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Han Y, Zhang L, Yu Z, Ling S, Zhang X, Yu D, Li Z. Prediction model for asymptomatic carotid atherosclerosis using retinal microvascular intelligent analysis: A retrospective study. J Stroke Cerebrovasc Dis 2024; 33:107780. [PMID: 38802034 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
IMPORTANCE Early detection and timely diagnosis of asymptomatic carotid atherosclerosis significantly assist in the prevention of ischemic stroke for them. OBJECTIVE This observational study aimed to develop and validate a novel prediction model to assist in the early diagnosis of carotid atherosclerosis based on new characteristic variables screened by retinal microvascular intelligence analysis. MAIN OUTCOME(S) AND METHOD (S) The least absolute shrinkage and selection operator (LASSO) combined with 10-fold cross-validation were screened for characteristic variables, and nomograms were plotted to demonstrate the prediction model. Receiver operating characteristic (ROC) curves and area under the curve (AUC), calibration plots and brier score (BS), and decision curve analysis (DCA) were used to evaluate the risk model's discrimination, calibration, and clinical applicability. RESULTS Age, gender, diabetes mellitus (DM), drinking history, vascular branching angle, mean vascular diameter within 0.5-1.0 papillary diameter (PD), curvature tortuosity arteriole in the inferior region of the optic disc, and vascular density in the nasal region of the optic disc were identified as characteristic variables for carotid atherosclerosis with retinal microvascular intelligence analysis. The predictive nomogram model presented good discrimination with AUCs of 0.790 (0.774-0.806), and the calibration curve displayed high consistency between predicted and actual probability. The DCA demonstrated that this nomogram model led to net benefits in a threshold probability range of 20 %-94 % and could be adapted for clinical decision-making. The results of the 100-bootstrap resampling strategy for internal validation also show that the risk model is well discriminated with an AUC of 0.789 and excellent calibration. External validation showed good discrimination with AUCs of 0.703 (0.627 - 0.779) and good calibration, the risk threshold is 10 %-92 % in terms of DCA. CONCLUSIONS AND RELEVANCE The novel prediction model based on retinal microvascular intelligence analysis constructed in this study could be effective prognoses for predicting the risk of asymptomatic carotid atherosclerosis in a Chinese screening population.
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Affiliation(s)
- Yuqing Han
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Lihua Zhang
- Department of Ultrasonography, Tianjin Institute of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Zhenjie Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Saiguang Ling
- Evision Technology (Beijing) Co. Ltd., Beijing 100085, China
| | - Xue Zhang
- Evision Technology (Beijing) Co. Ltd., Beijing 100085, China
| | - Delin Yu
- Department of Ultrasonography, Tianjin Institute of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Zhiqing Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China.
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Lu Y, Hua Y, Wang B, Zhong F, Theophanous A, Tahir S, Lee PY, Sigal IA. The Robust Lamina Cribrosa Vasculature: Perfusion and Oxygenation Under Elevated Intraocular Pressure. Invest Ophthalmol Vis Sci 2024; 65:1. [PMID: 38691092 PMCID: PMC11077910 DOI: 10.1167/iovs.65.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/21/2024] [Indexed: 05/03/2024] Open
Abstract
Purpose Elevated intraocular pressure (IOP) is thought to cause lamina cribrosa (LC) blood vessel distortions and potentially collapse, adversely affecting LC hemodynamics, reducing oxygenation, and triggering, or contributing to, glaucomatous neuropathy. We assessed the robustness of LC perfusion and oxygenation to vessel collapses. Methods From histology, we reconstructed three-dimensional eye-specific LC vessel networks of two healthy monkey eyes. We used numerical simulations to estimate LC perfusion and from this the oxygenation. We then evaluated the effects of collapsing a fraction of LC vessels (0%-36%). The collapsed vessels were selected through three scenarios: stochastic (collapse randomly), systematic (collapse strictly by the magnitude of local experimentally determined IOP-induced compression), and mixed (a combination of stochastic and systematic). Results LC blood flow decreased linearly as vessels collapsed-faster for stochastic and mixed scenarios and slower for the systematic one. LC regions suffering severe hypoxia (oxygen <8 mm Hg) increased proportionally to the collapsed vessels in the systematic scenario. For the stochastic and mixed scenarios, severe hypoxia did not occur until 15% of vessels collapsed. Some LC regions had higher perfusion and oxygenation as vessels collapsed elsewhere. Some severely hypoxic regions maintained normal blood flow. Results were equivalent for both networks and patterns of experimental IOP-induced compression. Conclusions LC blood flow was sensitive to distributed vessel collapses (stochastic and mixed) and moderately vulnerable to clustered collapses (systematic). Conversely, LC oxygenation was robust to distributed vessel collapses and sensitive to clustered collapses. Locally normal flow does not imply adequate oxygenation. The actual nature of IOP-induced vessel collapse remains unknown.
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Affiliation(s)
- Yuankai Lu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Biomedical Engineering, University of Mississippi, Mississippi, United States
- Department of Mechanical Engineering, University of Mississippi, Mississippi, United States
| | - Bingrui Wang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Fuqiang Zhong
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Andrew Theophanous
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Shaharoz Tahir
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Po-Yi Lee
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ian A. Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Wang J, Li J, Shi Y, Chu T, Shen H, Qian X, Wang C. Effects of antivascular endothelial growth factor drug treatment on changes in vitreomacular interface, intraocular pressure and visual acuity of patients with age-related macular degeneration. Minerva Med 2023; 114:529-530. [PMID: 35332759 DOI: 10.23736/s0026-4806.22.08047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jihong Wang
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China -
| | - Jia Li
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yeqin Shi
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ting Chu
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Haicui Shen
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xin Qian
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Chun Wang
- Department of Ophthalmology, Affiliated Hospital of Jiangnan University, Wuxi, China
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Baek SU, Kwon S, Kim YK, Jeoung JW, Park KH. Diurnal change of retinal vessel density related to hemodynamic variation in treatment-naïve low-teens normal-tension glaucoma. Sci Rep 2023; 13:10613. [PMID: 37391532 PMCID: PMC10313821 DOI: 10.1038/s41598-023-37214-w] [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: 10/25/2022] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
This study undertook to investigate the diurnal variation of optical coherence tomography angiography (OCTA) -derived retinal vessel density (RVD) in glaucoma patients with low baseline intraocular pressure (IOP). A prospective evaluation was performed on low-teens normal-tension glaucoma (low-teens NTG) patients with pre-treatment IOP < 15 mmHg and 32 healthy subjects. Superficial peripapillary and macular RVD by OCTA, IOP, and systemic blood pressure (BP) were all measured four times per day (from 9:00 a.m. to 6:00 p.m.). In the low-teens NTG group, the magnitude of diurnal changes in peripapillary RVD and macular RVD were greater than those in the healthy group. Diurnal variations of diastolic BP (DBP) and mean ocular perfusion pressure (MOPP) also were greater in the low-teens NTG group. As for the patterns of diurnal RVD change, the inferior and temporal sections of macular RVD showed significant differences between the two groups. Diurnal changes of RVD and MOPP and were greater than those in healthy eyes. The macular RVD and MOPP showed different diurnal patterns between the two groups. From these findings, OCTA-derived RVD variation could be related to hemodynamic variability in low-teens NTG.
