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Taroza S, Jatužis D, Matijošaitis V, Raugelė S, Valaikienė J. Central retinal artery occlusion or retinal stroke: a neurosonologist's perspective. Front Neurol 2024; 15:1397751. [PMID: 38915799 PMCID: PMC11194405 DOI: 10.3389/fneur.2024.1397751] [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: 03/08/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
In central retinal artery occlusion (CRAO) or retinal stroke, which is usually a vision-threatening condition, timely diagnosis is imperative to improve the chances of retinal preservation and to establish adequate secondary prevention measures. Even though retinal strokes have been traditionally assigned to the field of ophthalmology, while considering reperfusion therapy as the only way to avoid permanent vision loss, we suggest prompt evaluation of CRAO causes (primarily related to cardiovascular risk factors) performed by a well-organized interdisciplinary team (ophthalmologist and neurologist) in a neurovascular center with stroke expertise. Therefore, the most suitable adjunct method for rapidly diagnosing non-arteritic CRAO could be target transorbital ultrasound, performed by an experienced neurologist/neurosonologist in the stroke unit. Consequently, after an ophthalmological assessment, a final decision on thrombolytic therapy could be made. We accept that further research is obviously needed to determine whether transorbital ultrasound could replace ophthalmological investigation in the case of a suspected acute retinal stroke. We assert that retinal stroke requires interdisciplinary treatment in cooperation with neurologists and ophthalmologists, with an additive value for each to achieve the best results for the patient.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
- Klaipėda University Hospital, Klaipėda, Lithuania
| | - Dalius Jatužis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vaidas Matijošaitis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Raugelė
- Klaipėda University Hospital, Klaipėda, Lithuania
- Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania
| | - Jurgita Valaikienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Rowe LW, Belamkar A, Antman G, Hajrasouliha AR, Harris A. Vascular imaging findings in retinopathy of prematurity. Acta Ophthalmol 2024; 102:e452-e472. [PMID: 37874229 PMCID: PMC11039572 DOI: 10.1111/aos.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Retinopathy of prematurity (ROP) is a vascular disease among preterm infants involving incomplete or abnormal retinal vascularization and is a leading cause of preventable blindness globally. Measurements of ocular blood flow originating from a variety of imaging modalities, including colour Doppler imaging (CDI), fluorescein angiography (FA) and ocular coherence tomography angiography (OCTA), have been associated with changes in ROP patients. Herein, we discuss and summarize the relevant current literature on vascular imaging and ROP reviewed through December 2022. Differences in vascular imaging parameters between ROP patients and healthy controls are reviewed and summarized. The available data identify significantly increased peak systolic velocity (PSV) in the central retinal artery and ophthalmic artery as measured by CDI, increased vascular tortuosity as measured by FA, smaller foveal avascular zone (FAZ) as measured by FA and OCTA, and increased foveal vessel density (VD) and reduced parafoveal VD as measured by OCTA in ROP patients compared with controls. None of the above findings appear to reliably correlate with visual acuity. The studies currently available, however, are inconclusive and lack robust longitudinal data. Vascular imaging demonstrates the potential to aid in the diagnosis, management and monitoring of ROP, alongside retinal examination via indirect ophthalmoscopy and fundus photography.
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Affiliation(s)
- Lucas W. Rowe
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditya Belamkar
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gal Antman
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir R. Hajrasouliha
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Kim M, Yoon K, Lee S, Shin MS, Kim KG. Development of an Artificial Soft Solid Gel Using Gelatin Material for High-Quality Ultrasound Diagnosis. Diagnostics (Basel) 2024; 14:335. [PMID: 38337851 PMCID: PMC10855452 DOI: 10.3390/diagnostics14030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
For ultrasound diagnosis, a gel is applied to the skin. Ultrasound gel serves to block air exposure and match impedance between the skin and the probe, enhancing imaging efficiency. However, if use of the ultrasound gel exceeds a certain period of time, it may dry out and be exposed to air, causing impedance mismatch and reducing imaging resolution. In such cases, the use of a soft, solid gel proves advantageous, as it can be employed for an extended period without succumbing to the drying phenomenon and can be reused after disinfection. Its soft consistency ensures excellent skin adhesion. Our soft solid gel demonstrated approximately 1.2 times better performance than water, silicone, and traditional ultrasound gels. When comparing the dimensions of grayscale, dead zone, vertical, and horizontal regions, the measurements for the traditional ultrasound gel were 93.79 mm, 45.32 mm, 103.13 mm, 83.86 mm, and 83.86 mm, respectively. In contrast, the proposed soft solid gel exhibited dimensions of 105.64 mm, 34.48 mm, 141.1 mm, and 102.8 mm.
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Affiliation(s)
- Minchan Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
| | - Kicheol Yoon
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Premedicine Course, College of Medicine, Gachon University, 38-13, 3 Beon-gil, Dokjom-ro 3, Namdong-gu, Incheon 21565, Republic of Korea
| | - Sangyun Lee
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Department of Health and Safety Convergence Sciences & Health and Environmental Convergence Sciences, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 Beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Kwang Gi Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 Beon-gil, Namdong-daero, Namdong-gu, Incheon 21565, Republic of Korea; (M.K.); (K.Y.); (S.L.)
- Department of Biomedical Engineering, College of Health Science, Gachon University, 191 Hambak-moero, Yeonsu-gu, Incheon 21936, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, 38-13, 3 Beon-gil, Dokjom-ro, Namdong-gu, Incheon 21565, Republic of Korea
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Han HJ, Kim JM. The Relationship between Transcranial Doppler Ultrasonography and Visual Field Test Results in Glaucoma and Glaucoma Suspect Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:437-445. [PMID: 37899287 PMCID: PMC10721401 DOI: 10.3341/kjo.2023.0052] [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: 05/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To evaluate the relationships between parameters of transcranial ultrasonography and results of visual field tests in patients with open angle glaucoma or suspected of having glaucoma. METHODS This retrospective study was based on data from medical records of patients who visited the Department of Ophthalmology in Kangbuk Samsung Hospital from January 1, 2016, to October 17, 2019, and underwent transcranial Doppler ultrasonography as part of a routine health examination. Ophthalmic data were visual acuity, intraocular pressure, optical coherence tomography, and Humphrey visual field test results. Retinal nerve fiber layer defect was confirmed by a glaucoma specialist. Patients' ophthalmic data, such as average ganglion cell layer thickness, visual field index, pattern standard deviation, and mean deviation, were divided into quartiles. Each ophthalmic artery parameter from transcranial Doppler ultrasonography was compared between quartiles. RESULTS A total of 162 patients were reviewed. There was no difference in Doppler ophthalmic artery (OA) parameters between patients with or without retinal nerve fiber layer defect. None of the quartile groups of average ganglion cell layer thickness showed significant difference in any OA parameters. Patients in the low-visual field index quartile showed significant low peak systolic velocities of OAs when adjusted for age, sex, and presence of diabetes mellitus or hypertension (p = 0.016). A higher pattern standard deviation showed lower peak systolic velocity (p = 0.046). There was no significant tendency between any other OA parameter and mean deviation value. CONCLUSIONS Our study suggests that hemodynamic parameters of ophthalmic arteries might be associated with visual field status of patients. Further large-population studies are needed in order to better understand the relationship between visual function and ocular blood flow.
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Affiliation(s)
- Hyo Ji Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Banou L, Dastiridou A, Giannoukas A, Kouvelos G, Baros C, Androudi S. The Role of Color Doppler Imaging in the Diagnosis of Glaucoma: A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13040588. [PMID: 36832076 PMCID: PMC9954817 DOI: 10.3390/diagnostics13040588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Glaucoma is a progressive optic neuropathy and one of the leading causes of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is the major risk factor for the onset and progression of glaucoma. In addition to elevated IOP, impaired intraocular blood flow is also considered to be involved in the pathogenesis of glaucoma. Various techniques have been used to assess ocular blood flow (OBF), including Color Doppler Imaging (CDI), a technique used in ophthalmology in recent decades. This article reviews the role of CDI in both the diagnosis and effective monitoring of glaucoma progression, presenting the protocol for imaging and its advantages, as well as the limitations of its use. Moreover, it analyzes the pathophysiology of glaucoma, focusing on vascular theory and its role in the onset and progression of the disease.
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Affiliation(s)
- Lamprini Banou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
- Correspondence:
| | | | - Georgios Kouvelos
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Christos Baros
- Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, 41334 Larissa, Greece
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Tufek M, Nalcacioglu P, Capraz M, Varol K, Kaya AT, Aydın N, Kara C. The impact of obesity on ocular hemodynamics and choroidal thickness. Ther Adv Ophthalmol 2023; 15:25158414231180985. [PMID: 37441618 PMCID: PMC10333989 DOI: 10.1177/25158414231180985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/22/2023] [Indexed: 07/15/2023] Open
Abstract
Background Obesity affects microvascular structures. The effect of obesity on the ocular vascular system can be evaluated by changes in the choroidal thickness (CT) and retrobulbar blood flow (RBF). Objectives To evaluate the CT and RBF parameters in obese patients with various body mass index (BMI) values and compare these parameters with normal weight, healthy subjects. Design A prospective study. Methods The study included 102 eyes of 102 female patients. Patients were divided into three groups according to BMI as group 1 with a BMI of 18.5-24.99 (n = 32), normal weight group; group 2 with a BMI of 30-34.99 (n = 35), as obese class I; and group 3 with a BMI of 35-39.99 (n = 35), as obese class II. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, and pulsatility index values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography. CT was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm by using the enhanced depth imaging technique of optical coherence tomography. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometry. Results There was a significant difference in IOP values within the groups with the highest values in group 3 (17.6 ± 2.1 mmHg) and the lowest in group 1 (12.4 ± 1.7 mmHg). The CT in groups 2 and 3 was found to be statistically significantly lower than that in group 1 at all measurement points (p < 0.001). There was a statistically significant negative correlation between CT at all measurement points and BMI (p < 0.001). The mean CRA PSV, EDV, and OA EDV values were statistically significantly lower in each obese group than those values in group 1 (p < 0.001). The OA PSV values were significantly lower in group 3 (36.5 ± 5.9 cm/s) than those in group 2 (43.8 ± 4 cm/s) and group 1 (44.6 ± 5.2 cm/s) (p < 0.001). Also, significant associations were found between BMI and CRA PSV, CRA EDV, and OA PSV values (p < 0.001). Conclusion Obesity may predispose to eye pathologies by changing the ocular vascular circulation.
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Affiliation(s)
| | - Pinar Nalcacioglu
- Department of Ophthalmology, Yildirim Beyazit
University Medical School, Ankara, Turkey
| | - Mustafa Capraz
- Department of Internal Medicine, Amasya
University, Sabuncuoglu Serafeddin Training and Research Hospital, Amasya,
Turkey
| | - Kenan Varol
- Department of Radiology, Private Rumeli
Hospital, Istanbul, Turkey
| | - Ahmet Turan Kaya
- Department of Radiology, Amasya University,
Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Nihat Aydın
- Department of Ophthalmology, Amasya University,
Sabuncuoglu Serafeddin Training and Research Hospital, Amasya, Turkey
| | - Caner Kara
- Department of Ophthalmology, Zubeyde Hanim
Women’s Education and Research Hospital, Ankara, Turkey
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Wu LT, Wang JL, Wang YL. Ophthalmic artery changes in type 2 diabetes with and without acute coronary syndrome. J Transl Med 2022; 20:512. [PMCID: PMC9636615 DOI: 10.1186/s12967-022-03712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Ocular blood flow provides a new perspective for studying the effects of diabetes and ischemic heart disease on systemic blood flow, pathological mechanisms, and prognosis. Previous studies have analyzed the hemodynamic changes of the ophthalmic artery (OA) in patients with diabetes and ischemic heart disease, but the results remain controversial due to limited observation methods. We aimed to explore the morphological and hemodynamic features in the OA in patients with type 2 diabetes (T2D) with and without acute coronary syndrome (ACS).
