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Hou X, Jie C, Liu Z, Bi X, Deng Y, Li Y, Wang J, Zhang W. Changes in the retina and choroid in patients with internal carotid artery stenosis: a systematic review and meta-analysis. Front Neurosci 2024; 18:1368957. [PMID: 38686328 PMCID: PMC11056587 DOI: 10.3389/fnins.2024.1368957] [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: 01/11/2024] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
Background Internal carotid artery stenosis (ICAS) is a prevalent vascular condition associated with ischemic cerebrovascular disease. The ophthalmic artery is the first branch of the internal carotid artery stenosis (ICA). Given the crucial role of the ICA in ocular perfusion, we aimed to assess the thickness and vessel density of the retina and choroid in individuals with ICAS. Methods The PubMed and Embase databases were searched from inception to 10 January 2023 for studies evaluating retinal and choroidal changes between ICAS patients and healthy controls using optical coherence tomography (OCT) or optical coherence tomography angiography (OCTA). Data of interest were extracted and analyzed using Stata software version 16. Results Thirteen studies involving 419 ICAS eyes and 398 healthy eyes were included. The pooled results demonstrated that the average thickness of peripapillary retinal nerve fiber layer (pRNFL) (WMD = -0.26, 95% CI: -0.45 to -0.08, P = 0.005), ganglion cell complex (GCC) (WMD = -0.36, 95% CI: -0.65 to -0.06, P = 0.017), and choroid (WMD = -1.06, 95% CI: -1.59 to -0.52, P = 0.000), were significantly thinner in patients with ICAS than in healthy controls. The overall vessel density of the radial peripapillary capillaries (RPC) in whole-image scans was lower in ICAS patients than in healthy control subjects (WMD = -0.94, 95% CI: -1.49 to -0.39, P = 0.001). No differences were detected in the vessel density of the superficial capillary plexus (SCP) (WMD = -0.84, 95% CI: -1.15 to -0.53, P = 0.092), the deep capillary plexus (DCP) (WMD = -0.27, 95% CI: -0.56 to 0.03, P = 0.074), or the choriocapillaris (CC) (WMD = -0.39, 95% CI: -1.12 to 0.35, P = 0.300). Conclusion This systematic review and meta-analysis demonstrated that ICAS can reduce the vessel density of the RPC and the thickness of the retina and choroid. The retinal and choroidal microvasculature is a potential biomarker of the initial signal of ICAS. Systematic review registration https://inplasy.com/, identifier NPLASY202410038.
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Affiliation(s)
| | - Chuanhong Jie
- Eye Hospital China Academy of Chinese Medical Sciences, Beijing, China
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Zhang Y, Zhou SW, Noam N, Rabinovitch D, Bar D, Yousif BS, O'Brien R, Gregori G, Wang RK, Rosenfeld PJ, Trivizki O. Influence of Carotid Endarterectomy on Choroidal Perfusion: The INFLATE Study. Ophthalmol Retina 2024; 8:62-71. [PMID: 37531996 DOI: 10.1016/j.oret.2023.07.026] [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: 05/29/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Patients with clinically significant carotid artery stenosis (CAS) undergoing carotid artery endarterectomy (CEA) were imaged with swept-source OCT angiography (SS-OCTA) imaging protocol to determine if there were changes in choroidal blood flow after surgery. DESIGN Prospective observational study. PARTICIPANTS Patients with clinically significant CAS undergoing unilateral CEA. METHODS All participants underwent SS-OCTA imaging using a 6 × 6-mm scan pattern on both eyes before CEA and within 1 week after CEA. Previously validated automated algorithms were used to measure the mean choroidal thickness (MCT) and choroidal vascular index (CVI) within 2.5-mm and 5-mm circles centered on the fovea. Multivariable regression analysis was conducted to evaluate the impact of various baseline factors including age, mean arterial blood pressure, and degree of stenosis, on both baseline of MCT and CVI, and the changes in MCT and CVI. MAIN OUTCOME MEASURES Changes in MCT and CVI. RESULTS One hundred sixteen eyes from 60 patients with a mean age of 71.57 ± 7.37 years were involved in the study. At baseline, MCT in both the 2.5-mm and 5-mm circles was significantly thinner on the surgical side compared with the nonsurgical side (P = 0.03), while no significant differences were seen in the CVI at baseline between the 2 sides (2.5-mm circle: P = 0.24; 5-mm circle: P = 0.09). Within 1 week after CEA, there were significant increases in the MCT on the surgical side, as compared with the nonsurgical side, in both the 2.5-mm (P < 0.001) and the 5-mm (P < 0.001) circles. No significant change in mean CVI was noted before and after CEA on the surgical side versus the nonsurgical side (2.5-mm circle: P = 0.30; 5-mm circle: P = 0.97). Multivariable regression analysis revealed that baseline MCT before CEA significantly decreased with age on both the surgical (P < 0.001) and nonsurgical sides (P = 0.003) while the changes in MCT and CVI after CEA were not associated with age, mean arterial blood pressure, or degree of stenosis. CONCLUSION A rapid and significant increase in MCT was observed on the ipsilateral side of CEA, suggesting an improvement in choroidal perfusion within 1 week after surgery. 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)