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Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Girkin CA, Garner MA, Fazio MA, Clark ME, Karuppanan U, Hubbard MG, Bianco G, Hubbard ST, Fortune B, Gross AK. Retinal electrophysiologic response to IOP elevation in living human eyes. Exp Eye Res 2023; 229:109420. [PMID: 36806673 PMCID: PMC11048619 DOI: 10.1016/j.exer.2023.109420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The relationships between intraocular pressure (IOP), ocular perfusion pressure (OPP), retinal perfusion, and retinal electrophysiologic responses have been explored experimentally across several animal models. These studies have demonstrated that elevated IOP reduces OPP, and when this reduction in OPP exceeds the autoregulatory capacity of the retina vasculature, retinal perfusion and electrophysiologic responses are reduced. This study aimed to evaluate these interactions for the first time in the living human eye. METHODS Five eyes from three research-consented brain-dead organ donors underwent optical coherence tomography with angiographic (OCT/A; Spectralis, Heidelberg Engineering) and electroretinographic (ERG, Diagnosys LLC) measurements while IOP was manometrically-elevated stepwise to pressures of 10, 30 and 50 mmHg. Systemic blood pressure (BP) was monitored continuously during testing. Correlation analysis was applied to assess association between ERG and OPP changes. In a single eye, prolonged IOP elevation was induced with viscoelastic injection and serial ERG measurements were obtained. RESULTS Reductions in inner retinal function defined by photopic ERG were observed with elevation in IOP and concomitant reduction in OPP. Reductions, especially in b-wave, and photopic negative response (PhNR) amplitudes and implicit times were significantly correlated with elevation in IOP and reduction in OPP. There were more appreciable changes in perfusion and functional responses in eyes tested while systemic blood pressure was lower. With prolonged IOP elevation, selective loss of the PhNR response was observed. CONCLUSIONS In the living human eye, retinal perfusion and inner retinal function are acutely impacted by elevation of IOP, and this impact is related to systemic BP and OPP. This novel approach provides a viable model to study the autoregulatory responses to IOP elevation in the living human eye.
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Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.
| | - Mary Anne Garner
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Udayakumar Karuppanan
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Meredith G Hubbard
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Gianfranco Bianco
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Seth T Hubbard
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Science and Technology Honors Program, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, Portland, OR, United States
| | - Alecia K Gross
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
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Wang R, Yang J, Shi L, Qu Y, Xu D, Liu Y, Li X. Changes of macular blood flow and structure in acute primary angle closure glaucoma. Int Ophthalmol 2022; 42:3789-3801. [PMID: 35781598 DOI: 10.1007/s10792-022-02399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE We assessed the relationship between acute primary angle closure glaucoma (APACG) severity and macular microcirculation, as well as the diagnostic ability of blood flow and macular structural parameters on optical coherence tomography angiography (OCTA) for APACG. METHODS APACG patients were assigned to mild, moderate, and severe groups in this cross-sectional study. Age-matched primary angle closure suspect (PACS) and healthy control groups were also recruited. The vessel density (VD) and foveal avascular zone (FAZ) in each macular superficial area were measured using OCTA. The retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) of the corresponding regions were measured using OCT. RESULTS All parameters in the control, PACS, and mild APACG groups differed significantly from those in the moderate and severe APACG groups (all P < 0.05). VD and RNFLT showed high and moderate diagnostic ability, respectively, to distinguish moderate APACG from PACS, with significant differences (P < 0.05) in areas under the receiver operating characteristic curve (AUCs) for VD and RNFLT in six macular areas. The diagnostic abilities of VD and RNFLT for distinguishing severe APACG from PACS were increased, with significant differences in the AUCs for VD and RNFLT in five macular areas (P < 0.05). All macular VDs and GCCTs were similar among the three APACG groups (P > 0.05). CONCLUSIONS Damage to the VD and FAZ in the macula increased with APACG severity. VD in the macular superficial layer showed a higher diagnostic ability than RNFLT, which was equivalent to that of GCCT.
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Affiliation(s)
- Rui Wang
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Jin Yang
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Liukun Shi
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Yue Qu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Dan Xu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Yufeng Liu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Xuan Li
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China.
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Behera G, Nagaraj GA, Thirunavukarasu SC, Jayaraman R, Murugesan R, Subramanian A. Effect of Blood Pressure Reduction on Intraocular Pressure and Ophthalmic Artery Blood Flow Velocity in Hypertension. J Ocul Pharmacol Ther 2021; 38:148-155. [PMID: 34964660 DOI: 10.1089/jop.2021.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the effect of reducing blood pressure (BP) by atenolol and amlodipine on (1) intraocular pressure (IOP) and (2) ophthalmic artery blood flow (OAF) velocity in new hypertensives. Methods: A prospective, observational cohort study conducted at a tertiary care center in India after IRB approval. New hypertensives treated with atenolol 25 mg or amlodipine 5 mg were divided into 2 groups of 30 patients each. BP, IOP by Goldmann applanation tonometry and OAF velocity by transcranial doppler sonography was performed before medication and post medication on day 1, 7, and 30. Results: There was a significant decrease in IOP with both drugs; the effect was greater with atenolol. Atenolol: premedication IOP - 16.06 ± 2.13 mmHg and day 30-12.46 ± 1.94 (22.4%) [P < 0.001], amlodipine: premedication IOP-15.13 ± 2.55 mmHg and day 30- 13.06 ± 2.14 (13.68%) [P < 0.001]. A decrease of 0.5 mmHg in IOP with every 10 mmHg (95% CI: 0.121-0.826, P value = 0.01) decrease in systolic BP was noted after oral atenolol. The OAF peak systolic velocity and mean flow velocity were equally reduced with both drugs (P < 0.001). The end-diastolic velocity, reduced only with atenolol (P = 0.049) but returned to baseline with amlodipine at 1 month. Conclusions: BP reduction by atenolol and amlodipine led to decreases in IOP and OAF velocity, greater with atenolol. The IOP decrease was likely due to reduced blood flow. A slight decrease in the diastolic flow of the ophthalmic artery was noted with atenolol.
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Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gururaj Alur Nagaraj
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI), Puducherry, India
| | | | - Ramesh Jayaraman
- Department of Internal Medicine, Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI), Puducherry, India
| | - Rajeswari Murugesan
- Department of Biostatistics, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandaraja Subramanian
- Department of Cardiology, Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI), Puducherry, India
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Vawda N, Munsamy AJ. A review of ocular perfusion pressure and retinal thickness: A case for the role of systemic hypotension in glaucoma. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Diener R, Leclaire MD, Eckardt F, Lauermann JL, Alnawaiseh M, Eter N, Treder M. CILIORETINAL ARTERIES INFLUENCE OPTIC NERVE HEAD, PERIPAPILLARY, AND MACULAR VESSEL DENSITIES IN HEALTHY EYES: An Optical Coherence Tomography Angiography Study. Retina 2021; 41:2399-2406. [PMID: 33990118 DOI: 10.1097/iae.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To analyze the influence of a cilioretinal artery (CRA) on macular and peripapillary vessel density in healthy eyes as measured using optical coherence tomography angiography. METHODS A total of 83 eyes of 83 patients were included in this study. Optical coherence tomography angiography was performed using the RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 3 × 3-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Optical coherence tomography angiography images of the optic nerve head were screened for the presence of a CRA. RESULTS In 31 eyes, a CRA was detected (37.3%). The vessel density in eyes with a CRA was significantly lower within the optic nerve head (P = 0.005) but higher in the peripapillary capillary network (P < 0.001) and (whole en face) macular superficial capillary plexus (P = 0.025), when compared with eyes with no CRA. CONCLUSION Our findings reveal that in eyes with a CRA, the vessel density in the peripapillary and macular superficial capillary plexus is increased, whereas the optic nerve head perfusion (as indicated by vessel density in the inside disk region) is decreased. This has to be considered when analyzing quantitative optical coherence tomography angiography parameters in scientific and clinical applications.
