Marathon Runner’s Retinopathy

Changes in blood rheological properties and biochemical markers after participation in the XTERRA Poland triathlon competition

The importance of physical activity in preventing chronic cardiovascular and metabolic diseases and the role of exercise as an adjunct therapy are widely recognized. Triathlon is a typically endurance discipline. Prolonged and intensive exercise is known to cause changes in blood rheological properties and biochemical markers; sometimes athletes participating in strenuous competitions need medical attention. To understand the phenomena occurring in the body in such situations, we decided to study participants’ biomarkers after the XTERRA Poland 2017 triathlon competition. The study involved 10 triathletes. The XTERRA Poland 2017 event comprised 1500-m swimming, 36-km cycling, and 10-km mountain running. Blood samples were collected 2 days before, immediately after, and 16 h after the competition. Immediately after the race, white blood cells count, platelets, and uric acid levels were significantly (P < 0.001) increased; haematocrit, Na⁺, Cl^–, and IgA were decreased. On the following day, Na⁺, Cl^–, and C-reactive protein levels were significantly (P < 0.001) increased; white blood cells count, red blood cells count, haemoglobin, haematocrit, mean corpuscular volume, platelets, IgG, and IgA were decreased. Assessing rheological parameters such as erythrocyte deformability and aggregation is useful for monitoring adverse effects of intensive and exhaustive exercise. The study illustrates the change in blood rheological properties and biochemical markers after intensive physical effort. Despite these differences, the indicators were within the reference range for the general population, which may demonstrate normal body function in the studied triathletes.

Retinal and choroidal blood flow variations after an endurance exercise: A real-life pilot study at the Paris Marathon

OBJECTIVES

To collect information about the retinal blood flow variations and other choroidal and retinal parameters during a prolonged effort such as marathon running.

DESIGN

Non-randomized prospective cohort study.

METHODS

Patients were recruited through an information campaign at the Rothschild Foundation Hospital (Paris, France). A first visit (V1) was planned in the month before the marathon. All participants underwent blood pressure measurement, fundus photography, spectral domain-optical coherence tomography (SD-OCT) and OCT-angiography (OCT-A). A second visit (V2) was scheduled within one hour of crossing the finish line. The same tests were repeated, using the same equipment.

RESULTS

Of the 31 runners who were included, 29 finished the marathon and attended V2. At baseline, various ophthalmological abnormalities were found in 45.2% of the 58 eyes, among which almost a third concerned the optic nerve and a quarter the pachychoroid spectrum. A significant decrease in retinal vascular plexus density was found between V1 and V2 (p<0.01). While median macular and retinal nerve fiber layer (RNFL) thicknesses significantly increased after the marathon (p<0.01), median choroidal thickness significantly decreased (p<0.01). Both systolic and diastolic blood pressures significantly decreased (p<0.01 and p=0.021 respectively).

CONCLUSIONS

Prolonged physical effort impacts the structure and vascularization of the retina and the choroid. Hypoxia and dehydration due to such an effort may induce a low ocular blood flow rate resulting in a choroidal thinning, contrasting with a transient subclinical ischemic edema of the inner retina and optic nerve head.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03864380.

Impact of vigorous effort on blood morphological indicators in triathletes participating in the XTERRA Poland 2017 competition

Purpose: The aim of the study was to determine the influence of participation in the XTERRA Poland 2017 triathlon on blood morphology indicators. Material and methods: The study was performed in a group among 10 triathletes aged 30-40 years. Blood was collected 24 hours before, immediately after , and 16 hours after the competition. Blood morphological indicators were evaluated using the ABXMicros60 analyser. Results: Comparison of the results among the first (24 hours before the competition), second (immediately after the competition), and third assessment (16 hours after the competition) revealed statistically significant changes for WBC [109/l], RBC [1012/l], HGB [g/l], HCT [l/l], MCV [fl] and PLT [109/l]. Conclusions: The intensity of effort in the XTERRA Poland 2017 triathlon competitors was confirmed in the results of blood morphology. Blood counts in those practicing triathlon well characterise the actual scope and direction of exercise changes and allow for the diagnosis of transient adaptive effects. The results of the research confirmed that vigorous physical effort during the triathlon increased leukocyte and platelet counts, but 16 hours after completing the competition, their value was close to baseline level. Most likely, this phenomenon was caused by the intense effort, stress or even eating a large meal before the competition. Analysing the red blood cell system showed a tendency towards decrease in the number of red blood cells, HGB and HCT both after the competition and 16 hours after its completion, which results from increased post-exercise haemolysis or the risk of anaemia.

