holden Vision Institute , Sydney, Australia .,2 Department of Clinical Research, Hai Yen Eye Care , Ho Chi Minh City, Vietnam .,3 Department of Ophthalmology, University of Medicine and Pharmacy at Ho Chi Minh City , Ho Chi Minh City, Vietnam .,4 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
| | - Yen H Tran
- 2 Department of Clinical Research, Hai Yen Eye Care , Ho Chi Minh City, Vietnam
| | - Tuan D Tran
- 3 Department of Ophthalmology, University of Medicine and Pharmacy at Ho Chi Minh City , Ho Chi Minh City, Vietnam
| | - Monica Jong
- 1 Myopia Program, Brien Holden Vision Institute , Sydney, Australia .,2 Department of Clinical Research, Hai Yen Eye Care , Ho Chi Minh City, Vietnam
| | - Minas Coroneo
- 5 Department of Ophthalmology, University of New South Wales , Sydney, Australia
| | - Padmaja Sankaridurg
- 1 Myopia Program, Brien Holden Vision Institute , Sydney, Australia .,4 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
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13
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Li C, Fitzgerald MEC, Del Mar N, Reiner A. Stimulation of Baroresponsive Parts of the Nucleus of the Solitary Tract Produces Nitric Oxide-mediated Choroidal Vasodilation in Rat Eye. Front Neuroanat 2016; 10:94. [PMID: 27774055 PMCID: PMC5053990 DOI: 10.3389/fnana.2016.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/21/2016] [Indexed: 01/07/2023] Open
Abstract
Preganglionic parasympathetic neurons of the ventromedial part of the superior salivatory nucleus (SSN) mediate vasodilation of orbital and choroidal blood vessels, via their projection to the nitrergic pterygopalatine ganglion (PPG) neurons that innervate these vessels. We recently showed that the baroresponsive part of the nucleus of the solitary tract (NTS) innervates choroidal control parasympathetic preganglionic neurons of SSN in rats. As this projection provides a means by which blood pressure (BP) signals may modulate choroidal blood flow (ChBF), we investigated if activation of baroresponsive NTS evokes ChBF increases in rat eye, using Laser Doppler Flowmetry (LDF) to measure ChBF transclerally. We found that electrical activation of ipsilateral baroresponsive NTS and its efferent fiber pathway to choroidal SSN increased mean ChBF by about 40-80% above baseline, depending on current level. The ChBF responses obtained with stimulation of baroresponsive NTS were driven by increases in both choroidal blood volume (ChBVol; i.e., vasodilation) and choroidal blood velocity (ChBVel; possibly due to orbital vessel dilation). Stimulation of baroresponsive NTS, by contrast, yielded no significant mean increases in systemic arterial blood pressure (ABP). We further found that the increases in ChBF with NTS stimulation were significantly reduced by administration of the neuronal nitric oxide (NO) synthase inhibitor Nω-propyl-l-arginine (NPA), thus implicating nitrergic PPG terminals in the NTS-elicited ChBF increases. Our results show that the NTS neurons projecting to choroidal SSN do mediate increase in ChBF, and thus suggest a role of baroresponsive NTS in the BP-dependent regulation of ChBF.