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Affiliation(s)
- Raphael Diener
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Martin D Leclaire
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Franziska Eckardt
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Jost L Lauermann
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
- Department of Ophthalmology, Fulda Medical Center, Fulda, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maximilian Treder
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
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Li Y, Li S, Wang Y, Zhou J, Yang J, Ma J. Effects of isometric resistance exercise of the lower limbs on intraocular pressure and ocular perfusion pressure among healthy adults: A meta-analysis. J Fr Ophtalmol 2021; 44:1596-1604. [PMID: 34454773 DOI: 10.1016/j.jfo.2021.05.005] [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: 03/26/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The main risks for glaucoma are increased intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP). This review aims to examine the potential impact of lower limb isometric resistance exercise on intraocular pressure and ocular perfusion pressure. METHOD A meta-analysis was conducted to determine the potential impact of isometric exercise on IOP and OPP. The literature on the relationship between isometric resistance exercise and IOP was systematically searched according to the "Cochrane Handbook" in the databases of Pubmed, Web of Science, EBSCO, and Scopus through December 31, 2020. The search terms used were "exercise," "train," "isometric," "intraocular pressure," and "ocular perfusion pressure," and the mean differences of the data were analyzed using the Stata 16.0 software, with a 95% confidence interval. RESULTS A total of 13 studies, which included 268 adult participants consisting of 162 men and 106 women, were selected. All the exercise programs that were included were isometric resistance exercises of the lower limbs with intervention times of 1min, 2min, or 6min. The increase in IOP after intervention was as follows: I2=87.1%, P=0.001 using random-effects model combined statistics, SMD=1.03 (0.48, 1.59), and the increase in OPP was as follows: I2=94.5%, P=0.001 using random-effects model combined statistics, SMD=2.94 (1.65, 4.22), with both results showing high heterogeneity. CONCLUSION As isometric exercise may cause an increase in IOP and OPP, therefore, people with glaucoma and related high risk should perform isometric exercise with caution.
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Affiliation(s)
- Y Li
- Zhengzhou Shengda University, Zhengzhou, China
| | - S Li
- Universiti Sains Malaysia, Kelantan, Malaysia
| | - Y Wang
- Inner Mongolia University, Inner Mongolia, China
| | - J Zhou
- Universiti Sains Malaysia, Kelantan, Malaysia
| | - J Yang
- Tangshan Hongci Hospital, Tangshan, China
| | - J Ma
- Hebei University of Architecture, Zhangjiakou, China.
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Krzyżanowska-Berkowska P, Czajor K, Iskander DR. Associating the biomarkers of ocular blood flow with lamina cribrosa parameters in normotensive glaucoma suspects. Comparison to glaucoma patients and healthy controls. PLoS One 2021; 16:e0248851. [PMID: 33755663 PMCID: PMC7987161 DOI: 10.1371/journal.pone.0248851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate association between ocular blood flow biomarkers and lamina cribrosa parameters in normotensive glaucoma suspects compared to glaucoma patients and healthy controls. Methods A total of 211 subjects (72 normotensive glaucoma suspects, 70 with primary open-angle glaucoma and 69 controls) were included. Ocular blood flow biomarkers in ophthalmic artery, central retinal artery, as well as in nasal and temporal short posterior ciliary arteries were measured using colour Doppler imaging. Lamina cribrosa position was assessed by measuring its depth, deflection depth, lamina cribrosa shape index and its horizontal equivalent (LCSIH) on B-scan images obtained using optical coherence tomography. Results Ocular blood flow biomarkers in glaucoma patients were statistically significantly reduced when compared to healthy controls in peak systolic velocity (PSV) (P = 0.001 in ophthalmic artery and P<0.001 in central retinal artery) and mean flow velocity (Vm) (P = 0.008 in ophthalmic artery and P = 0.008 in central retinal artery), but not statistically significantly different to that of glaucoma suspects except for PSV in central retinal artery (P = 0.011). Statistically significant correlations corrected for age, central corneal thickness and intraocular pressure were found in glaucoma patients between LCSIH and end diastolic velocity of central retinal artery (P = 0.011), and of nasal short posterior ciliary artery (P = 0.028), and between LCSIH and Vm of central retinal artery (P = 0.011) and of nasal short posterior ciliary artery (P = 0.007). No significant correlations were observed between these parameters in glaucoma suspects and healthy controls. Conclusions Impaired ocular blood flow associated with the deformation of lamina cribrosa was found in glaucoma patients, whereas glaucoma suspects had similar lamina cribrosa shape to glaucoma patients but that deformation was not associated with ocular blood flow biomarkers.
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Affiliation(s)
| | - Karolina Czajor
- Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - D. Robert Iskander
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland
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12
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Zhang W, Li L, Zou D, Ren Q, Zhang Y, Kang L, Gu X, Wu H, Zhang S, Zhu R, Zhang Y, Yang L. Retinal vessel oxygen saturation in patients with unilateral internal carotid artery stenosis: a pilot study. Acta Ophthalmol 2021; 99:e13-e18. [PMID: 32519804 DOI: 10.1111/aos.14503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/17/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the retinal vessel oxygen saturation in patients with internal carotid artery stenosis (ICAS). METHODS This is a cross-sectional study. Sixteen patients with unilateral moderate or worse ICAS (≥50%) and no fundus diseases were included in the study. Sixteen gender- and age-matched healthy subjects were selected as controls. The mean oxygen saturation and vessel diameters of the retinal arterioles and venules were obtained using a dual-wavelength spectrophotometric retinal oximeter. RESULTS In the eye of the stenotic side, the retinal vessel oxygen saturation was 100.14 ± 10.27% in the arterioles and 56.50 ± 10.79% in the venules, and the arteriovenous (A-V) difference was 43.63 ± 7.71%. In the eye of the contralateral side, the oxygen saturation was 96.55 ± 7.50% in the arterioles and 57.42 ± 9.84% in the venules, and the A-V difference was 39.39 ± 6.33%. In healthy subjects, the oxygen saturation was 93.22 ± 5.98% in the arterioles and 56.57 ± 7.05% in the venules, and the A-V difference was 36.65 ± 7.33%. The arteriolar oxygen saturation in the stenotic side was higher than that in the contralateral side (p = 0.025) and that in the healthy subjects (p = 0.027), and the A-V difference in the stenotic side was significantly higher than that in the contralateral side (p = 0.009) and that in the healthy subjects (p = 0.013). The diameters of the arterioles in the stenotic side were smaller than those in the healthy subjects (p = 0.030). CONCLUSIONS Patients with ICAS had decreased retinal arteriole diameters and increased retinal vessel oxygen saturation in the arterioles and A-V differences, suggesting the presence of microcirculation disorder and hyperoxia in the retina.
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Affiliation(s)
- Wenbo Zhang
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Liangliang Li
- Department of Ultrasonography Peking University First Hospital Beijing China
| | - Da Zou
- Department of Biomedical Engineering College of Engineering Peking University Beijing China
| | - Qiushi Ren
- Department of Biomedical Engineering College of Engineering Peking University Beijing China
| | - Yadi Zhang
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Lei Kang
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Xiaopeng Gu
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Hailong Wu
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Shijie Zhang
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Ruilin Zhu
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Yanzhen Zhang
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Liu Yang
- Department of Ophthalmology Peking University First Hospital Beijing China
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13
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Ahmed OM, Waisbourd M, Spaeth GL, Katz LJ. Improvement in structure and visual function in patients with glaucoma: the possible key to better treatment? Surv Ophthalmol 2020; 66:644-652. [PMID: 33316283 DOI: 10.1016/j.survophthal.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
Glaucoma is characterized by retinal ganglion cell loss that can lead to permanent visual loss. Current clinical management practice assumes that glaucomatous visual loss is irreversible; however, there is increasing evidence that permanent vision loss and cell death are preceded by reversible functional and structural changes. We propose that these changes should be considered by glaucoma specialists when treating their patients. We discuss the neurobiological basis of this phenomenon and provide clinical evidence of reversibility in both structure and function. Specifically, we review the findings of visual field testing, contrast sensitivity, electroretinography, and imaging of the optic nerve and their correlation with functional changes. We then discuss the clinical value of these observations in helping guide approaches toward the diagnosis and treatment of patients with glaucoma.