- Yi Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Sandy Wenting Zhou
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Tan Tock Seng Hospital, National Health Group Eye Institute, Singapore
| | - Natalie Noam
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - David Rabinovitch
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Davidov Bar
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Basheer Sheick Yousif
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Robert O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel.
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Shahriari M, Nikkhah H, Mahjoob MP, Behnaz N, Barkhordari S, Cheraqpour K. Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics. World J Clin Cases 2023; 11:6754-6762. [PMID: 37901009 PMCID: PMC10600861 DOI: 10.12998/wjcc.v11.i28.6754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. METHODS In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. RESULTS Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CONCLUSION CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.
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Affiliation(s)
- Mansoor Shahriari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Homayoun Nikkhah
- Department of Ophthalmology, Torfe Medical Center, Tehran 1149847514, Iran
| | | | - Nazanin Behnaz
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran
| | - Shahriar Barkhordari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Kasra Cheraqpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran 1336616351, Iran
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Magyar-Stang R, István L, Pál H, Csányi B, Gaál A, Mihály Z, Czinege Z, Sótonyi P, Tamás H, Koller A, Bereczki D, Kovács I, Debreczeni R. Impaired cerebrovascular reactivity correlates with reduced retinal vessel density in patients with carotid artery stenosis: Cross-sectional, single center study. PLoS One 2023; 18:e0291521. [PMID: 37708176 PMCID: PMC10501613 DOI: 10.1371/journal.pone.0291521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The cerebral and retinal circulation systems are developmentally, anatomically, and physiologically interconnected. Thus, we hypothesized that hypoperfusion due to atherosclerotic stenosis of the internal carotid artery (ICA) can result in disturbances of both cerebral and retinal microcirculations. We aimed to characterize parameters indicating cerebrovascular reactivity (CVR) and retinal microvascular density in patients with ICA stenosis, and assess if there is correlation between them. METHODS In this cross-sectional study the middle cerebral artery (MCA) blood flow velocity was measured by transcranial Doppler (TCD) and, simultaneously, continuous non-invasive arterial blood pressure measurement was performed on the radial artery by applanation tonometry. CVR was assessed based on the response to the common carotid artery compression (CCC) test. The transient hyperemic response ratio (THRR) and cerebral arterial resistance transient hyperemic response ratio (CAR-THRR) were calculated. Optical coherence tomography angiography (OCTA) was used to determine vessel density (VD) on the papilla whole image for all (VDP-WIall) and for small vessels (VDP-WIsmall). The same was done in the peripapillary region: all (VDPPall), and small (VDPPsmall) vessels. The VD of superficial (VDMspf) and deep (VDMdeep) macula was also determined. Significance was accepted when p<0.05. RESULTS Twenty-four ICA stenotic patients were evaluated. Both CVR and retinal VD were characterized. There was a significant, negative correlation between CAR-THRR (median = -0.40) and VDPPsmall vessels (median = 52%), as well as between VDPPall vessels (median = 58%), and similar correlation between CAR-THRR and VDP-WIsmall (median = 49.5%) and between VDP-WIall (median = 55%). CONCLUSION The significant correlation between impaired cerebrovascular reactivity and retinal vessel density in patients with ICA stenosis suggests a common mechanism of action. We propose that the combined use of these diagnostic tools (TCD and OCTA) helps to better identify patients with increased ischemic or other cerebrovascular risks.