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Affiliation(s)
- Chunyan Li
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
| | - Malinda E. C. Fitzgerald
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Ophthalmology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Biology, Christian Brothers UniversityMemphis, TN, USA
| | - Nobel Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Ophthalmology, The University of Tennessee Health Science CenterMemphis, TN, USA
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Yakut ZI, Karadag R, Akcay A, Bavbek N, Akay H, Koktener A. Effect of Dialysis Type on Orbital Vascular Flow in Patients with End-Stage Renal Disease. Ren Fail 2012; 34:691-6. [DOI: 10.3109/0886022x.2012.681532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Knecht PB, Menghini M, Bachmann LM, Baumgartner RW, Landau K. The ocular pulse amplitude as a noninvasive parameter for carotid artery stenosis screening: a test accuracy study. Ophthalmology 2012; 119:1244-9. [PMID: 22361314 DOI: 10.1016/j.ophtha.2011.12.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/21/2011] [Accepted: 12/21/2011] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To investigate a potential correlation between the ocular pulse amplitude (OPA; i.e., the intraocular pressure difference between the systolic and diastolic phases of the heartbeat) and the severity of carotid artery stenosis (CAS) and to test its role as a screening parameter for CAS during routine ophthalmic examination. DESIGN Test accuracy study. PARTICIPANTS Patients referred for color duplex ultrasound examination of the extra- and intracranial cerebral arteries were enrolled consecutively. METHODS We measured OPA on both eyes by dynamic contour tonometry. Multivariate analyses were performed with risk factors for CAS (age, total cholesterol, low-density lipoprotein, and triglycerides) to compare the diagnostic value of OPA measurements with other non- or minimally invasive screening parameters. MAIN OUTCOME MEASURES The difference between OPA measurements in patients with no (<50%) and patients with severe CAS (>70%) as well as the value of OPA measurements to predict the severity of CAS taking further risk factors of CAS into consideration. RESULTS One hundred thirty-four eyes of 67 patients (25 women, 42 men) with a mean age of 67±13 years (range, 25-87) were included. The means of the OPA values of those patients showing no CAS (<50%) differed significantly (P = 0.036) from those with a stenosis of ≥70%. The multivariate model produced a statistically significant odds ratio (0.46; P = 0.007) for CAS of ≥70%. CONCLUSIONS The results of the present study provide proof of principle that the OPA is reduced in patients with CAS and may be used as a noninvasive, inexpensive, readily available, and unconfounded screening parameter to detect CAS and possibly to reduce the incidence of stroke. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Pascal B Knecht
- University Hospital Zurich, Department of Ophthalmology, Zurich, Switzerland.
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Shih YYI, Li G, Muir ER, De La Garza BH, Kiel JW, Duong TQ. Pharmacological MRI of the choroid and retina: blood flow and BOLD responses during nitroprusside infusion. Magn Reson Med 2011; 68:1273-8. [PMID: 22183830 DOI: 10.1002/mrm.24112] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/06/2011] [Accepted: 11/18/2011] [Indexed: 11/10/2022]
Abstract
Nitroprusside, a vasodilatory nitric oxide donor, is clinically used during vascular surgery and to lower blood pressure in acute hypertension. This article reports a novel application of blood flow (BF) and blood oxygenation level dependent (BOLD) MRI on an 11.7T scanner to image the rat chorioretinal BF and BOLD changes associated with graded nitroprusside infusion. At low doses (1 or 2 μg/kg/min), nitroprusside increased BF as expected but decreased BOLD signals, showing an intriguing BF-BOLD uncoupling. At high doses (3-5 μg/kg/min), nitroprusside decreased BF and markedly decreased BOLD signals. To our knowledge, this is the first pharmacological MRI application of the retina. This approach has potential to open up new avenues to study the drug-related hemodynamic functions and to evaluate the effects of novel therapeutic interventions on BOLD and BF in the normal and diseased retinas.
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Affiliation(s)
- Yen-Yu I Shih
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas 78229, USA.
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Stalmans I, Vandewalle E, Anderson DR, Costa VP, Frenkel REP, Garhofer G, Grunwald J, Gugleta K, Harris A, Hudson C, Januleviciene I, Kagemann L, Kergoat H, Lovasik JV, Lanzl I, Martinez A, Nguyen QD, Plange N, Reitsamer HA, Sehi M, Siesky B, Zeitz O, Orgül S, Schmetterer L. Use of colour Doppler imaging in ocular blood flow research. Acta Ophthalmol 2011; 89:e609-30. [PMID: 21989301 DOI: 10.1111/j.1755-3768.2011.02178.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main objective of this report is to encourage consistent quality of testing and reporting within and between centres that use colour Doppler imaging (CDI) for assessment of retrobulbar blood flow. The intention of this review is to standardize methods in CDI assessment that are used widely, but not to exclude other approaches or additional tests that individual laboratories may choose or continue to use.