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Affiliation(s)
- Osama M Ahmed
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
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14
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Pappelis K, Choritz L, Jansonius NM. Microcirculatory model predicts blood flow and autoregulation range in the human retina: in vivo investigation with laser speckle flowgraphy. Am J Physiol Heart Circ Physiol 2020; 319:H1253-H1273. [PMID: 32986964 DOI: 10.1152/ajpheart.00404.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this study, we mathematically predict retinal vascular resistance (RVR) and retinal blood flow (RBF), we test predictions using laser speckle flowgraphy (LSFG), we estimate the range of vascular autoregulation, and we examine the relationship of RBF with the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). Fundus, optical coherence tomography (OCT), and OCT-angiography images, systolic/diastolic blood pressure (SBP/DBP), and intraocular pressure (IOP) measurements were obtained from 36 human subjects. We modeled two circulation markers (RVR and RBF) and estimated individualized lower/higher autoregulation limits (LARL/HARL), using retinal vessel calibers, fractal dimension, perfusion pressure, and population-based hematocrit values. Quantitative LSFG waveforms were extracted from vessels of the same eyes, before and during IOP elevation. LSFG metrics explained most variance in RVR (R2 = 0.77/P = 6.9·10-9) and RBF (R2 = 0.65/P = 1.0·10-6), suggesting that the markers strongly reflect blood flow physiology. Higher RBF was associated with thicker RNFL (P = 4.0·10-4) and GCC (P = 0.003), thus also verifying agreement with structural measurements. LARL was at SBP/DBP of 105/65 mmHg for the average subject without arterial hypertension and at 115/75 mmHg for the average hypertensive subject. Moreover, during IOP elevation, changes in RBF were more pronounced than changes in RVR. These observations physiologically imply that healthy subjects are already close to LARL, thus prone to hypoperfusion. In conclusion, we modeled two clinical markers and described a novel method to predict individualized autoregulation limits. These findings could improve understanding of retinal perfusion and pave the way for personalized intervention decisions, when treating patients with coexisting ophthalmic and cardiovascular pathologies.NEW & NOTEWORTHY We describe and test a new approach to quantify retinal blood flow, based on standard clinical examinations and imaging techniques, linked together with a physiological model. We use these findings to generate individualized estimates of the autoregulation range. We provide evidence that healthy subjects are closer to the lower autoregulation limit than thought before. This suggests that some retinas are less prepared to withstand hypoperfusion, even after small intraocular pressure rises or blood pressure drops.
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Affiliation(s)
- Konstantinos Pappelis
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Lars Choritz
- University Eye Clinic, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
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15
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Abstract
Cannabis ranks among the most commonly used psychotropic drugs worldwide. In the context of the global movement toward more widespread legalisation, there is a growing need toward developing a better understanding of the physiological and pathological effects. We provide an overview of the current evidence on the effects of cannabinoids on the eye. Of the identified cannabinoids, Δ9-tetrahydrocannabinol is recognized to be the primary psychotropic compound, and cannabidiol is the predominant nonpsychoactive ingredient. Despite demonstrating ocular hypotensive and neuroprotective activity, the use of cannabinoids as a treatment for glaucoma is limited by a large number of potential systemic and ophthalmic side effects. Anterior segment effects of cannabinoids are complex, with preliminary evidence showing decreased corneal endothelial density in chronic cannabinoid users. Experiments in rodents, however, have shown potential promise for the treatment of ocular surface injury via antinociceptive and antiinflammatory effects. Electroretinography studies demonstrating adverse effects on photoreceptor, bipolar, and ganglion cell function suggest links between cannabis and neuroretinal dysfunction. Neuro-ophthalmic associations include ocular motility deficits and decrements in smooth pursuit and saccadic eye movements, although potential therapeutic effects for congenital and acquired nystagmus have been observed.
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16
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Zhao D, He Z, Wang L, Fortune B, Lim JKH, Wong VHY, Nguyen CTO, Bui BV. Response of the Trilaminar Retinal Vessel Network to Intraocular Pressure Elevation in Rat Eyes. Invest Ophthalmol Vis Sci 2020; 61:2. [PMID: 32031574 PMCID: PMC7325622 DOI: 10.1167/iovs.61.2.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose The purpose of this study was to test the hypothesis that the superficial, intermediate, and deep retinal vascular plexus show different responses to intraocular pressure (IOP) elevation. Methods Anesthetized adult Long Evans rats (n = 14) were imaged using optical coherence tomography angiography (OCTA; Spectralis) at baseline (IOP 10 mm Hg) and in follow-up mode to examine the vasculature during IOP elevation (10 to 110 mm Hg, 10 mm Hg steps, each step 3 minutes). A 20° × 10° field was imaged. Vessel density within a 2D projection image was determined (%) for the superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Comparisons were made between layers using 2-way repeated measures ANOVA (layer versus IOP) following normalization to baseline (% relative to 10 mm Hg). Results The three vascular layers responded differently to IOP elevation. For IOPs between 40 and 60 mm Hg, DCP and ICP capillaries were significantly more resistant to IOP elevation than those in the SVC. When IOP was elevated above 70 mm Hg, all layers showed reduced vessel density. IOP induced change in SVC vessel density closely followed reductions in thickness of the inner retinal layers (nerve fiber, ganglion cell, and inner plexiform layer). This close relationship between reductions in tissue thickness and vessel density was less apparent for the ICP and DCP. Conclusions These data show that the intermediate and deep vascular plexus in the rat retina have a greater capacity for autoregulation against mild IOP elevation but are more affected at high IOP.
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17
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Lommatzsch C, Rothaus K, Koch JM, Heinz C, Grisanti S. Vessel Density in Glaucoma of Different Entities as Measured with Optical Coherence Tomography Angiography. Clin Ophthalmol 2019; 13:2527-2534. [PMID: 31908407 PMCID: PMC6925548 DOI: 10.2147/opth.s230192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/14/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose To compare papillary and macular vessel density (VD), as measured by optical coherence tomography angiography (OCTA), in eyes with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and exfoliation glaucoma (XFG). Methods The papillary and macular VD of 40 eyes with POAG, 19 with NTG and 21 with XFG were examined using OCTA (AngioVue™). The VD was measured at two different layers of segmentation (optic nerve head: radial peripapillary capillary [RPC] and nerve head [NH]; macula: superficial [SL] and deep [DL] retinal vascular plexus) with a 4.5×4.5mm papillary and 6×6-mm macular scan. VD was calculated by an automated density measuring tool in the AngioVue™ software. Results There were no significant differences in the total value of the papillary, peripapillary and macular VD. A significantly higher VD could be measured for NTG compared to POAG, as well as for XFG in the inferior nasal peripapillary sector at RPC-segmentation and at the NH-level between NDG and XFG. Conclusion OCTA can detect a difference in VD in the nasal inferior peripapillary sector in NTG compared with POAG and XFG. These findings may help to improve the understanding of further pathophysiological mechanisms.