Methods
In total, 134 participants, including 30 control participants, 34 with ACS only, 34 with T2D only, and 36 with both ACS and T2D, undergoing computed tomography angiography were enrolled. Three-dimensional OA models were reconstructed, and morphological parameters of the OA were measured. In addition, numerical simulations using computational fluid dynamics were used to acquire hemodynamic parameters of the OA.
Results
In this study, 134 OA models were reconstructed. Morphological measurements revealed a smaller initial OA diameter in the T2D group than in the other two ACS groups. A hemodynamic simulation showed a significantly lower OA blood velocity in patients with ACS and T2D than that in controls (P < 0.001). The mass flow ratios in all disease groups were lower than those in the control group (P < 0.001, P = 0.020, and P < 0.001, respectively). The ACS and T2D groups had higher OA pressure levels than those of the control group (P = 0.013). The OA blood velocity and mass flow ratio were correlated with several clinical parameters.
Conclusions
This study revealed morphological and hemodynamic differences in the OA between patients with T2D with and without ACS. Furthermore, the hemodynamic characteristics of the OA correlated with clinical prognostic biomarkers, suggesting the potential predictive ability of the OA.
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Král M, Svrčinová T, Hok P, Dorňák T, Rybáriková M, Mareš J, Kaňovský P, Šín M. Correlation between retinal oxygen saturation and the haemodynamic parameters of the ophthalmic artery in healthy subjects. Acta Ophthalmol 2022; 100:e1489-e1495. [PMID: 35599335 PMCID: PMC9790634 DOI: 10.1111/aos.15189] [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: 04/16/2021] [Accepted: 05/11/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of the study was to obtain the values of oxygen saturation in retinal vessels and ophthalmic blood flow parameters in a healthy Caucasian population and assess whether the oximetry parameters are affected by the flow rate or the vascular resistance. METHODS The spectrophotometric retinal oximetry and colour Doppler imaging (CDI) of retinal vessels were successfully performed with 52 healthy subjects (average age 29.7 ± 5.6 years). The retinal oximeter simultaneously measures the wavelength difference of haemoglobin oxygen saturation in retinal arterioles and venules. The arteriolar and venular saturation in both eyes was measured. The peak systolic (PSV) end diastolic (EDV) velocities, resistive (RI) and pulsatility (PI) indices were obtained for both eyes using CDI in the ophthalmic artery. A paired t-test and two sample t-tests were used for statistical analyses. The correlation was assessed using the Pearson coefficient correlation. RESULTS The mean oxygen saturation level was 96.9 ± 3.0% for the retinal arterioles and 65.0 ± 5.1% for the retinal venules. The A-V difference was 31.8 ± 4.6%. The mean of the measured haemodynamic parameters was PSV 46.6 ± 9.4 cm/s, EDV 12.0 ± 3.5 cm/s, PI 1.68 ± 0.38 and RI 0.74 ± 0.05. No significant difference in oxygen saturation and haemodynamic parameters was found between the left and the right eyes or the dominant and non-dominant eye. The oximetry and ultrasound values were sex independent. The Pearson correlation coefficient demonstrated a significant yet weak negative correlation between A-V difference and RI (r = -0.321, p = 0.020). CONCLUSIONS A negative correlation between A-V difference and resistance index was observed, suggesting that reduced oxygen consumption may reflect the increased vascular tone of the ophthalmic vessels, which is likely determined by autoregulatory mechanisms.
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Affiliation(s)
- Michal Král
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Tereza Svrčinová
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Pavel Hok
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Tomáš Dorňák
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Martina Rybáriková
- Department of OphthalmologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Jan Mareš
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Petr Kaňovský
- Department of NeurologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
| | - Martin Šín
- Department of OphthalmologyUniversity Hospital and Faculty of Medicine and Dentistry, Palacky University OlomoucOlomoucCzech Republic
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Deshmukh K, Gupta S, Mitra K, Bit A. Numerical and Experimental Analysis of Shear Stress Influence on Cellular Viability in Serpentine Vascular Channels. MICROMACHINES 2022; 13:mi13101766. [PMID: 36296119 PMCID: PMC9611698 DOI: 10.3390/mi13101766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 05/29/2023]
Abstract
3D bioprinting has emerged as a tool for developing in vitro tissue models for studying disease progression and drug development. The objective of the current study was to evaluate the influence of flow driven shear stress on the viability of cultured cells inside the luminal wall of a serpentine network. Fluid-structure interaction was modeled using COMSOL Multiphysics for representing the elasticity of the serpentine wall. Experimental analysis of the serpentine model was performed on the basis of a desirable inlet flow boundary condition for which the most homogeneously distributed wall shear stress had been obtained from numerical study. A blend of Gelatin-methacryloyl (GelMA) and PEGDA200 PhotoInk was used as a bioink for printing the serpentine network, while facilitating cell growth within the pores of the gelatin substrate. Human umbilical vein endothelial cells were seeded into the channels of the network to simulate the blood vessels. A Live-Dead assay was performed over a period of 14 days to observe the cellular viability in the printed vascular channels. It was observed that cell viability increases when the seeded cells were exposed to the evenly distributed shear stresses at an input flow rate of 4.62 mm/min of the culture media, similar to that predicted in the numerical model with the same inlet boundary condition. It leads to recruitment of a large number of focal adhesion point nodes on cellular membrane, emphasizing the influence of such phenomena on promoting cellular morphologies.
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Affiliation(s)
- Khemraj Deshmukh
- Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India
| | - Saurabh Gupta
- Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India
| | - Kunal Mitra
- Biomedical Engineering, Florida Tech, Melbourne, FL 32901, USA
| | - Arindam Bit
- Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India
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Lommatzsch C, Rothaus K, Schopmeyer L, Feldmann M, Bauer D, Grisanti S, Heinz C, Kasper M. Elevated endothelin-1 levels as risk factor for an impaired ocular blood flow measured by OCT-A in glaucoma. Sci Rep 2022; 12:11801. [PMID: 35821224 PMCID: PMC9276731 DOI: 10.1038/s41598-022-15401-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to ascertain whether a correlation exists between glaucoma-associated alteration of ocular vascular haemodynamics and endothelin-1 (ET-1) levels exist. Eyes of patients with cataract (n = 30) or glaucoma (n = 68) were examined with optical coherence tomography (OCT) and OCT-angiography (OCT-A; AngioVue™-RTVue-XR; Optovue, Fremont, California, USA). The peripapillary and the macular vessel density (VD) values were measured. Inferior and superior retinal nerve fibre layer (RNFL) thickness loss was used for further OCT staging. Aqueous humour of the examined eye and plasma were sampled during cataract or glaucoma surgery and analysed by means of ELISA to determine their ET-1 level. Glaucoma eyes are characterised by reductions in RNFL thickness and VD that correlate significantly with the OCT GSS score. Peripheral and ocular ET-1 level were significantly elevated in patients with glaucoma and correlate positively with the OCT-GSS score of the entire study population. Peripapillary and macula VD of glaucoma patients correlates negatively with plasma ET-1 levels. Multivariable analysis showed a subordinate role of intraocular pressure predictive factor for impaired retinal blood flow compared with plasma ET-1 level in glaucoma. Peripheral ET-1 level serves as risk factor for detection of ocular blood flow changes in the optic nerve head region of glaucomatous eyes.
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Affiliation(s)
- Claudia Lommatzsch
- Department of Ophthalmology and Ophtha Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany. .,Department of Ophthalmology, University of Luebeck, Luebeck, Germany.
| | - Kai Rothaus
- Department of Ophthalmology and Ophtha Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | | | - Maria Feldmann
- Department of Ophthalmology, Braunschweig Hospital, Braunschweig, Germany
| | - Dirk Bauer
- Department of Ophthalmology and Ophtha Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | - Swaantje Grisanti
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | - Carsten Heinz
- Department of Ophthalmology and Ophtha Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.,Department of Ophthalmology, University of Essen, Essen, Germany
| | - Maren Kasper
- Department of Ophthalmology and Ophtha Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
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11
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Abramowicz JS, Adhikari S, Dickman E, Estroff JA, Harris GR, Nomura J, Silverman RH, Taylor LA, Barr RG. Ocular Ultrasound: Review of Bioeffects and Safety, Including Fetal and Point of Care Perspective: Review of Bioeffects and Safety, Including Fetal and Point-of-Care Perspective. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1609-1622. [PMID: 34724263 DOI: 10.1002/jum.15864] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Ocular ultrasound is an invaluable tool for the evaluation of the eye and orbit. However, the eye and orbit are potentially sensitive to the thermal and mechanical effects of ultrasound. When performing B-mode imaging, dedicated ocular settings should be used. If these settings are not available, limiting the acoustic output to Food and Drug Administration (FDA) recommended maximum levels is strongly advised. Especially important is the acoustic output in spectral (pulsed) and color Doppler modes, which can exceed the FDA's maximum recommended levels for the eye. Adjusting settings to decrease acoustic output and limiting the time of the examination should be done when performing a Doppler examination. The acoustic output of shear wave elastography is significantly higher than FDA guidelines for the eye and should be considered experimental.
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Affiliation(s)
- Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Eitan Dickman
- Department of Emergency Medicine, Maimonides Medical Center, New York, NY, USA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Gerald R Harris
- Department of Pediatrics, U.S Food and Drug Administration, Durango, CO, USA
| | - Jason Nomura
- Department of Emergency Medicine, ChristianaCare, Newark, DE, USA
| | - Ronald H Silverman
- Department of Opthalmic Science, Columbia University Irving Medical Center, New York, NY, USA
| | - Lindsay A Taylor
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH, USA
- Department of Radiology, Southwoods Imaging, Boardman, OH, USA
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12
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Hemodynamic and morphological changes of the central retinal artery in myopic eyes. Sci Rep 2022; 12:7104. [PMID: 35501327 PMCID: PMC9061854 DOI: 10.1038/s41598-022-11087-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Due to excessive elongation of the eyeball, myopia-related vascular abnormalities are frequently observed in the central retinal artery (CRA) and its intraretinal branches. In addition to inconsistency in previously reported findings, hemodynamic (reduced flow velocity, increased vascular resistance) and morphological changes (narrower vessel diameter) were usually studied separately. This cross-sectional study evaluated the hemodynamic and morphological characteristics concurrently in a large sample of healthy myopes, by using the color Doppler ultrasound and adaptive optics retinal camera. Results showed that the retrobulbar segment of CRA had a tendency of slightly reduced flow velocity in eyeballs with longer axial length, but the correlation was not significant after adjusting for the multiple correlations. Vascular resistance was not affected by the axial elongation. With respect to the intraretinal branches, no significant changes in longer eyes of total diameter or lumen diameter were observed, while both the wall thickness and the wall cross-sectional area were significantly increased, but only a marginally increase in the wall to lumen ratio was found with increasing axial length. This implies some potential small artery remodeling in the intraretinal CRA branches. Overall, blood supply of the inner retina in healthy young myopes is likely to be maintained. Additionally, morphological parameters of vascular microstructure could be potential biomarkers to monitor myopia progression and understand myopia-related vascular abnormalities in future studies.