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Affiliation(s)
- Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
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Plange N, Rennings C, Herr A, Weber A, Roessler GF, Mazinani BE, Kaup M, Remky A. Ocular pulse amplitude before and after cataract surgery. Curr Eye Res 2011; 37:115-9. [PMID: 22007729 DOI: 10.3109/02713683.2011.626910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the impact of cataract surgery on the association of the ocular pulse amplitude (OPA) and intraocular pressure (IOP) with respect to the interpretation of OPA as an estimate of ocular blood flow. METHODS Twenty-four patients with cataract were included in a clinical study. OPA was measured using dynamic contour tonometry (DCT, Pascal(®), SMT Swiss Microtechnology AG, Switzerland). IOP was measured by means of Goldmann applanation tonometry (IOP GAT) and DCT (IOP DCT). All measurements were performed before and one day after cataract surgery. RESULTS At baseline, OPA was correlated to IOP GAT (r = 0.67, P = 0.0002) and IOP DCT (r = 0.82, P < 0.0001), but not to age or axial length. Postoperative OPA was correlated to IOP GAT (r = 0.67, P = 0.0002) and IOP DCT (r = 0.65, P = 0.0004). In 17 patients, IOP GAT decreased after surgery (IOP DCT n = 14), whereas an increase was apparent in seven patients (IOP DCT n = 10). The mean absolute deviation of IOP GAT pre- to post-surgery was 4.54 mmHg ± 2.47 (range 1-10 mmHg) and 5.4 mmHg ± 3.2 (range 1.1-13.1 mmHg) for IOP DCT. The changes of OPA were significantly correlated to changes in IOP GAT (r = 0.48, P = 0.017) and IOP DCT (r = 0.60, P = 0.001). IOP GAT and IOP DCT changes were not correlated to changes in corneal thickness. CONCLUSIONS The OPA measured with the Pascal(®) device seems to be dependent on IOP changes. Particular caution should be taken in the interpretation of OPA in estimating pulsatile ocular blood flow.
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Affiliation(s)
- Niklas Plange
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
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Knecht PB, Bosch MM, Michels S, Mannhardt S, Schmid U, Bosch MA, Menke MN. The ocular pulse amplitude at different intraocular pressure: a prospective study. Acta Ophthalmol 2011; 89:e466-71. [PMID: 21401909 DOI: 10.1111/j.1755-3768.2011.02141.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate changes in ocular pulse amplitude (OPA) during a short-term increase in intraocular pressure (IOP) and to assess possible influences of biometrical properties of the eye, including central corneal thickness (CCT) and axial length. METHODS In a prospective, single centre study, OPA and IOP as measured by dynamic contour tonometry (DCT) were taken before baseline- and post-OPA (delta) intravitreal injection of 0.05 ml anti-vascular endothelial growth factor agents. Analysis was performed employing linear regression with baseline- and post (delta)-OPA differences as the dependent and post-IOP as well as delta IOP as the independent variable. A multilinear regression analysis with delta OPA as the dependent variable and baseline IOP, post-IOP, CCT and axial length as independent variables was conducted. RESULTS Forty eyes of 40 patients were included. IOP and OPA increased significantly after injection (IOP mean increase ± SD: 17.83 ± 9.83 mmHg, p < 0.001; OPA mean increase ± SD: 1.39 ± 1.16 mmHg, p < 0.001). For every mmHg increase in IOP, the OPA showed a linear increase of 0.05 mmHg (slope 0.05, 95% CI: 0.02-0.09, p = 0.003, r(2) = 0.20). Multiple regression analysis with delta OPA as the dependent variable revealed a partial correlation coefficient of 0.47 (p = 0.003) for post-IOP as the only significant contribution. CONCLUSION A clear positive relationship between OPA measurements and IOP levels was shown in a clinical routine setting using DCT focusing on baseline and postinterventional comparisons of OPA values after intravitreal injections in patients with exudative age related macular degeneration. When considering the OPA for diagnostic purposes, we recommend indication of corresponding IOP values.