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Affiliation(s)
- C Lommatzsch
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - K Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - J M Koch
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - C Heinz
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany.,Department of Ophthalmology, University of Essen, Essen, Germany
| | - S Grisanti
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
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18
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19
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Popa-Cherecheanu A, Schmidl D, Werkmeister RM, Chua J, Garhöfer G, Schmetterer L. Regulation of Choroidal Blood Flow During Isometric Exercise at Different Levels of Intraocular Pressure. Invest Ophthalmol Vis Sci 2019; 60:176-182. [PMID: 30640970 DOI: 10.1167/iovs.18-24992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose There is evidence that choroidal blood flow (ChBF) is regulated in a complex way during changes in ocular perfusion pressure (OPP). We hypothesized that ChBF regulates better in response to changes in mean arterial pressure (MAP) than in intraocular pressure (IOP). Methods Eighteen volunteers (mean age, 26 years) were recruited for a randomized, three-way crossover design. MAP was varied via isometric exercise. IOP was either kept normal or elevated by 10 or 20 mm Hg by using a suction cup. Subfoveal ChBF was measured continuously for 8 minutes with laser Doppler flowmetry and OPP was calculated as 2/3*MAP-IOP. For data analysis, values from all subjects were pooled according to either IOP or MAP values, and correlation analyses were done. Results When data were grouped according to IOP, no correlation was observed between ChBF and MAP, but ChBF was lower the higher the IOP (P < 0.001). When data were grouped according to MAP, a significant correlation was found between ChBF and IOP (P < 0.001). When data were pooled according to IOP, the correlation between ChBF and OPP was weaker (P < 0.05). The OPP at which ChBF significantly increased from baseline was 61.3% ± 4.9% without suction cup, 65.2% ± 3.5% when IOP was increased by 10 mm Hg, and slightly lower when IOP was increased by 20 mm Hg (56.3% ± 4.8%, P = 0.07), but this effect did not reach the level of significance. Conclusions The present study provides further evidence that the regulation of ChBF during changes in OPP is controlled by complex mechanisms in humans and has less capacity to adapt to IOP elevation than to MAP increase.
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Affiliation(s)
- Alina Popa-Cherecheanu
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - René M Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - 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 National Eye Centre, 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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20
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Kim YS, Han NR, Seo KH. Changes of intraocular pressure and ocular perfusion pressure during controlled hypotension in patients undergoing arthroscopic shoulder surgery: A prospective, randomized, controlled study comparing propofol, and desflurane anesthesia. Medicine (Baltimore) 2019; 98:e15461. [PMID: 31045821 PMCID: PMC6504298 DOI: 10.1097/md.0000000000015461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of the present study is to evaluate the effects of deliberate hypotensive anesthesia on intraocular pressure (IOP) and ocular perfusion pressure (OPP) and compare the effects of propofol total intravenous anesthesia (TIVA) and desflurane anesthesia on IOP and OPP. METHODS A total of 50 patients undergoing arthroscopic shoulder surgery in the lateral decubitus position were randomized to receive desflurane or propofol anesthesia. Mean arterial pressure (MAP) was maintained in the range of 60-75 mm Hg during hypotensive anesthesia. IOP was measured using a handheld tonometer at 7 time points: before induction (T1, baseline); immediately after endotracheal intubation (T2); 10 minutes after position change to lateral decubitus (T3); 10, 30, and 50 minutes after the start of hypotensive anesthesia (T4-T6); and at the end of surgery (T7). RESULTS MAP decreased about 35% to 38% during hypotensive anesthesia. Compared to baseline values, the IOP at T6 in dependent and non-dependent eyes decreased by 0.43 and 2.74 mm Hg, respectively in desflurane group; 3.61 and 6.05 mm Hg, respectively in the propofol group. IOP of both eyes in the propofol group was significantly lower than in the desflurane group from T2 to T7. OPP of both eyes in both groups was significantly lower than at baseline, except at T2 in the desflurane group. OPP of both eyes in the propofol group was significantly higher than that in the desflurane group at T5 and T6. CONCLUSIONS Hypotensive anesthesia reduced IOP and OPP, but propofol TIVA maintained higher OPP than desflurane anesthesia. These findings suggest that propofol TIVA can help mitigate the decrease of OPP during hypotensive anesthesia.
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Affiliation(s)
- Yong-Shin Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Na-Re Han
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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21
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Bata AM, Fondi K, Witkowska KJ, Werkmeister RM, Hommer A, Vass C, Resch H, Schmidl D, Popa‐Cherecheanu A, Chua J, Garhöfer G, Schmetterer L. Optic nerve head blood flow regulation during changes in arterial blood pressure in patients with primary open-angle glaucoma. Acta Ophthalmol 2019; 97:e36-e41. [PMID: 30218499 PMCID: PMC6492118 DOI: 10.1111/aos.13850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/20/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Abnormal autoregulation of optic nerve head blood flow (ONHBF) has been postulated to play an important role in primary open-angle glaucoma (POAG). We used laser Doppler flowmetry (LDF) to estimate quantitatively the ONHBF and compared ONHBF autoregulation between glaucoma patients and healthy controls during isometric exercise. METHODS Forty patients with POAG and 40 healthy age- and sex-matched subjects underwent three periods of isometric exercise, each consisting of 2 min of handgripping. Optic nerve head blood flow (ONHBF) was measured continuously using LDF. Systemic blood pressure, intraocular pressure and ocular perfusion pressure were assessed in all participants. RESULTS Isometric exercise was associated with an increase in ocular perfusion pressure during all handgripping periods in both groups (p < 0.001). However, there was no change in ONHBF in either group. Three of the glaucoma patients and two of the healthy subjects showed a consistent 10% decrease in blood flow during isometric exercise, in spite of an increase in their blood pressure. This difference between groups was not significant (p = 0.61). Four other glaucoma subjects showed a consistent increase in blood flow of more than 10% during isometric exercise, whereas this was not seen in healthy subjects (p = 0.035). CONCLUSION This study suggests that abnormal ONHBF autoregulation is more often seen in patients with POAG than healthy control subjects. The relationship to the glaucoma disease process is currently unknown and requires further investigation.
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Affiliation(s)
- Ahmed M. Bata
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Klemens Fondi
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | | | - René M. Werkmeister
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Anton Hommer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria,Department of OphthalmologySanatorium HeraViennaAustria
| | - Clemens Vass
- Department of OphthalmologyMedical University of ViennaViennaAustria
| | - Hemma Resch
- Department of OphthalmologyMedical University of ViennaViennaAustria
| | - Doreen Schmidl
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria,Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Alina Popa‐Cherecheanu
- Department of OphthalmologyEmergency University HospitalBucharestRomania,Carol Davila University of Medicine and PharmacyBucharestRomania
| | | | - Gerhard Garhöfer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Leopold Schmetterer
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria,Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria,Singapore Eye Research InstituteSingaporeSingapore,Lee Kong School of MedicineNanyang Technological UniversitySingaporeSingapore,Ophthalmology and Visual Sciences Academic Clinical ProgramDuke‐NUS Medical SchoolSingaporeSingapore
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22
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Wey S, Amanullah S, Spaeth GL, Ustaoglu M, Rahmatnejad K, Katz LJ. Is primary open-angle glaucoma an ocular manifestation of systemic disease? Graefes Arch Clin Exp Ophthalmol 2019; 257:665-673. [PMID: 30643967 DOI: 10.1007/s00417-019-04239-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/26/2018] [Accepted: 01/07/2019] [Indexed: 01/05/2023] Open
Abstract
Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a complex underlying pathophysiology that remains poorly elucidated. The roles of blood flow and intraocular pressure (IOP) in glaucoma pathogenesis have been extensively studied. Further, it has been established that lowering IOP can slow the progression of glaucoma. In addition, a number of influential factors have emerged and gained momentum over the years. Increasing evidence implicates the contributions of low cerebrospinal fluid pressure, autoimmunity, neurodegeneration, and impaired autoregulation towards glaucoma pathophysiology. We aggregate and explore these different camps of thought that have garnered attention over the last few decades, and, in doing so, aim to challenge the long-standing view of glaucoma as a primary disease of the eye. A shift in our perspective towards understanding glaucoma as an ocular manifestation of systemic dysregulation may lead ultimately to better clinical management of the disease.
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Affiliation(s)
- Stephanie Wey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah Amanullah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Melih Ustaoglu
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA.