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Affiliation(s)
- Rita Magyar-Stang
- Department of Neurology, Semmelweis University, Budapest, Hungary
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Hanga Pál
- Department of Neurology, Semmelweis University, Budapest, Hungary
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Borbála Csányi
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Gaál
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zsófia Czinege
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Horváth Tamás
- Research Center for Sport Physiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Akos Koller
- Research Center for Sport Physiology, Hungarian University of Sports Science, Budapest, Hungary
- Department of Morphology&Physiology, Faculty of Health Sciences, and Translational Medicine Institute, Faculty of Medicine, and ELKH-SE, Cerebrovascular and Neurocognitive Disorders Research Group, Semmelweis University, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY, United States of America
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, United States of America
- Department of Clinical Ophthalmology, Semmelweis University, Budapest, Hungary
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Lei C, Ran Q, Duan J, Zhang M. The Association Between Lipid Profile and Subfoveal Choroidal Thickness in Chinese Patients with Proliferative Diabetic Retinopathy Secondary to Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:2477-2489. [PMID: 37608850 PMCID: PMC10441652 DOI: 10.2147/dmso.s419794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Extensive studies have studied the factors associated with subfoveal choroidal thickness (SFCT). However, studies of the association between lipid profile and SFCT in patients with proliferative diabetic retinopathy (PDR) in type 2 diabetes remain limited. Thus, we aimed to investigate the relationship between lipid profile and SFCT in patients with PDR. Materials and Methods This was a retrospective cross-sectional study. The included participants were inpatients who underwent vitrectomy for PDR with type 2 diabetes and contralateral eyes of PDR patients meeting the criteria. Multivariate linear regression analysis was used to determine the independent association between lipid profile and SFCT. Results A total of 131 participants with PDR were enrolled in the final analysis. The average age of the participants was 55.76 ± 9.88 years, and the average SFCT was 276.10 ± 92.92 μm. Multivariate linear regression model results showed that in the fully adjusted model, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) had a negative association with SFCT (β = -16.51, 95% CI: -29.57, -3.46; P = 0.0148; β = -42.65, 95% CI: -82.60, -2.70; P = 0.0390; β = -17.89, 95% CI: -33.24, -2.54; P = 0.0245, respectively), while triglyceride was not significantly associated with SFCT (β = 5.23, 95% CI: -18.57, 29.02; P = 0.6678). Furthermore, the results of stratified analysis showed that except for triglyceride, the trends of total cholesterol, HDL-C, LDL-C, and SFCT were consistent among different stratifications in participants. Conclusion The cholesterol profile had a significant negative association with SFCT in Chinese PDR patients, but triglyceride was not significantly associated with SFCT. This suggests that these systemic imbalances contribute to choroidal changes, and often coexist in diabetic patients.
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Affiliation(s)
- Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qibo Ran
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Ala-Kauhaluoma M, Ijäs P, Koskinen SM, Nuotio K, Vikatmaa P, Silvennoinen H, Relander K, Lindsberg PJ, Soinne L, Summanen PA. Retinal vessel diameters and microvascular abnormalities in patients with carotid stenosis before and 6 months after carotid endarterectomy: A prospective study. Acta Ophthalmol 2023. [PMID: 36709474 DOI: 10.1111/aos.15633] [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: 06/19/2022] [Revised: 10/06/2022] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess retinal findings in patients with severe carotid stenosis (CS) before and after carotid endarterectomy (CEA) compared to those in controls. METHODS This study is based on 70 patients (male 81%, mean age 69) scheduled for CEA in Helsinki University Hospital and 41 healthy nonmedicated controls (male 76%, mean age 68). Our examinations included fundus photographs. Semi-automated software (Vesselmap, Imedos) served for evaluation of central retinal arterial equivalent (CRAE) and venular equivalent (CRVE), and arterio-venous ratio (AVR) in both eyes. We assessed fundus photographs to subjectively grade microvascular abnormalities in the ipsilateral eyes including focal arteriolar narrowing and irregularities, arteriolar wall reflex, arterio-venous crossing signs and arteriolar and venular tortuosity in the macula. RESULTS CRAE was similar in the ipsi-and contralateral eyes of our patients, and similar to that of the controls both pre- and postoperatively. Preoperatively, we observed higher CRVE in the patients' ipsilateral than in their contralateral eyes (222 vs. 217 μm, p = 0.009), and likewise higher than in controls' eyes (222 vs. 214 μm, p = 0.024). CRVE decreased postoperatively in the patients' ipsilateral eyes (222 vs. 217 μm, p = 0.037). Among the microvascular abnormalities, arteriolar and venular tortuosity in the macula showed higher grades in the patients than in the controls preoperatively (p = 0.035 and p = 0.043), but not postoperatively (p = 0.15 and p = 0.10). CONCLUSIONS CRVE decreased after CEA, showing that venules constrict after the mechanical hindrance of blood flow is removed. Higher grades in arteriolar and venular tortuosity in the macula, a potential ocular biomarker of CS, subsided after CEA.