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13
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Wu LT, Wang JL, Wang YL. Ophthalmic Artery Morphological and Hemodynamic Features in Acute Coronary Syndrome. Invest Ophthalmol Vis Sci 2021; 62:7. [PMID: 34757418 PMCID: PMC8590173 DOI: 10.1167/iovs.62.14.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the morphological and hemodynamic changes of the ophthalmic artery (OA) in patients with acute coronary syndrome (ACS). Methods This cross-sectional observational study included 31 patients with ACS and 10 healthy controls (HCs). The ACS subgroups were ST-segment elevation myocardial infarction (STEMI; n = 10), non-STEMI (n = 10), and unstable angina (n = 11). OA three-dimensional (3D) models were reconstructed based on computed tomographic angiography, and morphological aspects of the OA were measured quantitatively. Moreover, numerical simulation by computational fluid dynamics was used to obtain hemodynamic information of the OA. Results The study reconstructed 41 OA models. Hemodynamic simulation revealed a significant decrease in OA blood velocity in patients with ACS compared with the HCs (median velocity, 0.046 vs. 0.147 m/s; P < 0.001). No differences in the morphological data for the OA were observed. Also, no differences in the mass flow ratio of OA to the ipsilateral internal carotid artery was found. Similar differences were observed between the ACS subgroups and HCs. OA blood velocity was negatively correlated with body mass index, abdominal circumference, left ventricular ejection fraction, and triacylglycerol and was positively correlated with early to late transmitral flow velocity, N-terminal pro-brain natriuretic peptide, serum creatinine, and potassium. Conclusions The initial OA blood velocity was slower in patients with ACS and was associated with ACS-related clinical parameters. To our knowledge, this is the first study to analyze OA characteristics in ACS using 3D model reconstruction and hemodynamic simulation, providing new perspectives on the relationship between ischemic heart disease and ocular manifestations.
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Affiliation(s)
- Lan-Ting Wu
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia-Lin Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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14
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Zhao M, Lam AK, Cheong AM. Structural and haemodynamic properties of ocular vasculature in axial myopia. Clin Exp Optom 2021; 105:247-262. [PMID: 34343434 DOI: 10.1080/08164622.2021.1943320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The high prevalence of myopia has become a global concern, especially in East and Southeast Asia. Alarmingly, the prevalence of high myopia is increasing. Mechanical stretching caused by excessive eyeball elongation leads to various anatomical changes in the fundus. This stretching force may also lead to the development of vascular abnormalities, which tend to be subtle and easily overlooked. A healthy ocular vasculature is a prerequisite of adequate oxygen supply for normal retinal functions. This review summarises previous findings on structural and haemodynamic aspects of myopia-related vascular changes.
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Affiliation(s)
- Mei Zhao
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Andrew Kc Lam
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Allen My Cheong
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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15
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Kristiansen M, Lindén C, Qvarlander S, Wåhlin A, Ambarki K, Hallberg P, Eklund A, Jóhannesson G. Feasibility of MRI to assess differences in ophthalmic artery blood flow rate in normal tension glaucoma and healthy controls. Acta Ophthalmol 2021; 99:e679-e685. [PMID: 33210819 PMCID: PMC8451810 DOI: 10.1111/aos.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose To examine feasibility of phase‐contrast magnetic resonance imaging (PCMRI) and to assess blood flow rate in the ophthalmic artery (OA) in patients with normal tension glaucoma (NTG) compared with healthy controls. Methods Sixteen patients with treated NTG and 16 age‐ and sex‐matched healthy controls underwent PCMRI using a 3‐Tesla scanner and ophthalmological examinations. OA blood flow rate was measured using a 2D PCMRI sequence with a spatial resolution of 0.35 mm2. Results The blood flow rate in the NTG group was 9.6 ± 3.9 ml/min [mean ± SD] compared with 11.9 ± 4.8 ml/min in the control group. Resistance Index (RI) and Pulsatility Index (PI) were 0.73 ± 0.08 and 1.36 ± 0.29, respectively, in the NTG group and 0.68 ± 0.13 and 1.22 ± 0.40, respectively, in the healthy group. The mean visual field index (VFI) was 46% ± 25 for the worse NTG eyes. The measured differences observed between the NTG group and the control group in blood flow rate (p = 0.12), RI (p = 0.18) and PI (p = 0.27) were non‐significant. Conclusions This case–control study, using PCMRI, showed a slight, but non‐significant, reduction in OA blood flow rate in the NTG patients compared with the healthy controls. These results indicate that blood flow may be of importance in the pathogenesis of NTG. Considering that only a limited portion of the total OA blood flow supplies the ocular system and the large inter‐individual differences, a larger study or more advanced PCMRI technique might give the answer.
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Affiliation(s)
- Martin Kristiansen
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
| | - Christina Lindén
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
| | - Sara Qvarlander
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
- Umeå Center for Functional Brain Imaging Umeå University Umeå Sweden
| | - Khalid Ambarki
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Per Hallberg
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
- Dept. of Applied Physics and Electronics Umeå University Umeå Sweden
| | - Anders Eklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
- Wallenberg Center for Molecular Medicine Umeå University Umeå Sweden
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16
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Grudzińska EM, Zaborski D, Modrzejewska M. Correlation between retrobulbar blood flow parameters and retinal nerve fiber, ganglion cell and inner plexus layer thickness in myopia. Eur J Ophthalmol 2021; 32:643-650. [PMID: 33530716 DOI: 10.1177/1120672121992007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the thickness of the retinal nerve fiber layer (RNFL), ganglion cell and inner plexus layer (GCIPL) and blood flow parameters in retrobulbar vessels, and to analyze correlations between these parameters in myopes. METHODS The study included forty myopic and 20 healthy eyes. Standard eye examination was supplemented with OCT of the optic nerve and macula (GCIPL, RNFL, RNFL in each quadrant and rim area of the optic nerve) and color Doppler imaging of retrobulbar arteries [peak systolic and end-diastolic velocities, pulsatile index and resistance index (RI) in the ophthalmic (OA), central retinal (CRA), nasal posterior ciliary and temporal posterior ciliary arteries]. RESULTS Significant correlations were found between blood flow parameters in the CRA, RNFL and GCIPL thickness, and axial length (AL) and spherical equivalent (SE). There were significant positive correlations between RNFL with PSV and EDV in the CRA and negative correlations between RNFL and RI in the CRA. GCIPL was positively correlated with PSV and EDV in the CRA. The decrease in RA was associated with reduced blood flow velocities in the CRA, TPCA and NPCA. CONCLUSION The reduced retrobulbar blood flow in healthy young myopes is correlated with increasing AL and refractive value, and thinning of the RNFL and GCIPL. Reduction of the rim-area of the optic disc is associated with vascular and retinal circulatory disorders. These phenomena indicate the vascular basis of the described changes. To the best of our knowledge, this is the first study which correlates ocular circulation with retinal structure.
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Affiliation(s)
- Ewa M Grudzińska
- Second Department of Ophthalmology, Pomeranian Medical University, Szczecin, Zachodniopomorskie, Poland
| | - Daniel Zaborski
- Laboratory of Biostatistics, West Pomeranian University of Technology, Szczecin, Poland
| | - Monika Modrzejewska
- Second Department of Ophthalmology, Pomeranian Medical University, Szczecin, Zachodniopomorskie, Poland
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17
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Castilla-Guerra L, Gómez-Escobar A, Carmona-González E. Usefulness of point-of-care ultrasound for the evaluation of non-traumatic eye emergencies. Med Clin (Barc) 2021; 156:503-508. [PMID: 33478811 DOI: 10.1016/j.medcli.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
The role of clinical ultrasound or Point-of-Care Ultrasound (POCUS) in patients with urgent pathology has expanded exponentially in recent years. With clinical ultrasound, physicians can make a quick assessment and decide how to act in time critical situations. Ocular ultrasound is one of the most recently developed applications. In patients with severe non-traumatic ocular pathology it has numerous clinically relevant uses: retinal detachment, occlusion of the central retinal artery or optic nerve pathologies, among others. The technique is widely available, easy to perform, and can provide information even when fundoscopy is impossible. In this review, we describe the bases of clinical ocular ultrasound, focusing on the management of the main non-traumatic urgent ophthalmological pathologies that the physician may face in their clinical practice.
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Affiliation(s)
- Luis Castilla-Guerra
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
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18
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Konstas AG, Schmetterer L, Katsanos A, Hutnik CML, Holló G, Quaranta L, Teus MA, Uusitalo H, Pfeiffer N, Katz LJ. Dorzolamide/Timolol Fixed Combination: Learning from the Past and Looking Toward the Future. Adv Ther 2021; 38:24-51. [PMID: 33108623 PMCID: PMC7854404 DOI: 10.1007/s12325-020-01525-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (IOP)-lowering fixed combination (FC) approved by the US Food and Drug Administration (FDA) and remains one of most commonly used medications worldwide. The pharmacological properties of DTFC reflect those of its two time-tested constituents, i.e., the carbonic anhydrase inhibitor dorzolamide and the non-selective beta-blocker timolol. In regulatory studies DTFC lowers IOP on average by 9 mmHg (32.7%) at peak and by 7.7 mmHg (27%) at trough. In trials DTFC shows equivalence to unfixed concomitant therapy, but in real-life practice it may prove superior owing to enhanced convenience, elimination of the washout effect from the second drop, improved tolerability, and better adherence. PF DTFC became the first PF FC approved, first in unit-dose pipettes, and more recently in a multidose format. Cumulative evidence has confirmed that PF DTFC is at least equivalent in efficacy to preserved DTFC and provides a tangible clinical benefit to patients with glaucoma suffering from ocular surface disease by improving tolerability and adherence. Finally, we identify areas that warrant further investigation with preserved and PF DTFC
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19
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Gombe A, Kabiru I, Anas I, Adamu Y, Sadiq H. A comparative control study of ophthalmic artery Doppler velocimetry in patients with primary open angle glaucoma in Kano, Nigeria. WEST AFRICAN JOURNAL OF RADIOLOGY 2021. [DOI: 10.4103/wajr.wajr_27_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Yang XY, Xu LF, Luo Y, Li N, Yang JP, Zhu LP, Li ZX. Effects of age on the peak ratio of ophthalmic artery Doppler. Medicine (Baltimore) 2020; 99:e23694. [PMID: 33350749 PMCID: PMC7769302 DOI: 10.1097/md.0000000000023694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the effects of age on the peak ratio (PR) of ophthalmic artery (OA) Doppler.The initial peak velocity (P1), second peak velocity (P2) and PR of OA were detected by color Doppler ultrasonography in 147 healthy subjects. All of the subjects were divided into 6 groups (G1-G6) according to the age. (G1, 20-29 years; G2, 30-39 years; G3, 40-49 years; G4, 50-59 years; G5, 60-69 years; and G6, 70 years or older). The blood pressure and heart rate were also examined before ultrasonography. The influences of age, blood pressure and heart rate on the P1, P2, and PR were further evaluated.There were significant differences in the P2 and PR among different age groups except for P1. There were no significant differences in the P2 and PR between the first 2 groups, neither among the latter 4 groups. Nevertheless, P2 and PR in the first 2 groups were significantly different from those in the latter 4 groups. In addition, both P2 and PR (not P1) increased significantly with age, systolic and diastolic blood pressure. P1, P2 and PR were not related to heart rate. Both P2 and PR were closely related to the age. PR also had a weak relationship with systolic blood pressure.Both P2 and PR of OA Doppler increase with age. Concern should be raised when P2 and PR are used to evaluate the hemodynamic change of OA.