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23
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Markert JE, Jasien JV, Turner DC, Huisingh C, Girkin CA, Downs JC. IOP, IOP Transient Impulse, Ocular Perfusion Pressure, and Mean Arterial Pressure Relationships in Nonhuman Primates Instrumented With Telemetry. Invest Ophthalmol Vis Sci 2018; 59:4496-4505. [PMID: 30208417 PMCID: PMC6133237 DOI: 10.1167/iovs.18-23802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose To characterize relationships between intraocular pressure (IOP), mean arterial pressure (MAP), ocular perfusion pressure (OPP), IOP transient impulse, and IOP baseline impulse using continuous telemetry in nonhuman primates. Methods We used our validated implantable telemetry system to wirelessly record bilateral IOP and arterial BP at 500 Hz in 7 eyes of 4 male rhesus macaques, aged 4 to 5 years. IOP, MAP, OPP, IOP transient impulse, and IOP baseline impulse were averaged into 1-hour periods over 20 days for each NHP. IOP transient impulse was defined as the portion of total IOP due to transient IOP fluctuations <0.5 seconds duration alone and IOP baseline impulse as the remaining area under the IOP versus time curve. OPP was defined as arterial BP-IOP (calculated continuously), and MAP was the hourly average of the continuous BP curve. Relationships between the variables were analyzed for each 24-hour period using either multivariate linear regression or Spearman Correlation Coefficients as appropriate. Results Over twenty 24-hour periods, IOP transient impulse and OPP showed significant positive relationship in all eyes, which was driven largely by the data during waking hours. There was no significant relationship between IOP and MAP, IOP transient impulse and MAP, or IOP baseline impulse and IOP transient impulse. Conclusions There are significant positive relationships between the frequency and/or size of transient IOP fluctuations (IOP transient impulse) and OPP. A possible explanation of this finding is that higher OPP, as well as a greater number of blinks and saccades (the primary sources of IOP transients), are associated with increased activity.
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Affiliation(s)
- John E Markert
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jessica V Jasien
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Daniel C Turner
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Carrie Huisingh
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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24
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Hosseinaee Z, Tan B, Martinez A, Bizheva KK. Comparative Study of Optical Coherence Tomography Angiography and Phase-Resolved Doppler Optical Coherence Tomography for Measurement of Retinal Blood Vessels Caliber. Transl Vis Sci Technol 2018; 7:18. [PMID: 30159211 PMCID: PMC6108529 DOI: 10.1167/tvst.7.4.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/12/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To compare the accuracy of Doppler optical coherence tomography (DOCT) and OCT angiography (OCTA) for measuring retinal blood vessel caliber at different flow rates. METHODS A research-grade 1060-nm OCT system with 3.5-μm axial resolution in retinal tissue and 92,000 A scan/s image acquisition rate was used in this study. DOCT and OCTA measurements were acquired both from a flow phantom and in vivo from retinal blood vessels in six male Brown Norway rats. The total retinal blood flow (TRBF) was modified from baseline to 70% and 20% of baseline by reducing the ocular perfusion pressure (OPP). The retinal blood vessel caliber (RBVC) was measured from OCTA and DOCT images. The caliber measurements were conducted by two separate graders using a custom MATLAB-based image processing algorithm. RESULTS The RBVC measured with OCTA and DOCT for normal blood flow rates were not significantly different (56.69 ± 12.17 and 57.17 ± 9.46 μm, P = 0.27, respectively). However, significant differences were detected when TRBF was reduced to 70% (55.69 ± 11.56 vs. 50.62 ± 8.85 μm, P < 0.01) and 20% (50.29 ± 9.29 vs. 44.88 ± 7.13 μm, P < 0.01) of baseline. CONCLUSIONS Reduced TRBF resulted in inaccuracy of the RBVC measurements with DOCT in both the phantom and animal study. This result suggests that OCTA is a more accurate tool for RBVC evaluation when applied to retinal diseases associated with reduced TRBF, such as glaucoma and diabetic retinopathy. TRANSLATIONAL RELEVANCE Results from this study are directly applicable to clinical studies of retinal blood flow measured with OCTA and DOCT.
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Affiliation(s)
- Zohreh Hosseinaee
- Department of System Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
| | - Bingyao Tan
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
| | - Adam Martinez
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
| | - Kostadinka K. Bizheva
- Department of System Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Zhang Q, Jonas JB, Wang Q, Chan SY, Xu L, Wei WB, Wang YX. Optical Coherence Tomography Angiography Vessel Density Changes after Acute Intraocular Pressure Elevation. Sci Rep 2018; 8:6024. [PMID: 29662112 PMCID: PMC5902444 DOI: 10.1038/s41598-018-24520-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/05/2018] [Indexed: 01/08/2023] Open
Abstract
To investigate changes in retinal vessel density in optic nerve head (ONH) and macula after acute intraocular pressure (IOP) elevation, we conducted a prospective observational study. Eyes with IOP rise ≥5 mmHg after 2-hour dark room prone provocative test (DRPPT) were included. Vasculature of ONH and macula was examined by optical coherence tomography angiography (OCTA) at baseline and after DRPPT. Among the 65 eyes of 42 individuals, 40 eyes with qualified images were enrolled. Mean IOP rise was 9.6 ± 4.2 mmHg (5.0-23.3 mmHg) after DRPPT. Retinal vessel density did not differ after IOP rise for either the papillary region (optic nerve head and radial peripapillary capillary layer) or the macula region (superficial, deep and outer retinal layer) (P > 0.05). Vessel density in each subregion did not change either. If only enrolled eyes with IOP rise ≥10 mmHg, similar results were obtained in condition of IOP increase by 15.0 ± 3.6 mmHg. To conclude, eyes with an acute IOP elevation by 10 or 15 mmHg for two hours, while the blood pressure remained constant, the vessel density in both ONH and macula region examined by OCTA did not show significant changes. The observations fit with an IOP-related autoregulation in retinal blood flow for a moderate elevation of IOP.
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Affiliation(s)
- Qi Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik, Heidelberg, Germany
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Szy Yann Chan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
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Patel N, McAllister F, Pardon L, Harwerth R. The effects of graded intraocular pressure challenge on the optic nerve head. Exp Eye Res 2018; 169:79-90. [PMID: 29409880 PMCID: PMC5878999 DOI: 10.1016/j.exer.2018.01.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
Intraocular pressure (IOP) is an important risk factor for glaucoma, and the response of the ONH and surrounding tissues to elevated IOP are often investigated to better understand pathophysiology. In vivo structure including that of the optic nerve head (ONH) and surrounding tissue of the eye are often assessed using optical coherence tomography (OCT). With advances in OCT technology, both large vessels and capillaries can be imaged non-invasively (OCT Angiography). Because a significant portion of retinal thickness is comprised of vasculature, the purpose of the current study was to investigate OCT structural and vascular changes in healthy non-human primate eyes with systematic graded increases and decreases in IOP. Six healthy animals with no previous experimental intervention were used. The pressure in the anterior chamber was adjusted from 10 mmHg to 60 mmHg and back to 10 mmHg in 10 mmHg steps every 10 min. Using optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, minimum rim width (MRW), Bruch's membrane opening (BMO) size and relative height, anterior lamina cribrosa surface (ALCS) depth, choroidal thickness, and angiography (OCTA) were quantified. With IOP challenge there were significant changes in all morphological measures quantified (p < 0.01) other than BMO size (p = 0.30) and RNFL thickness (p = 0.29). Specifically, the position of the BMO was sensitive to both an increase and decease in IOP. The inner retinal capillary density gradually decreased with increasing IOP, reaching statistical significance when pressure exceeded 50 mmHg, but returned when IOP was reduced. The average choroidal thickness around the ONH decreased for elliptical annuli 500-1000 μm and 1000-1500 μm, from the BMO, with increasing IOP (p < 0.01). For the 1000-1500 μm annulus, choroid thickness did not return to baseline with IOP reduction. Similarly, the MRW decreased with increase in IOP, but with pressure reduction did not return, and at the final 10 mmHg time point was thinner than at baseline (p < 0.01). The results from this experiment illustrate differences in ONH neural rim tissue, RNFL and vessel density changes with acute IOP challenge. Overall, vessel collapse could not completely account for changes in RNFL or ONH MRW thickness. The study supports the hypothesis neural rim compression may be an important part of IOP-induced damage.