[Combined retinal vascular occlusion after overexertion in sport at a young age : An unusual case as interdisciplinary challenge]

This case report presents a unilateral visual impairment after overexertion in sport at a young age. A combined central retinal vein occlusion with a cilioretinal arterial branch occlusion was diagnosed. This clinical picture has been described in case series and does not usually have an embolic etiology. In the cardiovascular clarification a patent foramen ovale was found, which was surgically closed.

Anti-VEGF in a Marathon Runner's Retinopathy Case

Central retinal vein occlusion (CRVO) is one of the most common retinal vascular disorders. Intense exercise associated CRVO have been described in otherwise healthy young patients. We describe a case of a young male ultramarathoner who presented with a CRVO, presumably associated with dehydration, making part of a marathon runner's retinopathy. Resolution of macular edema and subretinal fluid, with visual acuity improvement, was observed after 3 monthly injections of ranibizumab. Our case suggests that dehydration could be involved in the mechanism of CRVO in healthy young patients and ranibizumab may be an effective treatment option for marathon runner's retinopathy.

Treatment of Valsalva retinopathy

PURPOSE

To report a case of Valsalva retinopathy treated by neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and discuss the previously reported treatments for Valsalva retinopathy.

CASE REPORT

A 35-year-old-woman experienced a sudden painless visual loss in her left eye after lifting heavy bags of manure on the farm. The patient was diagnosed as having Valsalva retinopathy. The examination revealed a macular preretinal hemorrhage. An Nd:YAG laser was used on the patient after conservative management afforded no resolution. After treatment, visual acuity improved.

CONCLUSIONS

Valsalva retinopathy can be treated by conservative management, Nd:YAG laser, and vitrectomy, but each treatment must be evaluated in regard to the duration, the location, and the amount of the hemorrhage.

Elk3 deficiency causes transient impairment in post-natal retinal vascular development and formation of tortuous arteries in adult murine retinae

Serum Response Factor (SRF) fulfills essential roles in post-natal retinal angiogenesis and adult neovascularization. These functions have been attributed to the recruitment by SRF of the cofactors Myocardin-Related Transcription Factors MRTF-A and -B, but not the Ternary Complex Factors (TCFs) Elk1 and Elk4. The role of the third TCF, Elk3, remained unknown. We generated a new Elk3 knockout mouse line and showed that Elk3 had specific, non-redundant functions in the retinal vasculature. In Elk3(−/−) mice, post-natal retinal angiogenesis was transiently delayed until P8, after which it proceeded normally. Interestingly, tortuous arteries developed in Elk3(−/−) mice from the age of four weeks, and persisted into late adulthood. Tortuous vessels have been observed in human pathologies, e.g. in ROP and FEVR. These human disorders were linked to altered activities of vascular endothelial growth factor (VEGF) in the affected eyes. However, in Elk3(−/−) mice, we did not observe any changes in VEGF or several other potential confounding factors, including mural cell coverage and blood pressure. Instead, concurrent with the post-natal transient delay of radial outgrowth and the formation of adult tortuous arteries, Elk3-dependent effects on the expression of Angiopoietin/Tie-signalling components were observed. Moreover, in vitro microvessel sprouting and microtube formation from P10 and adult aortic ring explants were reduced. Collectively, these results indicate that Elk3 has distinct roles in maintaining retinal artery integrity. The Elk3 knockout mouse is presented as a new animal model to study retinal artery tortuousity in mice and human patients.

Central retinal vein occlusion after prolonged vomiting and repeated valsalva maneuvers associated with gastroenteritis and dehydration

A 44-year-old man presented with central retinal vein occlusion (CRVO) in his right eye after prolonged vomiting and repeated Valsalva maneuvers associated with gastroenteritis and dehydration. He had no other pertinent medical history, and a subsequent systemic and hematologic evaluation was within normal limits. At initial diagnosis, his visual acuity was 20/70 due to diffuse cystoid macular edema (CME) and nonischemic CRVO. After six monthly intravitreal bevacizumab injections, his vision improved to 20/20 and the CME greatly improved. An episode of prolonged vomiting and repeated Valsalva maneuvers may be a potential risk factor for CRVO in younger patients.

Central retinal vein occlusion after intense exercise: response to intravitreal bevacizumab

A 40-year-old male athlete developed a central retinal vein occlusion after intense exercise and secondary dehydration. A comprehensive systemic evaluation was within the normal range. After a series of 11 intravitreal injections of bevacizumab over a 24-month period, spectral-domain optical coherence tomography showed resolution of macular edema with a 55-letter gain in visual acuity.