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Affiliation(s)
- Xi-Yue Yang
- Department of Diagnostic Ultrasound, Guigang People's Hospital, Guigang
| | - Li-Fang Xu
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Guangxi Medical University
| | - Yuan Luo
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University
| | - Na Li
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University
| | - Jin-Pin Yang
- Department of Diagnostic Ultrasound, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Nanning, Guangxi, China
| | - Lin-Ping Zhu
- Department of Diagnostic Ultrasound, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Nanning, Guangxi, China
| | - Zhi-Xian Li
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University
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21
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Andrade De Jesus D, Sánchez Brea L, Barbosa Breda J, Fokkinga E, Ederveen V, Borren N, Bekkers A, Pircher M, Stalmans I, Klein S, van Walsum T. OCTA Multilayer and Multisector Peripapillary Microvascular Modeling for Diagnosing and Staging of Glaucoma. Transl Vis Sci Technol 2020; 9:58. [PMID: 33224631 PMCID: PMC7674004 DOI: 10.1167/tvst.9.2.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To develop and assess an automatic procedure for classifying and staging glaucomatous vascular damage based on optical coherence tomography angiography (OCTA) imaging. Methods OCTA scans (Zeiss Cirrus 5000 HD-OCT) from a random eye of 39 healthy subjects and 82 glaucoma patients were used to develop a new classification algorithm based on multilayer and multisector information. The averaged circumpapillary retinal nerve fiber layer (RNFL) thickness was also collected. Three models, support vector machine (SVM), random forest (RF), and gradient boosting (xGB), were developed and optimized for classifying between healthy and glaucoma patients, primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG), and glaucoma severity groups. Results All the models, the SVM (area under the receiver operating characteristic [AUROC] 0.89 ± 0.06), the RF (AUROC 0.86 ± 0.06), and the xGB (AUROC 0.85 ± 0.07), with 26, 22, and 29 vascular features obtained after feature selection, respectively, presented a similar performance to the RNFL thickness (AUROC 0.85± 0.06) in classifying healthy and glaucoma patients. The superficial vascular plexus was the most informative layer with the infero temporal sector as the most discriminative region of interest. No significant differentiation was obtained in discriminating the POAG from the NTG group. The xGB model, after feature selection, presented the best performance in classifying the severity groups (AUROC 0.76± 0.06), outperforming the RNFL (AUROC 0.67± 0.06). Conclusions OCTA multilayer and multisector information has similar performance to RNFL for glaucoma diagnosis, but it has an added value for glaucoma severity classification, showing promising results for staging glaucoma progression. Translational Relevance OCTA, in its current stage, has the potential to be used in clinical practice as a complementary imaging technique in glaucoma management.
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Affiliation(s)
- Danilo Andrade De Jesus
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Luisa Sánchez Brea
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - João Barbosa Breda
- Research Group of Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ella Fokkinga
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Vera Ederveen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Noor Borren
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Amerens Bekkers
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ingeborg Stalmans
- Research Group of Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Ophthalmology Department, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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22
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Matias DS, Santos R, Ferreira T, Matias BS, Correia LCL. Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:388-395. [PMID: 32129500 DOI: 10.1002/jcu.22823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/21/2019] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To test the predictive value of ophthalmic artery (OA) Doppler velocimetry in relation to the occurrence of hypertensive disorders of pregnancy (HDP). METHODS We compared, by analysis of variance, the values of seven OA Doppler variables (peak systolic velocity, second systolic peak velocity [P2], mean velocity, end diastolic velocity, resistance index [RI], pulsatility index [PI], and peak ratio) of 31 women with preeclampsia and 33 women with gestational hypertension vs those of 227 women without HDP. The prognostic value of these variables in relation to the occurrence of HDP was evaluated by the area under the curve (AUC) receiver operating characteristic curve. RESULTS All OA Doppler variables except RI and PI showed significant (P < .5) differences between groups. After adjustment for confounders, only P2 was an independent predictor of HDP (P < .001), with an AUC of 0.76. The best cut-off point for predicting HDP was P2 ≥ 21.4 cm/s, with sensitivity 69%, specificity 78%, positive likelihood ratio 3.1, negative likelihood ratio 0.4, positive predictive value 47%, and negative predictive value 90%. P2 improved the predictive ability of a model based on clinical variables, incrementing AUC from 0.77 to 0.84 in the final model containing clinical and Doppler variables. CONCLUSION The elevation of OA P2 in the second trimester of pregnancy is an independent predictor of hypertensive disorders, and improves the discriminatory ability of clinical markers.
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Affiliation(s)
- Denise S Matias
- Bahiana School of Medicine and Public Health - Salvador, Bahia, Brazil
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Rebeca Santos
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Tatiana Ferreira
- Perinatology Institute of Bahia (IPERBA) - Salvador, Bahia, Brazil
| | - Bruno S Matias
- Santo Amaro Hospital - José Silveira Foundation - Salvador, Bahia, Brazil
| | - Luis Cláudio L Correia
- Bahiana School of Medicine and Public Health - Salvador, Bahia, Brazil
- São Rafael Hospital - Monte Tabor Association - Salvador, Bahia, Brazil
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23
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Bekkers A, Borren N, Ederveen V, Fokkinga E, Andrade De Jesus D, Sánchez Brea L, Klein S, van Walsum T, Barbosa‐Breda J, Stalmans I. Microvascular damage assessed by optical coherence tomography angiography for glaucoma diagnosis: a systematic review of the most discriminative regions. Acta Ophthalmol 2020; 98:537-558. [PMID: 32180360 PMCID: PMC7497179 DOI: 10.1111/aos.14392] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/09/2020] [Indexed: 01/14/2023]
Abstract
A growing number of studies have reported a link between vascular damage and glaucoma based on optical coherence tomography angiography (OCTA) imaging. This multitude of studies focused on different regions of interest (ROIs) which offers the possibility to draw conclusions on the most discriminative locations to diagnose glaucoma. The objective of this work was to review and analyse the discriminative capacity of vascular density, retrieved from different ROIs, on differentiating healthy subjects from glaucoma patients. PubMed was used to perform a systematic review on the analysis of glaucomatous vascular damage using OCTA. All studies up to 21 April 2019 were considered. The ROIs were analysed by region (macula, optic disc and peripapillary region), layer (superficial and deep capillary plexus, avascular, whole retina, choriocapillaris and choroid) and sector (according to the Garway-Heath map). The area under receiver operator characteristic curve (AUROC) and the statistical difference (p-value) were used to report the importance of each ROI for diagnosing glaucoma. From 96 screened studies, 43 were eligible for this review. Overall, the peripapillary region showed to be the most discriminative region with the highest mean AUROC (0.80 ± 0.09). An improvement of the AUROC from this region is observed when a sectorial analysis is performed, with the highest AUROCs obtained at the inferior and superior sectors of the superficial capillary plexus in the peripapillary region (0.86 ± 0.03 and 0.87 ± 0.10, respectively). The presented work shows that glaucomatous vascular damage can be assessed using OCTA, and its added value as a complementary feature for glaucoma diagnosis depends on the region of interest. A sectorial analysis of the superficial layer at the peripapillary region is preferable for assessing glaucomatous vascular damage.
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Affiliation(s)
- Amerens Bekkers
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands,Clinical TechnologyDelft University of TechnologyDelftThe Netherlands
| | - Noor Borren
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands,Clinical TechnologyDelft University of TechnologyDelftThe Netherlands
| | - Vera Ederveen
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands,Clinical TechnologyDelft University of TechnologyDelftThe Netherlands
| | - Ella Fokkinga
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands,Clinical TechnologyDelft University of TechnologyDelftThe Netherlands
| | - Danilo Andrade De Jesus
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands,Research Group OphthalmologyDepartment of NeurosciencesKU LeuvenLeuvenBelgium
| | - Luisa Sánchez Brea
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Stefan Klein
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group RotterdamDepartment of Radiology & Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - João Barbosa‐Breda
- Research Group OphthalmologyDepartment of NeurosciencesKU LeuvenLeuvenBelgium,Ophthalmology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal,Cardiovascular R&D CenterFaculty of Medicine of the University of PortoPortoPortugal
| | - Ingeborg Stalmans
- Research Group OphthalmologyDepartment of NeurosciencesKU LeuvenLeuvenBelgium,Department of OphthalmologyUniversity Hospitals LeuvenLeuvenBelgium
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24
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Ophthalmic artery resistance index after peribulbar block in the presence of epinephrine. Int Ophthalmol 2020; 41:203-210. [PMID: 32857309 DOI: 10.1007/s10792-020-01567-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There are controversies regarding ophthalmic artery (OA) flow after peribulbar block in the presence of epinephrine. Therefore, we aimed to evaluate OA flow via echo-Doppler before and after peribulbar block with lidocaine in the presence or absence of epinephrine. METHODS Fifty-six patients who had an American Society of Anesthesiologists (ASA) classification of I, II or III and were eligible for cataract phacoemulsification surgery were selected. Patients with other eye diseases were excluded. Patients were divided into two groups: group 1-peribulbar block with lidocaine and 1/200,000 epinephrine; group 2-peribulbar block with lidocaine in the absence of epinephrine. The resistance index (RI), peak systolic velocity (PSV), end diastolic velocity (EDV) of the OA were evaluated using echo-Doppler before and 10 min after the peribulbar block. RESULTS No differences between groups were observed in the RI before the peribulbar block as well regarding the presence of hypertension and the age or gender of the patient. After the peribulbar block, we observed a decrease in the RI in group 1 (p = 0.038, Cohen's d = 0.336) and no difference in the RI in group 2 (p = 0.109, Cohen's d = 0.172). When comparing group 1 and group 2, we observed a decrease in the RI in group 1 (p = 0.028, Cohen's d = 0,583). There was no difference between groups regarding the PSV and EDV after the peribulbar block. CONCLUSIONS A decrease in RI was observed in the OA after peribulbar block with a vasoconstrictor, an effect that could be a benefit in some ocular surgeries.
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Kalayci M, Tahtabasi M. Assessment of Doppler flow parameters of the retrobulbar arteries and internal carotid artery in patients with glaucoma: the significance of ophthalmic artery peak ratio and the intima-media thickness of the internal carotid artery. Int Ophthalmol 2020; 40:3337-3348. [PMID: 32720168 DOI: 10.1007/s10792-020-01520-3] [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: 05/06/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to analyze flow parameters of the central retinal artery (CRA), ophthalmic artery (OA), and internal carotid artery (ICA) assessed by color Doppler ultrasound. METHODS Thirty-five patients with primary open-angle glaucoma (PAAG), 65 patients with normal-tension glaucoma (NTG), and 45 healthy controls, a total of 145 patients were included in this study and study participants were divided into three groups. All study participants underwent color Doppler ultrasound to assess blood flow parameters of CRA, OA and ICA. RESULTS Comparisons among three groups revealed that pulsatility index and resistive index of the OA were significantly higher and peak ratio and end-systolic volume were significantly lower in patients with NTG or PAAG compared to healthy controls (p < 0.001 for all). As with OA, resistive index of the CRA was statistically significantly higher in patients with glaucoma (PAAG and NTG) compared to healthy controls (p < 0.001). The peak systolic volume and intima-media thickness of the ICA were statistically significantly higher in patients with PAAG compared to the other two groups (p < 0.001). ROC curve analysis of the CRA resistive index, OA resistive index and OA peak ratio in patients with glaucoma (PAAG and NTG) revealed that the sensitivity and specificity were 89% and 88%; 86% and 84%; 84% and 82%, respectively, at cutoff values of 0.64, 0.78 and 0.59, respectively. CONCLUSIONS Ophthalmic artery peak ratio and ICA intima-media thickness may be useful parameters in the diagnosis of patients with glaucoma.