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Affiliation(s)
- Nimesh Patel
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA.
| | - Faith McAllister
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
| | - Laura Pardon
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
| | - Ronald Harwerth
- University of Houston, College of Optometry, 4901 Calhoun Road, Houston, TX 77204, USA
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Comparison of Optic Nerve Head Blood Flow Autoregulation among Quadrants Induced by Decreased Ocular Perfusion Pressure during Vitrectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2017:6041590. [PMID: 29362713 PMCID: PMC5738581 DOI: 10.1155/2017/6041590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
Abstract
Purpose The present study aimed to examine changes in optic nerve head (ONH) blood flow autoregulation in 4 quadrants (superior, nasal, inferior, and temporal) with decreased ocular perfusion pressure (OPP) during vitrectomy in order to determine whether there is a significant difference of autoregulatory capacity in response to OPP decrease at each ONH quadrant. Methods This study included 24 eyes with an epiretinal membrane or macular hole that underwent vitrectomy at Toho University Sakura Medical Center. Following vitrectomy, the tissue mean blur rate (MBR), which reflects ONH blood flow, was measured. Mean tissue MBRs in the four quadrants were generated automatically in the software analysis report. Measurements were conducted before and 5 and 10 min after intraocular pressure (IOP) elevation of approximately 15 mmHg in the subjects without systemic disorders. Results The baseline tissue MBR of the temporal quadrant was significantly lower than that of the other 3 quadrants (all P < 0.05). However, the time courses of tissue MBR in response to OPP decrease were not significantly different among the four quadrants during vitrectomy (P = 0.23). Conclusions There is no significant difference in the autoregulatory capacity of the four ONH quadrants in patients without systemic disorders during vitrectomy.
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Witkowska KJ, Bata AM, Calzetti G, Luft N, Fondi K, Wozniak PA, Schmidl D, Bolz M, Popa-Cherecheanu A, Werkmeister RM, Garhöfer G, Schmetterer L. Optic nerve head and retinal blood flow regulation during isometric exercise as assessed with laser speckle flowgraphy. PLoS One 2017; 12:e0184772. [PMID: 28898284 PMCID: PMC5595424 DOI: 10.1371/journal.pone.0184772] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to investigate regulation of blood flow (BF) in the optic nerve head (ONH) and a peripapillary region (PPR) during an isometric exercise-induced increase in ocular perfusion pressure (OPP) using laser speckle flowgraphy (LSFG) in healthy subjects. For this purpose, a total of 27 subjects was included in this study. Mean blur rate in tissue (MT) was measured in the ONH and in a PPR as well as relative flow volume (RFV) in retinal arteries (ART) and veins (VEIN) using LSFG. All participants performed isometric exercise for 6 minutes during which MT and mean arterial pressure were measured every minute. From these data OPP and pressure/flow curves were calculated. Isometric exercise increased OPP, MTONH and MTPRR. The relative increase in OPP (78.5 ± 19.8%) was more pronounced than the increase in BF parameters (MTONH: 18.1 ± 7.7%, MTPRR: 21.1 ± 8.3%, RFVART: 16.5 ±12.0%, RFVVEIN: 17.7 ± 12.4%) indicating for an autoregulatory response of the vasculature. The pressure/flow curves show that MTONH, MTPRR, RFVART, RFVVEIN started to increase at OPP levels of 51.2 ± 2.0%, 58.1 ± 2.4%, 45.6 ± 1.9% and 45.6 ± 1.9% above baseline. These data indicate that ONHBF starts to increase at levels of approx. 50% increase in OPP: This is slightly lower than the values we previously reported from LDF data. Signals from the PPR may have input from both, the retina and the choroid, but the relative contribution is unknown. In addition, retinal BF appears to increase at slightly lower OPP values of approximately 45%. LSFG may be used to study ONH autoregulation in diseases such as glaucoma. Trial Registration: ClinicalTrials.gov NCT02102880
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Affiliation(s)
| | - Ahmed M. Bata
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Nikolaus Luft
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria
| | - Klemens Fondi
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Piotr A. Wozniak
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - 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
| | - 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, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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Ocular fundus pulsations within the posterior rat eye: Chorioscleral motion and response to elevated intraocular pressure. Sci Rep 2017; 7:8780. [PMID: 28821834 PMCID: PMC5562765 DOI: 10.1038/s41598-017-09310-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
A multi-functional optical coherence tomography (OCT) approach is presented to determine ocular fundus pulsations as an axial displacement between the retina and the chorioscleral complex in the albino rat eye. By combining optical coherence elastography and OCT angiography (OCTA), we measure subtle deformations in the nanometer range within the eye and simultaneously map retinal and choroidal perfusion. The conventional OCT reflectivity contrast serves as a backbone to segment the retina and to define several slabs which are subsequently used for quantitative ocular pulsation measurements as well as for a qualitative exploration of the multi-functional OCT image data. The proposed concept is applied in healthy albino rats as well as in rats under acute elevation of the intraocular pressure (IOP). The evaluation of this experiment revealed an increased pulsatility and deformation between the retinal and chorioscleral complex while increasing the IOP level from 15 mmHg to 65 mmHg. At IOP levels exceeding 65 mmHg, the pulsatility decreased significantly and retinal as well as choroidal perfusion vanished in OCTA. Furthermore, the evaluation of the multi-parametric experiment revealed a spatial correlation between fundus pulsatility and choroidal blood flow. This indicates that the assessed pulsatility may be a valuable parameter describing the choroidal perfusion.
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Yang H, Reynaud J, Lockwood H, Williams G, Hardin C, Reyes L, Stowell C, Gardiner SK, Burgoyne CF. The connective tissue phenotype of glaucomatous cupping in the monkey eye - Clinical and research implications. Prog Retin Eye Res 2017; 59:1-52. [PMID: 28300644 PMCID: PMC5603293 DOI: 10.1016/j.preteyeres.2017.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon, laminar beam and retrolaminar capillary homeostasis that may initially be "protective" but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Juan Reynaud
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Howard Lockwood
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Galen Williams
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Luke Reyes
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Cheri Stowell
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, OR, United States; Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, OR, United States.
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Hashimoto R, Sugiyama T, Ubuka M, Maeno T. Autoregulation of Optic Nerve Head Blood Flow Induced by Elevated Intraocular Pressure during Vitreous Surgery. Curr Eye Res 2016; 42:625-628. [PMID: 27767373 DOI: 10.1080/02713683.2016.1220592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate optic nerve head (ONH) blood flow changes resulting from intraocular pressure (IOP) elevation in subjects without systemic disorders. MATERIALS AND METHODS Eighteen eyes of 18 patients who underwent vitrectomy to treat an epiretinal membrane or macular hole at Toho University Sakura Medical Center were included. Following standard 25-gauge microincision vitreous surgery, mean blur rate (MBR) in tissue (MT), an index of ONH blood flow, was measured using laser speckle flowgraphy. Measurements were taken before and 5 and 10 minutes after a 15 mmHg IOP elevation. RESULTS The ONH blood flow was initially lower than baseline (P = 0.001) after elevating IOP from 14.8 ± 2.8 mmHg to approximately 30 mmHg. Between 5 and 10 minutes after elevating IOP, ONH blood flow partially recovered (P = 0.004), even though ocular perfusion pressure was 20.2% lower than at baseline. CONCLUSIONS The ONH blood flow in subjects without systemic disorders was initially lower, but began to recover 5-10 minutes after a 15 mmHg elevation in IOP. These results indicate that autoregulatory mechanisms of ONH blood flow may help to minimize the effects of IOP elevations and fluctuations during vitreous surgery.