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Affiliation(s)
- Marianne Ala-Kauhaluoma
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Ijäs
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi M Koskinen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Krista Nuotio
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heli Silvennoinen
- Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Relander
- Department of Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Lindsberg
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Soinne
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paula A Summanen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ala‐Kauhaluoma M, Vikatmaa P, Koskinen SM, Ijäs P, Nuotio K, Silvennoinen H, Relander K, Lindsberg PJ, Soinne L, Summanen PA. Flicker-induced retinal vascular dilation in ipsi- and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy: a prospective study. Acta Ophthalmol 2022; 100:e1370-e1377. [PMID: 35128838 PMCID: PMC9790524 DOI: 10.1111/aos.15107] [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: 11/28/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Retinal vascular function was assessed in patients with carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) and in controls at a six-month interval. METHODS We studied 68 patients (81% male, mean age 69) and 41 healthy non-medicated controls (77%, 68) from March 2015 to December 2018. Our ophthalmological examination included flicker-induced arteriolar and venular measurements with a Dynamic Vessel Analyser in both eyes. RESULTS At baseline, flicker-induced arteriolar and venular dilation was reduced in the ipsilateral eyes of the patients compared with dilation in the controls (arteriolar 1.0% versus 2.6%, p = 0.001 and venular 2.2% versus 2.8%, p = 0.049). These differences subsided after CEA. In patients' ipsilateral eyes, flicker-induced arteriolar dilation was borderline postoperatively (preoperative 1.0% versus postoperative 1.6%, p = 0.06), whereas venular dilation increased (2.2% versus 2.8%, p = 0.025). We found various tentative associations with the change in flicker-induced dilations after CEA, but not with the preoperative dilations. CONCLUSIONS Postoperative recovery of the reduced flicker-induced arteriolar and venular dilatation in the ipsilateral eye shows that, after CEA, the activity-dependent vascular reactivity of haemodynamically compromised retinal tissue can improve.