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Affiliation(s)
- Mustafa Kalayci
- Department of Ophthalmology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia.
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Mehmet Tahtabasi
- Department of Radiology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
- Department of Radiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
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Demirtaş AA, Karahan M, Ava S, Çilem Han Ç, Keklikçi U. Evaluation of Diurnal Fluctuation in Parafoveal and Peripapillary Vascular Density Using Optical Coherence Tomography Angiography in Patients with Exfoliative Glaucoma and Primary Open-Angle Glaucoma. Curr Eye Res 2020; 46:96-106. [PMID: 32546011 DOI: 10.1080/02713683.2020.1784437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the diurnal variations in parafoveal and peripapillary vessel density using optical coherence tomography angiography in patients with exfoliative glaucoma, patients with primary open-angle glaucoma and healthy individuals. MATERIALS AND METHODS In this prospective cross-sectional study, 36 exfoliative glaucoma patients, 34 primary open-angle glaucoma patients and 35 healthy individuals were examined. Optical coherence tomography angiography was used for examining the vessel density of peripapillary (radial peripapillary capillary) and parafoveal (superficial layer) regions. Optical coherence tomography angiography readings were obtained at 09:00, 11:00, 14:00 and 16:00 on the same day. Intraocular pressure values were assessed accordingly. The intraclass correlation coefficients were used to evaluate test-retest variability. RESULTS Diurnal variation in intraocular pressure or vessel density values was not found in any parafoveal or peripapillary region in any of the groups at any hour of measurement. The vessel density in the temporal sector of the exfoliative glaucoma group was significantly lower than in the primary open-angle glaucoma group at all time points. (Mann-Whitney U test; 09:00, P= .015; 11:00, P= .002; 14:00, P= .040; and 16:00, P= .048, respectively). The test-retest repeatability was high and almost excellent for the parafoveal and peripapillary regions in each group (XFG range: 0.757 - 0.985, POAG range: 0.834 - 0.985, and control range: 0.708 - 0.983). CONCLUSIONS It may be important to estimate the diurnal fluctuation occurring in retinal haemodynamics in patients with exfoliative glaucoma and primary open-angle glaucoma despite the lack of any considerable variation in intraocular pressure and retinal vessel density values in one day. The study found that at any point of time, vessel density of radial peripapillary capillary in temporal region was lower in exfoliative glaucoma patients than in primary open-angle glaucoma patients having the same glaucoma severity.
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Affiliation(s)
- Atılım Armağan Demirtaş
- Department of Ophthalmology, Health Sciences University, Tepecik Training and Research Hospital , Izmir, Turkey
| | - Mine Karahan
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Sedat Ava
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Çağla Çilem Han
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
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Sengul Samanci N, Poturoglu S, Samanci C, Ustabasioglu FE, Koldas M, Duman AE, Ormeci AC. The Relationship between Ocular Vascular Changes and the Levels of Malondialdehyde and Vascular Endothelial Growth Factor in Patients with Inflammatory Bowel Disease. Ocul Immunol Inflamm 2020; 29:1459-1463. [PMID: 32255700 DOI: 10.1080/09273948.2020.1740281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: We evaluated ocular hemodynamic changes, malondialdehyde(MDA) and vascular endothelial growth factor (VEGF) levels in patients with IBD.Methods: We used ocular color Doppler ultrasonography to analyze 56 eyes with Crohn's disease (CD), 62 eyes with ulcerative colitis (UC), 68 eyes of healthy volunteers. We measured peak systolic velocity (PSV),end-diastolic velocity (EDV),and the resistivity index (RI) of ophthalmic artery (OA) and central retinal artery (CRA). MDA and VEGF levels were measured in the plasma samples.Results: MDA levels were significantly higher in both UC and CD patients, whereas VEGF levels were only higher in the CD group (p = .003,p < .001,p = .01).The PSV and EDV of the OA were significantly lower in CD patients (p = .017,p = .001). The EDV of the CRA was significantly lower in CD patients than UC patients and controls (p = .014,p < .001).Conclusions: CD patients exhibited decreased blood flow in both the OA and CRA. Ocular vascular flow was only affected in CD patients. We found that ocular ischemia may occur in CD patients even in the absence of any clinical finding.
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Affiliation(s)
- Nilay Sengul Samanci
- Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sule Poturoglu
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Macit Koldas
- Biochemistry Department, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Ali Erkan Duman
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aslı Ciftcibası Ormeci
- Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Harris A, Guidoboni G, Siesky B, Mathew S, Verticchio Vercellin AC, Rowe L, Arciero J. Ocular blood flow as a clinical observation: Value, limitations and data analysis. Prog Retin Eye Res 2020; 78:100841. [PMID: 31987983 PMCID: PMC8908549 DOI: 10.1016/j.preteyeres.2020.100841] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Alterations in ocular blood flow have been identified as important risk factors for the onset and progression of numerous diseases of the eye. In particular, several population-based and longitudinal-based studies have provided compelling evidence of hemodynamic biomarkers as independent risk factors for ocular disease throughout several different geographic regions. Despite this evidence, the relative contribution of blood flow to ocular physiology and pathology in synergy with other risk factors and comorbidities (e.g., age, gender, race, diabetes and hypertension) remains uncertain. There is currently no gold standard for assessing all relevant vascular beds in the eye, and the heterogeneous vascular biomarkers derived from multiple ocular imaging technologies are non-interchangeable and difficult to interpret as a whole. As a result of these disease complexities and imaging limitations, standard statistical methods often yield inconsistent results across studies and are unable to quantify or explain a patient's overall risk for ocular disease. Combining mathematical modeling with artificial intelligence holds great promise for advancing data analysis in ophthalmology and enabling individualized risk assessment from diverse, multi-input clinical and demographic biomarkers. Mechanism-driven mathematical modeling makes virtual laboratories available to investigate pathogenic mechanisms, advance diagnostic ability and improve disease management. Artificial intelligence provides a novel method for utilizing a vast amount of data from a wide range of patient types to diagnose and monitor ocular disease. This article reviews the state of the art and major unanswered questions related to ocular vascular anatomy and physiology, ocular imaging techniques, clinical findings in glaucoma and other eye diseases, and mechanistic modeling predictions, while laying a path for integrating clinical observations with mathematical models and artificial intelligence. Viable alternatives for integrated data analysis are proposed that aim to overcome the limitations of standard statistical approaches and enable individually tailored precision medicine in ophthalmology.
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Affiliation(s)
- Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sunu Mathew
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alice C Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; University of Pavia, Pavia, Italy; IRCCS - Fondazione Bietti, Rome, Italy
| | - Lucas Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Arciero
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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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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Cınar E, Yuce B, Zengin MO, Kucukerdonmez C. The Effect of Nicotine on Macular Microcirculation in Healthy Subjects. Ophthalmic Surg Lasers Imaging Retina 2019; 50:691-700. [DOI: 10.3928/23258160-20191031-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/25/2019] [Indexed: 01/23/2023]
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Age-related changes in retrobulbar circulation: a literature review. Int Ophthalmol 2019; 40:493-501. [DOI: 10.1007/s10792-019-01176-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/19/2019] [Indexed: 12/28/2022]
Abstract
Abstract
Introduction
The advances in research methods used in ophthalmology allow for an increasingly accurate examination of the eyes, as well as the morphology and function of the vessels. Colour Doppler imaging is still the first-line method for the analysis of parameters of retrobulbar circulation. Therefore, the aim of this work was to present the current state of knowledge about anatomical and functional age-related changes in retrobulbar arteries.
Methods
A literature search was performed mainly based on the PubMed database.
Results
The anatomy of retrobulbar arteries, histological background of age-related vascular changes, age-related changes in retrobulbar blood flow in the ophthalmic artery, central retinal artery, short posterior ciliary arteries, and the reference values for the age-dependent retrobulbar circulation parameters measured by colour Doppler imaging are discussed in this review.
Conclusion
The age of the subject should always be taken into account when interpreting the parameters of retrobulbar blood flow measured by colour Doppler imaging.
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Modrzejewska M. Guidelines for ultrasound examination in ophthalmology. Part III: Color Doppler ultrasonography. J Ultrason 2019; 19:128-136. [PMID: 31355585 PMCID: PMC6750311 DOI: 10.15557/jou.2019.0019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
Abstract
The aim of this article was to present the possibilities of use and application of color-coded Doppler ultrasonography in the diagnosis of various diseases of the eyeball and orbit which result from vascular disorders. Color-coded Doppler ultrasonography is recommended for the assessment of blood flow velocity in the retrobulbar arteries. That is why the article contains current recommendations for Doppler imaging in ophthalmology. The paper provides detailed recommendations for patient's preparation for the examination, presents the scanning technique and safety of the examination, and lists ophthalmological diseases of vascular origin for which color-coded Doppler ultrasonography can be applied. Furthermore, the article also presents other techniques applied in clinical practice for the assessment of blood flow or imaging of vasculature of a given eyeball structure, inter alia: power Doppler ultrasonography, 3D and 4D ultrasonography, magnetic resonance angiography, spiral computer tomography, transcranial ultrasonography and modern microvascular imaging. The authors emphasize the usefulness of color-coded Doppler ultrasonography in the diagnosis of diseases which result from blood flow disorders within the eyeball, such as amaurosis fugax, ocular ischemic syndrome, insufficiency in vessels supplying the carotid and vertebral arteries, posterior ischemic optic neuropathy, glaucoma, age-related macular degeneration, vascular vision disorders, vascular malformations, such as arteriovenous fistula, orbital varices, systemic connective tissue diseases in retinopathy of prematurity, diabetes, thyroid disorders or strabismus. The application of color-coded Doppler ultrasonography is especially important in the assessment of the vasculature of intrabulbar tumorous lesions and in the differential diagnosis of intrabulbar tumors. The aim of this article was to present the possibilities of use and application of color-coded Doppler ultrasonography in the diagnosis of various diseases of the eyeball and orbit which result from vascular disorders. Color-coded Doppler ultrasonography is recommended for the assessment of blood flow velocity in the retrobulbar arteries. That is why the article contains current recommendations for Doppler imaging in ophthalmology. The paper provides detailed recommendations for patient’s preparation for the examination, presents the scanning technique and safety of the examination, and lists ophthalmological diseases of vascular origin for which color-coded Doppler ultrasonography can be applied. Furthermore, the article also presents other techniques applied in clinical practice for the assessment of blood flow or imaging of vasculature of a given eyeball structure, inter alia: power Doppler ultrasonography, 3D and 4D ultrasonography, magnetic resonance angiography, spiral computer tomography, transcranial ultrasonography and modern microvascular imaging. The authors emphasize the usefulness of color-coded Doppler ultrasonography in the diagnosis of diseases which result from blood flow disorders within the eyeball, such as amaurosis fugax, ocular ischemic syndrome, insufficiency in vessels supplying the carotid and vertebral arteries, posterior ischemic optic neuropathy, glaucoma, age-related macular degeneration, vascular vision disorders, vascular malformations, such as arteriovenous fistula, orbital varices, systemic connective tissue diseases in retinopathy of prematurity, diabetes, thyroid disorders or strabismus. The application of color-coded Doppler ultrasonography is especially important in the assessment of the vasculature of intrabulbar tumorous lesions and in the differential diagnosis of intrabulbar tumors.