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Affiliation(s)
- Ryuya Hashimoto
- a Department of Ophthalmology , Toho University Sakura Medical Center , Chiba , Japan
| | - Tetsuya Sugiyama
- b Nakano Eye Clinic of Kyoto Medical Co-operative , Kyoto , Japan
| | - Makoto Ubuka
- a Department of Ophthalmology , Toho University Sakura Medical Center , Chiba , Japan
| | - Takatoshi Maeno
- a Department of Ophthalmology , Toho University Sakura Medical Center , Chiba , Japan
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Ocular Decompression Retinopathy After Uncomplicated Cataract Surgery in a Patient With a History of Narrow-Angle Glaucoma. J Glaucoma 2016; 25:e756-8. [PMID: 27175993 DOI: 10.1097/ijg.0000000000000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of ocular decompression retinopathy following uncomplicated cataract surgery in a patient with phacomorphic narrow-angle glaucoma. METHODS Case report with wide-field fundus imaging. RESULTS A 57-year-old woman with a history of phacomorphic narrow-angle glaucoma presented 1 day after uncomplicated cataract extraction with intraocular lens insertion of the left eye with hand motion vision. She was found to have decompression retinopathy with large prefoveal subhyaloid hemorrhage. The hemorrhages gradually improved over time with observation. CONCLUSIONS We report a case of decompression retinopathy after uncomplicated cataract extraction in a patient with phacomorphic narrow-angle glaucoma. This report expands upon the procedures after which decompression retinopathy has been diagnosed and suggests a need for careful perioperative management in patients with glaucoma.
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Cull G, Told R, Burgoyne CF, Thompson S, Fortune B, Wang L. Compromised Optic Nerve Blood Flow and Autoregulation Secondary to Neural Degeneration. Invest Ophthalmol Vis Sci 2016; 56:7286-92. [PMID: 26551332 DOI: 10.1167/iovs.15-17879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To test the hypothesis that optic nerve head (ONH) blood flow (BF) and autoregulation compromise are consequences of optic nerve degeneration induced by surgical optic nerve transection (ONT). METHODS In both eyes of five nonhuman primates, peripapillary retinal nerve fiber layer thickness (RNFLT) was measured by spectral-domain optical coherence tomography. Optic nerve head BF and dynamic autoregulation responses to a rapid manometric IOP increase (from 10-40 mm Hg) were measured by Laser Speckle Flowgraphy. The measurements were conducted every 10 to 15 days before and after unilateral ONT. Post-ONT measurements were repeated until RNFLT in the ONT eye was reduced by more than 40% of baseline value. RESULTS After ONT, RNFLT, and ONH BF progressively declined over time (P < 0.0001 and P = 0.02, respectively). Longitudinal changes between the two were highly correlated (P < 0.0001). When data was grouped by test session, the first significant decreases for RNFLT and BF were found 13 ± 0.8 and 24 ± 3.2 days post ONT, respectively (P < 0.05, both). At the final time point (55 ± 0.5 days post ONT), RNFLT, and BF were reduced by 44% ± 2.0% and 38 ± 5.0% from baseline, respectively. Dynamic autoregulation analysis showed marginal increased response time in post-ONT eyes (P = 0.05). Control eyes showed no longitudinal changes for any parameter. CONCLUSIONS The close association between RNFLT loss and ONH BF decrease following optic nerve degeneration demonstrated a clear cause and effect relationship. Increased BF response time appears to be a sign of dynamic autoregulation dysfunction in this ONT model.
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Affiliation(s)
- Grant Cull
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Reinhard Told
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Claude F Burgoyne
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Simon Thompson
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
| | - Lin Wang
- Devers Eye Institute Legacy Research Institute, Portland, Oregon, United States
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Fernández-Fernández FJ, Merino Rego D, Sesma P. Cronoterapia con fármacos antihipertensivos y glaucoma. Med Clin (Barc) 2016; 146:45-6. [DOI: 10.1016/j.medcli.2015.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Pillunat KR, Spoerl E, Jasper C, Furashova O, Hermann C, Borrmann A, Passauer J, Middeke M, Pillunat LE. Nocturnal blood pressure in primary open-angle glaucoma. Acta Ophthalmol 2015; 93:e621-6. [PMID: 25913492 DOI: 10.1111/aos.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/18/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the nocturnal blood pressure (BP) dipping-pattern in patients with manifest primary open-angle glaucoma (POAG) and to find possible associations with the severity of visual field damage. METHODS A number of 314 patients suffering from POAG were consecutively enrolled in this cross-sectional hospital-based study. Each patient had diurnal intraocular pressure (IOP) measurements, 24-hr BP monitoring and computerized perimetry with the Humphrey 30-2 sita Standard program. Inclusion criteria were a mean IOP of less than 15 mmHg with fluctuations of less than 5 mmHg and a visual acuity of at least 20/40. One eye was randomly selected. Based on the night-day BP ratio, a mean arterial nocturnal BP drop of less than 10% was considered as non-dipping, between 10% and 20% as physiological dipping and of more than 20% as over-dipping. RESULTS Glaucoma patients with daytime systemic normotension on the average had more visual field loss in the over-dipper group (MD = - 16.6 dB, IQR = -18.9 to -2.7 dB) than glaucoma patients with daytime systemic hypertension, who had less visual field defects in the over-dipper group (MD = -3.9 dB, IQR = -6.2 to -1.9 dB) (p = 0.004). This result was also found taking age, glaucoma duration, visual acuity, gender, systemic and topical medication as covariates into account. CONCLUSIONS To judge the nocturnal BP situation of an individual patient, it is important to do this in relation to the daytime BP level. Twenty-four-hour BP evaluation might be important for all patients with POAG, as nocturnal BP could be a modifiable risk factor for glaucoma severity and progression.
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Affiliation(s)
- Karin R. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Eberhard Spoerl
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Carolin Jasper
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Olga Furashova
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Cosima Hermann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Anne Borrmann
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Jens Passauer
- Department of Internal Medicine; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
| | - Martin Middeke
- Hypertension Center Munich; Excellence Centre of the European Society of Hypertension; Munich Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology; University Hospital Carl Gustav Carus; TU Dresden; Dresden Germany
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Choi J, Kook MS. Systemic and Ocular Hemodynamic Risk Factors in Glaucoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:141905. [PMID: 26557650 PMCID: PMC4628774 DOI: 10.1155/2015/141905] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/03/2015] [Indexed: 01/31/2023]
Abstract
Primary open angle glaucoma (POAG) is a multifactorial disease characterized by progressive retinal ganglion cell death and visual field loss. It is known that alterations in intraocular pressure (IOP), blood pressure (BP), and ocular perfusion pressure (OPP) can play a significant role in the pathogenesis of the disease. Impaired autoregulatory capacity of ocular blood vessels may render tissues vulnerable to OPP changes and potentially harmful tissue ischemia-reperfusion damage. Vascular risk factors should be considered more important in a subgroup of patients with POAG, and especially in patients with normal tension glaucoma (NTG) with evidence of unphysiological BP response. For example, reduction of BP during the nighttime has an influence on OPP, and increased circadian OPP fluctuation, which might stand for unstable ocular blood flow, has been found to be the consistent risk factor for NTG development and progression. Central visual field may be affected more severely than peripheral visual field in NTG patients with higher 24-hour fluctuation of OPP. This review will discuss the current understanding of allegedly major systemic and ocular hemodynamic risk factors for glaucoma including systemic hypertension, arterial stiffness, antihypertensive medication, exaggerated nocturnal hypotension, OPP, and autonomic dysregulation.
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Affiliation(s)
- Jaewan Choi
- Central Seoul Eye Center, 224 Ichon-ro, Yongsan-gu, Seoul 04427, Republic of Korea
| | - Michael S. Kook
- Department of Ophthalmology, University of Ulsan, Asan Medical Center, Seoul 05505, Republic of Korea
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