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Gül C, Erşan HBA, Karapapak M, Güven D. Optical Coherence Tomography Angiography Evaluation of Retinal and Choroidal Microvascular Morphological Changes Following Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2024:1-7. [PMID: 38940311 DOI: 10.3928/01913913-20240508-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
PURPOSE To evaluate the structural and microvascular changes in the retina and choroid after strabismus surgery. METHODS The study included 44 eyes from 44 patients who underwent strabismus surgery between August 2020 and December 2021. Among these patients, 9 (20%) underwent horizontal one-muscle surgery, 27 (61%) underwent horizontal two-muscle surgery, and 8 (18%) underwent inferior oblique muscle anteriorization surgery. Optical coherence tomography angiography scans were conducted preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS The outer retinal blood flow showed a significant increase at 1 day postoperatively in horizontal two-muscle and inferior oblique muscle anteriorization surgery, whereas no significant difference was observed between periods in horizontal one-muscle surgery (P = .007). Choriocapillaris blood flow exhibited a significant increase at 1 day and 1 month postoperatively compared to the preoperative period (P < .001). Whole image superficial capillary plexus vascular density was significantly lower at 1 day postoperatively than preoperatively and 1 and 3 months postoperatively (P < .001). Whole image deep capillary plexus vascular density was significantly lower at 1 day than at 1 month postoperatively (P = .002). CONCLUSIONS Following strabismus surgery, temporary changes in the hemodynamic microcirculation in the retina and choroid are observed. A transient decrease in retinal artery blood supply may be noticed, possibly attributed to the reduced anterior segment blood supply. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Viggiano P, Gaudiomonte M, Procoli U, Micelli Ferrari L, Borrelli E, Boscia G, Ferrara A, De Vitis F, Scalise G, Albano V, Alessio G, Boscia F. Short-Term Morpho-Functional Changes before and after Strabismus Surgery in Children Using Structural Optical Coherence Tomography: A Pilot Study. Vision (Basel) 2024; 8:21. [PMID: 38651442 PMCID: PMC11036279 DOI: 10.3390/vision8020021] [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: 01/19/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To evaluate the immediate alterations in the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL), peripapillary retinal nerve fiber layer (RNFL), inner retinal layer (IRL), and outer retinal layer (ORL) using spectral domain optical coherence tomography (SD-OCT) subsequent to strabismus surgery in pediatric patients diagnosed with horizontal esotropia. METHODS Twenty-eight eyes from twenty-one child patients who had undergone uncomplicated horizontal rectus muscle surgery due to strabismus were included. Measurements of RNFL, mGCL-IPL, IRL, and ORL using structural OCT were conducted both before the surgery and one month after the surgical procedure. Importantly, a control group comprising 14 healthy eyes, matched for age and significant refractive error (<3.00 diopters), was included in the current analysis. RESULTS Our analysis indicated no significant disparity before and after surgery in terms of best-corrected visual acuity (BCVA), RNFL, IRL, and ORL. Conversely, concerning the macular ganglion cell layer-inner plexiform layer analysis, a substantial increase in mGCL-IPL was observed following the surgical intervention. The mean mGCL-IPL measured 60.8 ± 9.2 μm at baseline and 66.1 ± 13.2 μm one month after the surgery (p = 0.026). Notably, comparison between the strabismus group at baseline and the healthy group revealed a significant reduction in mGCL-IPL in the strabismus group (60.8 ± 9.2) compared to the healthy control group (68.3 ± 7.2; p = 0.014). CONCLUSIONS Following strabismus surgery, our observations pointed towards a thickening of the mGCL-IPL layer, which is likely attributable to transient local inflammation. Additionally, we identified a significant differentiation in the mGCL-IPL complex between the pediatric patient group with strabismus and the control group.
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Affiliation(s)
- Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Marida Gaudiomonte
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Ugo Procoli
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Luisa Micelli Ferrari
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy;
- Department of Ophthalmology, “City of Health and Science” Hospital, 10124 Turin, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Andrea Ferrara
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Fabio De Vitis
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Gemma Scalise
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Valeria Albano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70125 Bari, Italy; (M.G.); (L.M.F.); (G.B.); (A.F.); (F.D.V.); (G.S.); (V.A.); (G.A.); (F.B.)