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Affiliation(s)
- Monika Modrzejewska
- 2 Department of Ophthalmology, Autonomous Public Clinical Hospital No 2, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Sousa DC, Leal I, Moreira S, do Vale S, Silva-Herdade AS, Aguiar P, Dionísio P, Abegão Pinto L, Castanho MARB, Marques-Neves C. A Protocol to Evaluate Retinal Vascular Response Using Optical Coherence Tomography Angiography. Front Neurosci 2019; 13:566. [PMID: 31249500 PMCID: PMC6582622 DOI: 10.3389/fnins.2019.00566] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/17/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Optical coherence tomography angiography (OCT-A) is a novel diagnostic tool with increasing applications in ophthalmology clinics that provides non-invasive high-resolution imaging of the retinal microvasculature. Our aim is to report in detail an experimental protocol for analyzing both vasodilatory and vasoconstriction retinal vascular responses with the available OCT-A technology. Methods A commercial OCT-A device was used (AngioVue®, Optovue, CA, United States), and all examinations were performed by an experienced technician using the standard protocol for macular examination. Two standardized tests were applied: (i) the hypoxia challenge test (HCT) and (ii) the handgrip test, in order to induce a vasodilatory and vasoconstriction response, respectively. OCT-A was performed at baseline conditions and during the stress test. Macular parafoveal vessel density of the superficial and deep plexuses was assessed from the en face angiograms. Statistical analysis was performed using STATA v14.1 and p < 0.05 was considered for statistical significance. Results Twenty-four eyes of 24 healthy subjects (10 male) were studied. Mean age was 31.8 ± 8.2 years (range, 18–57 years). Mean parafoveal vessel density in the superficial plexus increased from 54.7 ± 2.6 in baseline conditions to 56.0 ± 2.0 in hypoxia (p < 0.01). Mean parafoveal vessel density in the deep plexuses also increased, from 60.4 ± 2.2 at baseline to 61.5 ± 2.1 during hypoxia (p < 0.01). The OCT-A during the handgrip test revealed a decrease in vessel density in both superficial (55.5 ± 2.6 to 53.7 ± 2.9, p < 0.001) and deep (60.2 ± 1.8 to 56.7 ± 2.8, p < 0.001) parafoveal plexuses. Discussion In this work, we detail a simple, non-invasive, safe, and non-costly protocol to assess a central nervous system vascular response (i.e., the retinal circulation) using OCT-A technology. A vasodilatory response and a vasoconstriction response were observed in two physiologic conditions—mild hypoxia and isometric exercise, respectively. This protocol constitutes a new way of studying retinal vascular changes that may be applied in health and disease of multiple medical fields.
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Affiliation(s)
- David Cordeiro Sousa
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Moreira
- Respiratory Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Sónia do Vale
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Endocrinology Department, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana S Silva-Herdade
- Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrício Aguiar
- Medicine I Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clinica Universitária de Medicina I, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Dionísio
- Respiratory Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Luís Abegão Pinto
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel A R B Castanho
- Instituto de Bioquímica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Marques-Neves
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Vision Sciences Study Center, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Jamshidian-Tehrani M, Nabavi A, Kasaee A, Hasanpoor N, Elhami E, Sharif-Kashani S, Masoumi A, Nowroozzadeh MH, Sadeghi-Tari A. Color Doppler imaging in thyroid eye disease and its correlation to disease activity. Orbit 2019; 38:440-445. [PMID: 30628510 DOI: 10.1080/01676830.2018.1556704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate alterations in orbital color Doppler imaging (CDI) parameters and their correlation to disease activity and severity in patients with thyroid eye disease (TED). Methods: Seventy-six orbits of 45 TED patients and 40 orbits of 40 normal controls were enrolled in this cross-sectional study. According to clinical activity score (CAS), patients were categorized to active (CAS ≥ 3) or inactive disease (CAS < 3). Patients were also classified as having mild, moderate or severe disease. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) in ophthalmic artery and central retinal artery, and maximum and minimum velocity in superior ophthalmic vein and central retinal vein were determined in all subjects. Results: There was a significant difference in maximum velocity of superior ophthalmic vein and EDV and RI of ophthalmic artery between patients with TED and normal subjects. Superior ophthalmic vein maximum and minimum velocity and ophthalmic artery RI were significantly higher in patients with active disease than inactive cases. Disease severity did not affect the blood flow parameters independently. A cutoff point of 3.99 cm/s in superior ophthalmic vein maximum velocity yielded a sensitivity of 91.2% and specificity of 81.2% in detecting active disease. Conclusion: Retrobulbar blood flow is altered in TED and is related to disease activity. Superior ophthalmic vein maximum velocity could be helpful in differentiation of active and inactive cases.
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Affiliation(s)
| | - Amin Nabavi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Narges Hasanpoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Eahsan Elhami
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Shervin Sharif-Kashani
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Ahamd Masoumi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - M Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Ali Sadeghi-Tari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran
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Ocular Hemodynamics in Acute Nonarteritic Anterior Ischemic Optic Neuropathy Compared With Normal Tension Glaucoma. J Glaucoma 2019; 28:334-340. [PMID: 30601221 DOI: 10.1097/ijg.0000000000001177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate ocular hemodynamics in patients with a disease believed to be related to a chronic vascular damage [ie, normal tension glaucoma (NTG)] in comparison with an entity with an acute ischemic impact on the optic nerve [ie, acute nonarteritic anterior ischemic optic neuropathy (NAION)]. MATERIALS AND METHODS Blood-flow velocities [peak systolic velocity (PSV), enddiastolic velocity (EDV)] of the ophthalmic artery (OA), central retinal artery (CRA), and nasal and temporal posterior ciliary arteries were measured using color Doppler imaging. Resistive index (RI) of all vessels was calculated (PSV-EDV/PSV). A total of 41 patients suffering from acute NAION (onset of symptoms <10 d) and 64 age-matched patients suffering from NTG were included in this prospective study. RESULTS No significant differences were recorded for either age or intraocular pressure inbetween the 2 groups. Systolic blood pressure was significantly higher in the NAION group, whereas no significant differences were recorded for the diastolic blood pressure. Only 3 color Doppler imaging parameters were found to differ significantly. The PSV (P<0.005) and EDV (P<0.02) in the CRA were significantly higher in NTG patients. Furthermore, the RI in the OA was significantly higher in the NAION patients (P<0.005). CONCLUSIONS Decreased blood-flow velocities in the CRA and a higher RI in the OA can be recorded in NAION patients as compared with NTG. No differences with regard to the posterior ciliary arteries' velocities were recorded. Ocular hemodynamics are suspected to play a critical role in NAION and NTG, whereas the blood-flow disturbances seem to be more severe in NAION than in NTG.
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Tan B, Chua J, Barathi VA, Baskaran M, Chan A, Lin E, Ang M, Klose G, Schmetterer L. Quantitative analysis of choriocapillaris in non-human primates using swept-source optical coherence tomography angiography (SS-OCTA). BIOMEDICAL OPTICS EXPRESS 2019; 10:356-371. [PMID: 30775105 PMCID: PMC6363185 DOI: 10.1364/boe.10.000356] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 05/12/2023]
Abstract
The choriocapillaris is a unique vascular plexus located posterior to the retinal pigment epithelium. In recent years, there is an increasing interest in the examination of the interrelationship between the choriocapillaris and eye diseases. We used several techniques to study choroidal perfusion, including laser Doppler flowmetry, laser speckle flowgraphy, and optical coherence tomography angiography (OCTA), but with the latter no standardized algorithm for quantitative analysis has been provided. We analyzed different algorithms to quantify flow voids in non-human primates that can be easily implemented into clinical research. In-vivo, high-resolution images of the non-human primate choriocapillaris were acquired with a swept-source OCTA (SS-OCTA) system with 100kHz A-scan/s rate, over regions of 3 × 3 mm2 and 12 × 12 mm2. The areas of non-perfusion, also called flow voids, were segmented with a structural, intensity adjusted, uneven illuminance-compensated algorithm and the new technique was compared to previously published methods. The new algorithm shows improved reproducibility and may have applications in a wide array of eye diseases including age-related macular degeneration (AMD).
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Veluchamy Amutha Barathi
- 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, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Anita Chan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Emily Lin
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Moorfield Hospital, London, UK
| | | | - 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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Richter GM, Sylvester B, Chu Z, Burkemper B, Madi I, Chang R, Reznik A, Varma R, Wang RK. Peripapillary microvasculature in the retinal nerve fiber layer in glaucoma by optical coherence tomography angiography: focal structural and functional correlations and diagnostic performance. Clin Ophthalmol 2018; 12:2285-2296. [PMID: 30510397 PMCID: PMC6231432 DOI: 10.2147/opth.s179816] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To quantify peripapillary microvasculature within the retinal nerve fiber layer (RNFL) in primary open-angle glaucoma (POAG) and normal eyes, determine association of perfusion parameters with structural and functional measures, and report diagnostic accuracy of perfusion parameters. Patients and methods POAG and normal patients underwent 6×6 mm2 optic nerve head scans (Angioplex optical coherence tomography angiography [OCTA]; Cirrus HD-OCT 5000) and Humphrey Field Analyzer II-i 24-2 visual field (VF) testing. Prototype software performed semiautomatic segmentation to create RNFL en face images and quantified vessel area density (VAD), vessel skeleton density (VSD), and vessel complexity index (VCI) in the optic nerve head globally and focally. Generalized estimating equations models assessed association of OCTA parameters with VF mean deviation (MD) and RNFL thickness. Results Thirty-eight POAG and 17 normal eyes were studied. Global VAD, VSD, and VCI were reduced in mild POAG vs normal (P<0.02) and moderate-severe vs mild POAG (P<0.04). Stepwise focal reductions across disease stage were demonstrated for OCTA parameters in the inferior hemisphere (P<0.05); reduction in OCTA parameters in mild POAG vs normal was demonstrated in inferior and superior quadrants (P<0.05). Reduced global VF MD was associated with reduced VAD, VSD, and VCI (P=0.0007, 0.0013, <0.0001; R2=0.449, 0.312, 0.399, respectively), and global RNFL thickness was associated with VAD, VSD, and VCI (P<0.0001; R2=0.499, 0.524, 0.542), superior and inferior hemifield MD were associated with corresponding VAD, VSD, and VCI (P≤0.001; R2 from 0.208 to 0.513). RNFL thickness in all quadrants was associated with corresponding OCTA parameters (P<0.05; R2 from 0.213 to 0.394), except temporal VAD and VCI. Area under curves for VAD, VSD, and VCI demonstrated good diagnostic ability (0.868, 0.855, 0.868; P<0.0001). Conclusion Glaucomatous eyes showed stepwise reductions in RNFL microcirculation across severity; focal reductions in the inferior hemisphere and inferior and superior quadrants were most significant. OCTA parameters had stronger associations with structural rather than functional measures of glaucoma.