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Affiliation(s)
- Marianne Ala‐Kauhaluoma
- Department of OphthalmologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Pirkka Vikatmaa
- Department of Vascular surgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Suvi M. Koskinen
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland,Department of Radiology, HUS Diagnostic CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Petra Ijäs
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Krista Nuotio
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Heli Silvennoinen
- Department of Radiology, HUS Diagnostic CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kristiina Relander
- Department of NeuropsychologyHUS Neurocenter, University of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Perttu J. Lindsberg
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Lauri Soinne
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Paula A. Summanen
- Department of OphthalmologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Ala‐Kauhaluoma M, Nuotio K, Ijäs P, Koskinen SM, Vikatmaa P, Silvennoinen H, Relander K, Lindsberg PJ, Soinne L, Summanen PA. Ocular signs of carotid stenosis in ipsi- and contralateral eyes before and after carotid endarterectomy: a prospective study. Acta Ophthalmol 2022; 100:e1015-e1023. [PMID: 34633762 DOI: 10.1111/aos.15019] [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: 02/28/2021] [Revised: 06/26/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We describe hypoperfusion-related and embolic ocular signs of carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) in a CS population. METHODS We enrolled prospectively 70 CEA patients (81% male, mean age 69) and 41 non-medicated control subjects (76%, 68), from March 2015 to December 2018, assessing intraocular pressure (IOP), best-corrected visual acuity (BCVA) in logMAR units and performing a bio-microscopy examination. RESULTS Main index symptoms included amaurosis fugax (Afx) (29, 41%) and hemispheric TIA (17, 24%), and 17 (24%) were asymptomatic. Of the 70, 17 patients (24%, 95% CI 16-36) showed ocular signs of CS. Of four embolic (Hollenhorst plaques) findings, one small macular plaque disappeared postoperatively. Four had hypoperfusion, that is ocular ischaemic syndrome (OIS), requiring panretinal photocoagulation: one for multiple mid-peripheral haemorrhages, two for iris neovascularization and one for neovascular glaucoma (NVG); only the NVG proved irreversible. Nine (de novo in three) showed mild OIS, that is only few mid-peripheral haemorrhages, ranging pre- /postoperatively in ipsilateral eyes from one to eleven (median two)/ one to two (median one), and in contralateral eyes from three to nine (median five)/ one to six (median three). Pre- and postoperative median BCVA was 0 or better, and mean IOP was normal, except in the NVG patient. Temporary visual impairment from 0 to 0.3 occurred in one eye soon after CEA due to ocular hyperperfusion causing macular oedema. CONCLUSIONS Ocular signs of CS are common in CEA patients, ranging from few mid-peripheral haemorrhages to irreversible NVG. Clinicians should be aware of these signs in detecting CS.
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Affiliation(s)
- Marianne Ala‐Kauhaluoma
- Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Krista Nuotio
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Petra Ijäs
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Suvi Maaria Koskinen
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
- Department of Radiology HUS Diagnostic Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Pirkka Vikatmaa
- Department of Vascular surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Heli Silvennoinen
- Department of Radiology HUS Diagnostic Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Kristiina Relander
- Department of Neuropsychology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Perttu J. Lindsberg
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Lauri Soinne
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Paula A. Summanen
- Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland
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Wan J, Kwapong WR, Tao W, Lu K, Jiang S, Zheng H, Hu F, Wu B. Choroidal changes in carotid stenosis patients after stenting detected by swept-source optical coherence tomography angiography. Curr Neurovasc Res 2022; 19:100-107. [PMID: 35388758 DOI: 10.2174/1567202619666220406092532] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Carotid artery stenosis (CAS) patients show reduced blood flow in the ophthalmic artery. This study aimed to assess the changes in the choriocapillaris and choroidal thickness in patients with unilateral carotid artery stenosis after carotid stenting using swept-source optical coherence tomography (SS-OCT)/swept-source optical coherence tomography angiography (SS-OCTA). METHODS Fifty-three mild to moderate CAS patients and 40 controls were enrolled in this study. All participants underwent digital subtraction angiography (DSA) and SS-OCT/SS-OCTAA imaging before and 4 days after carotid artery stenting. SS-OCTA was used to image and measure the perfusion of the choriocapillaris (mm2) while SS-OCT was used to image and measure the choroidal thickness (µm). The stenosed side was described as the ipsilateral eye while the other side was the contralateral eye. RESULTS Choroidal thickness was significantly thinner (P = 0.024) in CAS when compared with controls. Ipsilateral eyes of CAS patients showed significantly thinner (P = 0.008) choroidal thickness when compared with contralateral eyes. Ipsilateral eyes of CAS patients showed thicker (P = 0.027) choroidal thickness after carotid artery stenting while contralateral eyes showed thinner choroidal thickness (P = 0.039). CONCLUSIONS Our report suggests that in vivo quantification of the choroid with the SS-OCT/SS-OCTA may allow monitoring of CAS and enable the assessment of purported treatments.
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Affiliation(s)
- Jincheng Wan
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode.,Department of Neurology, Minda Hospital of Hubei Minzu University, Enshi, Hubei Province, China. Zipcode
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Kun Lu
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Hongbo Zheng
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Fayun Hu
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, China. No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China. Zipcode
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