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Guler Alis M, Alis A, Kucuk A, Acikalin B. Short-term Effect of Strabismus Surgery on Choroidal Vasculature. J Pediatr Ophthalmol Strabismus 2024; 61:114-119. [PMID: 37615420 DOI: 10.3928/01913913-20230721-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE To investigate the effect of strabismus surgery on choroidal structure using the binarization method. METHODS Forty-two eyes of 27 patients who had surgery for horizontal strabismus were included in the study. Optical coherence tomography (OCT) images of the patients before the operation and at 1 day and 1 week after the operation were binarized. Total choroidal area (TCA), stromal area (SA), luminal area (LA), and choroidal vascularity index (CVI) were calculated and compared. RESULTS The mean age of the patients was 16.7 ± 13.5 years; 12 were female, and 15 were male. The mean spherical equivalent was 0.125 ± 0.50 diopters (D). The mean axial length value was 23.3 ± 1.3 mm. Preoperative TCA was 599686 ± 113451, LA was 394259 ± 67259, SA was 209180 ± 47723, and CVI was 0.66 ± 0.02. At 1 day postoperatively, TCA was 615575 ± 103686, LA was 395364 ± 60314, SA was 218418 ± 45620, and CVI was 0.65 ± 0.02. At 1 week postoperatively, TCA was 610997 ± 110578, LA was 394002 ± 65186, SA was 214995 ± 46481, and CVI was 0.66 ± 0.04. A statistically significant decrease in CVI and increase in TCA and SA were observed on the first postoperative day; these changes were observed as returning to preoperative values at 1 week postoperatively. CONCLUSIONS Strabismus surgery temporarily decreases the CVI by increasing the SA of the choroidal layer, possibly due to hemodynamic changes and/or inflammatory causes in the early period. [J Pediatr Ophthalmol Strabismus. 2024;61(2):114-119.].
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Xiao D, Cao T, Meng Y, Xu Y, Xu Y, Chen C, Chen Z, Zheng H, Hua D. Changes in retinal and choroidal blood flow after one or two horizontal rectus muscle surgeries by optical coherence tomography angiography. Ann Med 2023; 55:2261494. [PMID: 37774085 PMCID: PMC10543349 DOI: 10.1080/07853890.2023.2261494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To evaluate the retinal and choroidal microvasculature after one or two horizontal rectus muscle surgeries in strabismus patients using swept-source optical coherence tomography angiography (SS-OCTA). METHODS 30 eyes of 26 patients who underwent horizontal rectus muscle surgery were included in this study. Group A, A' and Group B , B' respectively consisted preoperative and postoperative measurements of patients who underwent one or two horizontal rectus muscle surgeries. We analyzed the vessel density (VD) of the superficial vascular complex (SVC), the deep vascular complex (DVC), the choriocapillary layer (CC), choroidal vascular index (CVI), choroidal thickness (T-Ch) and retinal nerve fiber layer thickness (T-RNFL) preoperatively, and one week postoperatively. RESULTS Only in the nasal sector of the perifoveal zone, the VD in SVC demonstrated a significant increase in Group A' (p = 0.027). There was a statistically significant difference in the VD changes of SVC between Group A and Group B (p = 0.043). The VD in DVC did not change significantly in the whole macular compared with the preoperative. Moreover, in both Group A' and Group B', the VD in CC showed a reduction in a single sector of the parafoveal area (p < 0.05). Group A' have increased CVI in the nasal sector of the perifoveal region (p = 0.008). In addition, the T-Ch increase in the perifoveal region was more significant in Group B' than in Group A' (p < 0.05). Group A' showed statistically significant decreases in T-RNFL in the foveal and parafoveal regions (p < 0.05). CONCLUSION This study revealed that the increase in choroidal thickness was more significant after two rectus muscle surgery. In addition, there were microvascular changes in sectional macular regions after strabismus surgery. OCTA is an excellent way to study the impact of strabismus surgery on the macular structure and blood flow.