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Affiliation(s)
- Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Beau Sylvester
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ingy Madi
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ryuna Chang
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Alena Reznik
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Rohit Varma
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Wei X, Balne PK, Meissner KE, Barathi VA, Schmetterer L, Agrawal R. Assessment of flow dynamics in retinal and choroidal microcirculation. Surv Ophthalmol 2018; 63:646-664. [DOI: 10.1016/j.survophthal.2018.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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Eniola MA, Adeyomoye AAO, Musa KO, Ishola AAS, Olatunji OO. OPHTHALMIC ARTERY AND CENTRAL RETINAL ARTERY DOPPLER PATTERNS IN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2018; 8:1-21. [PMID: 32754454 PMCID: PMC7368574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Circulatory abnormalities of retrobulbar vessels are increasingly being linked to the aetiopathogenesis of primary open angle glaucoma. These abnormalities can be assessed with a colour Doppler Imaging of retrobulbar vessels. AIMS AND OBJECTIVES To compare the Doppler ultrasound patterns of central retinal artery and ophthalmic artery in new patients with primary open angle glaucoma (POAG) diagnosis with those of non-glaucomatous group. DESIGN OF THE STUDY A hospital-based, comparative, cross-sectional study. SETTING Department of Ophthalmology (Guinness Eye Centre) and Department of Radiology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. MATERIALS AND METHODS End diastolic velocity (EDV), Peak systolic velocity (PSV) and resistivity index (RI) were measured in the central retinal artery (CRA) and ophthalmic artery (OA) of both eyes of newly diagnosed POAG patients. The CDI values of newly diagnosed POAG patients were compared with age-gender matched non-glaucomatous group. The Doppler values of the better and worse eye of patients with asymmetrical POAG were also compared. RESULTS One hundred subjects (200 eyes) comprising of 50 POAG patients and 50 non-glaucomatous healthy subjects were recruited for this study. The male to female ratio was 1:1.1(24 males and 26 females) for POAG patients and 1:1 (25 males and 25 females) for non-glaucomatous subjects. The CRA and OA in both eyes of POAG patients had a significantly lower mean EDV and PSV compared with those of non-glaucomatous group (p< 0.001). The CRA and OA in both eyes of POAG patients had a significantly higher mean RI compared with those of non-glaucomatous group (p< 0.001). A significant positive Pearson correlation was seen between the IOP and the RI in the CRA and OA in both eyes. Also, statistically significant negative Pearson correlations were seen between the IOP and the PSV and EDV in the OA and CRA in both eyes. CONCLUSION This study demonstrated a significant reduction in EDV and PSV as well as an increase in RI of the CRA and OA in both eyes among POAG patients compared to the non-glaucomatous group.
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Affiliation(s)
| | - A A O Adeyomoye
- Department of Radiodiagnosis, Lagos University Teaching Hospital, Lagos, Nigeria
| | - K O Musa
- Department of Ophthalmology (Guinness Eye Centre), Lagos University Teaching Hospital/ College of Medicine of the University of Lagos, Lagos, Nigeria
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Bittner AK, Seger K, Salveson R, Kayser S, Morrison N, Vargas P, Mendelsohn D, Han J, Bi H, Dagnelie G, Benavente A, Ramella-Roman J. Randomized controlled trial of electro-stimulation therapies to modulate retinal blood flow and visual function in retinitis pigmentosa. Acta Ophthalmol 2018; 96:e366-e376. [PMID: 29130647 DOI: 10.1111/aos.13581] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined changes in visual function and ocular and retinal blood flow (RBF) among retinitis pigmentosa (RP) participants in a randomized controlled trial of electro-stimulation therapies. METHODS Twenty-one RP participants were randomized (1:1:1) to transcorneal electrical stimulation (TES) at 6 weekly half-hour sessions, electro-acupuncture or inactive laser acupuncture (sham control) at 10 half-hour sessions over 2 weeks. Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity (VA), quick contrast sensitivity function, Goldmann visual fields, AdaptDx scotopic sensitivity, spectral flow and colour Doppler imaging of the central retinal artery (CRA), and RBF in macular capillaries were measured twice pre-treatment, after 2 TES sessions, within a week and a month after intervention completion. RESULTS We measured a significant improvement in retrobulbar CRA mean flow velocity for both the TES (p = 0.038) and electro-acupuncture groups (p = 0.001) on average after 2 weeks of treatment when compared to sham controls. Transcorneal electrical simulation (TES) and electro-acupuncture subjects had significant 55% and 34% greater increases, respectively, in RBF in the macular vessels when compared to sham controls (p < 0.001; p = 0.008) within a week of completing six TES sessions or a month after electro-acupuncture. There was a significant difference in the proportion of eyes that had improved visual function when comparing the three intervention groups (p = 0.038): four of seven TES subjects (57%), two of seven electro-acupuncture subjects (29%) and none of the seven control subjects (0%) had a significant visual improvement outside of typical test-retest variability at two consecutive post-treatment visits. CONCLUSION Increased blood flow following electro-stimulation therapies is an objective, physiological change that occurred in addition to visual function improvements in some RP patients.
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Affiliation(s)
- Ava K. Bittner
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Kenneth Seger
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Rachel Salveson
- College of Osteopathic Medicine; Nova Southeastern University; Fort Lauderdale FL USA
| | - Samantha Kayser
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Natalia Morrison
- Healing Blossom - Acupuncture and Holistic Medicine; Miami FL USA
| | - Patricia Vargas
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Deborah Mendelsohn
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Jorge Han
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Hua Bi
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | | | | | - Jessica Ramella-Roman
- Department of Biomedical Engineering; Florida International University; Miami FL USA
- Department of Cellular Biology and Pharmacology and Ophthalmology; Herbert Wertheim College of Medicine; Miami FL USA
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Dervenis P, Dervenis N, Mikropoulou AM. Imaging modalities for assessing ocular hemodynamics. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1465408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Diurnal Variations of Peripapillary and Macular Vessel Density in Glaucomatous Eyes Using Optical Coherence Tomography Angiography. J Glaucoma 2018; 27:336-341. [PMID: 29462016 DOI: 10.1097/ijg.0000000000000914] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the diurnal variation in peripapillary and macular vessel density (VD) measurements using optical coherence tomographic angiography (OCT-A) and its correlation to intraocular pressure (IOP) changes in glaucoma patients. METHODS Prospective, observational cross-sectional study including 37 patients (74 eyes; age, 63.8±12.9 y) with open-angle glaucoma. OCT-A imaging and IOP measurements were performed at 08:00, 11:00, 14:00, and 16:00 timepoints on a single day. At each timepoint, 2 scan protocols were used to generate 3-dimensional en face OCT angiograms: 4.5×4.5-mm scan centered on the optic nerve head and 6×6-mm scan centered on the fovea. For each scan mode, the "radial peripapillary capillary" segment, composed of the vasculature of the retinal nerve fiber layer and ganglion cell layer, was calculated. Two trained readers reviewed OCT-A image quality. Only scans with signal strength intensity (SSI) higher than 46 and without image artifacts interfering with measurements were included. Variation in VD measurements assessed using analysis of variance (ANOVA) and the association between VD and IOP changes assessed using linear mixed modeling methods. RESULTS The optic nerve head and peripapillary VD measurements at 14:00 and 16:00 timepoints were greater than the measurements at 08:00 and 11:00 timepoints. The 14:00 and 16:00 VD measurements were statistically significantly greater (P<0.05) than the 08:00 measurements for the whole en face (50.1% and 50.1% vs. 49.4%), inside disc (50.6% and 50.5% vs. 49.6%), and average peripapillary (58.2% and 58.5% vs. 57.5%) VDs. The macular VD measurements at the 14:00 timepoint were greater than the measurements at 08:00 and 11:00 timepoints. Changes in VD were significantly associated with changes in SSI but not IOP. CONCLUSIONS Diurnal changes in OCT-A-measured VD in glaucoma patients were small and clinically insignificant. These changes were not associated with IOP changes.
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Calzetti G, Fondi K, Bata AM, Luft N, Wozniak PA, Witkowska KJ, Bolz M, Popa-Cherecheanu A, Werkmeister RM, Schmidl D, Garhöfer G, Schmetterer L. Assessment of choroidal blood flow using laser speckle flowgraphy. Br J Ophthalmol 2018; 102:1679-1683. [PMID: 29472236 PMCID: PMC6287569 DOI: 10.1136/bjophthalmol-2017-311750] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/15/2018] [Accepted: 02/03/2018] [Indexed: 11/26/2022]
Abstract
Background/aims There is considerable interest in novel techniques to quantify choroidal blood flow (CBF) in humans. In the present study, we investigated a novel technique to measure CBF based on laser speckle flowgraphy (LSFG) in healthy subjects. Methods This study included 31 eyes of 31 healthy, non-smoking subjects aged between 19 and 74 years. A commercial LSFG instrument was used to measure choroidal vessel diameter (CVD) and relative flow volume (RFV) in choroidal vessels that were identified on fundus photos, an approach that was used previously only for retinal vessels. The reproducibility and the effect of isometric exercise on these parameters were investigated. The latter was compared with measurement of subfoveal CBF using laser Doppler flowmetry (LDF). Results Intraclass correlation coefficients for CVD and RFV were higher than 0.8 indicating excellent reproducibility. During isometric exercise, we observed an increase in ocular perfusion pressure of approximately 60% (P<0.001). The increase in RFV and CBF was lower, but also highly significant versus baseline (at minute 6 of isometric exercise: RFV 10.5%±4.2%, CBF 8.3%±3.6%; P<0.001 each) indicating choroidal autoregulation. Conclusion LSFG may be a novel approach to study blood flow in choroidal vessels. Data are reproducible and show good agreement with LDF data. Trial registration number NCT02102880, Results.
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Affiliation(s)
- Giacomo Calzetti
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Ophthalmology, University of Parma, Parma, Italy
| | - Klemens Fondi
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ahmed M Bata
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Luft
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria.,Center for Refractive Therapy, University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Piotr A Wozniak
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Matthias Bolz
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - René M Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Singapore Eye Research Institute, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Kayser S, Vargas P, Mendelsohn D, Han J, Bi H, Benavente A, Bittner AK. Reduced Central Retinal Artery Blood Flow Is Related to Impaired Central Visual Function in Retinitis Pigmentosa Patients. Curr Eye Res 2017; 42:1503-1510. [PMID: 28910168 DOI: 10.1080/02713683.2017.1338350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE We evaluated the test-retest repeatability of blood flow velocities in the retrobulbar central retinal artery (CRA) and explored whether reduced blood flow is related to the degree of visual function loss in retinitis pigmentosa (RP) patients with wide range of disease severity. MATERIALS AND METHODS We measured CRA peak systolic velocity (PSV) and end diastolic velocity (EDV) to calculate mean flow velocity (MFV) in 18 RP patients using color Doppler imaging with spectral flow Doppler (GE Logiq7 ultrasound) twice in each eye at each of two visits within a month. At each of these two visits, we measured ETDRS visual acuity (VA), quick Contrast Sensitivity Function (qCSF), Goldmann visual fields (GVF), 10-2 Humphrey visual fields (HVF), and dark-adaptation at 5° from fixation with the AdaptDx; multifocal electroretinography (mfERG) was obtained at a single visit. RESULTS Mean coefficients of variation for PSV, EDV and MFV were 16.1-19.2% for within-visit measurements and 20.1-22.4% for between-visit measures. Across patients, greater visual function loss assessed with VA (p = 0.04), extinguished versus measurable amplitude in ring 1 for mfERG (p = 0.001), and cone-only versus rod function with the AdaptDx (p = 0.002) were statistically significantly correlated with reduced MFV in the CRA when included a multilevel multivariate regression model along with the qCSF and HVF results, which all together accounted for 47% of the total variance in MFV. GVF log retinal areas (V4e and III4e; p = 0.30 and p = 0.95, respectively) and measurable far peripheral vision during GVF testing (p = 0.66) were not significantly related to MFV. CONCLUSIONS MFV in the CRA decreased with impaired central vision due to loss of both rod and cone function, had good test-retest repeatability, and may serve as a biomarker outcome to determine the potential physiological basis for improvements in RP clinical trials of therapies with indirect effects on blood flow to the retina.