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Affiliation(s)
- Pascal Bruno Knecht
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.
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Govêia CS, Magalhães E. Ropivacaine in peribulbar anesthesia - vasoconstrictive properties. Rev Bras Anestesiol 2011; 60:495-512. [PMID: 20863930 DOI: 10.1016/s0034-7094(10)70061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 05/03/2010] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Peribulbar anesthesia can reduce ocular blood flow (OBF) by increasing intraocular pressure (IOP) or due to the action of drugs. Ropivacaine has low toxicity and intrinsic vasoconstrictive properties, yet to be proven on the ocular vasculature. Measurements of ocular pulse amplitude (OPA) allow the indirect evaluation of the OBF. The objective of the present study was to evaluate through the OBF the vasoconstrictive properties of ropivacaine in peribulbar anesthesia. METHODS Forty eyes undergoing peribulbar anesthesia with 7 mL of anesthetic solution without vasoconstrictor were randomly divided into two groups: ropivacaine (n = 20) and bupivacaine (n = 20). The IOP, ocular perfusion pressure (OPP), OPA, hemodynamic parameters, and the degree of akinesia before and 5 and 10 minutes after the blockade were evaluated. A dynamic contour tonometer was used to evaluate ocular parameters. Sedation was similar in both groups. RESULTS A significant variation in hemodynamic parameters and intensity of the motor blockade was not observed between groups. Differences in IOP, OPP, and OPA (p < 0.05) were observed between both groups at 5 and 10 minutes. The variation of IOP at 5 and 10 minutes was -0.88% and -4.54%, respectively with ropivacaine, and 17.61% and 16.56% with bupivacaine. The change in OPP after 5 and 10 minutes was 1.5% and 4.2% with ropivacaine, and -7% and -6% with bupivacaine. Ocular pulse amplitude varied -55.59% and -59.67% with ropivacaine at 5 and 10 minutes, and -34.71% and -28.82% with bupivacaine. CONCLUSIONS Ropivacaine reduced more intensely the ocular pulse amplitude despite little changes in IOP and OPP. The reduction in ocular blood flow caused by ropivacaine can be attributed to its vasoconstrictive effect.
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Boltz A, Lasta M, Schmidl D, Kaya S, Garhöfer G, Schmetterer L. Risikofaktoren der altersbedingten Makuladegeneration. SPEKTRUM DER AUGENHEILKUNDE 2010. [DOI: 10.1007/s00717-010-0445-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Risk factors for age-related maculopathy. J Ophthalmol 2009; 2009:360764. [PMID: 20339564 PMCID: PMC2836883 DOI: 10.1155/2009/360764] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 07/08/2009] [Indexed: 11/20/2022] Open
Abstract
Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition.
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Noma H, Funatsu H, Sakata K, Harino S, Mimura T, Hori S. Macular microcirculation in hypertensive patients with and without branch retinal vein occlusion. Acta Ophthalmol 2009; 87:638-42. [PMID: 18631327 DOI: 10.1111/j.1755-3768.2008.01318.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Our purpose was to determine whether a reduction in blood flow velocity (BFV) in the perifoveal capillaries is involved in the pathogenesis of branch retinal vein occlusion (BRVO) in patients with hypertension. METHODS Subjects included hypertensive patients with (n = 12) and without (n = 16) BRVO and healthy volunteers (n = 16). Perifoveal BFV was measured by the tracing method using fluorescein angiography and a scanning laser ophthalmoscope. Logistic regression analysis was performed to assess factors that influenced the presence or absence of BRVO. RESULTS Mean BFV showed a significant decrease across the three groups (healthy controls: 1.49 +/- 0.11 mm/second; hypertensive patients without BRVO: 1.36 +/- 0.12 mm/second; hypertensive patients with BRVO: 1.16 +/- 0.24 mm/second; p(trend) < 0.001). Multivariate logistic regression analysis showed that BFV was a significant risk factor for the presence of BRVO. CONCLUSIONS Perifoveal capillary BFV is reduced in hypertensive patients with and without BRVO. It is possible that a decrease in BFV may be involved in the occurrence of BRVO. Measurement of perifoveal capillary BFV may be useful for investigating the pathogenesis and progression of BRVO.