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Affiliation(s)
- Di Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tianyue Cao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yishuang Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yonghong Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongmei Zheng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dihao Hua
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Chen CW, Ma CH, Yao JY. Evaluation of retinal microvasculature in exotropia with abnormal binocular vision by optical coherence tomography angiography. BMC Ophthalmol 2023; 23:152. [PMID: 37041540 PMCID: PMC10091658 DOI: 10.1186/s12886-023-02900-w] [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: 11/19/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To explore the retinal microvasculature in large-angle concomitant exotropia patients with abnormal binocular vision using optical coherence tomography angiography (OCTA) analysis. METHODS OCTA images of 52 healthy and 100 strabismic eyes were analyzed to quantify the retinal thickness (RT), superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ). Paired t-tests were performed to compare differences between the two groups, the dominant eye and the deviated eye in the exotropia group, respectively. A p-value < 0.01 was considered significant. RESULTS The mean angle of deviation was 79.38 [± 25.64] (prism diopters, PD). There were significant differences in the DCP in deviated eyes between the exotropia group and the control group (fovea: p = 0.007; temporal: p = 0.014; nasal: p = 0.028; inferior: p = 0.013). The temporal SCP in the exotropia group was significantly higher than in the control group in deviated eyes (p = 0.020). No significant difference was found between dominant eyes and strabismic eyes (p > 0.01). CONCLUSIONS The study showed that OCTA revealed subnormal DCP in patients with large-angle exotropia and abnormal binocularity which may be related to retinal suppression. Changes in the macular microvasculature may provide valuable insights into the development of strabismus. Further studies are needed to determine the clinical relevance of this finding. TRIAL REGISTRATION This trial is registered as ChiCTR2100052577 at www.Chictr.org.cn .
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Affiliation(s)
- Chun-Wen Chen
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Hui Ma
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing-Yan Yao
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Yetkin AA. Effect of inferior oblique muscle myomectomy on choroidal and macular thicknesses in strabismus. Photodiagnosis Photodyn Ther 2023; 41:103283. [PMID: 36627068 DOI: 10.1016/j.pdpdt.2023.103283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/06/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND In this study, we aimed to determine postoperative changes in macular and choroidal thicknesses in patients who underwent inferior oblique myomectomy. METHODS The study included 54 eyes of 44 patients who underwent inferior oblique muscle myectomy between January 2018 and April 2022. Visual acuity and macular and choroidal thickness measurements were performed preoperatively and postoperatively (day 1, week 1, month 1, and month 3). RESULTS When the choroidal thickness measurements were examined, it was determined that choroidal thicknesses decreased especially in the nasal and subfoveal regions on the first day and at the first week after surgery (p < 0.05) but approached their preoperative values at the first- and third-month evaluations (p > 0.05). The macular thickness measurements revealed an increase in all macular regions on the first day and at the end of the first week (p < 0.05) and approached their preoperative values at the end of the first and third months (p > 0.05). CONCLUSIONS In this study, although choroidal thicknesses decreased in the early postoperative period in patients who had undergone inferior oblique myomectomy, there was an increase in macular thicknesses. However, at the third postoperative month, choroid and macular thicknesses were found to be similar to the preoperative values.
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Affiliation(s)
- Ali Asgar Yetkin
- Department of Ophthalmology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey.
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Huseyinhan Z, Ozcaliskan S, Gurez C, Artunay O. Retinal and choroidal microvasculature is altered after strabismus surgery. Eur J Ophthalmol 2022; 33:11206721221137156. [PMID: 36325688 DOI: 10.1177/11206721221137156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the retinal and choroidal microvasculature after strabismus surgery using swept-source optical coherence tomography angiography (OCTA). METHODS Thirty-three eyes of 33 patients who underwent horizontal rectus surgery for strabismus were included in this retrospective study. The unoperated fellow eyes were used as the control group. The macular microvasculature was assessed using a 3 × 3 scan pattern centred on the fovea preoperatively, and one week and one month postoperatively. The vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) were automatically analyzed. The foveal avascular zone (FAZ) was calculated manually using the tool of the device. RESULTS The VD in SCP demonstrated a significant difference between operated and fellow eyes at one week (p = 0.017). Moreover, a significant increase was observed in the mean VD values in SCP of operated eyes after surgery (p = 0.037). The VD in DCP exhibited no significant differences between operated and fellow eyes before and after strabismus surgery. However, there was a significant difference in VD was observed between operated and fellow eyes one week after surgery (p = 0.001). The mean VD in CC was significantly increased in the operated eyes one week after surgery compared to preoperative values (p = 0.006). CONCLUSION This study revealed that strabismus surgery may cause transient alterations both in retinal and choroidal microcirculation in the early postoperative period.