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Affiliation(s)
- Samantha Kayser
- a College of Optometry, Nova Southeastern University , Fort Lauderdale , FL , USA
| | - Patricia Vargas
- b College of Health Care Sciences, Medical Sonography Program , Fort Lauderdale , FL , USA
| | - Deborah Mendelsohn
- b College of Health Care Sciences, Medical Sonography Program , Fort Lauderdale , FL , USA
| | - Jorge Han
- b College of Health Care Sciences, Medical Sonography Program , Fort Lauderdale , FL , USA
| | - Hua Bi
- a College of Optometry, Nova Southeastern University , Fort Lauderdale , FL , USA
| | - Alexandra Benavente
- c SUNY College of Optometry, The State University of New York College , New York , NY , USA
| | - Ava K Bittner
- a College of Optometry, Nova Southeastern University , Fort Lauderdale , FL , USA
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Bittner M, Faes L, Boehni SC, Bachmann LM, Schlingemann RO, Schmid MK. Colour Doppler analysis of ophthalmic vessels in the diagnosis of carotic artery and retinal vein occlusion, diabetic retinopathy and glaucoma: systematic review of test accuracy studies. BMC Ophthalmol 2016; 16:214. [PMID: 27927176 PMCID: PMC5142387 DOI: 10.1186/s12886-016-0384-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Colour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has not yet been assessed systematically. We performed a comprehensive systematic review of the literature on the diagnostic properties of Colour Doppler imaging (CDI) assessing ophthalmic vessels and provide an inventory of the available evidence. Methods Eligible papers were searched electronically in (Pre) Medline, Embase and Scopus, and via cross-checking of reference lists. The minimum requirement to be included was the availability of original data and the possibility to construct a two-by-two table. Study selection, critical appraisal using the QUADAS II instrument and extraction of salient study characteristics was made in duplicate. Sensitivity and specificity was computed for each study. Results We included 11 studies (15 two-by-two tables) of moderate methodological quality enrolling 820 participants (range 30 to 118). In 44.4% participants were female (range 37–59% in specific subgroups). CDI was assessed for internal carotid stenosis, diabetic retinopathy, glaucoma, and branch or central retinal vein occlusion diagnosis. There was insufficient data to pool the results for specific illnesses. For the assessments of ophthalmic arteries, mean sensitivity was 0.69 (range 0.27–0.96) with a corresponding mean specificity of 0.83 (range 0.70–0.96). Mean sensitivity of the central retinal artery assessments was 0.58 (range 0.31–0.84) and the corresponding mean specificity was 0.82 (range 0.63–0.94). Conclusions Robust assessments of the diagnostic value of colour Doppler analysis remain uncommon, limiting the possibilities to extrapolate its true potential for clinical practice. PROSPERO 2014:CRD42014014027.
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Affiliation(s)
- Mario Bittner
- Eye Clinic, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6001, Lucerne, Switzerland
| | - Livia Faes
- medignition Inc, Verena Conzett-Strasse 9, CH-8004, Zurich, Switzerland
| | - Sophie C Boehni
- Eye Clinic, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6001, Lucerne, Switzerland
| | - Lucas M Bachmann
- medignition Inc, Verena Conzett-Strasse 9, CH-8004, Zurich, Switzerland.
| | - Reinier O Schlingemann
- Department of Ophthalmology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Martin K Schmid
- Eye Clinic, Cantonal Hospital of Lucerne, Spitalstrasse, CH-6001, Lucerne, Switzerland
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Lee KM, Lee EJ, Kim TW. Juxtapapillary choroid is thinner in normal-tension glaucoma than in healthy eyes. Acta Ophthalmol 2016; 94:e697-e708. [PMID: 27288014 DOI: 10.1111/aos.13086] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/07/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To measure the juxtapapillary choroidal thickness in eyes with normal-tension glaucoma (NTG) and to compare it with healthy eyes. METHODS Twelve radial B-scan images of the optic nerve head (ONH) were obtained from 96 patients with NTG and 48 healthy subjects matched by age using swept-source (SS) optical coherence tomography (OCT). The juxtapapillary choroidal thickness was defined as the average choroidal thickness within 500 μm from the border tissue of Elschnig. Choroidal thinning in patients with NTG was assessed by calculating the relative choroidal thickness, defined as the ratio of the measured juxtapapillary choroidal thickness in each meridian to the corresponding value in age-matched healthy controls. Retinal nerve fibre layer (RNFL) damage as reflected by circumpapillary RNFL thickness (measured using spectral-domain OCT) was also assessed. RESULTS The juxtapapillary choroid was significantly thinner in NTG eyes than in healthy control eyes in the inferotemporal and superotemporal sectors. The relative choroidal thinning was topographically associated with the hemispheric location of dominant RNFL damage. The average juxtapapillary choroidal thickness was not associated with either the global RNFL thickness or the visual field mean deviation. Age and untreated intraocular pressure were significantly associated with the juxtapapillary choroidal thickness in NTG eyes in both univariate and multivariate analyses (all p < 0.05). CONCLUSIONS Decreased microvascular circulation in the ONH as a result of juxtapapillary choroidal thinning could be an important part of the pathogenesis of optic nerve damage in NTG.
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Affiliation(s)
- Kyoung Min Lee
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - Eun Ji Lee
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - Tae-Woo Kim
- Department of Ophthalmology; Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seongnam Korea
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Mansouri K. Optical coherence tomography angiography and glaucoma: searching for the missing link. Expert Rev Med Devices 2016; 13:879-880. [DOI: 10.1080/17434440.2016.1230014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kaweh Mansouri
- Glaucoma Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA
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Abegão Pinto L, Willekens K, Van Keer K, Shibesh A, Molenberghs G, Vandewalle E, Stalmans I. Ocular blood flow in glaucoma - the Leuven Eye Study. Acta Ophthalmol 2016; 94:592-8. [PMID: 26895610 DOI: 10.1111/aos.12962] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. METHOD Prospective, cross-sectional, case-control hospital-based study. Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. RESULTS A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p < 0.001). Glaucoma groups had lower retrobulbar velocities, higher retinal venous saturation and choroidal thickness asymmetries when compared to the healthy group, in line with the current literature. CONCLUSIONS The Leuven Eye Study stands as one of the largest clinical trials on ocular blood flow in glaucoma. The creation of this vast database may help integrate the vascular aspects of glaucoma into the clinical practice of glaucoma.
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Affiliation(s)
- Luís Abegão Pinto
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Visual Sciences Study Center; Faculty of Medicine of Lisbon University; Lisbon Portugal
| | - Koen Willekens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Karel Van Keer
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | | | - Geert Molenberghs
- I-BioStat; KU Leuven; Leuven Belgium
- I-BioStat; Hasselt University; Hasselt Belgium
| | - Evelien Vandewalle
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
- Department of Ophthalmology Neurosciences; Laboratory of Ophthalmology; KU Leuven; Leuven Belgium
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Son T, Wang B, Thapa D, Lu Y, Chen Y, Cao D, Yao X. Optical coherence tomography angiography of stimulus evoked hemodynamic responses in individual retinal layers. BIOMEDICAL OPTICS EXPRESS 2016; 7:3151-62. [PMID: 27570706 PMCID: PMC4986822 DOI: 10.1364/boe.7.003151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 05/05/2023]
Abstract
Blood flow changes are highly related to neural activities in the retina. It has been reported that neural activity increases when flickering light stimulation of the retina is used. It is known that blood flow changes with flickering light stimulation can be altered in patients with vascular disease and that measurement of flicker-induced vasodilatation is an easily applied tool for monitoring functional microvascular alterations. However, details of distortions in retinal neurovascular coupling associated with major eye diseases are not well understood due to the limitation of existing techniques. In this study, flickering light stimulation was applied to mouse retinas to investigate stimulus evoked hemodynamic responses in individual retinal layers. A spectral domain optical coherence tomography (OCT) angiography imaging system was developed to provide dynamic mapping of hemodynamic responses in the ganglion cell layer, inner plexiform layer, outer plexiform layer and choroid layer before, during and after flickering light stimulation. Experimental results showed hemodynamic responses with different magnitudes and time courses in individual retinal layers. We anticipate that the dynamic OCT angiography of stimulus evoked hemodynamic responses can greatly foster the study of neurovascular coupling mechanisms in the retina, promising new biomarkers for retinal disease detection and diagnosis.
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Affiliation(s)
- Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Benquan Wang
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Damber Thapa
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Yiming Lu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Yanjun Chen
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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Kurysheva NI, Parshunina OA, Shatalova EO, Kiseleva TN, Lagutin MB, Fomin AV. Value of Structural and Hemodynamic Parameters for the Early Detection of Primary Open-Angle Glaucoma. Curr Eye Res 2016; 42:411-417. [PMID: 27341295 DOI: 10.1080/02713683.2016.1184281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the diagnostic value of ocular blood flow parameters and choroidal thickness (CT) with standard structural parameters for early glaucoma detection. METHODS A total of 32 patients with pre-perimetric glaucoma were compared with 30 age-matched normal subjects. The thickness of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL), and the choroid and foveal loss volume (FLV) were measured by means of optical coherence tomography (OCT). Retrobulbar blood velocities (Color Doppler Imaging), corneal compensated intraocular pressure (IOPcc), and corneal hysteresis (CH) were also evaluated. Mean ocular perfusion pressure (MOPP) was calculated by measuring IOP and mean arterial blood pressure as MOPP = ([2/3 diastolic BP + 1/3 systolic BP] × 2/3-IOP). The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon-Mann-Whitney test and the area under the receiver operating characteristic curve (AUC). RESULTS The following indicators had the largest AUC and diagnostic value (z-value): mean blood flow velocity in the vortex veins (AUC 1.0; z-value 5.35) and central retinal vein (0.85; 3.74), diastolic blood flow velocity in the central retinal artery (0.73; 2.74) and lateral short posterior ciliary arteries (0.71; 2.53), IOPcc (0.74; -2.9), CH (0.69; 2.24), CT (0.69; -2.28), GCC (0.67; 2.05), and FLV (0.66; -1.86) to discriminate pre-perimetric glaucoma from healthy subjects. CONCLUSIONS Interestingly, ocular hemodynamic parameters performed better than structural parameters in detecting early glaucoma. This highlights the potential of techniques to measure ocular blood flow in glaucoma diagnostics independently of the question whether perfusion abnormalities are a cause or a consequence of the disease.
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Affiliation(s)
- Natalia I Kurysheva
- a Ophthalmological Center of the Federal Medical and Biological Agency of Russia , Moscow , Russia
| | - Olga A Parshunina
- a Ophthalmological Center of the Federal Medical and Biological Agency of Russia , Moscow , Russia
| | - Ekaterina O Shatalova
- a Ophthalmological Center of the Federal Medical and Biological Agency of Russia , Moscow , Russia
| | - Tatiana N Kiseleva
- b Ultrasound Department of Helmholtz Moscow Research Institute of Eye Diseases of the Ministry of Health of Russia , Moscow , Russia
| | - Michael B Lagutin
- c Faculty of Mechanics and Mathematics, Department of Mathematical Statistics and Random Processes , Lomonosov Moscow State University , Moscow , Russia
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