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Affiliation(s)
- Hidetaka Noma
- Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Tokyo, Japan.
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25
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Dragostinoff N, Werkmeister RM, Gröschl M, Schmetterer L. Depth-resolved measurement of ocular fundus pulsations by low-coherence tissue interferometry. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:054047. [PMID: 19895148 DOI: 10.1117/1.3251049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A device that allows for the measurement of ocular fundus pulsations at preselected axial positions of a subject's eye is presented. Unlike previously presented systems, which only allow for observation of the strongest reflecting retinal layer, our system enables the measurement of fundus pulsations at a preselected ocular layer. For this purpose the sample is illuminated by light of low temporal coherence. The layer is then selected by positioning one mirror of a Michelson interferometer according to the depth of the layer. The device contains a length measurement system based on partial coherence interferometry and a line scan charge-coupled device camera for recording and online inspection of the fringe system. In-vivo measurements in healthy humans are performed as proof of principle. The algorithms used for enhancing the recorded images are briefly introduced. The contrast of the observed interference pattern is evaluated for different positions of the measurement mirror and at various distances from the front surface of the cornea. The applications of such a system may be wide, including assessment of eye elongation during myopia development and blood-flow-related changes in intraocular volume.
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Affiliation(s)
- Nikolaus Dragostinoff
- Medical University of Vienna, Center for Biomedical Engineering and Physics, Wahringer Strasse 13, Vienna 1090, Austria
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Grieshaber MC, Katamay R, Gugleta K, Kochkorov A, Flammer J, Orgül S. Relationship between ocular pulse amplitude and systemic blood pressure measurements. Acta Ophthalmol 2009; 87:329-34. [PMID: 18937813 DOI: 10.1111/j.1755-3768.2008.01217.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to determine whether ocular pulse amplitude (OPA) measured with dynamic contour tonometry (DCT) is related to systemic blood pressure (BP) parameters. METHODS Blood pressure was measured continuously and simultaneously with OPA in one randomly selected eye in 29 healthy subjects. Systemic parameters of interest were: systolic and diastolic BPs and their difference (BP amplitude), and left ventricle ejection time (LVET; defined as the time between the diastolic trough and the incisural notch in the BP curve). In addition, the axial length (AL) of the eye was measured. Associations between OPA, AL and systemic cardiovascular parameters were analysed in a multivariate regression model. RESULTS Measurements of OPA ranged from 1.0 mmHg to 4.9 mmHg (mean 2.3 +/- 0.9 mmHg, median 1.9 mmHg). In a univariate analysis with one predictor at a time, means of intraocular pressure (IOP) (p = 0.008), AL (p = 0.046) and LVET (p = 0.037) were significantly correlated with OPA, whereas systolic and diastolic BPs and their amplitude were not. A multiple linear regression analysis showed that mean IOP (p < 0.005), AL (p = 0.01) and LVET (p = 0.002) all independently contributed to OPA. CONCLUSIONS The OPA readings measured with DCT in healthy subjects were not related to BP levels and amplitude. It seems that the OPA strongly depends on the time-course of the cardiac contraction. Regulating mechanisms in the carotid system as well as scleral rigidity may be responsible for dampening the direct effect of BP variations.