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Affiliation(s)
- Zahid Huseyinhan
- 147017Beyoğlu Eye Training and Research Hospital, 448249University of Health Sciences, Istanbul, Turkey
| | - Sehnaz Ozcaliskan
- 147017Beyoğlu Eye Training and Research Hospital, 448249University of Health Sciences, Istanbul, Turkey
| | - Ceren Gurez
- 147017Beyoğlu Eye Training and Research Hospital, 448249University of Health Sciences, Istanbul, Turkey
| | - Ozgur Artunay
- 147017Beyoğlu Eye Training and Research Hospital, 448249University of Health Sciences, Istanbul, Turkey
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Abstract
We investigate the effects of differences between one or two horizontal rectus muscle surgeries (recession ± resection) on the central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and retinal nerve fiber layer (RNFL). Measurements of the CMT, SFCT, and RNFL in patients who underwent horizontal rectus muscle surgery were obtained using optical coherence tomography (OCT). Patients were grouped as those who had undergone rectus muscle recession surgery (Group 1) and those who had undergone rectus muscle recession + resection surgery (Group 2). The CMT, SFCT, and RNFL in patients were measured preoperatively and 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. A total of 65 eyes of 50 patients were analyzed retrospectively. The average age of the 25 patients in Group 1 was 8.96 ± 7.966 years (min 3, max 38). The average age of the 25 patients in Group 2 was 15.17 ± 6.806 years (min 2, max 34). The comparison of the preoperative and the 1-day and 1-week postoperative values revealed an increase in CMT and SFCT in Group 1 and Group 2. There were no significant differences between the two groups. It was observed that this increase reached the preoperative values after 1-3 months and 6 months in both groups. There was no statistically significant change in the RNFL. Rectus muscle surgery (recession±resection) caused an increase in CMT and SFCT in the early stage, which was possibly caused by the altered choroidal microcirculation resulting from mechanical traction during surgery and by postoperative inflammation. There was no difference between one or two muscle surgeries.
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Guler Alis M, Alis A. Does exotropia surgery have a long-term effect on choroidal vasculature? Photodiagnosis Photodyn Ther 2021; 35:102421. [PMID: 34214687 DOI: 10.1016/j.pdpdt.2021.102421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the long-term effect of exotropia surgery on the choroidal structure. MATERIAL AND METHOD The study included 18 patients treated with medial rectus resection and lateral rectus recession for exotropia and 18 healthy patients as a control group. Demographic and clinical characteristics as well as enhanced depth imaging optical coherence tomography (EDI-OCT) scans were collected retrospectively. Images were binarized using ImageJ software; total choroidal area along with luminal and stromal areas (TCA, LA, and SA) were segmented, and CVI was computed as the ratio of LA/TCA. In addition, choroidal thickness (CT) was evaluated. RESULTS No significant differences were found between operated eyes, fellow eyes, and control group eyes in terms of CT, TCA, LA, SA, and CVI. CONCLUSION Strabismus surgery does not appear to negatively effect the choroidal layer in the long term. We recommend that this surgery be performed without delay as it positively affects the psychological health of the patient and improves quality of life.
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Affiliation(s)
- Meryem Guler Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey.
| | - Abdulkadir Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey
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Evaluation of Visual Field and Balance Function Alterations in Patients Who Underwent Dermatochalasis Surgery. J Ophthalmol 2020; 2020:1310947. [PMID: 32377411 PMCID: PMC7180500 DOI: 10.1155/2020/1310947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/25/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare perioperative visual field (VF), balance functions (BF), and changes in the other ocular parameters in patients undergoing upper eyelid dermatochalasis (DC) surgery. Methods One hundred and fifty-eight eyes of 79 patients who underwent DC surgery were included in the study. The VF, BF, intraocular pressure (IOP), pachymetry (PM), macular, and optic nerve measurements were recorded. Measurements were repeated at postoperative month 1. The preoperative and postoperative ocular measurements and the balance data were compared. Results Nineteen of 79 (24.05%) patients were male and 60 of 79 (75.95%) were female, while the mean age of the patients was 58.65 ± 7.38 years. There were statistically significant differences in terms of VF and macular thickness between the preoperative and postoperative values. The improvements in mean defect, standard loss variance, and mean sensitivity values of global VF parameters in both eyes were statistically significant after surgery. Central macular thickness, mean macular thickness, and macular volume decreased significantly in all eyes after surgery (p < 0.05). Conclusions Although a marked improvement was observed in VF and peripheral vision after surgery, no significant change was found in BF parameters including primarily falling risk. The significant change in the macular parameters was only remarkable, and we think that the decrease was due to subtle vasospasm. There is a need for further comprehensive studies including especially patients older than 65 with a view to understanding the effect of DC surgery on BF.
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