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Affiliation(s)
- Christoph Kniestedt
- Department of Ophthalmology, University Hospital Zurich (USZ), Zurich, Switzerland
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28
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Riva CE, Schmetterer L. Microcirculation of the Ocular Fundus. Microcirculation 2008. [DOI: 10.1016/b978-0-12-374530-9.00018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Metelitsina TI, Grunwald JE, DuPont JC, Ying GS. Effect of systemic hypertension on foveolar choroidal blood flow in age related macular degeneration. Br J Ophthalmol 2006; 90:342-6. [PMID: 16488959 PMCID: PMC1856936 DOI: 10.1136/bjo.2005.082974] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the effect of systemic hypertension (SH) on the foveolar choroidal circulation in patients with age related macular degeneration (AMD). METHODS This study included 163 study eyes with early AMD characteristics of 124 AMD patients. Study eyes had visual acuity of 20/40 or better, drusen > or =63 microm, and/or RPE hypertrophy. 56 of the AMD patients had a history of SH and 47 of these patients were receiving antihypertensive medications. Laser Doppler flowmetry (Oculix) was used to assess relative choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) in the centre of the fovea of the study eyes. Differences in the mean haemodynamic parameters between groups of eyes were assessed using analysis of variance (ANOVA) and a test of linear trend, with adjustment for the correlation between eyes of the same patient. RESULTS AMD patients with SH showed decreased ChBFlow in comparison with those without SH (ANOVA, p = 0.02). This association was maintained after adjustments for multiple factors (p = 0.04). CONCLUSIONS AMD patients with SH have lower ChBFlow than those without SH. This decrease in choroidal blood circulation may help explain the mechanism by which systemic hypertension may contribute to the progression of AMD and the development of choroidal neovascularisation.
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Affiliation(s)
- T I Metelitsina
- Department of Opthalmology, Scheie Eye Institute, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Dorner GT, Garhöfer G, Selenko N, Fasching P, Bayerle-Eder M, Schmetterer L, Wolzt M. The ocular hemodynamic response to nitric oxide synthase inhibition is unaltered in patients with early type I diabetes. Graefes Arch Clin Exp Ophthalmol 2003; 241:619-24. [PMID: 12836035 DOI: 10.1007/s00417-003-0708-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Revised: 03/27/2003] [Accepted: 05/07/2003] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND An impaired ocular hemodynamic response to systemic nitric oxide synthesis inhibition has been demonstrated in patients with long-standing insulin-dependent diabetes mellitus. It is unclear whether this altered responsiveness is already detectable in early uncomplicated type I diabetes. METHODS The effect of the nitric oxide synthase inhibitor N(G)-monomethyl- l-arginine (L-NMMA) was studied in 10 male patients with early type I diabetes under euglycemic conditions and 10 healthy matched control subjects in a single (analyst) blinded cohort study design. Changes in ocular hemodynamics (fundus pulsation amplitude, mean flow velocity in the ophthalmic artery) and in pulse rate and mean blood pressure were measured in response to systemic intravenous doses of 1.5, 3, and 6 mg/kg L-NMMA. RESULTS L-NMMA dose-dependently and significantly decreased fundus pulsation amplitude (-21.0% vs -23.3% in diabetics and controls, respectively), mean flow velocity in the ophthalmic artery (-12.3% vs -10.8%) and pulse rate (-15.4% vs -16.6%) and increased mean arterial pressure (+19.5% vs +14.7%). The ocular and systemic hemodynamic effects of L-NMMA were not different between patients with diabetes and controls. CONCLUSION The responsiveness of the choroidal vasculature and the ophthalmic artery to L-NMMA is not altered in early type 1 diabetes. An impaired hemodynamic response to nitric oxide synthesis inhibition in diabetes is therefore not caused by a primary defect but rather due to altered vascular responsiveness secondary to long-standing disease.
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Affiliation(s)
- Guido T Dorner
- Department of Clinical Pharmacology, University of Vienna Medical School, Währinger Gürtel 18-20, 1090 Vienna, Austria
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